Retrospective Collection Research Articles

MS O08 - HPB Biomarkers for risk stratification of Intraductal Papillary Mucinous Neoplasm of the pancreas: A systematic review

Abstract Background Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas is the precursor lesion from which pancreatic ductal adenocarcinoma (PDAC) arises in 10% of individuals. IPMNs may be associated with low-grade or high-grade dysplasia or an associated adenocarcinoma. Accurately determining low-risk from high-risk IPMN is crucial for early detection initiatives for PDAC, so treatment can be offered before invasive cancer in high-risk individuals but without causing harm to low-risk individuals. Currently, imaging forms the basis for stratification but this is costly, resource intense and is limited in accuracy. There is a need to develop biomarkers to improve the risk stratification of IPMN. Method A systematic review was conducted according to PRISMA-DTA guidelines by screening EMBASE, MEDLINE, CENTRAL and bibliographic reference lists for comparative studies. Studies were excluded if they were based on non-human subjects, not specific to IPMN, or determined IPMN from PDAC rather than low-grade from high-grade dysplasia in IPMN. Data extracted included study design, cohort demographics, specimen type, biomarker type, methodology for biomarker discovery, positive predictive value, negative predictive value, sensitivity, specificity or AUC value and were evaluated against the STARD checklist. Study quality was evaluated using the QUADAS-2 tool. Results We identified 1761 studies of which 88 were selected for analysis. Twenty-six studies identified biomarkers derived from serum/plasma, 25 from biopsy specimens, 18 from cystic fluid, 13 from radiological findings, 4 from pancreatic juice, 3 from clinical risk stratification and 1 urinary biomarker. Markers were based on proteins (43%), mRNA (1%), miRNA (14%), lncRNA (2%), DNA (16%), metabolites (1%), radiomics (19%), glycans (5%), inflammatory markers (5%) and clinical history (5%). We observed discriminatory values ranging from AUC 0.58-1, specificity 64-100% and sensitivity 56-90.9%. Conclusion This systematic review outlines the current evidence-base for potential biomarkers to determine low-risk from high-risk IPMNs of the pancreas. Current studies are limited by retrospective sample collection, limited cohort sizes and lack of external validation of candidate biomarkers. There is a need to develop and validate biomarkers in a longitudinal prospective cohort study of individuals undergoing IPMN screening with the ability to characterise low-risk to high-risk transformation which after external validation would be suitable for adoption into clinical practice.

An Association Between Fetal Subarachnoid Space and Various Pathologies Using MR Imaging

Background/Objectives: This study aimed to explore a relationship between the fetal subarachnoid space (SAS) width and various fetal pathologies, employing fetal brain MRI scans. Methods: A retrospective collection of fetal brain MRI scans of 78 fetuses was performed with sonographic indications of microcephaly, macrocephaly, or fetal growth restriction (FGR), during a 7-year period at a single tertiary center. The SAS width (named the SAS index) was manually measured in millimeters in ten specific anatomical locations (four in the axial plane and six in the coronal plane), and then converted to centiles by comparing it to (previously collected) data of apparently healthy fetuses. We evaluated the median SAS centiles using the Kruskal–Wallis and Mann–Whitney U tests for statistical comparison. Results: Seventy-eight subjects (mean gestational age of MRI scan 34.2 ± 2.2 weeks) were evaluated. The median SAS centiles were consistently higher in the macrocephaly group compared to the microcephaly group in all ten anatomical locations (statistically significant except coronal left inferior temporal gyri). Most pronounced difference was displayed in the insula gyri (axial and coronal). The median SAS centiles were higher in the microcephaly group when compared with FGR across all ten anatomical locations (all were statistically significant except for coronal frontal and insula gyri), and the maximal difference was found in the frontal gyri of both planes. The median SAS indexes (IQR) of the three groups in millimeters: macrocephaly 91.55 (86.35–101.05), microcephaly 59.46 (50.00–66.91), and FGR 53.21 (49.71–59.10), p < 0.001. Conclusions: We found a statistically significant association between the fetal subarachnoid space and various fetal pathologies: macrocephaly, microcephaly, and FGR.

Successful treatment of refractory palmoplantar pustulosis by upadacitinib: report of 28 patients

BackgroundUpadacitinib, a specific JAK1 inhibitor, has minimal effect on other JAK subtypes. It influences the inflammatory process in various ways. Upadacitinib has been approved for conditions such as rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, and ulcerative colitis in various countries. The purpose of this study is to assess the clinical efficacy and safety of upadacitinib in patients with refractory palmoplantar pustulosis who have not responded to conventional treatments (e.g., Acitretin, Tripterygium wilfordii Hook F, cyclosporine, methotrexate).MethodsWe conducted a retrospective collection of clinical data from 28 patients who received upadacitinib treatment at the Department of Dermatology, First Affiliated Hospital of Suzhou University, from July 2022 to December 2023. We evaluated the Palmoplantar Pustulosis Area and Severity Index (PPPASI) scores, Dermatology Life Quality Index (DLQI) scores, and Physician’s Global Assessment (PGA) scores before and after treatment. We also recorded any adverse events during the treatment process.ResultsA total of 28 patients were diagnosed with PPP, including 10 males and 18 females, and 8 patients (3 males and 5 females) were diagnosed with SAPHO syndrome. The mean age was (36.3 ± 10.5) years. After 12 weeks of treatment, PPPASI scores decreased from baseline (13.86 ± 2.76) to (5.56 ± 1.08), with a statistically significant difference (p < 0.05). DLQI scores decreased from (12.55 ± 4.56) to (2.03 ± 1.13), also showing a statistically significant difference (p < 0.05). Additionally, 20 patients achieved a PGA score of 0/1. No severe adverse events were reported during the treatment and follow-up period.ConclusionUpadacitinib could be an additional safe and effective treatment for treating refractory palmoplantar pustulosis with a potential benefit on patients’ quality of life. Further studies are needed to assess its short-and long-term efficacy and safety in larger sample sizes in randomized double-blind controlled trials.

Artificial intelligence-assisted magnetic resonance imaging technology in the differential diagnosis and prognosis prediction of endometrial cancer

It aimed to analyze the value of deep learning algorithm combined with magnetic resonance imaging (MRI) in the risk diagnosis and prognosis of endometrial cancer (EC). Based on the deep learning convolutional neural network (CNN) architecture residual network with 101 layers (ResNet-101), spatial attention and channel attention modules were introduced to optimize the model. A retrospective collection of MRI image data from 210 EC patients was used for model segmentation and reconstruction, with 140 cases as the test set and 70 cases as the validation set. The performance was compared with traditional ResNet-101 model, ResNet-101 model based on spatial attention mechanism (SA-ResNet-101), and ResNet-101 model based on channel attention mechanism (CA-ResNet-101), using accuracy (AC), precision (PR), recall (RE), and F1 score as evaluation metrics. Among the 70 cases in the validation set, there were 45 cases of low-risk EC and 25 cases of high-risk EC. Using ROC curve analysis, it was found that the area under the curve (AUC) for the diagnosis of high-risk EC of the proposed model in this article (0.918) was visibly larger as against traditional ResNet-101 (0.613), SA-ResNet-101 (0.760), and CA-ResNet-101 models (0.758). The AC, PR, RE, and F1 values of the proposed model for the diagnosis of EC risk were visibly higher (P < 0.05). In the validation set, postoperative recurrence occurred in 13 cases and did not occur in 57 cases. Using ROC curve analysis, it was found that the AUC for postoperative recurrence prediction of the patients by the proposed model (0.926) was visibly larger as against traditional ResNet-101 (0.620), SA-ResNet-101 (0.729), and CA-ResNet-101 models (0.767). The AC, PR, RE, and F1 values of the proposed model for postoperative recurrence prediction were visibly higher (P < 0.05). The proposed model in this article, assisted by MRI, presented superior performance in diagnosing high-risk EC patients, with higher sensitivity (Sen) and specificity (Spe), and also demonstrated excellent predictive AC in postoperative recurrence prediction.

Study on the impact of refractive anisometropia on strabismus, stereopsis, and amblyopia in children.

To preliminarily explore the correlation between different types and degrees of refractive errors and strabismus, amblyopia, and stereopsis. A retrospective collection was conducted on a total of 145 patients with anisometropia who visited our hospital for strabismus and pediatric ophthalmology from January 2023 to August 2023.Based on the nature of anisometropia in both eyes, it was divided into 4 groups: Farsighted anisometropia (36 cases); myopic anisometropia (38 cases); astigmatic anisometropia (35 cases); mixed anisometropia (36 cases), and 30 children with normal vision were collected. Both groups of subjects underwent routine slit lamp and fundus examinations to exclude other organic eye diseases. The test indexes were: visual acuity, diopter, strabismus, far-stereoscopic vision, near-stereoscopic Titmus, and random static zero-order stereoscopic vision. The results of this study showed that compared with the normal control group, the incidence of strabismus was higher in the anisometropia group. When the refractive error was ≥1.00D, the far stereopsis and random dot static 0-order stereopsis in the anisometropia group decreased more significantly, and the difference between the groups was statistically significant (P < .05). Far-sighted and mixed astigmatism were more prone to amblyopia than myopia and regular astigmatism (P < .05). However, there was no statistical difference in near stereopsis Titmus between the anisometropia group and the control group (P > .05). Children with anisometropia are more likely to have strabismus, stereopsis and amblyopia than normal children.

Clinical characteristics and prognostic factors of epidermal growth factor receptor-mutated non-small cell lung cancer transformed into small-cell lung cancer after treatment

Objective: To analyze the clinical characteristics and prognostic factors of non-small cell lung cancer (NSCLC) patients with sensitive epidermal growth factor receptor (EGFR) mutations who developed small cell lung cancer (SCLC) transformation after treatment with EGFR tyrosine kinase inhibitors (TKI). Methods: We conducted a retrospective collection of clinical data for 21 patients with advanced EGFR mutant NSCLC who developed SCLC transformation after EGFR-TKI treatment at Beijing Chest Hospital, Capital Medical University from January 2015 to December 2021. The clinical characteristics were summarized and the prognosis analysis was conducted. Patients were followed up until February 2024. The efficacy was evaluated using Solid Tumor Response Evaluation Criteria, and survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the differences in survival time (OS) between limited stage and extensive stage in transformed SCLC patients. Cox proportional hazards model was used to analyze the influencing factors of survival after SCLC transformation. Results: Among the 21 patients, there were 5 males and 16 females, with an age range of 33-74 years old [(58.9±2.6) years old]. All 21 patients were adenocarcinoma with sensitive EGFR mutations. There were 18 cases (85.7%) with EGFR gene 19del mutation, including 1 case of 19del+anaplastic lymphoma kinase (ALK) mutation, and 3 cases of L858R mutation. Among the transformed SCLC, there were 11 cases of pure SCLC and 10 cases of mixed SCLC (coexisting of adenocarcinoma and small cell carcinoma components). The median time from diagnosis of NSCLC to SCLC transformation was 12.0 months (95%CI: 7.6-16.3 months). Among the 21 cases of SCLC transformation, there were 13 cases with the extensive stage and 8 cases with the limited stage. Among them, 16 patients received systemic chemotherapy based on etoposide, of which 13 cases could be evaluated for efficacy, 11 cases could be calculated for PFS. Five cases had partial remission, 5 cases were stable, 3 cases had disease progression, and 3 cases cloud not be evaluated. The median progression free survival time (PFS) was 4.8 months (95%CI: 2.8-6.8 months). The median survival time (OS) after SCLC transformation in 21 patients was 10.6 months (95%CI: 7.0-14.2 months), with a median OS of 8.8 months (95%CI: 6.3-11.4 months) for patients with the extensive stage and 27.5 months (95%CI: 9.6-34.4 months) for patients with the limited stage, with statistically significant differences (P=0.002). Cox proportional hazards model analysis showed that the limited stage after SCLC transformation was a protective factor for OS (HR=0.32, 95%CI: 0.12-0.73, P=0.010). The median OS of 21 patients from the diagnosis of lung cancer was 24.9 months (95%CI: 13.0-36.7 months). Conclusions: NSCLC patients with SCLC transformation are all adenocarcinomas, and the proportion of EGFR19del mutations is relatively high. After SCLC transformation, the standard chemotherapy regimen for SCLC is generally used for treatment. The OS after SCLC transformation is related to the stage, and the prognosis is better in the limited stage.

Application of high-throughput drug sensitivity testing in children with relapsed and refractory acute leukemia

To explore the current application of high-throughput drug sensitivity (HDS) testing in children with relapsed and refractory acute leukemia (RR-AL) and analyze the feasibility of salvage treatment plans. A retrospective collection of clinical data from children with RR-AL who underwent HDS testing at the Department of Children's Hematology and Oncology of the First Affiliated Hospital of Zhengzhou University from November 2021 to October 2023 was conducted, followed by an analysis of drug sensitivity results and treatment outcomes. A total of 17 children with RR-AL underwent HDS testing, including 7 cases of relapsed refractory acute myeloid leukemia and 10 cases of relapsed refractory acute lymphoblastic leukemia. The detection rate of highly sensitive chemotherapy drugs/regimens was 53% (9/17), while the detection rate of moderately sensitive chemotherapy drugs/regimens was 100% (17/17). Among the 17 RR-AL patients with highly and moderately sensitive chemotherapy drugs and regimens, the MOACD regimen (mitoxantrone + vincristine + cytarabine + cyclophosphamide + dexamethasone) accounted for 100%, with the highest inhibition rate for single-agent mitoxantrone (94%, 16/17), and the highest inhibition rate for targeted therapy being bortezomib (94%, 16/17). Nine patients adjusted their chemotherapy based on HDS testing results, with 4 undergoing hematopoietic stem cell transplantation. Four patients achieved disease-free survival, while 5 died. Eight patients received empirical chemotherapy, with 2 undergoing hematopoietic stem cell transplantation; 4 achieved disease-free survival, while 4 died. HDS testing can identify highly sensitive drugs/regimens for children with RR-AL, improving the rate of re-remission and creating conditions for subsequent hematopoietic stem cell transplantation.

GeriNOT in the Surgical Inpatient Setting.

The guideline of the Federal Joint Committee (G-BA) on quality assessment measures for the care of patients with hip fracture makes it mandatory for hospitals to use an appropriate geriatric screening instrument in the context of acute inpatient care. After systematic application of GeriNOT and data collection in the admission process with integration into the Hospital Information System (HIS), it is possible to identify potential risks in geriatric patients with other diagnoses as well.With the integration of GeriNOT into the acute inpatient admission process, it was examined whether vulnerable geriatric patients with other diagnoses could benefit from the early initiation of risk identification.The data base for the present study was a retrospective bicentric collection of electronic case records (May 2014 to April 2015, n=3,443). From this primary data set, the subgroup of inpatient acute admissions (n=821) in the orthopaedic/trauma surgery of a study centre was analysed and evaluated with respect to the endpoints "utilisation of needs-based post-inpatient care services" and "new admission to inpatient permanent/short-term care". The predictive power and classification accuracy of GeriNOT of these patients who were 70 years and older to the endpoints were assessed for several groups: total acute admissions, total fractures, hip fracture, and spinal disorders including spinal fractures.A total of 821 patients were admitted as acute inpatients during the study period. The mean age of the patients was 81.4±6.8 years (n=821; 68.1% women, 31.9% men). The following subgroups were formed and analysed: total fractures (n=490), spinal disorders (n=265) including spinal fractures (n=174), and hip fracture (n=108). Both in the overall group (n=821; M=4.279; SD=2.180) and in the subgroups, the mean GeriNOT score was above the threshold ≥4. The highest score was found in the hip fracture group (M=4.852; SD=2.022), and the lowest in the spine fracture group (M=4.177; SD=2.171). At admission, if the terms of variables for requiring treatment were "polypharmacy" and "nursing services already used as needed", there were only slight differences in the diagnostic groups. Admissions from short-term and long-term care occurred in the total group in 16.44% of cases, most frequently with 31.48% in the group of hip fractures, compared to spinal diseases with 6.79%. For this group, GeriNOT detected an elevated risk with respect to the defined endpoints. However, only 4.26% of all patients with identified geriatric risk potential received further geriatric care.The results showed increased geriatric risk in all analysed groups, but most pronouncedly within the group of spinal diseases. The HIS-supported use of GeriNOT offers the possibility of systematic risk identification in acute inpatient admission management. The continuous visualisation of results at HIS workstations throughout the workflow could be used as a starting point for the subsequent application of standardized assessment tools and risk-adjusted treatment pathways. These findings could potentially improve outcomes.

Assessment of Maxillofacial Trauma Due to Road Traffic Accidents in an Insecure Environment at Sominé Dolo Hospital in Mopti (Mali) from 2019-2023

Introduction: Maxillofacial trauma represents a social issue that continues to grow. According to WHO, 1.2 million people lose their lives each year on the road, or more than 3,000 deaths per day. The aim of this study is to evaluate the epidemiological, clinical and therapeutic aspects of maxillofacial trauma related to road accidents at Sominé Dolo Hospital in Mopti. Patients and Method: From 2019 to 2023, we conducted a descriptive cross-sectional study with retrospective collection on cases of maxillofacial trauma due to road traffic accidents at Sominé Dolo hospital in Mopti. Results: The frequency was 85.59%, the age was 28.37 years and a sex ratio of 5. The Bandiagara region represented 34.6% and that of Mopti 49.76%. 2-wheeled vehicles accounted for 60%. Open fractures accounted for 67.8%, located at the mandibular level 40.10%. Contention associated with osteosynthesis was performed in 49.1%. Discussion: In our study, the hospital frequency of maxillofacial trauma following a road traffic accident is 85.60%. This high frequency in our country could be explained by the non-compliance with the highway code, the poor condition of the roads, the multiplication of means of transport and the security situation. Conclusion: The increasing frequency of maxillofacial trauma over the years is a reality in Mopti (Mali) and poses a public health problem. Only early appropriate treatment and peace can minimize the sometimes serious and difficult to correct after-effects.

Digital anatomical features of morphological development in the atlantoaxial synchondroses in children aged 1 to 6 years old: a retrospective study of CT images.

To investigate the anatomical indexes and anatomical positional indexes of the atlantoaxial synchondroses in normal Chinese Han children aged 1-6 years, and to analyze the changing law of the atlantoaxial cartilage union with the growth and development of age and its influence on the atlantoaxial ossification in children. A retrospective collection of CT imaging of 160 cases of normal cervical spine in children aged 1 to 6 years old was conducted. The cases were divided into six age groups, with each group representing a one-year age range. Measure the morphological anatomical indicators and anatomical positional indicators of the atlantoaxial synchondroses. Record and statistically analyze the measurements of each indicator. Measurements were taken on various parameters of the atlantoaxial synchondroses. TD, SD, height, area, and perimeter all gradually decreased among the groups. Distance between bilateral atlantal anterolateral synchondroses increased gradually from Group A to Group F, while the angle formed along the long axis in the cross-section showed a decreasing trend. Distance between the axoid dentolateral synchondroses and between the neurocentral synchondroses increased gradually from Group A to Group F, with the angle value in the cross-section showing a gradual decrease, and distance from the odontoid apex increasing from Group A to Group F. The atlantoaxial synchondroses gradually decrease in size with age, and ossification levels increase with age, with faster ossification occurring during a 1-2 years-old period. The anterolateral synchondroses, dentolateral synchondroses, and neurocentral synchondroses all gradually ossify towards the lateral direction with increasing age.

FIJACIÓN DE LAS FRACTURAS DE CUELLO FEMORAL DEL ADULTO: COMPARACIÓN RETROSPECTIVA ENTRE TORNILLOS CANULADOS Y EL SISTEMA DE CUELLO FEMORAL (FNS)

The FNS System DePuy Synthes® (EEUU, 2018) represents a recent alternative treatment for the fixation of femoral neck fractures, providing biomechanical advantages with respect to cannulated screws (3CS). The objective of this study is to compare the clinical results of both fixation methods. A retrospective collection of the 36 subcapital fractures treated with the FNS system was carried out compared with a retrospective search of the last 35 patients treated with 3CS. Age, sex, fracture pattern, delay until the intervention, lenght of intervention, hospital length stay, and haemoglobin loss were analyzed. In addition, the rate of avascular necrosis, nonunion, symptomatic femoral neck shortening, and material protrusion with or without its removal were recorded during a minimum follow-up of 6 months. No significant differences were found in age (p-value 0.32), fracture patterns (p-value 0.77), surgical delay (p-value 0.28), surgical time (p-value 0.226), length of hospital stay (p-value 0.921) and blood loss (p-value 0.086) between the two groups. A significantly higher overall complication rate was observed in the group treated with cannulated screws (p-value 0.004). Analysed separately, a higher rate of avascular necrosis, symptomatic shortening of the femoral neck, protrusion of the osteosynthesis material with or without removal was observed in the group treated with cannulated screws. The FNS system represents a safe and reproductible alternative for the fixation of femoral neck fractures, showing non-inferior outcomes to treatment with cannulated screws.

Current trends in vestibular schwannoma management at a referral center in Indonesia: A cross-sectional study with retrospective data collection

Background. Vestibular schwannoma (VS) is the most common benign brain tumor of the cerebellopontine angle. Due to its location, this pathology can create both focal and general deficits. The registry system for VS in Indonesia is developing, including in the author’s institution, which eventually shows a changing trend in managing VS. Methods. We retrospectively collected data from all patients diagnosed with vestibular schwannoma, based on histological or radiological results. Treatments included craniotomy and/or Gamma Knife Radiosurgery (GKRS) from 2018 to 2023. Results. Data from 88 patients were analyzed. The number of treated patients has increased annually. VS predominantly affects females (64%). The proportion between GKRS and craniotomy procedures also shifted throughout the year. Common symptoms included hearing loss (63.6%), disequilibrium (50%), and headaches (39.7%). The most common tumor size was medium (15-30 mm; n=37; 42%). Tumors that fell into the intrameatal and small (&lt;15 mm) categories were all treated with GKRS, whereas the other groups were divided into GKRS and craniotomy. GKRS demonstrated high efficacy in tumor control and favorable hearing and facial nerve preservation, whereas craniotomy remained crucial for larger tumors. Conclusion. The number of VS diagnosed each year has increased in our center, accompanied by a noticeable shift in preference from GKRS to craniotomy, which is influenced by the integration of intraoperative monitoring. Treatment preference was further determined based on the clinical profile and tumor size. In the future, there is a need to develop a national registry to better reflect the true incidence of VS within the Indonesian population.

Adverse events during general anesthesia at the university hospital center (CHU) “Hôpital du Mali”

Objective: To evaluate the incidence of adverse events during general anesthesia and to describe their progression. Methodology: Cross sectional study with retrospective collection over 6 months at the Mali Hospital University Hospital. It included all patients who underwent elective or urgent surgeries under general anesthesia (GA) with tracheal intubation. Vital parameters and details of incidents and accidents were collected and analyzed. Results: During the study period, 723 anesthesia procedures were performed, of which 339 were GA, a prevalence of 46.9%. Among these patients, 149 (43.9%) experienced at least one AE. The mean age was 28 ± 19.9 years old [3 days old; 85 years old], with a sex ratio ~1. AEs occurred during elective anesthesia in 68.4%. The primary surgical specialties were thoracic/cardiovascular surgery (40.4%) and neurosurgery (37.8%). Patients were classified as American Society of Anesthesiologists-2 (ASA 2) in 49.5%. Pharmacological premedication was administered in 84.7%. The intravenous hypnotics used included propofol (85.5%), thiopental (8%), and ketamine (6.5%). Inhalation agents used were isoflurane (99.4%) and halothane (0.6%). Vecuronium (95.5%) was the most commonly used muscle relaxant, while suxamethonium (4.5%) was used for intubation. AEs predominantly occurred during induction and maintenance of anesthesia, with hypotension (84.6%), desaturation, hypertension, and cardiac arrest being the most common. Delayed awakening was observed in 5.6%, including one instance of unrecovered cardiac arrest (0.6%). The overall mortality rate due to AEs was 0.6%. Conclusion: Adverse events are common during GA, particularly during induction and entretien phases, and are associated with a mortality rate of 0.6%. Keywords: Adverse events, GA, Incidence, Mali.

Deep Learning Classification of Ischemic Stroke Territory on Diffusion-Weighted MRI: Added Value of Augmenting the Input with Image Transformations.

Our primary aim with this study was to build a patient-level classifier for stroke territory in DWI using AI to facilitate fast triage of stroke to a dedicated stroke center. A retrospective collection of DWI images of 271 and 122 consecutive acute ischemic stroke patients from two centers was carried out. Pretrained MobileNetV2 and EfficientNetB0 architectures were used to classify territorial subtypes as middle cerebral artery, posterior circulation, or watershed infarcts along with normal slices. Various input combinations using edge maps, thresholding, and hard attention versions were explored. The effect of augmenting the three-channel inputs of pre-trained models on classification performance was analyzed. ROC analyses and confusion matrix-derived performance metrics of the models were reported. Of the 271 patients included in this study, 151 (55.7%) were male and 120 (44.3%) were female. One hundred twenty-nine patients had MCA (47.6%), 65 patients had posterior circulation (24%), and 77 patients had watershed (28.0%) infarcts for center 1. Of the 122 patients from center 2, 78 (64%) were male and 44 (34%) were female. Fifty-two patients (43%) had MCA, 51 patients had posterior circulation (42%), and 19 (15%) patients had watershed infarcts. The Mobile-Crop model had the best performance with 0.95 accuracy and a 0.91 mean f1 score for slice-wise classification and 0.88 accuracy on external test sets, along with a 0.92 mean AUC. In conclusion, modified pre-trained models may be augmented with the transformation of images to provide a more accurate classification of affected territory by stroke in DWI.

A novel online calculator based on inflammation-related endotypes and clinical features to predict postoperative pulmonary infection in patients with cervical spinal cord injury

BackgroundPostoperative pulmonary infection (POI) of patients with cervical spinal cord injury (CSCI) is highly heterogeneous, while the potential endotypes and related risk factors remain unclear. MethodsA retrospective collection of 290 CSCI patients was conducted from January 2010 to July 2024 using 1:1 propensity score matching to compare POI (n = 145) and non-POI (n = 145) groups. We generated laboratory examination data from admission patients and identified endotypes using unsupervised consensus clustering and machine learning. CSCI patients were randomly assigned to the training set (n = 203) and internal validation set (n = 87). A separate cohort comprising 245 CSCI patients were used for external validation. Independent predictors for POI were identified using univariate and multivariate logistic regression. A nomogram and an online calculator were developed and validated, both internally and externally. ResultsTwo inflammation-related endotypes were identified: high inflammation endotype (endotype C1) and low inflammation endotype (endotype C2). Eight predictors for POI were identified (including age, operation duration, number of surgical segments, time between injury and surgery, preoperative steroid pulse, American Spinal Injury Association (ASIA) grade, smoking history, and inflammation-related endotype). A nomogram integrating the risk factors showed excellent discrimination in the training set (AUC, 0.976; 95% CI 0.956–0.996), internal validation set (AUC, 0.993; 95% CI 0.981–1.000), and external validation set (AUC, 0.799; 95%CI 0.744–0.854). Calibration curves demonstrated excellent fit, and decision curves highlighted its favorable clinical value. An online calculator (https://tjspine.shinyapps.io/dynnomapp/) was constructed to improve the convenience and efficiency of our prediction model. ConclusionsWe identified inflammation-related endotype and constructed a web-based calculator for predicting POI in patients with CSCI, exhibiting excellent clinical utility.

Prevalence Characteristics of Osteoporosis Fractures in the Elderly in Two Regions of China and Analysis of the Lag Effect of Air Pollutants on them.

Air pollution is increasing and threatening human health. The objective of this study is to investigate the population distribution characteristics of elderly osteoporosis fractures in Hebei Province and Xinjiang Uygur Autonomous Region and to analyze the effects of air pollutants on the number of elderly osteoporosis fracture inpatients in the two regions. A retrospective collection of elderly osteoporosis fracture cases was conducted in selected hospitals in Hebei Province and Xinjiang Uygur Autonomous Region from January 1, 2018 to December 31, 2022. The chi-square test was used to compare the distributional characteristics of the population in the two regions. Additionally, we used a distributed lag nonlinear model (DLNM) in order to assess the effect of air pollutants on the number of daily hospital admissions of elderly osteoporosis fracture patients in different regions. A total of 19,203 elderly osteoporosis fracture patients were included in the study. The average age of these patients was 76.66 ± 7.55 years, and the majority of them were female (13,514 instances, 70.37%). The disparities in age distribution (χ2 = 133.9 p < 0.001), fracture site (χ2 = 62.0 p < 0.001), and hospitalization cost (Z = -15.635 p < 0.001) between the two regions were statistically significant. The lag effect curves of PM2.5, PM10, and NO2 on the number of elderly osteoporosis fracture hospitalizations in Xinjiang Uygur Autonomous Region exhibited a similar pattern resembling a "W"-shaped curve. All three pollutants reached their highest values after a lag time of 14 days (PM2.5: RR = 1.053, 95% CI: 1.031, 1.074; PM10: RR = 1.031, 95% CI: 1.018, 1.043; NO2: RR = 1.125, 95% CI: 1.070, 1.182). In Hebei Province, the largest impacts of PM2.5 and PM10 were observed after a lag of 14 days (PM2.5: RR = 1.022, 95% CI: 1.013, 1.028; PM10: RR = 1.013, 95% CI: 1.008, 1.018). Similarly, the maximum effect of NO2 was observed after a lag of 11 days (RR = 1.020, 95% CI: 1.010, 1.028). There were differences in the epidemiological characteristics of hospitalized patients with osteoporosis fractures between the two regions, PM2.5, PM10, and NO2 increased the number of hospitalizations for osteoporosis fractures. Exposure to air pollutants such as PM2.5 increases the risk of osteoporosis fractures in the elderly population.

Interpretable multitemporal liver function indicator model for prediction and risk factor analysis of drug induced liver injury

The occurrence of liver injury during cancer treatment is extremely harmful. The risk factors for drug.induced liver injury (DILI) in the pancreatic cancer population have not been investigated. This study aims to develop and validate an interpretable decision tree (DT) model for the early prediction of DILI in pancreatic cancer patients using multitemporal clinical data and screening for related risk factors. A retrospective collection of data was conducted on 307 patients, the training set (n = 215) was used to develop the model, and the test set (n = 92) was used to evaluate the model. The classification and regression trees algorithm was employed to establish the DT model. The Shapley Additive explanations (SHAP) method was used to facilitate clinical interpretation. Model performance was assessed using AUC and the Hosmer‒Lemeshow test. The DT model exhibited superior diagnostic efficacy, the AUC values were 0.995 and 0.994 in the training and test sets, respectively. Four risk factors associated with DILI occurrence were identified: delta.albumin, delta.ALT, and post (AST: ALT), and post.GGT. The multiperiod liver function indicator.based interpretable DT model predicted DILI occurrence in the pancreatic cancer population and contributes to personalized clinical management of pancreatic cancer patients.

WP4.9 - Audit on writing outpatient clinic letters in the general surgery department at a tertiary care hospital

Abstract Background Clinic letters are crucial medical notes for a patient’s medical history and medico-legal purposes. We assessed the quality of clinic letters with the guidelines from the Academy of Medical Royal College suggested for writing a clinic letter. Method A retrospective collection of data was done from January – May 2023 and a total of 166 clinic letters were collected by independent authors and then analysed to avoid any bias in the collection. Results Multiple parameters were poorly documented and are mentioned in increasing order of missing data – Plan for patient/carer (37.5%), Care planning arrangements (44.6%), Complications (67.5%), Anaesthesia issues (89.4%), Allergies (94%), Diagnosis (94%), Time (99.4%), Preferred name (100%) and Personal identifiers (100%). These findings were presented in the clinical governance meeting and to improve the quality of the clinic letters, we created a generic clinic letter including mandatory parameters suggested by the guidelines. Conclusion There were a few parameters missing from the analysed clinic letters. An adequate intervention after being discussed in the clinical governance meeting, in the form of a generic clinic letter has been introduced. A repeat cycle is planned in 3-5 months to assess the improvement in the quality. There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.

Changes in nonfunctional adrenal incidentaloma after COVID-19 infection and a model for predicting benign and malignant adrenal incidentaloma.

To compare nonfunctional adrenal incidentalomas (NFAI) in individuals with and without a history of COVID-19 infection, while also establishing predictive models for distinguishing between benign and malignant adrenal incidentalomas (AI). A retrospective collection of data from patients with AI who underwent surgery and were verified in our hospital between April 2022 and June 2023 was conducted. A total of 121 patients were included in the study. Demographic information, tumor characteristics, functional indicators, and complications were compared among the patients. Statistical analyses utilized the t-test for continuous variables and Pearson chi-square test or Fisher's exact test for categorical variables. Patients with COVID-19 exhibited a higher prevalence of obesity (84.2% vs. 63.3%, P=0.048) and elevated direct bilirubin (DBIL) levels (44.1% vs. 19.2%, P=0.043) compared to those without COVID-19. Moreover, patients with Malignant AI, in contrast to Benign AI, showed higher normal total protein (TP) levels (28.8% vs. 57.1%, P=0.016) and larger tumor sizes (20 vs. 32.5mm, P=0.009). Univariate analysis identified low TP (OR=0.303, 95% CI=0.111-0.825, P=0.020) and tumor size (OR=1.045, 95% CI=1.011-1.080, P=0.009) as potential risk factors for multivariate analysis. A predictive model comprising clinical risk factors (tumor size and low TP) demonstrated an AUC of 0.754 (95% CI, 0.603-0.904) with a sensitivity of 0.75 and specificity of 0.775. The calibration curve revealed a bias-corrected AUC of 0.77. No discernible differences in the clinical manifestations of adrenal incidentalomas were observed between cases with and without a history of COVID-19 infection. However, AI with larger tumor diameters and lower than normal levels of total protein exhibited a more pronounced malignant potential.

Clinical characteristics and risk factors analysis of dengue fever incidence in Xishuangbanna, Yunnan Province in 2023

To analyze the clinical characteristics of dengue fever patients, summarize the course and characteristics of the disease, and analyze the risk factors that affect the condition. Retrospective collection of general information, clinical symptoms, medical history, laboratory tests, prognosis and other clinical data of dengue fever patients that admitted to Jinghong First People's Hospital and severe dengue fever patients at People's Hospital of Xishuangbanna Dai Autonomous Prefecture from June to December 2023 was conducted using a case report form (CRF). According to the diagnostic criteria of the World Health Organization (WHO), patients were divided into dengue fever group, dengue fever with warning signs group, and severe dengue fever group. The differences in clinical data between different groups of patients were analyzed and compared. Binary multiple factor Logistic regression analysis was used to explore the risk factors affecting the severity of dengue fever in patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of prediction models constructed for various risk factors for severe dengue fever. Subgroup analysis was performed on the prognosis of severe dengue fever patients, and the differences in clinical data between two groups of patients with different prognoses were compared. Binary multivariate Logistic regression analysis was used to explore the risk factors affecting the prognosis of severe dengue fever patients. ROC curve was drawn to analyze the predictive value of prediction models constructed for various risk factors on the prognosis of severe dengue fever patients. A total of 2 264 patients were included, including 499 cases in the dengue fever group, 1 379 cases in the dengue fever with warning signs group, and 386 in the severe dengue fever group (43 deaths and 343 survivors). The most common symptom of dengue fever patients was fever (94.70%), followed by muscle soreness (70.54%), headache (63.12%), fatigue (58.92%), and chills (46.02%). Compared with the dengue fever group and the dengue fever with warning signs group, the ratio of thalassemia and the levels of cardiac troponin (cTnI, cTnT), MB isoenzyme of creatine kinase (CK-MB), and myoglobin were significantly increased in patients with severe dengue fever group, albumin (Alb) was significantly decreased in patients with severe dengue fever group. The levels of cTnT and myoglobin in patients with dengue fever with warning signs group were significantly higher than those in the dengue fever group, and the level of Alb in patients with dengue fever with warning signs group was significantly lower than that in the dengue fever group, the differences were statistically significant (all P < 0.05). Binary multivariate Logistic regression analysis showed that thalassemia [odds ratio (OR) = 6.214, 95% confidence interval (95%CI) was 2.337-16.524, P < 0.001], Alb ≤ 36 g/L (OR = 6.297, 95%CI was 4.270-9.286, P < 0.001), and cTnT levels (OR = 1.008, 95%CI was 1.002-1.015, P = 0.016) were risk factors for severe dengue fever. ROC curve analysis showed that the area under the ROC curve (AUC) for predicting severe dengue fever based on the prediction models constructed for the above risk factors was 0.856, with the best predictive value of 0.067, sensitivity of 67.1%, and specificity of 99.4%. In the subgroup analysis of patients with severe dengue fever, compared with the survival group, the levels of hematocrit (HCT), cTnT, and CK-MB in the death group patients were significantly increased, while the level of Alb was significantly decreased, and the differences were statistically significant. Binary multivariate Logistic regression analysis showed that Alb (OR = 0.839, 95%CI was 0.755-0.932, P = 0.001), HCT (OR = 1.086, 95%CI was 1.010-1.168, P = 0.025), elevated troponin level (OR = 10.119, 95%CI was 2.596-39.440, P < 0.001), and CK-MB (OR = 1.081, 95%CI was 1.032-1.133, P < 0.001) were risk factors for mortality in patients with severe dengue fever. ROC curve analysis showed that the AUC for predicting death in severe dengue fever patients based on the prediction models constructed for the above risk factors was 0.881, with the best predictive value of 0.113, sensitivity of 75.0%, and specificity of 88.9%. Thalassemia, Alb ≤ 36 g/L, and cTnT level are risk factors for severe dengue fever, while HCT level, Alb level, CK-MB level, and elevated troponin level are risk factors for death in patients with severe dengue fever.