Distal Research Articles

Ultrasound-guided localization of the radial nerve along the humerus: providing reference points for safer upper arm surgery.

The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy. A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle. The distance from the lateral epicondyle to RD was on average 15.5cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side. The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.

Biodistribution and Absorption of Radiopharmaceutical 99mTc MDP in Various Bones of Lung Cancer Patients Using SPECT/CT Modalities

Lung-to-bone cancer metastasis frequently involves bone lesions, particularly in the vertebrae. A bone scan using the radiopharmaceutical 99mTc MDP is a common diagnostic tool for detecting advanced metastases. This research aimed to determine the conversion factor of count rate to unit activity, assess the range of source activity in bones with and without lesions, and analyze the relationship between lung cancer metastasis and radiopharmaceutical activity in various bones. The study involved 28 patients. Procedures included phantom manufacturing, determining the depth of Antero Posterior (AP) and Postero Anterior (PA) position bones, converting count rates to activity units, and assessing 99mTc MDP biodistribution in bones. Results indicated that the conversion factor of count rate to activity units in AP and PA positions for lumbar vertebrae, costa vera, ilium, and sacrum were (〖13.2×10〗^(-4); 4.9〖×10〗^(-4)) mCi/cps; (4.0〖×10〗^(-4); 4.4〖×10〗^(-4)) mCi/cps; (4.0〖×10〗^(-4); 4.9〖×10〗^(-4)) mCi/cps; and (〖12.2×10〗^(-4); 〖4.5×10〗^(-4)) mCi/cps. In addition, there is a range of source activity values and percentage of activity in the bones (lumbar vertebrae; costa vera; ilium; and sacrum), namely (0.019-0.053) mCi and (0.107-0.498)%; (0.020-0.045) mCi and (0.139-0.338)%; (0.024-0.066) mCi and (0.128-0.551)%; and (0.012-0.028) mCi and (0.078-0.264)%. Furthermore, there is a range of source activity values in the lesion-indicated bone (lumbar vertebrae; costa vera; ilium; and sacrum), namely (0.038-0.053) mCi; (0.024-0.045) mCi; (0.033-0.066) mCi; and (0.017-0.028) mCi. The relationship between lung cancer metastasis to various bones studied and the range of radiopharmaceutical activity values obtained is moderately positive.

Automatic segmentation of intraluminal thrombosis of abdominal aortic aneurysms from CT angiography using a mixed-scale-driven multiview perception network (M2Net) model

Intraluminal thrombosis (ILT) plays a critical role in the progression of abdominal aortic aneurysms (AAA). Understanding the role of ILT can improve the evaluation and management of AAAs. However, compared with highly developed automatic vessel lumen segmentation methods, ILT segmentation is challenging. Angiographic contrast agents can enhance the vessel lumen but cannot improve boundary delineation of the ILT regions; the lack of intrinsic contrast in the ILT structure significantly limits the accurate segmentation of ILT. Additionally, ILT is not evenly distributed within AAAs; its sparsity and scattered distributions in the imaging data pose challenges to the learning process of neural networks. Thus, we propose a multiview fusion approach, allowing us to obtain high-quality ILT delineation from computed tomography angiography (CTA) data. Our multiview fusion network is named Mixed-scale-driven Multiview Perception Network (M2Net), and it consists of two major steps. Following image preprocessing, the 2D mixed-scale ZoomNet segments ILT from each orthogonal view (i.e., Axial, Sagittal, and Coronal views) to enhance the prior information. Then, the proposed context-aware volume integration network (CVIN) effectively fuses the multiview results.Using contrast-enhanced computed tomography angiography (CTA) data from human subjects with AAAs, we evaluated the proposed M2Net. A quantitative analysis shows that the proposed deep-learning M2Net model achieved superior performance (e.g., DICE scores of 0.88 with a sensitivity of 0.92, respectively) compared with other state-of-the-art deep-learning models. In closing, the proposed M2Net model can provide high-quality delineation of ILT in an automated fashion and has the potential to be translated into the clinical workflow.

Estimating infant age from skull X-ray images using deep learning

This study constructed deep learning models using plain skull radiograph images to predict the accurate postnatal age of infants under 12 months. Utilizing the results of the trained deep learning models, it aimed to evaluate the feasibility of employing major changes visible in skull X-ray images for assessing postnatal cranial development through gradient-weighted class activation mapping. We developed DenseNet-121 and EfficientNet-v2-M convolutional neural network models to analyze 4933 skull X-ray images collected from 1343 infants. Notably, allowing for a ± 1 month error margin, DenseNet-121 reached a maximum corrected accuracy of 79.4% for anteroposterior (AP) views (average: 78.0 ± 1.5%) and 84.2% for lateral views (average: 81.1 ± 2.9%). EfficientNet-v2-M reached a maximum corrected accuracy 79.1% for AP views (average: 77.0 ± 2.3%) and 87.3% for lateral views (average: 85.1 ± 2.5%). Saliency maps identified critical discriminative areas in skull radiographs, including the coronal, sagittal, and metopic sutures in AP skull X-ray images, and the lambdoid suture and cortical bone density in lateral images, marking them as indicators for evaluating cranial development. These findings highlight the precision of deep learning in estimating infant age through non-invasive methods, offering the progress for clinical diagnostics and developmental assessment tools.

Achieving high accuracy in meniscus tear detection using advanced deep learning models with a relatively small data set.

This study aims to evaluate the effectiveness of advanced deep learning models, specifically YOLOv8 and EfficientNetV2, in detecting meniscal tears on magnetic resonance imaging (MRI)using a relatively small data set. Our data set consisted of MRIstudies from 642 knees-two orthopaedic surgeons labelled and annotated the MR images. The training pipeline included MRI scans of these knees. It was divided into two stages: initially, a deep learning algorithm called YOLO was employed to identify the meniscus location, and subsequently, the EfficientNetV2 deep learning architecture was utilized to detect meniscal tears. A concise report indicating the location and detection of a torn meniscus is provided at the end. The YOLOv8 model achieved mean average precision at 50% threshold (mAP@50) scores of 0.98 in the sagittal view and 0.985 in the coronal view. Similarly, the EfficientNetV2 model obtained area under the curve scores of 0.97 and 0.98 in the sagittal and coronal views, respectively. These outstanding results demonstrate exceptional performance in meniscus localization and tear detection. Despite a relatively small data set, state-of-the-art models like YOLOv8 and EfficientNetV2 yielded promising results. This artificial intelligence system enhances meniscal injury diagnosis by generating instant structured reports, facilitating faster image interpretationand reducing physician workload. Level III.

The Escherichia coli chromosome moves to the replisome

In Escherichia coli, it is debated whether the two replisomes move independently along the two chromosome arms during replication or if they remain spatially confined. Here, we use high-throughput fluorescence microscopy to simultaneously determine the location and short-time-scale (1 s) movement of the replisome and a chromosomal locus throughout the cell cycle. The assay is performed for several loci. We find that (i) the two replisomes are confined to a region of ~250 nm and ~120 nm along the cell’s long and short axis, respectively, (ii) the chromosomal loci move to and through this region sequentially based on their distance from the origin of replication, and (iii) when a locus is being replicated, its short time-scale movement slows down. This behavior is the same at different growth rates. In conclusion, our data supports a model with DNA moving towards spatially confined replisomes at replication.

Can We Screen for Limb Length Discrepancy on Spinal Radiographs of Patients With Adolescent Idiopathic Scoliosis?

The aim of this study was to determine whether height differences in the levels of the iliac crests and femoral heads on erect spinal radiographs can be used as indirect measurements for the screening and surveillance of limb length discrepancy (LLD) in patients with scoliosis. Whole body posteroanterior (PA) and lateral erect radiographs of patients with adolescent idiopathic scoliosis (AIS) were retrospectively reviewed. Patients with congenital, syndromic, and neuromuscular scoliosis were excluded. A direct measurement of each limb was taken from the highest point of the femoral head to the middle of the tibial plafond; any difference between the sides was recorded as the LLD. In addition, the PACS Software tool was used to measure femoral head height difference (FHHD) and iliac crest height difference (ICHD). Pearson's correlation, linear regression, and Bland-Altman plots were used to determine the relationships between LLD and FHHD, and LLD and ICHD. Radiographs of 141 patients (92 women, 49 men) with an average age of 12.0±2.65 years were analyzed. A strong correlation (r=0.730, P<0.001) was found between LLD and FHHD; the correlation between LLD and ICHD was weaker (r=0.585, P<0.001). The Bland-Altman analysis showed good agreements of LLD with FHHD and ICHD. Linear regression analysis predicted an LLD of ≤10mm based on an FHHD of ≤11.5mm or an ICHD of ≤15.3mm. FHHD and ICHD on spinal PA radiographs can be used for the screening and monitoring of LLD in patients with AIS with FHHD being the preferred indirect measurement. These measurements are readily learned and quick to perform. The FHHD and ICHD can be measured on any erect scoliosis PA radiograph. Therefore, these proxy measurements can be used to screen and monitor for LLD in patients with AIS. Level III.

Perioperative Glutamine Supplementation May Restore Atrophy of Psoas Muscles in Gastric Adenocarcinoma Patients Undergoing Gastrectomy

Background: Sarcopenia, characterized by degenerative skeletal muscle loss, is increasingly linked to poor surgical outcomes. Glutamine, an immune-modulating formula, may stimulate muscle protein synthesis and inhibit degradation. We used the psoas major muscle area (PMMA) at the third lumbar vertebra, normalized for height (PMMA index), as a skeletal muscle indicator. This study investigates whether perioperative glutamine supplementation mitigates psoas muscle atrophy. Methods: We enrolled gastric adenocarcinoma (GA) patients undergoing gastrectomy. Computed tomography assessed the psoas muscle short axis. Muscle atrophy was estimated by changes between preoperative and three-month post-gastrectomy scans. Perioperative glutamine supplementation (PGS) comprised five-day parenteral plus one-month oral use. Propensity score matching minimized potential bias. A linear regression model predicted the association. Results: Of 516 patients analyzed (2016–2019), 100 (19.4%) received PGS. After propensity score matching, each group contained 97 cases. The PGS group showed a significantly higher median PMMA index change than the non-PGS group (0.3 vs. −0.3 cm2/m2, p = 0.004). Multivariate analysis revealed that PGS was significantly associated with increased PMMA index (coefficient = 0.60; 95% CI: 0.19–1.01; p = 0.005). Conclusions: PGS may help restore psoas muscle atrophy in GA patients undergoing gastrectomy. The underlying mechanisms likely relate to glutamine’s role in protein metabolism and immune function. Further studies are needed to elucidate these mechanisms fully.

Intradural Melanotic Schwannoma of the Sacral Spine: An Illustrated Case Report of Diagnostic Conundrum

Schwannomas are benign and slow-growing peripheral nerve sheath neoplasms of Schwann cells. These are generally encountered in the neck, head, and flexor areas of the extremities. Even though many schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. In this study, we present a rare case of melanotic schwannoma of the sacrum, emphasizing the need for routine biopsy to understand the etiology. A 46-year-old man presented to the Department of Neurosurgery, Taipei Medical University Hospital, with buttock pain in the sacrum area for 1 year, which worsened in the last 1–2 months. The patient had no known history of trauma or malignancy. We evidenced an intradural extramedullary neurogenic tumor at the caudal end from S1 to S3. Histologic analysis revealed melanin deposition in the tumor cells. Round to oval tumor cells were positive for HMB-45 and S-100 proteins, suggestive of melanotic Schwannoma, which were removed by laminectomy. After 1 month, the tumor recurred and was further removed surgically. Conclusively, we observed the sacrum as an unusual anatomic site for the possible occurrence of melanotic schwannoma, especially in patients with no known history of trauma and malignancy. The possibility of melanotic schwannoma is very high. We hypothesize that melanotic schwannoma was possible because it occurred in the intradural and extramedullary regions of the spine. Hence, a routine biopsy should be performed to corroborate the exact cause and prevent incorrect presumptions.

Ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of popliteal artery for recanalization of femoropopliteal lesions

To assess the safety and efficacy of ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of popliteal artery(PA) for treating femoropopliteal lesions. A retrospective study was conducted on consecutive patients who underwent retrograde puncture of the popliteal artery (PA) for the recanalization of femoropopliteal lesions. A retrograde access was made to either the P2 or P3 segment of the PA in 23 cases. In 10 cases (8 men; mean age 68±9 years), ultrasound-guided retrograde PA (P2 segment) puncture using the long-axis in-the-plane approach was performed, and in 13 cases (11 men; mean age 69±5 years), angiography-guided retrograde PA (P3 segment) puncture was performed. Clinical data was compared pre-intra-operatively and post-operatively in the two groups. All occluded lesions were successfully recanalized via dual channel intervention. Puncture success were 100%(10/10) in the P2 group compared with 92.3%(12/13) in the P3 group (p>0.05). The mean puncture time in the P2 group was significantly shorter when compared to the P3 group (4.70±0.95 mins vs 11.33±6.37mins; p< 0.05). There was no difference in mean hemostasis time between the two groups (6.11±2.20 mins vs 8.46±3.76mins; p>0.05). There were no in-hospital deaths in all patients. The occurrence of puncture-related complications in the P2 group was 10% compared with 15% in the P3 group (p>0.05). A low-flow AVF was observed in one case in the P3 group. None of the patients reported any access-related complication at a mean follow-up of 11.3±5.5months. Ultrasound-assisted sagittal view for retrograde puncture of the P2 segment of PA is at least as safe as angiography-guided retrograde puncture of the P3 segment for femoropopliteal lesions. Furthermore, this technique appears to be more suitable for patients with tandem iliofemoral artery occlusion, as it allows for the creation of a retrograde access.

Experimental study on pore structure evolution of thermally treated shales: implications for CO2 storage in underground thermally treated shale horizons

Extracting gas from unconventional shale reservoirs with low permeability is challenging. To overcome this, hydraulic fracturing (HF) is employed. Despite enhancing shale gas production, HF has drawbacks like groundwater pollution and induced earthquakes. Such issues highlight the need for ongoing exploration of novel shale gas extraction methods such as in situ heating through combustion or pyrolysis to mitigate operational and environmental concerns. In this study, thermally immature shales of contrasting organic richness from Rajmahal Basin of India were heated to different temperatures (pyrolysis at 350, 500 and 650 °C) to assess the temperature protocols necessary for hydrocarbon liberation and investigate the evolution of pore structural facets with implications for CO2 sequestration in underground thermally treated shale horizons. Our results from low-pressure N2 adsorption reveal reduced adsorption capacity in the shale splits treated at 350 and 500 ºC, which can be attributed to structural reworking of the organic matter within the samples leading to formation of complex pore structures that limits the access of nitrogen at low experimental temperatures. Consequently, for both the studied samples BET SSA decreased by ∼58% and 72% at 350 °C, and ∼67% and 68% at 500 °C, whereas average pore diameter increased by ∼45% and 91% at 350 °C, and ∼100% and 94% at 500 °C compared to their untreated counterparts. CO2 adsorption results, unlike N2, revealed a pronounced rise in micropore properties (surface area and volume) at 500 and 650 ºC (∼30%–35% and ∼41%–63%, respectively for both samples), contradicting the N2 adsorption outcomes. Scanning electron microscope (SEM) images complemented the findings, showing pore structures evolving from microcracks to collapsed pores with increasing thermal treatment. Analysis of the SEM images of both samples revealed a notable increase in average pore width (short axis): by ∼4 and 10 times at 350 °C, ∼5 and 12 times at 500 °C, and ∼10 and 28 times at 650 °C compared to the untreated samples. Rock-Eval analysis demonstrated the liberation of almost all pyrolyzable kerogen components in the shales heated to 650 °C. Additionally, the maximum micropore capacity, identified from CO2 gas adsorption analysis, indicated 650 °C as the ideal temperature for in situ conversion and CO2 sequestration. Nevertheless, project viability hinges on assessing other relevant aspects of shale gas development such as geomechanical stability and supercritical CO2 interactions in addition to thermal treatment.

Changes in femoral anteversion after intramedullary nailing for pediatric femoral shaft fracture: a multicenter study

BackgroundThe rotational change after using a flexible intramedullary (IM) nail for femoral shaft fractures has been a concern for many surgeons. Recently, a statistical shape model (SSM) was developed for the three-dimensional reconstruction of the femur from two-dimensional plain radiographs. In this study, we measured postoperative femoral anteversion (FAV) in patients diagnosed with femoral shaft fractures who were treated with flexible IM nails and investigated age-related changes in FAV using the SSM.MethodsThis study used radiographic data collected from six regional tertiary centers specializing in pediatric trauma in South Korea. Patients diagnosed with femoral shaft fractures between September 2002 and June 2020 and patients aged < 18 years with at least two anteroposterior (AP) and lateral (LAT) femur plain radiographs obtained at least three months apart were included. A linear mixed model (LMM) was used for statistical analysis.ResultsOverall, 72 patients were included in the study. The average patient age was 7.6 years and the average follow-up duration was 6.8 years. The average FAV of immediate postoperative images was 27.5 ± 11.5°. Out of 72 patients, 52 patients (72.2%) showed immediate postoperative FAV greater than 20°. The average FAV in patients with initial FAV > 20° was 32.74°, and the LMM showed that FAV decreased by 2.5° (p = 0.0001) with each 1-year increase from the time of initial trauma.ConclusionsThis study explored changes in FAV after femoral shaft fracture using a newly developed technology that allows 3D reconstruction from uncalibrated 2D images. There was a pattern of change on the rotation of the femur after initial fixation, with a 2.5° decrease of FAV per year.

Risk factors for anteroposterior laxity increase over time in double-bundle anterior cruciate ligament reconstruction using hamstring autografts.

An anteroposterior (AP) laxity can increase over time after anterior cruciate ligament reconstruction (ACLR) using hamstring tendons; however, the associated risk factors remain unclear. This study aimed to investigate the risk factors of this phenomenon. Overall, 151 patients who underwent ACLR using hamstring autografts were recruited. AP laxity was evaluated using Knee Lax 3 arthrometer at 5 months, 1 and 2 years postsurgery. Patients were categorised into groups I (>1 mm increase) and C (<1 mm increase) based on whether they experienced an irreversible increase in AP laxity after 1 or 2 years compared with 5 months. Patient demographics and Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years postsurgery were compared between groups. Group I (n = 33, 21%) showed a side-to-side difference of 4.6 (3.0-7.2) mm in AP laxity preoperatively and 0.3 (-0.7 to 1.3), 1.1 (0.2-1.9) and 2.4 (1.7-3.2) mm at 5 months, 1 and 2 years postoperatively, while group C (n = 119, 79%) showed 4.3 (2.8-5.7) mm preoperatively and 1.3 (0-1.9), 0.9 (0.1-1.8) and 0.6 (-0.3 to 1.5) mm, respectively. No significant differences were observed in the overall KOOS at 2 years (n.s.). However, group I was older (36 [22-46] vs. 28 [19-39] years; p = 0.044), had longer surgical waiting periods (122 [69-341] vs. 81 [52-136] days; p = 0.041) and lower preoperative Tegner activity scale scores (6 [5-7] vs. 7 [6,7]; p = 0.002). While 33 patients (21%) experienced AP laxity increase over time, they had comparable clinical outcomes with group C. Level III.

Adaptive optics in an oblique plane microscope

Adaptive optics (AO) can restore diffraction-limited performance when imaging beyond superficial cell layers in vivo and in vitro, and as such, is of interest for advanced 3D microscopy methods such as light-sheet fluorescence microscopy (LSFM). In a typical LSFM system, the illumination and detection paths are separate and subject to different optical aberrations. To achieve optimal microscope performance, it is necessary to sense and correct these aberrations in both light paths, resulting in a complex microscope system. Here, we show that in an oblique plane microscope (OPM), a type of LSFM with a single primary objective lens, the same deformable mirror can correct both illumination and fluorescence detection. Besides reducing the complexity, we show that AO in OPM also restores the relative alignment of the light-sheet and focal plane, and that a projection imaging mode can stabilize and improve the wavefront correction in a sensorless AO format. We demonstrate OPM with AO on fluorescent nanospheres and by imaging the vasculature and cancer cells in zebrafish embryos embedded in a glass capillary, restoring diffraction limited resolution and improving the signal strength twofold.

Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

BackgroundA bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.MethodsIn...

Assessment of Pelvic Tilt in Anteroposterior Radiographs by Area Ratio Based on Deep Learning.

Diagnostics. Based on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs. Pelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement. PT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases. We observed no disparity between males and females in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD±4.71°), with a correlation coefficient between them reaching 0.96. Additionally, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is -0.58° (SD±5.97°). We found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.

Can Highly Specific Ultrasound Criteria Obviate the Need for Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Lymph Node Metastasis

Background: Sentinel lymph node biopsy (SLNB) is primarily performed to detect axillary lymph node involvement and determine the need for surgical axillary lymph node dissection (ALND). However, the procedure is expensive and necessitates the use of radio-labelled colloids that are not readily available to a large number of patients. It also carries the risk of producing occasional false negative results. Objectives: This study aimed to define highly specific ultrasound parameters to ascertain axillary lymph node involvement as an alternative or complementary method to SLNB in selected patients who require ALND. Patients and Methods: In this prospective cross-sectional study, 256 patients with confirmed breast cancer and normal axillary clinical examination were selected through non-probability purposive sampling. The selected patients were referred to Omid Hospital, a tertiary educational oncology center in Mashhad, Iran, from 2018 to 2022. This study identified highly specific cut-off points for ultrasound parameters to determine lymph node involvement in comparison with the histological diagnosis post-SLNB or ALND. Measurements were taken of the tumor size, the cortical thickness of the axillary lymph node, the short axis diameter of the node, and the count of lymph nodes with a cortical thickness of ≥ 3 mm. Patients without visible lymph nodes in axillary ultrasound and those with a history of neo-adjuvant treatments were excluded from the study. Results: Among 256 patients with a mean age of 46.41 ± 10.77 years, 202 (87.9%) had histologically confirmed metastatic adenopathy. The ultrasound cut-off values identified to define metastasis with high certainty were as follows: A tumor size &gt; 50.5 mm (with 97% specificity), a difference in cortical thickness of ≥ 4.5 mm (with 100% specificity), a short axis diameter of the node &gt;12 mm (with 95% specificity), more than three lymph nodes with a cortical thickness of ≥ 3 mm (with 94.3% specificity), and a cortical thickness of ≥ 6 mm (with 95% specificity). Conclusions: Highly specific ultrasound findings can diagnose lymph node metastasis with a high degree of certainty. Patients exhibiting these abnormal findings should be managed with caution, even in cases where SLNB results are negative. Under certain conditions, these patients may be directly referred for ALND.

Hemi-diaphragm detection of chest X-ray images based on convolutional neural network and graphics.

Chest X-rays (CXR) are widely used to facilitate the diagnosis and treatment of critically ill and emergency patients in clinical practice. Accurate hemi-diaphragm detection based on postero-anterior (P-A) CXR images is crucial for the diaphragm function assessment of critically ill and emergency patients to provide precision healthcare for these vulnerable populations. Therefore, an effective and accurate hemi-diaphragm detection method for P-A CXR images is urgently developed to assess these vulnerable populations' diaphragm function. Based on the above, this paper proposes an effective hemi-diaphragm detection method for P-A CXR images based on the convolutional neural network (CNN) and graphics. First, we develop a robust and standard CNN model of pathological lungs trained by human P-A CXR images of normal and abnormal cases with multiple lung diseases to extract lung fields from P-A CXR images. Second, we propose a novel localization method of the cardiophrenic angle based on the two-dimensional projection morphology of the left and right lungs by graphics for detecting the hemi-diaphragm. The mean errors of the four key hemi-diaphragm points in the lung field mask images abstracted from static P-A CXR images based on five different segmentation models are 9.05, 7.19, 7.92, 7.27, and 6.73 pixels, respectively. Besides, the results also show that the mean errors of these four key hemi-diaphragm points in the lung field mask images abstracted from dynamic P-A CXR images based on these segmentation models are 5.50, 7.07, 4.43, 4.74, and 6.24 pixels,respectively. Our proposed hemi-diaphragm detection method can effectively perform hemi-diaphragm detection and may become an effective tool to assess these vulnerable populations' diaphragm function for precision healthcare.

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective.

Since nasal valve surgery for internal nasal valve (INV) compromise has gained popularity, controversies over its indications and insurance coverage disputes have emerged due to the absence of a gold-standard evaluation. Therefore, we aimed to identify the objective parameters for the INV compromise. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data included facial computed tomography images, acoustic rhinometry, modified Cottle test, and symptom scores. The patients were categorized based on their symptoms and modified Cottle's test results. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using computed tomography (CT). The compromised INV group (nasal obstruction with a positive modified Cottle test) was characterized by smaller INV areas on both the coronal and axial views, smaller INV volume on the axial view, and thinner lateral wall on the coronal view (all P < 0.05). Acoustic rhinometry revealed a smaller minimal cross-sectional area and volume in the compromised INV group (both P < .001). Regression analysis revealed significant associations between a compromised INV and the INV area on the axial view and the minimal cross-sectional area on acoustic rhinometry. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Instead, the INV area on axial CT scans and the minimal crosssectional area on acoustic rhinometry hold potential as objective parameters for evaluating INV compromise.

Prickle2 regulates apical junction remodeling and tissue fluidity during vertebrate neurulation.

The process of folding the flat neuroectoderm into an elongated neural tube depends on tissue fluidity, a property that allows epithelial deformation while preserving tissue integrity. Neural tube folding also requires the planar cell polarity (PCP) pathway. Here, we report that Prickle2 (Pk2), a core PCP component, increases tissue fluidity by promoting the remodeling of apical junctions (AJs) in Xenopus embryos. This Pk2 activity is mediated by the unique evolutionarily conserved Ser-Thr-rich region (STR) in the carboxyterminal half of the protein. Mechanistically, the effects of Pk2 require Rac1 and are accompanied by increased cadherin dynamics and destabilization of tricellular junctions, the hotspots of AJ remodeling. Notably, Pk2 depletion leads to the accumulation of mediolaterally oriented cells in the neuroectoderm, whereas the overexpression of Pk2 or Pk1 containing the Pk2-derived STR promotes cell elongation along the anteroposterior axis. We propose that Pk2-dependent regulation of tissue fluidity contributes to anteroposterior tissue elongation in response to extrinsic cues.