Visual Score Research Articles

Needle tenoscopy of the digital flexor tendon sheath in a standing equine cadaver model using a novel approach and guided palmar/plantar annular ligament desmotomy.

(1) To evaluate the feasibility of needle tenoscopy of the digital flexor tendon sheath (DFTS) using basisesamoid (BS) and proximolateral (PL) approaches in a standing equine cadaver model. (2) To report visualization of intrathecal DFTS anatomy via both approaches. (3) To determine the efficacy of needle scope-guided palmar/plantar annular ligament (PAL) desmotomy. (4) To report any iatrogenic damage associated with the procedure. Ex vivo experimental. Ten equine cadaver limbs. Limbs were placed in a Kimzey leg-saver splint and needle tenoscopy was performed using the BS and PL approaches. Two European College of Veterinary Surgeons (ECVS) Diplomates assessed and categorized intrathecal site visualization as poor, partial, or excellent. Needle scope-guided PAL desmotomy was performed after DFTS exploratory needle tenoscopy. Limbs were dissected and examined for the presence of iatrogenic damage and completeness of PAL desmotomy. A Wilcoxon signed-rank test was used to compare visualization scores for both approaches. Needle tenoscopy of the DFTS in a standing model was feasible from both BS and PL approaches. Excellent visualization of clinically significant intrathecal anatomy within the fetlock canal was achieved from both approaches (p ≤ .001), with minimal iatrogenic damage. The PL approach allowed more structures to be visualized than the BS approach (p = .025). All PAL desmotomies were completed without associated iatrogenic damage. Needle tenoscopy of the DFTS in a standing model provided excellent visualization of intrathecal sites within the fetlock canal. It facilitated complete PAL desmotomy. Needle ten0oscopy can be used to assess the DFTS and to guide PAL desmotomy in a standing horse.

Opioid sparing anesthesia in patients with liver cirrhosis undergoing liver resection: a controlled randomized double-blind study

ObjectiveOpioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection.MethodsThis study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded.ResultsThe total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group.ConclusionsAdministering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.

Hybrid PET/MRI Imaging of 18F-Fluorodeoxyglucose and 18-kDa Translocator Protein for Presurgical Localization in Refractory Epilepsy.

Surgery remains the only curative option for a third of refractory epilepsy patients, though success depends on precise localization of the epileptogenic zone (EZ). This study aims to assess the clinical value of hybrid 18F-FDG and 18F-DPA-714 PET/MRI for accurate localization and precise boundary delineation. The refractory epilepsy patients who underwent surgery at Xuanwu Hospital from November 2022 to November 2023 were retrospectively recruited. Preoperative simultaneous 18F-FDG and 18F-DPA-714 PET/MRI imaging were analyzed using the asymmetry index (AI) and a 4-point visual score, with the surgical site and pathological findings serving as the gold standard. A total of 43 patients (mean age: 26.30 ± 8.37 years, male: 28) were included in this study. Lesion localization accuracy within the EZ was 76.7% for 18F-FDG PET/MRI, 69.8% for 18F-DPA-714 PET/MRI, and 60.5% for conventional MRI (p = 0.26). In 26 MRI-positive cases, conventional MRI accurately localized all lesions within the EZ, with three cases showing negative findings on 18F-FDG images and six on 18F-DPA-714. Among 17 MRI-negative patients, thirteen demonstrated positive results on hybrid PET/MRI. Additionally, 18F-DPA-714 PET/MRI proved more effective in delineating lesion boundaries. Compared to 18F-FDG, the AI score was significantly lower (0.25 ± 0.18 vs. 0.46 ± 0.19, p < 0.001), while the visual score was higher (4.00 ± 2.00 vs. 3.00 ± 0.00, p = 0.01). 18F-DPA-714 PET/MRI can effectively complement conventional MRI in the preoperative assessment of refractory epilepsy, with localization accuracy on par with 18F-FDG and enhanced capability in delineating lesion boundaries.

Outcomes following stenting for symptomatic chronic iliofemoral venous stenosis - A comparison of three stent types.

Venous stenting has become the standard of care for patients with iliofemoral venous stenosis who have failed conservative therapy. While outcome data following such stenting exist for Wallstents and Wallstent - Z stent combination, such data for dedicated stents is sparse outside of industry-sponsored trials. This study aims to address this gap by comparing the outcomes of matched cohorts of limbs that underwent stenting with either the Medtronic Abre stent (Medtronic Inc, Minneapolis, MN), the Bard Venovo stent (Becton, Dickinson, and Co, Franklin Lakes, NJ), or Wallstent-Zenith (Z) stent combination (Boston Scientific, Marlborough, MA; Cook Medical Inc, Bloomington, IN). Contemporaneously entered data on matched cohorts of patients who underwent stenting from 2016 to 2022 for quality of life (QOL)-impairing iliofemoral venous stenosis (not occlusion) after failing conservative therapy was analyzed. The venous clinical severity score (VCSS: 0-27), grade of swelling (GOS: 0-4), visual analog scale pain score (VAS pain score: 0-10), and CIVIQ-20 quality of life (QOL) score were evaluated initially and post stenting to assess the effects of stenting. ANOVA and paired t-tests were used to compare clinical and QOL variables, while Kaplan-Meier analysis was used to examine primary, primary-assisted, and secondary stent patencies with log-rank test used to discriminate between different curves. There was a total of 198 limbs that had undergone stenting including 68 in the Abre, 60 in the Venovo and 70 in the Wallstent - Z stent groups. The median age for the entire cohort was 65 years (range 21-101 years). The cohort included 141 women and 57 men. Left laterality (112 limbs) was more common than right laterality (86 limbs). Post-thrombotic syndrome was seen in 146 limbs and nonthrombotic iliac vein lesions/May-Thurner syndrome in 52 limbs. The median BMI was 35. Median follow up was 20 months. For the entire cohort, post stenting, VCSS improved from 6 to 4.5 at 3 months (p<0.0001) further improved to 4 at 6 months (p<0.0001) and remained at 4 at 12 months (p<0.0001), and 24 months (p<0.0001). GOS for the entire cohort improved from 3 to 1 at 3 months (p<0.0001) and remained at 1 at 6 months, (p<0.0001), 12 months (p<0.0001), and 24 months (p<0.0001). VAS pain score for the entire cohort improved from 8 to 2 at 3 months (p<0.0001), increased to 3 at 6 months (p<0.0001) before dropping to 2 at 12 months (p<0.0001), and remained at 2 at 24 months (p<0.0001). The CIVIQ-20 score for the entire cohort improved from 61 to 38 (p<0.0001) over the duration of follow up. The primary patencies for the Abre, Bard, and Wallstent-Z stent groups at 32 months were 93%, 86%, and 92%, respectively (p=0.37). Primary assisted patencies for all 3 groups at 32 months was 100% (p=0.08). There were no stent occlusions in any of the groups. Reintervention was pursued for QOL impairing recurrent clinical manifestations in 13 limbs (7%), without a significant difference between groups (p=0.46). For patients undergoing stenting for quality-of-life impairing symptoms of iliofemoral venous stenosis after failing conservative therapy, Abre, Venovo and Wallstent-Z stent combination all appear to provide similar clinical and quality of life improvement. A significant difference between stent patencies for the three stent types was also not detected. Stent selection for treatment of stenotic lesions of the iliofemoral venous territory can be based on stent availability and the preference/expertise of the interventionalist.

Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches.

The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches. Prospective Review. Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses. A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. -1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group. Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required. Level IV evidence.

Shock Wave Therapy in the Treatment of Erection Dysfunction: How to Define Clinical Outcomes? A Comparison Between Penile Doppler Ultrasound and a New Visual Erec-tion Hardness Score (V-EHS) During a Blinded, Sham-Controlled Trial.

In the last decade, several studies have proven the effectiveness of low-intensity shock waves (LI-ESWT), but with several factors that make it difficult to carry out systematic reviews. To demonstrate the effectiveness of LI-ESWT and define the best tool for routine clinical assessment of erectile dysfunction. Twenty-one participants with purely vasculogenic erectile dysfunction were selected and randomized to LI-ESWT or placebo. All patients underwent evaluation with The International Index of Erectile Function (IIEF-5), V-EHS (new visual scale), and standardized penile doppler ultrasound before and after shock wave therapy. LI-ESWT has proven effective in the treatment of moderate erectile dysfunction, and the new V-EHS has demonstrated greater accuracy than Doppler in the diagnosis and follow-up of erectile dysfunction. Using the IIEF-5 as a control tool, we observed a clinical response after 1 month, with a greater increase in the shock wave therapy arm of +3.21 points compared to + 0.57 in the sham group. At six months, the treated group showed a mean increase of 4.71 points compared to baseline (p = 0.006), while those who received sham therapy had a decrease (case = +4.71 points vs. sham control = -1.0, p = 0.006). Based on this observed difference, we performed a comparative analysis between the V-EHS and penile doppler ultrasound to observe whether the test results corroborated the IIEF-5 findings. The correlation between V-EHS and IIEF-5 in the therapy group in the pre-therapy period was strong (r = 0.816, p < 0.001), and at 6 months it increased to very strong (r = 0.928, p < 0.001). Penile Doppler ultrasound did not show the same correlation strength with IIEF-5, presenting a moderate correlation at 6 months (Pearson correlation score = 0.540), as also demonstrated in the ROC curve through the V-EHS AUC = 0.963 (p = 0.001) vs. Doppler AUC = 0.713 (p = 0,290). Strengths and Limitations: The main strengths of the present study are the blinded, randomized, placebo-controlled clinical trial and the comparison between penile Doppler and a new visual classification for erection hardness score. The limitations are the number of patients and the short follow-up. LI-ESWT has proven effective in the treatment of moderate vasculogenic erectile dysfunction, with optimal results at 6 months. The new V-EHS offers a simple, reliable and reproducible assessment of erectile function.

Visual Assessment Tools and Therapeutic Implications for Acanthosis Nigricans.

Acanthosis nigricans significantly impacts individuals with skin of color. No United States Food and Drug Administration (FDA)-approved therapy exists for acanthosis nigricans. This review evaluates visual scoring tools for assessing acanthosis nigricans severity, focusing on their utility in monitoring therapy response in clinical trials. Our analysis included five visual scoring tools and revealed that the Acanthosis Nigricans Scoring Chart is the most effective tool for monitoring acanthosis nigricans severity in response to therapy, while the Acanthosis Nigricans Area and Severity Index also remains a strong option for split-neck trials. Future tools should match severity scores with detailed descriptions and images. The inclusion of lesion size in future assessment tools requires careful consideration due to variable reliability among evaluators. This study highlights the need for a universally accepted acanthosis nigricans severity assessment tool. Advancing such methods is crucial to developing effective treatments and addressing healthcare disparities, particularly for individuals with skin of color. J Drugs Dermatol. 2025;24(2):156-161. doi:10.36849/JDD.8168R1.

The effect of a biweekly novel selenium sulfide-containing topical treatment in symptomatic contact lens wearers: An exploratory study.

To explore effects of topical 1% selenium sulfide on signs and symptoms in symptomatic contact lens-wearers, in an exploratory 4-month prospective placebo-controlled double-masked randomised trial. Symptomatic wearers (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8] score>12) with meibomian gland dysfunction (meibomian gland score (MGS)≤12), were enrolled and received either active (AZR-MD-001-containing 1% selenium sulfide), or vehicle ointment, to the lower eyelid margin twice-weekly. MGS, meibomian glands-yielding liquid secretion (MGYLS), lipid layer thickness, tear meniscus height, tear break-up time, tear evaporation rate, lid wiper epitheliopathy, CLDEQ-8 and comfortable wear time (CWT) were measured at baseline and to 4-months. Differences between active and placebo were compared to baseline. Fourteen participants (5M:9F, 30.8±13.8 years) completed the study. In the active group, change in MGS from baseline improved by 1-month (mean difference 7.9±8.0, p=0.03), to 4-months (16.0±11.3, p<0.01). MGYLS improved from baseline by 1.5-months (4.0±3.3) to 4-months (4.1±4.3, p<0.01). In the vehicle, change in MGS (12.1±10.7) and MGYLS (3.9±3.2) were improved at 4-months only (p<0.01). CLDEQ-8 score improved at 1-month and 4-months compared to baseline (-4.4±3.2, -5.1±4.7, p≤0.02) in the active and at 4-months only in the vehicle group (-4.4±6.4, p=0.02). In the active group, CLDEQ-8 visual function scores improved at 1- and 4-months (p ≤ 0.02) and CWT at 4-months (median 7 vs.10 hours, p=0.025). Other signs were unchanged. This exploratory study indicates that twice-weekly use of AZR-MD-001 ointment can rapidly improve gland patency and secretion in symptomatic contact lens-wearers. AZR-MD-001 reduced changeable/blurry vision and prolonged CWT, suggesting relevant future endpoints.

Reopenable clip over-the-line method in endoscopic full-thickness resection of gastric submucosal tumors: A historical control study.

Endoscopic full-thickness resection for gastric submucosal tumors is gradually gaining popularity, and secure and amenable closure is key to its success. This study aimed to compare the reopenable clip over-the-line method with the purse-string method for defect closure after endoscopic full-thickness resection for gastric submucosal tumors. This historical control trial included 37 consecutive patients with 37 gastric submucosal tumors, who underwent endoscopic full-thickness resection between January 2021 and July 2024. All lesions were resected en bloc. After excluding three patients who underwent non-full-thickness resection, 34 patients were analyzed. Post-endoscopic full-thickness resection defects were closed using the purse-string method (n=18) until 2022 and the reopenable clip over-the-line method (n=16) from 2023. The median (interquartile range) time for defect closure was longer in the reopenable clip over-the-line method group of 33 (31-57) min than in the purse-string method group of 26 (24-35) min (p=0.013). The visual analog scale pain score at the umbilical region was lower (p=0.048) after the reopenable clip over-the-line method than after the purse-string method. In the reopenable clip over-the-line method group, post-procedural abdominal pain was confined to the epigastrium, whereas it extended to the umbilical or left lateral regions in the purse-string method group. The reopenable clip over-the-line method group commenced the diet (p=0.001) and discharged (p=0.024) earlier than the purse-string method group. Reopenable clip over-the-line method facilitated secure post-endoscopic full-thickness resection defect closure, reduced post-procedural abdominal pain, and shortened the fasting and hospitalization periods after endoscopic full-thickness resection in gastric submucosal tumors.

Patients With Chronic Lateral Ankle Instability and Small Osteochondral Lesions of the Talus Obtain Good Postoperative Results: A Minimum 10-Year Follow-up With Radiographic Evidence.

Few studies reported the long-term clinical outcomes and joint degeneration of patients with chronic lateral ankle instability (CLAI) and small osteochondral lesions of the talus (OLTs) following simultaneous open modified Broström-Gould (MBG) surgery and arthroscopic bone marrow stimulation (BMS). The purpose of this study was to study the long-term results of patients after BMS and BMG surgery, and to further evaluate the potential effect of OLT size on postoperative results. In this retrospective study, 110 CLAI patients were divided into 57 patients with OLTs (including 24 patients having combined small osteochondral lesions of the tibial plafond) receiving simultaneous BMS and MBG surgeries (BMS+MBG group), and 53 patients without OLTs receiving isolated open MBG surgery (MBG group). The OLT size and pre- and postoperative Kellgren-Lawrence grade were assessed. The subjective scores (visual analog scale pain score, Tegner activity, and Karlsson-Peterson scores), surgical complications, and return to sports were also compared pre- and postoperatively. Patients were followed up at a mean of 144.2 ± 14.9 and 145.6 ± 11.4 months for the BMS+MBG and MBG groups, respectively. Subjective scores were significantly improved (P < .001), and no difference was found in subjective scores or surgical complications between the 2 groups (P > .05). Both groups showed progression of osteoarthritis grade (P < .001), but with no significant difference of changes from the preoperative to the final follow-up (BMS+MBG group: 0.84 ± 0.75 to 1.32 ± 0.80; MBG group: 0.32 ± 0.48 to 0.86 ± 0.56, changes: 0.48 ± 0.59 vs 0.55 ± 0.51, P = .575). For sports function, both groups had similar results in Tegner scores (5.8 ± 1.3 vs 6.2 ± 1.3, P = .081). However, in a subgroup analysis, we found that in the BMS+MBG group, patients exceeding the mean size of OLTs (50 mm2) were associated with an average lower postoperative Karlsson-Peterson score (P = .025) and higher postoperative osteoarthritis grade (P = .037), with more changes (P = .017) than those with OLTs <50 mm2. Patients with CLAI and small OLTs following simultaneous open MBG surgery and arthroscopic BMS showed good long-term outcomes and only mild progression of joint degeneration-overall similar to patients treated for CLAI with MBG surgery. Moreover, as OLT size increased, good outcomes were less predictable.

Explainable vision transformer for automatic visual sleep staging on multimodal PSG signals

Polysomnography (PSG) is crucial for diagnosing sleep disorders, but manual scoring of PSG is time-consuming and subjective, leading to high variability. While machine-learning models have improved PSG scoring, their clinical use is hindered by the ‘black-box’ nature. In this study, we present SleepXViT, an automatic sleep staging system using Vision Transformer (ViT) that provides intuitive, consistent explanations by mimicking human ‘visual scoring’. Tested on KISS–a PSG image dataset from 7745 patients across four hospitals–SleepXViT achieved a Macro F1 score of 81.94%, outperforming baseline models and showing robust performances on public datasets SHHS1 and SHHS2. Furthermore, SleepXViT offers well-calibrated confidence scores, enabling expert review for low-confidence predictions, alongside high-resolution heatmaps highlighting essential features and relevance scores for adjacent epochs’ influence on sleep stage predictions. Together, these explanations reinforce the scoring consistency of SleepXViT, making it both reliable and interpretable, thereby facilitating the synergy between the AI model and human scorers in clinical settings.

Rate and Timing of Progression to Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction in Patients With Systemic Inflammatory Disease: A Long-term Propensity-Matched Cohort Study.

Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures and one of the most well studied. Despite extensive research dedicated to ACLR, there is limited understanding of how chronic inflammatory systemic diseases (CIDs) such as rheumatoid arthritis and systemic lupus erythematosus affect outcomes. To compare the outcomes of ACLR in cohorts of patients with and without CID. Cohort study; Level of evidence, 3. A retrospective query of a regional data set was conducted for all patients who underwent ACLR from 1990 to 2021 for traumatic ACL rupture. All patients with CID were identified and propensity matched to non-CID controls. Baseline characteristics and clinical outcomes were identified through retrospective chart review, and patients were contacted for subjective outcomes. A total of 30 patients with ACLR and a diagnosis of CID were identified. These patients were propensity matched to 120 non-CID controls. Baseline demographic and surgical characteristics demonstrated no statistical differences. Follow-up duration was similar between the CID and non-CID groups (mean, 14.6 vs 14.2 years; P = .868). The CID cohort had a higher arthrofibrosis rate (16.7% vs 4.3%; P = .031), higher osteoarthritis rate (33.3% vs 16.7%; P = .041), higher total knee arthroplasty (TKA) rate (16.7% vs 3.3%; P = .016), and earlier time to TKA (14.7 vs 23.5 years; P = .032). Knee range of motion, infection rate, retear rate, time to retear, and time to osteoarthritis were not statistically different between the cohorts. The CID cohort had higher visual analog scale pain scores (mean, 2.00 vs 1.20; P = .043) but slightly higher satisfaction (mean, 3.92 vs 3.39; P = .043). There were no differences in preinjury Tegner, postoperative Tegner, change in Tegner, or IKDC score. In a univariate Cox regression model, the CID cohort had a retear hazard ratio of 1.43 (95% CI, 0.46-4.51; P = .537). Kaplan-Meier survival revealed no significant differences in retear-free survival between the CID and non-CID cohorts at 25 years (85.7% vs 87.3%; P = .53). The CID cohort had a TKA hazard ratio of 3.94 (95% CI, 1.05-14.8; P = .042). Kaplan-Meier survival demonstrated significantly decreased TKA-free survival at 25 years in the CID cohort (64.9% vs 91.2%; P = .029). CID increases the incidence of arthrofibrosis, osteoarthritis, and TKA in those undergoing ACLR. Patients with CID also undergo TKA significantly sooner than non-CID counterparts. Notably, the majority of patient-reported outcome measures are no worse in patients who have a CID diagnosis. Thus, ACLR constructs themselves may not necessarily fare worse in patients with CID. Nonetheless, these patients need to be cautiously counseled on the clinical outlook after their ACLR.

Effects of data-driven respiratory gating on visualization and quantification of breast and upper abdominal cancers in FDG PET/CT examinations.

Data-driven respiratory gating (DDG) has recently been introduced to improve image quality in the PET portion of PET/CT examinations. The latest DDG system does not require any external equipment or extended examination time. In this study, we investigated the effects of the new DDG system on the visualization and quantification of breast and upper abdominal cancers, comparing the results with those obtained using the standard free-breathing (STD) PET protocol. A total of 223 cancer lesions (138 breast and 85 upper abdominal) evaluated with FDG PET/CT were included in this study. PET images were reconstructed using the STD and DDG algorithms. Lesion blurring and conspicuity were each visually graded on a three-point scale. The longest diameter (LD), SUVmax, and metabolic tumor volume (MTV) of the lesions were used for quantitative analysis. % change in SUVmax or MTV was calculated from the metrics in STD and DDG images. Fifty-six texture features (TFs) were also evaluated. Visual scores and quantitative metrics were compared between STD and DDG images. % change in SUVmax or MTV was compared in the lesion location groups or in the high and low groups based on LD, SUVmax, or MTV in STD images. Visual scores for lesion blurring and conspicuity were both significantly higher in DDG than in STD PET images. SUVmax and MTV were significantly higher and lower, respectively, in DDG than in STD images. An increase in SUVmax and a decrease in MTV were observed in 96% and 86% of all lesions, respectively. Group analysis revealed that % change in SUVmax was greater in the upper abdominal than the breast lesions and % change in MTV was greater in the high LD and high MTV groups than in the lowLD and lowMTV groups, respectively. Quantitative changes in TFs were observed between STD and DDG images for most of the features. This study demonstrated that DDG improved visualization and quantification of breast and upper abdominal cancers in FDG PET/CT examinations. DDG PET images exhibited an increase in SUVmax, a decrease in MTV, and changes in TFs.

Qualitative and quantitative analysis of reduced bed position acquisition time on FDG PET image quality.

The study aim was to evaluate whether reducing bed position acquisition time would result in significant detriment to image quality. Secondary aims were to compare effect of time of flight (TOF) and Q.Clear reconstructions and patient BMI on image quality. Fluorodeoxyglucose PET-CT performed in 30 patients on a new scanner at our institution between March and May 2024 was retrospectively evaluated. Four PET reconstructions were performed: (a) 1 min 45 s TOF, (b) 2 min TOF, (c) 1 min 45 s Q.Clear, and (d) 2 min Q.Clear. For qualitative analysis, four maximum intensity projection images were evaluated side-by-sideusing a five-point visual score (1 = non-diagnostic, 5 = excellent). For quantitative analysis, liver signal-to-noise ratio (SNR) was calculated. A statistically significant reduction in visual score occurred when reducing bed position time from 2 min to 1 min 45 s (mean TOF scores 0.24 reduction, P = 0.0002; mean Q.Clear scores 0.04 reduction, P = 0.02. There was also a statistically significant difference in liver SNR when reducing bed position time. Deterioration in image quality was minimised when bed position acquisition time was reduced if Q.Clear construction was utilized. This could facilitate increased scanning capacity without clinical detriment.

Single Axillary Incision Versus Triple Lateral Chest Wall Incisions in Endoscopic Mastectomy for Gynecomastia: A Single-Center Retrospective Analysis with Propensity Score Matching.

Endoscopic mastectomy has gradually become an important surgical modality for the treatment of breast diseases, and is the preferred procedure for gynecomastia. However, endoscopic mastectomy presents challenges such as a steep learning curve, prolonged surgical duration, increased hospitalization costs, and high technical difficulty. This study aimed to evaluate the clinical efficacy and patient satisfaction of endoscopic mastectomy using a single axillary incision versus a triple lateral chest wall incision for gynecomastia. Patients were stratified into a single-port group and a three-port group based on the surgical approach. Propensity score matching was used for the nearest neighbor matching, adjusting baseline data differences at a 1:1 ratio, with a caliper value set at 0.2 to ensure comparability between the two groups. Clinical efficacy and patient satisfaction were compared after propensity score matching. A total of 36 pairs of patients were successfully matched after propensity score matching, with no differences in baseline characteristics (P > 0.05). Notably, the three-port group experienced longer surgical durations compared to the single-port group, alongside higher hospitalization costs (P < 0.05). There were no differences in surgical bleeding volume, postoperative drainage volume, extubation time, postoperative hospitalization time , surgical complications, visual analog scale pain scores, and recurrence rate (P > 0.05). After a 6-month follow-up, the vancouver scar scale assessment showed no differences in scar color, thickness, vascularity, softness, and total score (P > 0.05). Based on the BODY-Q questionnaire chest module scores, the single-port group showed better overall satisfaction in appearance (P = 0.038), especially in the smoothness of the chest wall, with significantly higher scores than the three-port group (P = 0.001). No differences were found in nipple symmetry, nipple sensation, and skin redundancy (P > 0.05). The single axillary incision endoscopic mastectomy demonstrated advantages in shorter surgical duration and lower hospitalization costs, while providing a smoother chest wall appearance, thereby enhancing overall patient satisfaction. Consequently, this surgical approach may arise as one of the preferred procedures for gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Transforaminal interbody debridement and fusion with antibiotic-impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: a comparative study in Asian population.

A retrospective cohort study. To evaluate whether using antibiotic-impregnated bone graft (AIBG) enhances infection control and shortens the postoperative course of pyogenic discitis and vertebral osteomyelitis (PDVO). Surgical treatment of PDVO is indicated for neurological deficit, instability, unknown pathogen, or poorly controlled infection. The posterior-only approach is effective but requires 4-6 weeks of antibiotic treatment postoperatively. We hypothesized that AIBG used in an all-posterior approach could enhance infection control and shorten the postoperative course of PDVO. Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups. Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°. TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.

A prospective self-controlled study on the alterations of the ocular surface and conjunctival transcriptomic profile associated with prolonged exposure to video display terminals.

To assess the impact of prolonged and intense exposure to video display terminals (VDTs) on ocular surface homeostasis. 30 subjects limited daily VDT usage to less than 3h for one week, then extended usage to more than 8h/day for the next three weeks. Ocular symptoms and signs were evaluated weekly using the Ocular Surface Disease Index (OSDI) questionnaire and clinical examinations. Eyelid margins and meibomian glands were examined, and ocular surface samples were collected for transcriptomic analysis. Average daily VDT time increased from 2.55±0.46h initially to 11.17±2.45, 11.75±2.63, and 10.89±2.41h over three weeks. The dry eye diagnosis rate rose from 6.67% to 51.67%. Total OSDI score (P=0.008), symptoms score (P=0.014), and visual function score (P=0.002) significantly increased. Mean fluorescein break-up time (FBUT) decreased from 6.46s to 3.08s. Corneal fluorescein staining (CFS) score (P<0.001) and lissamine green conjunctival staining (LCjs) score (P=0.036) worsened. Ocular redness index (RI) increased at 1 week and 3 weeks (P=0.007, P=0.001). Telangiectasia scores of both upper and lower eyelid margins increased at 3 weeks (P=0.002, P<0.001). Meibomian gland orifice blockage worsened (P=0.014, P=0.002). Transcriptomic analysis revealed dynamic alterations in ocular surface gene expression, including inflammatory and hormonal responses. MUC5AC and TFF1 genes showed negative correlations with OSDI and conjunctival staining score, respectively. Prolonged VDT exposure deteriorates ocular surface symptoms and signs, with significant inflammatory responses and hormonal activity indicating an imbalance in ocular surface homeostasis.

Synthetic [18F]FET-PET Generation and Hotspot Prediction Via Preoperative MRI Fusion of Glioma Lacking Radiographic High-Grade Characteristics

Abstract Background Limited amino acid availability for Positron Emission Tomography (PET) imaging hinders therapeutic decision-making for gliomas without typical high-grade imaging features. To address this gap, we evaluated a generative artificial intelligence (AI) approach for creating synthetic [18F]FET-PET and predicting high [18F]FET-uptake from magnetic resonance imaging (MRI). Methods We trained a deep learning (DL)-based model to segment tumors in MRI and extracted radiomic features using the pyradiomics package and classification with a Random Forest classifier. To generate [18F]FET-PET images, we employed a Generative Adversarial Network (GAN) framework and utilized a split-input fusion module for processing different MRI sequences through feature extraction, concatenation, and self-attention. Results We included MR and PET images from 215 studies for the hotspot classification and 211 studies for the synthetic PET generation task. The top-performing radiomic features achieved 80% accuracy for hotspot prediction. From the synthetic [18F]FET-PET, 85% were classified as clinically useful by senior physicians. Peak Signal-to-Noise Ratio analysis indicated high signal fidelity with a peak at 40 dB, while Structural Similarity Index values showed structural congruence. Root Mean Square Error analysis demonstrated lower values below 5.6. Most Visual Information Fidelity scores ranged between 0.6 and 0.7. This indicates that synthetic PET images retain the essential information required for clinical assessment and diagnosis. Conclusion For the first time, we demonstrate that predicting high [18F]FET-uptake and generating synthetic PET images from preoperative MRI in LGG and HGG is feasible. Advanced MRI modalities and other generative AI models will be used to improve the algorithm further in future studies.

Comparison of dark-field chest radiography and CT for the assessment of COVID-19 pneumonia.

Dark-field chest radiography allows the assessment of the structural integrity of the alveoli by exploiting the wave properties of x-rays. To compare the qualitative and quantitative features of dark-field chest radiography in patients with COVID-19 pneumonia with conventional CT imaging. In this prospective study conducted from May 2020 to December 2020, patients aged at least 18 years who underwent chest CT for clinically suspected COVID-19 infection were screened for participation. Inclusion criteria were a CO-RADS score ≥4, the ability to consent to the procedure and to stand upright without help. Participants were examined with a clinical dark-field chest radiography prototype. For comparison, a healthy control cohort of 40 subjects was evaluated. Using Spearman's correlation coefficient, correlation was tested between dark-field coefficient and CT-based COVID-19 index and visual total CT score as well as between the visual total dark-field score and the visual total CT score. A total of 98 participants [mean age 58 ± 14 (standard deviation) years; 59 men] were studied. The areas of signal intensity reduction observed in dark-field images showed a strong correlation with infiltrates identified on CT scans. The dark-field coefficient had a negative correlation with both the quantitative CT-based COVID-19 index (r = -.34, p = .001) and the overall CT score used for visual grading of COVID-19 severity (r = -.44, p < .001). The total visual dark-field score for the presence of COVID-19 was positively correlated to the total CT score for visual COVID-19 severity grading (r = .85, p < .001). COVID-19 pneumonia-induced signal intensity losses in dark-field chest radiographs are consistent with CT-based findings, showing the technique's potential for COVID-19 assessment.

Improving skin screening capabilities for Veterans with spinal cord injuries

Context Clinical Practice Guidelines from the Consortium for Spinal Cord Injury (SCI) Medicine recommend daily self-screening of at-risk skin surfaces, but many Veterans with SCI describe challenges using the standard issue long-handled self-inspection mirror (LSIM). Objective The objective of this project was to compare the LSIM to a recently developed camera-based self-inspection system (CSIS). User feedback guided iterative engineering to improve and develop the new technology in preparation for transfer to industry. Methods Five Veterans with spinal cord injury (SCI) volunteered to compare use of a LSIM versus the CSIS to identify purposefully placed stickers with varying letters and colors over their high-risk skin surfaces while lying in bed. Each Veteran also responded to a series of interview questions and completed the QUEST 2.0 questionnaire on satisfaction with assistive technology. Results Veterans with SCI were able to correctly identify sticker letters and colors with significantly higher fidelity (P = .001 and P = .001 respectively) using the CSIS compared to using LSIM. Further the CSIS, was significantly (P = .004) preferred over the LSIM on the QUEST 2.0. The Cohen’s D effect sizes for these paired comparisons were large (for color: 5.7, for sticker letter: 5.0 and QUEST 2.0: 2.6). Conclusions Improved visualization and satisfaction scores using the newly developed CSIS suggest that adoption of this new technology could improve the quality and acceptance of this skin screening strategy for persons with spinal cord injury.