Visual Score Research Articles

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.

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.

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.

Intra-Interobserver Variability in Myocardial Perfusion and Function Interpretation and Reproducibility of QGS/QPS Software

Aim: To assess three different level experienced nuclear medicine specialists’ intra- and interobserver variability of semiquantitative visual interpretations of left ventricular (LV) myocardial perfusion, wall motion (WM), and wall thickening (WT) in gated myocardial perfusion single- photon emission tomography (gMPS), and to compare the compatibility between the observers’ and coronary angiography (CAG) reports. Methods: A 5-point perfusion scale, a 6-point scale for WM, and a 4-point scale for WT were used to score each segment. The images were interpreted 3 times at least one-month intervals separately by 3 observers. Subsequently, the visual semiquantitative summed scores for stress (SSS) and rest (SRS) were calculated by summing the respective segmental perfusion scores. Summed difference score (SDS) was also calculated as the difference between SSS and SRS. Both visual semiquantitative WM and WT scores were calculated from the stress images by summing all corresponding segmental scores. Results: Intraobserver agreement in the evaluation of global perfusion was statistically significant (71.9-100 %). There was a significant agreement in all LAD-SSS, Cx-SSS, ve RCA-SSS interpretations. There was good agreement between 3 readings of 3 observers' (p=0.0). Due to the high interobserver agreement levels in the global evaluation, the mean values of the 1. and the 2. interpretations (mean 1.-2. int.) were calculated and regional comparisons were made with this new value and the 3. interpretation. There was a a significant agreement in 3 of the regional SSS interpretations. Although lowest agreement rates were calculated in LAD artery territory, the agreement levels were statistically, and highly significant in all territories. In both Cx and RCA territories, the agreement levels were statistically significant (p

Efficacy of Magnifying Texture and Color Enhancement Imaging With Indigo Carmine as an Alternative to Crystal Violet for Colorectal Tumors.

Pit pattern diagnosis using crystal violet staining for colorectal tumors is useful for qualitative and depth diagnosis. However, due to its reported carcinogenic potential, the use of crystal violet has been restricted. This study was aimed at investigating the efficacy of texture and color enhancement imaging (TXI) magnification in pit pattern diagnosis. This study enrolled consecutive patients with consent obtained and with colonic tumors indicated for magnifying endoscopy in which all modalities' images (magnified observation with crystal violet staining (CV), magnified white light observation with indigo carmine (IC-WLI), and magnified TXI observation with indigo carmine (IC-TXI)) were evaluable between July 2020 and January 2023. The visibility of the pit pattern using a 5-point Likert scale and its diagnostic accuracy were compared (IC-TXI vs. IC-WLI, reference: CV, by three experts). A total of 145 colorectal tumors from 145 patients were included. Visibility scores for the pit pattern were significantly higher with IC-TXI compared to IC-WLI (all three experts, p < 0.0001). The pit pattern match rate (Type II/III/IV/V) of IC-TXI compared to CV was also superior to IC-WLI (72.9% vs. 59.7%; p = 0.02). IC-TXI provided reasonably good and higher visibility and diagnostic accuracy than IC-WLI for pit pattern diagnosis of colorectal tumors compared to CV, suggesting it as an alternative to CV.

Impact of Tafamidis on [99mTc]Tc-pyrophosphate Scintigraphy in Ala97Ser Hereditary Transthyretin amyloid cardiomyopathy: significant initial reduction with stable Long-Term effects.

Tafamidis has shown potential in slowing disease progression in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This study aimed to evaluate serial changes on [99mTc]Tc-pyrophosphate (PYP) scintigraphy during tafamidis treatment for hereditary ATTR-CM. We retrospectively analyzed a prospectively collected cohort of Ala97Ser (A97S) hereditary ATTR-CM patients treated with tafamidis (61mg/day) and a control group comprising A97S hereditary ATTR-CM patients who had not received disease-modifying medications. The tafamidis group was further divided into two cohorts: cohort A received [99mTc]Tc-PYP SPECT/CT scans at baseline, 1 year, and 2 years; cohort B at baseline, 2 years, and 3 years. Visual score, planar heart to contralateral lung (H/CL) ratio, and volumetric heart to lung (H/L) ratio were measured. Nineteen patients were enrolled in the tafamidis group and nine in the control group. After 2 years of follow-up, a significant decrease in volumetric H/L ratio (3.86 ± 0.91 to 3.01 ± 0.19, p < 0.001) was noted in the tafamidis group, while there was no significant change in the control group. When evaluated over time, a significant decrease in volumetric H/L ratio was observed during the first year of tafamidis treatment (3.75 ± 0.37 to 2.82 ± 0.15, p = 0.004), followed by stable [99mTc]Tc-PYP uptake in the subsequent two years (2.82 ± 0.15 to 2.83 ± 0.18, p = 0.934 and 3.20 ± 0.14 to 3.09 ± 0.16, p = 0.404, respectively). A significant reduction in [99mTc]Tc-PYP uptake was observed in hereditary ATTR-CM patients after tafamidis treatment, particularly within the first year. While the effect appeared to be sustained, stable [99mTc]Tc-PYP uptake without further significant reductions was observed in the subsequent years.

Neighborhood environment associations with cognitive function and structural brain measures in older African Americans

BackgroundSince older adults spend significant time in their neighborhood environment, environmental factors such as neighborhood socioeconomic disadvantage, high racial segregation, low healthy food availability, low access to recreation, and minimal social engagement may have adverse effects on cognitive function and increase susceptibility to dementia. DNA methylation, which is associated with neighborhood characteristics as well as cognitive function and white matter hyperintensity (WMH), may act as a mediator between neighborhood characteristics and neurocognitive outcomes.MethodsIn this study, we examined whether DNA methylation in peripheral blood leukocytes mediates the relationship between neighborhood characteristics and cognitive function (N = 542) or WMH (N = 466) in older African American (AA) participants without preliminary evidence of dementia from the Genetic Epidemiology Network of Arteriopathy (GENOA).ResultsFor a 1-mile buffer around a participant’s residence, each additional fast food destination or unfavorable food store with alcohol per square mile was nominally associated with a 0.05 (95%CI: 0.01, 0.09) and a 0.04 (0.00, 0.08) second improvement in visual conceptual tracking score, respectively. Also, each additional alcohol drinking place per square mile was nominally associated with a 0.62 (0.05, 1.19) word increase in delayed recall score, indicating better memory function (all p < 0.05). Neighborhood characteristics were not associated with WMH. We did not find evidence that DNA methylation mediates the observed associations between neighborhood characteristics and cognitive function.ConclusionsThe presence of fast food destinations and unfavorable food stores with alcohol was associated cognitive measures, possibly due to greater social interaction provided in these venues. However, replication of these findings is necessary. Further examination of the potential pathways between the neighborhood environment and cognitive function/WMH may allow the development of potential behavioral, infrastructural, and pharmaceutical interventions to facilitate aging in place and healthy brain aging in older adults, especially in marginal populations that are most at risk.

Brainsourcing for temporal visual attention estimation

AbstractThe concept of temporal visual attention in dynamic contents, such as videos, has been much less studied than its spatial counterpart, i.e., visual salience. Yet, temporal visual attention is useful for many downstream tasks, such as video compression and summarisation, or monitoring users’ engagement with visual information. Previous work has considered quantifying a temporal salience score from spatio-temporal user agreements from gaze data. Instead of gaze-based or content-based approaches, we explore to what extent only brain signals can reveal temporal visual attention. We propose methods for (1) computing a temporal visual salience score from salience maps of video frames; (2) quantifying the temporal brain salience score as a cognitive consistency score from the brain signals from multiple observers; and (3) assessing the correlation between both temporal salience scores, and computing its relevance. Two public EEG datasets (DEAP and MAHNOB) are used for experimental validation. Relevant correlations between temporal visual attention and EEG-based inter-subject consistency were found, as compared with a random baseline. In particular, effect sizes, measured with Cohen’s d, ranged from very small to large in one dataset, and from medium to very large in another dataset. Brain consistency among subjects watching videos unveils temporal visual attention cues. This has relevant practical implications for analysing attention for visual design in human-computer interaction, in the medical domain, and in brain-computer interfaces at large.