Parkinson's disease patients show delayed hemodynamic changes in primary motor cortex in fine motor tasks and decreased resting-state interhemispheric functional connectivity: a functional near-infrared spectroscopy study.

Significance: People with Parkinson's disease (PD) experience changes in fine motor skills, which is viewed as one of the hallmark signs of this disease. Due to its non-invasive nature and portability, functional near-infrared spectroscopy (fNIRS) is a promising tool for assessing changes related to fine motor skills. Aim: We aim to compare activation patterns in the primary motor cortex using fNIRS, comparing volunteers with PD and sex- and age-matched control participants during a fine motor task and walking. Moreover, inter and intrahemispheric functional connectivity (FC) was investigated during the resting state. Approach: We used fNIRS to measure the hemodynamic changes in the primary motor cortex elicited by a finger-tapping task in 20 PD patients and 20 controls matched for age, sex, education, and body mass index. In addition, a two-minute walking task was carried out. Resting-state FC was also assessed. Results: Patients with PD showed delayed hypoactivation in the motor cortex during the fine motor task with the dominant hand and delayed hyperactivation with the non-dominant hand. The findings also revealed significant correlations among various measures of hemodynamic activity in the motor cortex using fNIRS and different cognitive and clinical variables. There were no significant differences between patients with PD and controls during the walking task. However, there were significant differences in interhemispheric connectivity between PD patients and control participants, with a statistically significant decrease in PD patients compared with control participants. Conclusions: Decreased interhemispheric FC and delayed activity in the primary motor cortex elicited by a fine motor task may one day serve as one of the many potential neuroimaging biomarkers for diagnosing PD.

Towards an AI-Based Objective Prognostic Model for Quantifying Wound Healing.

Chronic wounds affect millions of people worldwide every year. An adequate assessment of a wound's prognosis is critical to wound care, guiding clinical decision making by helping clinicians understand wound healing status, severity, triaging and determining the efficacy of a treatment regimen. The current standard of care involves using wound assessment tools, such as Pressure Ulcer Scale for Healing (PUSH) and Bates-Jensen Wound Assessment Tool (BWAT), to determine wound prognosis. However, these tools involve manual assessment of a multitude of wound characteristics and skilled consideration of a variety of factors, thus, making wound prognosis a slow process which is prone to misinterpretation and high degree of variability. Therefore, in this work we have explored the viability of replacing subjective clinical information with deep learning-based objective features derived from wound images, pertaining to wound area and tissue amounts. These objective features were used to train prognostic models that quantified the risk of delayed wound healing, using a dataset consisting of 2.1 million wound evaluations derived from more than 200,000 wounds. The objective model, which was trained exclusively using image-based objective features, achieved at minimum a 5% and 9% improvement over PUSH and BWAT, respectively. Our best performing model, that used both subjective and objective features, achieved at minimum an 8% and 13% improvement over PUSH and BWAT, respectively. Moreover, the reported models consistently outperformed the standard tools across various clinical settings, wound etiologies, sexes, age groups and wound ages, thus establishing the generalizability of the models.

Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer.

Importance: Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. Objective: To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. Design, Settings, and Participants: This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. Outcome Measures: QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. Results: Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, -4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, -1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. Conclusion and Relevance: The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.

Observation of Tissue Oxygenation Changes Using Remote Photoplesysmography with a Smartphone.

BACKGROUND: Tissue oxygenation is a critical marker of tissue status and can be used to evaluate and track wound progress, the viability of transplanted tissue, and burns. Thus, the determination of tissue oxygenation (preferably remotely) is of great importance. AIM: Explore the impact of oxygenation changes on tissue color. MATERIAL AND METHODS: The rPPG of both hands was acquired using a stand-mounted smartphone (iPhone 8) placed about 10 cm above the hands. A 60 s baseline was followed by occlusion of one arm using a cuff inflated to 200 mmHg for approximately 2 min. The cuff was then rapidly deflated, followed by a 60 s recovery period. The reference muscle oxygenation signal (SmO2) was acquired using the near-infrared contact Moxy device (Fortiori Design LLC) placed on the forearm distal to the occlusion. The data were collected on both hands of 28 healthy volunteers. RESULTS: rPPG can observe changes in tissue oxygenation, which was confirmed across 28 participants using a robust reference standard. CONCLUSION: We have an initial confirmation of the notion that rPPG can monitor changes in tissue oxygenation. However, a spectrum of rPPG and SmO2 reductions is observed, which should be explored in future work.

Is my wound infected? A study on the use of hyperspectral imaging to assess wound infection.

Introduction: Clinical signs and symptoms (CSS) of infection are a standard part of wound care, yet they can have low specificity and sensitivity, which can further vary due to clinician knowledge, experience, and education. Wound photography is becoming more widely adopted to support wound care. Thermography has been studied in the medical literature to assess signs of perfusion and inflammation for decades. Bacterial fluorescence has recently emerged as a valuable tool to detect a high bacterial load within wounds. Combining these modalities offers a potential objective screening tool for wound infection. Methods: A multi-center prospective study of 66 outpatient wound care patients used hyperspectral imaging to collect visible light, thermography, and bacterial fluorescence images. Wounds were assessed and screened using the International Wound Infection Institute (IWII) checklist for CSS of infection. Principal component analysis was performed on the images to identify wounds presenting as infected, inflamed, or non-infected. Results: The model could accurately predict all three wound classes (infected, inflamed, and non-infected) with an accuracy of 74%. They performed best on infected wounds (100% sensitivity and 91% specificity) compared to non-inflamed (sensitivity 94%, specificity 70%) and inflamed wounds (85% sensitivity, 77% specificity). Discussion: Combining multiple imaging modalities enables the application of models to improve wound assessment. Infection detection by CSS is vulnerable to subjective interpretation and variability based on clinicians' education and skills. Enabling clinicians to use point-of-care hyperspectral imaging may allow earlier infection detection and intervention, possibly preventing delays in wound healing and minimizing adverse events.

Efficacy of a polylactic acid matrix for the closure of Wagner grade 1 and 2 diabetic foot ulcers: a single-center, prospective randomized trial.

INTRODUCTION: CAMPs are used for treating refractory DFUs where other treatments have failed. PLA is a CAMP that has demonstrated effectiveness in promoting healing in burns and acute wounds. OBJECTIVE: A single-center, prospective, randomized controlled trial comparing PLA-guided closure matrices versus collagen dressings was conducted to assess healing of Wagner grades 1 and 2 DFUs. MATERIALS AND METHODS: A total of 30 participants were randomized to receive weekly debridement, wound care, and DFU offloading plus either PLA or collagen CAMPs. The primary outcome was the time to achieve full healing, and the secondary outcome was the proportion of ulcers healed at 12 weeks. RESULTS: The median time to achieve full healing was 9.3 ± 2.9 weeks in the PLA group versus 14.8 ± 8.1 weeks in the collagen group (P = .021), representing a 44% reduction in the time to heal. Furthermore, by 12 weeks, 80% of the PLA-treated ulcers were healed compared to only 33% in the collagen group (P = .025). CONCLUSION: The results of this study show PLA matrices induce a potent healing response that leads to reduced healing time and an increased OR for achieving healing by 12 weeks.

Diagnostic reliability in teledermatology: a systematic review and a meta-analysis.

OBJECTIVES: To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions. DESIGN: Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results. RESULTS: 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology. CONCLUSIONS AND RELEVANCE: Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/FJDVG.

Clinical Performance of Decision Support Systems in Anesthesia, Intensive Care, and Emergency Medicine: A Systematic Review and Meta-Analysis.

BACKGROUND: Medical technology is expanding at an alarming rate, with its integration into health care often reflected by the constant evolution of best practices. This rapid expansion of available treatment modalities, when coupled with progressively increasing amounts of consequential data for health care professionals to manage, creates an environment where complex and timely decision-making without the aid of technology is inconceivable. Decision support systems (DSSs) were, therefore, developed as a means of supporting the clinical duties of health care professionals through immediate point-of-care referencing. The integration of DSS can be especially useful in critical care medicine, where the combination of complex pathologies, the multitude of parameters, and the general state of patients require swift informed decision-making. The systematic review and meta-analysis were performed to evaluate DSS outcomes compared to the standard of care (SOC) in critical care medicine. METHODS: This systematic review and subsequent meta-analysis were performed after the EQUATOR networks Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). We systematically explored PubMed, Ovid, Central, and Scopus for randomized controlled trials (RCTs) from January 2000 to December 2021. The primary outcome of this study was to evaluate whether DSS is more effective than SOC practice in critical care medicine within the following disciplines: anesthesia, emergency department (ED), and intensive care unit (ICU). A random-effects model was used to estimate the effect of DSS performance, with 95% confidence intervals (CIs) in both continuous and dichotomous results. Outcome-based, department-specific, and study-design subgroup analyses were performed. RESULTS: A total of 34 RCTs were included for analysis. In total, 68,102 participants received DSS intervention, while 111,515 received SOC. Analysis of the continuous (standardized mean difference [SMD], -0.66; 95% CI [-1.01 to -0.30]; P < .01) and binary outcomes (odds ratio [OR], 0.64; 95% CI, [0.44-0.91]; P < .01) was statistically significant and suggests that health interventions are marginally improved with DSS integration in comparison to SOC in critical care medicine. Subgroup analysis in anesthesia (SMD, -0.89; 95% CI, [-1.71 to -0.07]; P < .01) and ICU (SMD, -0.63; 95% CI [-1.14 to -0.12]; P < .01) were deemed statistically supportive of DSS in improving outcome, with evidence being indeterminate in the field of emergency medicine (SMD, -0.24; 95% CI, [-0.71 to 0.23]; P < .01). CONCLUSIONS: DSSs were associated with a beneficial impact in critical care medicine on a continuous and binary scale; however, the ED subgroup was found to be inconclusive. Additional RCTs are required to determine the effectiveness of DSS in critical care medicine.

Local Insulin Improves Wound Healing: A Systematic Review and Bayesian Network Meta-Analysis.

BACKGROUND: Wounds are a significant health issue, and reliable and safe strategies to promote repair are needed. Clinical trials have demonstrated that local insulin promotes healing in acute and chronic wounds (ie, reductions of 7% to 40% versus placebo). However, the trials' sample sizes have prevented drawing solid conclusions. Furthermore, no analysis has focused on safety concerns (ie, hypoglycemia). Under the hypothesis that local insulin promotes healing through proangiogenic effects and cellular recruitment, the aim of this systematic review and network meta-analysis (NMA) was to assess its safety and relative effectiveness using a Bayesian approach. METHODS: Medline, CENTRAL, Embase, Scopus, LILACS, and gray literature sources were searched for human studies assessing the local use of insulin versus any comparator since inception to October of 2020. Data on glucose changes and adverse events, wound and treatment characteristics, and healing outcomes were extracted, and an NMA was conducted. RESULTS: A total of 949 reports were found, of which 23 ( n = 1240 patients) were included in the NMA. The studies evaluated six different therapies, and most comparisons were against placebo. NMA showed -1.8 mg/dL blood glucose level change with insulin and a lack of reported adverse events. Statistically significant clinical outcomes identified include reduction in wound size (-27%), increased healing rate (23 mm/day), reduction in Pressure Ulcer Scale for Healing scores (-2.7), -10 days to attain complete closure, and an odds ratio of 20 for complete wound closure with insulin use. Likewise, significantly increased neoangiogenesis (+30 vessels/mm 2 ) and granulation tissue (+25%) were also found. CONCLUSION: Local insulin promotes wound healing without significant adverse events.

Relation between mismatch repair status, chemoresponse, survival and anatomic location in gastroesophageal adenocarcinoma.

BACKGROUND: It has recently been reported that mismatch repair (MMR) status and microsatellite instability (MSI) status in gastroesophageal carcinomas predict surgical, chemotherapeutic and immunotherapeutic outcomes; however, there is extensive variability in the reported incidence and clinical implications of MMR/MSI status in gastroesophaegal adenocarcinomas. We characterized a Canadian surgical patient cohort with respect to MMR status, clinicopathologic correlates and anatomic tumour location. METHODS: We investigated MMR and BRAF V600E status of gastroesophaegal adenocarcinomas in patients who underwent gastrectomy or esophagectomy with extended (D2) lymphadenectomy at a single centre between 2011 and 2019. We correlated patterns of MMR expression in the overall cohort and in anatomic location-defined subgroups with treatment response and overall survival using multivariate analysis. RESULTS: In all, 226 cases of gastroesophaegal adenocarcinoma (63 esophageal, 98 gastroesophageal junctional and 65 gastric) were included. The MMR-deficient (dMMR) immunophenotype was found in 28 tumours (12.3%) (15 junctional [15.3%], 13 gastric [20.0%] and none of the esophageal). The majority (25 [89%]) of dMMR cases showed MLH1/PMS2 loss without concurrent BRAF V600E mutation. Two MSH2/ MSH6-deficient gastric tumours and 1 MSH6-deficient junctional tumour were detected. The pathologic response to preoperative chemotherapy was comparable in the dMMR and MMR-proficient (pMMR) cohorts. However, dMMR status was associated with significantly longer median overall survival than pMMR status (5.8 yr v. 2.4 yr, hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.06-3.46), particularly in junctional tumours (4.6 yr v. 1.9 yr, HR 2.97, 95% CI 1.27-6.94). CONCLUSION: Our study shows that MMR status has at least prognostic value, which supports the need for biomarker testing in gastroesophageal adenocarcinomas, including junctional adenocarcinomas. This highlights the clinical significance of determining the MMR status in all adenocarcinomas of the upper gastrointestinal tract. Response to induction chemotherapy, however, was not influenced by MMR status.

Capsular Repair Counteracts the Risk of Dislocation in Hemiarthroplasty Conversion to Total Hip Arthroplasty.

This study investigated whether decreasing the femoral head size, in addition to performing a posterior capsular closure and short external rotator repair, influences the historical rate of dislocation after conversion of a failed hemiarthroplasty (HA) to a total hip arthroplasty (THA) through a posterior approach. We reviewed 15 patients from our prospective arthroplasty database who underwent a conversion from an HA to a THA with closure of the posterior capsule, had downsizing of the femoral head, and had at least a 2-year follow-up. Patients were clinically observed to determine whether their hip dislocated postoperatively or required re-revision. Radiographs were evaluated to assess for known risk factors for dislocation, including component position and restoration of hip biomechanics. The femoral head size was downsized from a mean of 45 mm (range, 42-57 mm) preoperatively to a mean of 32 mm (range, 28-36 mm) postoperatively (P<.001). Femoral heads sized 36, 32, and 28 mm were used in the revision of 4, 5, and 6 hips, respectively. At the mean 84-month follow-up (range, 24-156 months), there were no dislocations. Attention to surgical technique and closing the posterior capsule can decrease the historically high dislocation rate associated with converting an HA to a total hip replacement using the posterolateral approach. Despite substantial reduction in size of the prosthetic femoral head, there were no postoperative dislocations with closure of the posterior capsule. Downsizing the femoral head during revision THA should be avoided; however, if not feasible, closure of the posterior capsule can offset the otherwise increased risk of dislocation. [Orthopedics. 2023;46(3):175-179.].

Use of Infrared Thermal Imaging for Assessing Acute Inflammatory Changes: A Case Series.

Infrared thermal imaging is a non-contact imaging modality that captures the heat emitted by the human body. Thermal regulation or heat load to the different body parts is mainly regulated via blood supply, which is increased during inflammation. The assessment of the body's level of inflammation with pain, erythema and heat is subjective clinical measurement. Infrared imaging can be an objective tool for identifying and following inflammatory and perfusion changes, thereby helping clinicians locate and document the extent of the inflammation as well as monitor the response to treatment. As an example of this, here, we present three clinical cases where the use of thermography aided the assessment of acute inflammatory changes due to trauma, vasodilation, and allergy.

A Randomized Controlled Trial on the Effect of Local Insulin Glargine on Venous Ulcer Healing.

INTRODUCTION: To determine whether the local administration of insulin glargine compared with placebo in nondiabetic patients with venous ulcers (VUs) leads to increased wound healing. METHODS: A randomized controlled trial using a split-plot design was performed in 36 adults with leg VUs >25 cm2 and more than 3 mo of evolution. Each hemi-wound received either 10 UI insulin glargine or saline solution once a day for 7 d. Size of the wounds, thermal asymmetry, the number of blood vessels, and the percentage area of collagen content in wound biopsies were assessed at baseline and after 7 d of treatment. Blood capillary glucose was monitored once a day after the insulin injection. RESULTS: After 7 d of treatment, the hemi-wounds treated with insulin glargine were significantly smaller, had less thermal asymmetry, more blood vessels, and more collagen content than the saline-treated side. Correlation between thermal asymmetry and the number of blood vessels was also found (r2 = 66.2, P < 0.001). No patient presented capillary glucose levels ≤3.3 mmol/L nor any adverse effects. CONCLUSIONS: In nondiabetic patients with chronic VUs, the topical administration of insulin glargine seems to be safe and promotes wound healing and tissue repair after 7 d of treatment.

Factors predicting recurrence in thymic epithelial neoplasms.

OBJECTIVES: Thymic epithelial neoplasms (TENs) represent a heterogeneous group of rare thoracic malignancies. We analysed the clinicopathological features, survival outcomes, risk factors, and patterns of recurrence in patients undergoing resection. METHODS: Records were reviewed for adult patients with TEN who underwent resection from 2006 to 2019. Survival rates were assessed using the Kaplan-Meier method. Univariable and multivariable analyses were performed using the log-rank test and Cox proportional hazards model. RESULTS: A total of 100 patients were analysed (51 females, median age 58 years). Thymoma was the most common histology (n = 92), followed by thymic carcinoma (n = 5) and thymic neuroendocrine tumour (n = 3). Stage II (Masaoka) tumours were most common (n = 51), followed by stage I (n = 27). World Health Organization B2/B3 was the most prominent histological subtype (n = 34). Complete resection (R0) was achieved in 91 patients: 86/92 thymoma, 4/5 thymic carcinoma and 1/3 neuroendocrine tumour. The most common treatment modality was surgery alone in 72 patients, followed by surgery and radiation therapy in 24, and adjuvant chemoradiotherapy in 3 patients. Only one patient with thymic carcinoma received neoadjuvant chemotherapy. The 10-year overall and disease-free survival rates were 86.6% and 83.9%, respectively. Recurrence was most common in neuroendocrine tumours (3/3). Risk factors for recurrence identified on multivariable analyses were: R1/2 resection (hazard ratio 9.30; 95% confidence interval 1.82-36.1), TEN subtype (hazard ratio 8.08; 95% confidence interval 1.24-34.6), and presence of lymphovascular invasion (hazard ratio 9.56; 95% confidence interval 2.56-25.8). CONCLUSIONS: Complete resection remains critical in patients with TEN. Incomplete resection, high-risk histology, and lymphovascular invasion highlight the need for effective adjuvant modalities. Given the rarity of these diseases, emphasis must be placed on collaborative research conducted on TEN.

Fully Automated Wound Tissue Segmentation Using Deep Learning on Mobile Devices: Cohort Study.

BACKGROUND: Composition of tissue types within a wound is a useful indicator of its healing progression. Tissue composition is clinically used in wound healing tools (eg, Bates-Jensen Wound Assessment Tool) to assess risk and recommend treatment. However, wound tissue identification and the estimation of their relative composition is highly subjective. Consequently, incorrect assessments could be reported, leading to downstream impacts including inappropriate dressing selection, failure to identify wounds at risk of not healing, or failure to make appropriate referrals to specialists. OBJECTIVE: This study aimed to measure inter- and intrarater variability in manual tissue segmentation and quantification among a cohort of wound care clinicians and determine if an objective assessment of tissue types (ie, size and amount) can be achieved using deep neural networks. METHODS: A data set of 58 anonymized wound images of various types of chronic wounds from Swift Medical's Wound Database was used to conduct the inter- and intrarater agreement study. The data set was split into 3 subsets with 50% overlap between subsets to measure intrarater agreement. In this study, 4 different tissue types (epithelial, granulation, slough, and eschar) within the wound bed were independently labeled by the 5 wound clinicians at 1-week intervals using a browser-based image annotation tool. In addition, 2 deep convolutional neural network architectures were developed for wound segmentation and tissue segmentation and were used in sequence in the workflow. These models were trained using 465,187 and 17,000 image-label pairs, respectively. This is the largest and most diverse reported data set used for training deep learning models for wound and wound tissue segmentation. The resulting models offer robust performance in diverse imaging conditions, are unbiased toward skin tones, and could execute in near real time on mobile devices. RESULTS: A poor to moderate interrater agreement in identifying tissue types in chronic wound images was reported. A very poor Krippendorff α value of .014 for interrater variability when identifying epithelization was observed, whereas granulation was most consistently identified by the clinicians. The intrarater intraclass correlation (3,1), however, indicates that raters were relatively consistent when labeling the same image multiple times over a period. Our deep learning models achieved a mean intersection over union of 0.8644 and 0.7192 for wound and tissue segmentation, respectively. A cohort of wound clinicians, by consensus, rated 91% (53/58) of the tissue segmentation results to be between fair and good in terms of tissue identification and segmentation quality. CONCLUSIONS: The interrater agreement study validates that clinicians exhibit considerable variability when identifying and visually estimating wound tissue proportion. The proposed deep learning technique provides objective tissue identification and measurements to assist clinicians in documenting the wound more accurately and could have a significant impact on wound care when deployed at scale.

Infrared Thermography in Wound Care, Surgery, and Sports Medicine: A Review.

For many years, the role of thermometry was limited to systemic (core body temperature) measurements (e.g., pulmonary catheter) or its approximation using skin/mucosa (e.g., axillary, oral, or rectal) temperature measurements. With recent advances in material science and technology, thermal measurements went beyond core body temperature measurements and found their way in many medical specialties. The article consists of two primary parts. In the first part we overviewed current clinical thermal measurement technologies across two dimensions: (a) direct vs. indirect and (b) single-point vs. multiple-point temperature measurements. In the second part, we focus primarily on clinical applications in wound care, surgery, and sports medicine. The primary focus here is the thermographic imaging modality. However, other thermal modalities are included where relevant for these clinical applications. The literature review identified two primary use scenarios for thermographic imaging: inflammation-based and perfusion-based. These scenarios rely on local (topical) temperature measurements, which are different from systemic (core body temperature) measurements. Quantifying these types of diseases benefits from thermographic imaging of an area in contrast to single-point measurements. The wide adoption of the technology would be accelerated by larger studies supporting the clinical utility of thermography.

Synchronous Esophageal and Lung Cancers-Is Combined Anatomic Resection Appropriate?

BACKGROUND: This study evaluated the safety and feasibility of combined resection for patients with synchronous pulmonary and esophageal cancer. METHODS: Patients undergoing esophagectomy between 1997 and 2019 were identified from prospectively collected databases at 3 tertiary referral centers, and those with combined anatomic lung resection at the same setting were matched in a 1:3 ratio to esophagectomy-alone patients, based on age, sex, pathologic stage, neoadjuvant therapy, and surgical procedure. Demographic data, perioperative data, and postoperative complications were compared. Statistical analysis included the unpaired t test, Fisher exact, or χ2 test and Gehan-Breslow analysis. RESULTS: Of 4729 esophagectomies, combined anatomic lung resection was performed in 18 patients with discrete pulmonary lesions. Matching yielded 49 patients who underwent esophagectomy only and were statistically similar compared with patients undergoing combined resections. Ivor Lewis esophagectomy and lobectomy were the most frequent procedures. Combined resections did not have a higher overall complication rate than esophagectomy alone; rather, these patients had fewer overall complications (56% vs 84%; P = .02). Specifically, there were no differences in anastomotic leak (17% vs 18%) or pulmonary complications (39% vs 33%) between combined resection and esophagectomy alone. No postoperative mortality were identified, and median overall survival was 4.1 years vs 6.5 years (P = .10). CONCLUSIONS: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased toward nonsurgical therapy, because the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone in this highly selected group of patients.

Enhanced Bone Remodeling After Fracture Priming.

The immune system is an active component of bone repair. Mast cells influence the recruitment of macrophages, osteoclasts and blood vessels into the repair tissue. We hypothesized that if mast cells and other immune cells are sensitized to recognize broken bone, they will mount an increased response to subsequent fractures that may be translated into enhanced healing. To test this, we created a bone defect on the left leg of anesthetized mice and 2 weeks later, a second one on the right leg. Bone repair in the right legs was then compared to control mice that underwent the creation of bilateral window bone defects at the same time. Mice were euthanized at 14 and 56 days. Mineralized tissue quantity and morphometric parameters were assessed using micro-CT and histology. The activity of osteoblasts, osteoclasts, vascular endothelial cells, mast cells, and macrophages was evaluated using histochemistry. Our main findings were (1) no significant differences in the amount of bone produced at 14- or 56 days post-operative between groups; (2) mice exposed to subsequent fractures showed significantly better bone morphometric parameters after 56 days post-operative; and (3) significant increases in the content of blood vessels, osteoclasts, and the number of macrophages in the subsequent fracture group. Our results provide strong evidence that a transient increase in the inflammatory state of a healing injury promotes faster bone remodelling and increased neo-angiogenesis. This phenomenon is also characterized by changes in mast cell and macrophage content that translate into more active recruitment of mesenchymal stromal cells.

Complications in Brachioplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Brachioplasty procedures have experienced a surge in popularity over the past decade, mirroring the rise in bariatric procedures and growing population of massive weight loss patients. The authors estimated the incidence of associated complications and identify possible patient- or procedure-related predictive factors. METHODS: A systematic review was performed using the PubMed, Cochrane, and Embase databases; extracted data were synthesized through a random-effects meta-analysis of proportions and a multivariate meta-regression. RESULTS: Twenty-nine studies were included in the meta-analysis, representing 1578 patients; all studies followed an observational design. The incidence of adverse outcomes assessed included aberrant scarring, 9.9 percent (95 percent CI, 6.1 to 15.6 percent); ptosis or recurrence, 7.79 percent (95 percent CI, 4.8 to 12.35 percent); wound dehiscence, 6.81 percent (95 percent CI, 4.63 to 9.90 percent); seroma, 5.91 percent (95 percent CI, 3.75 to 9.25 percent); infection, 3.64 percent (95 percent CI, 2.38 to 5.53 percent); nerve-related complications, 2.47 percent (95 percent CI, 1.45 to 4.18 percent); lymphedema or lymphocele formation, 2.46 percent (95 percent CI, 1.55 to 3.88 percent); skin necrosis or delayed healing, 2.27 percent (95 percent CI, 1.37 to 3.74 percent); and hematoma, 2.06 percent (95 percent CI, 1.38 to 3.06 percent). The operative reintervention rate for aesthetic purposes was 7.46 percent (95 percent CI, 5.05 to 10.88 percent), and the operative reintervention rate for nonaesthetic purposes was 1.62 percent (95 percent CI, 1.00 to 2.61 percent). Multivariate meta-regression demonstrated that medial incision placement was associated with a higher risk of complications, whereas the incidence of certain complications was lowered with adjunctive liposuction (p < 0.05). CONCLUSION: In the absence of large clinical trials, the present meta-analysis can serve to provide plastic surgeons with an evidence-based reference to improve informed consent and guide procedure selection with respect to the complication profile of brachioplasty.