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The etiology of sellar xanthogranuloma (SXG) remains unclear,1-5 and the surgical strategy for treating SXG is debatable. In this study, we present the surgical case of a symptomatic SXG associated with Rathke cleft cyst. The intraoperative decision to prevent postoperative cerebrospinal fluid (CSF) leakage and secure the drainage route is discussed. A 72-year-old woman presented with severe headaches, visual loss, and gradual enlargement of a cystic lesion on magnetic resonance imaging. The cyst compressed the chiasm upward. The cyst wall was partially thickened and contained a solid mass that was weakly enhanced after gadolinium administration. The endoscopic transsphenoidal cyst was drained, the solid tumor was partially removed for histological diagnosis, and the wide drainage orifice was secured. Intraoperatively, the cyst wall was widely open, but CSF leaked during manipulation of the solid tumor. The sellar floor was partially reconstructed by a multilayer technique to prevent postoperative CSF leakage. The wide cyst drainage route to the sphenoid sinus was also secured. Histologic diagnosis revealed SXG with ciliated columnar epithelium. No postoperative CSF leakage occurred, and the cyst continued to shrink. The patient's visual acuity improved, and pituitary function was preserved. If a CSF leak is identified intraoperatively in a case of secondary SXG associated with Rathke cleft cyst, a cystic fenestration with partial sellar reconstruction may reduce the likelihood of postoperative CSF leakage and ensure continuous drainage. Institutional Review Board approval was not required; The patient consented to the surgery and the publication of her images and surgical video.
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Here, we report an unusual case of ulnar neuropathy at the elbow caused by a giant epidermal cyst. A 76-year-old man was assessed on an outpatient basis for ulnar numbness of the left hand that had persisted for 6 months. A soft, elastic subcutaneous mass 6 cm in size was noted on his left elbow. He felt numbness on the ulnar aspect of the left fourth and fifth fingers, corresponding to the area innervated by the ulnar nerve, which worsened upon elbow flexion. An electrophysiological study revealed ulnar neuropathy at the elbow. To remove the subcutaneous mass at the left elbow and open up the ulnar tunnel, surgery was performed. There were no signs of nerve impingement or a neuroma on the ulnar nerve. The histological diagnosis was an epidermal cyst. On the day after surgery, numbness on the ulnar aspect of the left hand upon elbow flexion was markedly abated.
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In recent years, the interest in cell transplantation therapy using human dental pulp cells (DPCs) has been increasing. However, significant differences exist in the individual cellular characteristics of human DPC clones and in their therapeutic efficacy in rodent models of spinal cord injury (SCI); moreover, the cellular properties associated with their therapeutic efficacy for SCI remain unclear. Here, using DPC clones from seven different donors, we found that most of the clones were highly resistant to H2O2 cytotoxicity if, after transplantation, they significantly improved the locomotor function of rats with complete SCI. Therefore, we examined the effects of the basic fibroblast growth factor 2 (FGF2) and bardoxolone methyl (RTA402), which is a nuclear factor erythroid 2-related factor 2 (Nrf2) chemical activator, on the total antioxidant capacity (TAC) and the resistance to H2O2 cytotoxicity. FGF2 treatment enhanced the resistance of a subset of clones to H2O2 cytotoxicity. Regardless of FGF2 priming, RTA402 markedly enhanced the resistance of many DPC clones to H2O2 cytotoxicity, concomitant with the upregulation of heme oxygenase-1 (HO-1) and NAD(P)H-quinone dehydrogenase 1 (NQO1). With the exception of a subset of clones, the TAC was not increased by either FGF2 priming or RTA402 treatment alone, whereas it was significantly upregulated by both treatments in each clone, or among all seven DPC clones together. Thus, the TAC and resistance to H2O2 cytotoxicity were, to some extent, independently regulated and were strongly enhanced by both FGF2 priming and RTA402 treatment. Moreover, even a DPC clone that originally exhibited no therapeutic effect on SCI improved the locomotor function of mice with SCI after transplantation under both treatment regimens. Thus, combined with FGF2, RTA402 may increase the number of transplanted DPCs that migrate into and secrete neurotrophic factors at the lesion epicenter, where reactive oxygen species are produced at a high level.
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Antioxidantes , Pulpa Dental , Factor 2 de Crecimiento de Fibroblastos , Factor 2 Relacionado con NF-E2 , Traumatismos de la Médula Espinal , Pulpa Dental/metabolismo , Pulpa Dental/citología , Factor 2 de Crecimiento de Fibroblastos/farmacología , Factor 2 de Crecimiento de Fibroblastos/metabolismo , Factor 2 Relacionado con NF-E2/metabolismo , Animales , Humanos , Traumatismos de la Médula Espinal/terapia , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/tratamiento farmacológico , Ratas , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Peróxido de Hidrógeno , Masculino , Ratas Sprague-Dawley , Hemo-Oxigenasa 1/metabolismo , RatonesRESUMEN
Chronic inflammation of the pancreas is considered to be one of the causes of pancreatic cancer. However, the diagnosis of chronic pancreatitis (CP) is very difficult in the pancreas, where biopsies are difficult to perform. The prevalence of CP is estimated to be many times more common than in patients with actual symptomatic CP. In recent years, abnormal cleavage of certain proteins has attracted attention as a biomarker for CP other than pancreatic enzymes. Connective tissue growth factor (CTGF) is one of the growth factors involved in tissue repair and other processes and is increased by stimulation of transforming growth factor-ß, suggesting a relationship of CTGF with fibrosis. In this study, we measured the total length of CTGF in blood and N-terminal fragment CTGF in 48 cases of chronic pancreatitis, 64 cases of pancreatic cancer and 45 healthy volunteers (HV). Interestingly, we found that blood N-terminal fragment CTGF level was significantly increased in CP and pancreatic cancer patients. Multiple logistic regression analysis showed serum levels of N-terminal fragment CTGF, CRP and amylase were significant and independent variables for the differential diagnosis of CP from HV. Receiver operating characteristic analysis showed that area under the curve (AUC) value of serum N-terminal fragment CTGF level was 0.933, which can differentiate between CP and HV. Several factors would be involved in the increase in serum N-terminal fragment CTGF level. In conclusion, serum N-terminal fragment CTGF level is a promising new biomarker for CP.
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PURPOSE: Each institution or physician has to decide on an individual basis whether to continue or discontinue antiplatelet (AP) therapy before spinal surgery. The purpose of this study was to determine if perioperative AP continuation is safe during single-level microsurgical decompression (MSD) for treating lumbar spinal stenosis (LSS) and lumbar disc hernia (LDH) without selection bias. METHODS: Patients who underwent single-level MSD for LSS and LDH between April 2018 to December 2022 at our institute were included in this retrospective study. We collected data regarding baseline characteristics, medical history/comorbidities, epidural hematoma (EDH) volume, reoperation for EDH, differences between preoperative and one-day postoperative blood cell counts (ΔRBC), hemoglobin (ΔHGB), and hematocrits (ΔHCT), and perioperative thromboembolic complications. Patients were divided into two groups: the AP continuation group received AP treatment before surgery and the control group did not receive antiplatelet medication before surgery. Propensity scores for receiving AP agents were calculated, with one-to-one matching of estimated propensity scores to adjust for patient baseline characteristics and past histories. Reoperation for EDH, EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complications were compared between the groups. RESULTS: The 303 enrolled patients included 41 patients in the AP continuation group. After propensity score matching, the rate of reoperation for EDH, the EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complication rates were not significantly different between the groups. CONCLUSION: Perioperative AP continuation is safe for single-level lumbar MSD, even without biases.
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Descompresión Quirúrgica , Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Microcirugia , Inhibidores de Agregación Plaquetaria , Estenosis Espinal , Humanos , Femenino , Masculino , Estenosis Espinal/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Anciano , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Microcirugia/métodos , Microcirugia/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Sesgo de Selección , Herniorrafia/métodos , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Resultado del Tratamiento , Atención Perioperativa/métodosRESUMEN
Microvascular decompression (MVD) is a well-established and definitive treatment option for trigeminal neuralgia (TN).1 However, complex vascular geometry and numerous offending vessels make it difficult to perform nerve decompression in certain cases.2 The trigeminocerebellar artery (TCA) is a unique branch of the basilar artery. The vessel is named the TCA because it supplies both the trigeminal nerve root and the cerebellar hemisphere.3 This anatomical variant may increase the risk of neurovascular compression in the trigeminal nerve. We present the case of a 74-year-old man with left TN in whom a TCA was one of the responsible compression vessels. Preoperative images revealed the ipsilateral anterior inferior cerebellar artery, well-developed TCA, and superior cerebellar artery, wherein these branches were all suspected to be involved in trigeminal nerve compression. In MVD, 3 arteries were suspected to compress the trigeminal nerve in 5 sites, and all of them needed to be meticulously dissected from the nerve root and decompressed. Moreover, 2 of them branched many short perforators to the brainstem. Three decompression procedures (transposition to the dura, transposition to the brain, and interposition) were performed to decompress the trigeminal nerve. Postoperatively, TN was completely resolved immediately. MVD for TN could be difficult to perform in cases with TCA, as in the present case, and rigorous procedures were required intraoperatively.
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Cirugía para Descompresión Microvascular , Neuralgia del Trigémino , Humanos , Neuralgia del Trigémino/cirugía , Neuralgia del Trigémino/diagnóstico por imagen , Cirugía para Descompresión Microvascular/métodos , Masculino , Anciano , Cerebelo/irrigación sanguínea , Cerebelo/cirugía , Nervio Trigémino/cirugía , Arteria Basilar/cirugía , Arteria Basilar/diagnóstico por imagenRESUMEN
BACKGROUND: Patients with acute vertebral compression fractures (aVCFs) are frequently transferred to an emergency department by ambulance. The most useful imaging modality is magnetic resonance imaging (MRI); however, which patients should be prioritized for MRI evaluation may be unclear. The aim of this study was to evaluate plasma D-dimer levels as a biomarker for aVCFs. METHODS: This retrospective cohort study included patients with low back pain in the emergency department between November 2017 and October 2020. Patients with infections, patients with coagulation disorders, and patients without D-dimer level measurements were excluded. The presence of an aVCF was detected with MRI. Blood samples were collected for routine blood tests. The predictive factors for aVCFs were evaluated with univariate and multivariable logistic regression analyses. RESULTS: Overall, 191 consecutive MRI evaluations were ordered. After exclusions, 101 patients were reviewed. Based on MRI, 65 (64.4%) patients were diagnosed with aVCF. The presence of aVCF was significantly correlated with age (odds ratio [OR] = 1.052, 95% confidence interval [CI] 1.018-1.191), an old vertebral compression fracture (OR = 3.290, 95% CI 1.342-8.075), hemoglobin (OR = 0.699, 95% CI 0.535-0.912), and D-dimer levels (OR = 1.829, 95% CI 1.260-2.656). Results from a multivariable logistic regression analysis showed that D-dimer levels (OR = 1.642, 95% CI 1.188-2.228) remained a significant risk factor for the presence of aVCFs after adjustment for potential confounders. CONCLUSIONS: Plasma D-dimer levels can provide useful diagnostic information about whether an aVCF is present.
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Biomarcadores , Servicio de Urgencia en Hospital , Productos de Degradación de Fibrina-Fibrinógeno , Fracturas por Compresión , Dolor de la Región Lumbar , Imagen por Resonancia Magnética , Fracturas de la Columna Vertebral , Humanos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Femenino , Masculino , Fracturas por Compresión/sangre , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/complicaciones , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Fracturas de la Columna Vertebral/sangre , Fracturas de la Columna Vertebral/diagnóstico por imagen , Dolor de la Región Lumbar/sangre , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/diagnóstico , Biomarcadores/sangre , Anciano de 80 o más Años , Estudios de Cohortes , AdultoRESUMEN
Tarlov cysts (TCs) rarely cause clinical symptoms, such as leg pain, buttock pain, and bladder/bowel dysfunction. Surgery is considered when these symptoms persist despite medical treatments. Among several surgical procedures, microsurgical wrapping (MSW) is a relatively novel, simple technique with few complications, including cerebrospinal fluid leakage. Herein, we report a case of multiple TCs treated with MSW and present the mechanism of symptoms generated by TC and the procedure's limitations. A 58-year-old man complained of severe right leg and buttock pain for 3 months and was admitted to our hospital. His symptoms aggravated with sitting and standing and improved with the prone position. Spinal magnetic resonance imaging (MRI) demonstrated multiple sacral cysts containing intense cerebrospinal fluid. The cysts connect to the right S3 and S4 nerve roots. He was treated conservatively with medications; however, his symptoms were not improved. Therefore, MSW was performed for TCs connected to the S3 and S4 roots. The postoperative course was uneventful, and cerebrospinal fluid leakage did not occur. MRI performed 1 year after the operation demonstrated no recurrence of the TCs, and his leg pain was completely relieved; however, the buttock pain remained. MSW for TCs is effective for symptoms of adjacent nerve root compression; however, repairing the damaged nerve root in TCs is sometimes difficult. This may be a limitation of present surgical interventions because these symptoms may be difficult to treat even with other interventions.
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PURPOSE: Patients with lumbar spinal stenosis (LSS) require microsurgical decompression (MSD) surgery; however, MSD is often associated with postoperative instability at the operated level. Paraspinal muscles support the spinal column; lately, paraspinal volume has been used as a good indicator of sarcopenia. This study aimed to determine preoperative radiological factors, including paraspinal muscle volume, associated with postoperative slippage progression after MSD in LSS patients. METHODS: Patients undergoing single-level (L3/4 or L4/5) MSD for symptomatic LSS and followed-up for ≥ 5 years in our institute were reviewed retrospectively to measure preoperative imaging parameters focused on the operated level. Paraspinal muscle volumes (psoas muscle index [PMI] and multifidus muscle index [MFMI]) defined using the total cross-sectional area of each muscle/L3 vertebral body area in the preoperative lumbar axial CT) were calculated. Postoperative slippage in the form of static translation (ST) ≥ 2 mm was assessed on the last follow-up X-ray. RESULTS: We included 95 patients with average age and follow-up periods of 69 ± 8.2 years and 7.51 ± 2.58 years, respectively. PMI and MFMI were significantly correlated with age and significantly larger in male patients. Female sex, preoperative ST, dynamic translation, sagittal rotation angle, facet angle, pelvic incidence, lumbar lordosis, and PMI were correlated with long-term postoperative worsening of ST. However, as per multivariate analysis, no independent factor was associated with postoperative slippage progression. CONCLUSION: Lower preoperative psoas muscle volume in LSS patients is an important predictive factor of postoperative slippage progression at the operated level after MSD. The predictors for postoperative slippage progression are multifactorial; however, a well-structured postoperative exercise regimen involving psoas muscle strengthening may be beneficial in LSS patients after MSD.
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Región Lumbosacra , Músculos Paraespinales , Animales , Humanos , Femenino , Masculino , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/cirugía , Estudios Retrospectivos , Músculos , DescompresiónRESUMEN
We conduct a longitudinal study to examine how new VCF alter spinal sagittal balance. New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a VCF develops in the lower lumbar spine. A new fracture below L1 increased the relative risk of a deterioration of sagittal balance 2.9-fold compared to one above Th12. PURPOSE: Studies on the relationship between osteoporotic vertebral fractures and spinal sagittal balance have all been limited to cross-sectional studies. The aim of this study is to conduct a longitudinal study to examine how new vertebral compression fracture (VCF) alter spinal sagittal balance. METHODS: Subjects were patients undergoing periodic examinations after treatment of a vertebral fracture or lumbar spinal canal stenosis. Forty patients who developed a new VCF were included in this study. Full-spine standing radiographs were compared before and after the fracture to examine changes in spinopelvic parameters and factors determining the changes in sagittal balance. RESULTS: The mean age of the patients was 79.0 years. The mean interval between pre- and post-fracture radiographs was 22.7 months, and the mean time between development of a fracture and post-fracture radiographs was 4.6 months. After a fracture, sagittal vertical axis (SVA) increased an average of 2.78 cm and spino-sacral angle (SSA) decreased an average of 5.3°. Both â¿SVA and â¿SSA were not related to pre-fracture parameters. The wedge angle of the fractured vertebra was not related to changes in sagittal balance. â¿SVA increased markedly in patients with a fracture of the lower lumbar vertebrae. receiver operating characteristic analysis revealed that the relative risk of a deterioration of sagittal balance was 2.9 times higher for a new fracture below L1 than for a fracture above Th12. CONCLUSION: New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a new fracture develops in the lower lumbar spine. Early intervention in osteoporosis is vital for the elderly.
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Enfermedades Óseas Metabólicas , Fracturas por Compresión , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Humanos , Anciano , Fracturas por Compresión/complicaciones , Fracturas por Compresión/diagnóstico por imagen , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Estudios Longitudinales , Estudios Transversales , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/cirugía , Vértebras Lumbares/lesiones , Estudios RetrospectivosRESUMEN
In mode-division multiplexing (MDM) optical transmission systems and MDM networks, the gain must be kept nearly constant even when the input signal power of the few-mode (FM), erbium-doped fiber amplifier (EDFA) changes. This paper investigates controllability of the gain in a 4-LP mode EDFA, whose EDF has signal modes of L P 01, L P 11, L P 21, and L P 02 or L P 01, L P 11, L P 21, and L P 31, by using analytical and full models. The results of calculation using the analytical model and a gain simulation using the full model show that the gain can be kept almost constant with an error less than 0.25 dB simply by adjusting the L P 01 pump power of the EDFA with signal modes of L P 01, L P 11, L P 21, and L P 31. This result suggests that it is possible to control the gain simply by adjusting the pump power in FM-EDFAs where all signal modes have a radial mode number of one.
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INTRODUCTION: Splenectomy for proximal gastric cancer was found to offer no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). Although many studies have explored risk factors for morbidities following total gastrectomy, none have assessed the risk factors for postoperative complications in spleen-preserving total gastrectomy. METHODS: Using data from 505 patients enrolled in a previous randomized trial, risk factors for postoperative complications were identified by multivariable logistic regression analysis. Then, the risk factors were assessed separately between splenectomy and spleen-preserving total gastrectomy. RESULTS: Postoperative complications were identified in 119 patients (23.6%) and were more common following splenectomy than following spleen-preserving surgery (30.7% and 16.1%, respectively, p < 0.01). Multivariable analysis revealed that age ≥65 years (p = 0.032), body mass index ≥25 (p = 0.003), and blood loss ≥350 (p = 0.019) were independent risk factors for postoperative complications in the entire cohort. Among them, only body mass index was a significant independent risk factor for complications in both spleen preservation (p = 0.047) and splenectomy groups (p = 0.017). CONCLUSION: Risk factors for postoperative complications were essentially the same between splenectomy and spleen preservation. Being overweight increased the risk of postoperative complications.
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Esplenectomía , Neoplasias Gástricas , Humanos , Anciano , Esplenectomía/efectos adversos , Bazo/cirugía , Neoplasias Gástricas/cirugía , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Escisión del Ganglio Linfático , Factores de Riesgo , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVE: The generation of three-dimensional (3D) medical images has great application potential since it takes into account the 3D anatomical structure. Two problems prevent effective training of a 3D medical generative model: (1) 3D medical images are expensive to acquire and annotate, resulting in an insufficient number of training images, and (2) a large number of parameters are involved in 3D convolution. METHODS: We propose a novel GAN model called 3D Split&Shuffle-GAN. To address the 3D data scarcity issue, we first pre-train a two-dimensional (2D) GAN model using abundant image slices and inflate the 2D convolution weights to improve the initialization of the 3D GAN. Novel 3D network architectures are proposed for both the generator and discriminator of the GAN model to significantly reduce the number of parameters while maintaining the quality of image generation. Several weight inflation strategies and parameter-efficient 3D architectures are investigated. RESULTS: Experiments on both heart (Stanford AIMI Coronary Calcium) and brain (Alzheimer's Disease Neuroimaging Initiative) datasets show that our method leads to improved 3D image generation quality (14.7 improvements on Frchet inception distance) with significantly fewer parameters (only 48.5% of the baseline method). CONCLUSIONS: We built a parameter-efficient 3D medical image generation model. Due to the efficiency and effectiveness, it has the potential to generate high-quality 3D brain and heart images for real use cases.
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Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Encéfalo/diagnóstico por imagen , NeuroimagenRESUMEN
OBJECTIVE: The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS). METHODS: Fifty-two patients who underwent microsurgical decompression for symptomatic single level L4/5 spinal canal stenosis at our hospital were included in the study. All patients had standing full spine radiographs taken preoperatively, 1 year postoperatively, and 5 years postoperatively. Spinal parameters including sagittal balance were measured from the obtained images. First, preoperative parameters were compared with 50 age-matched asymptomatic volunteers. Next, the parameters before and after surgery were compared to examine long-term changes. RESULTS: Sagittal vertical axis (SVA) was significantly increased in the LCS cases compared to the volunteers (P = 0.03). Postoperative lumbar lordosis (LL) was significantly increased (P = 0.03). Postoperative mean SVA decreased but the difference was not significant (P = 0.12). Although there was no correlation between preoperative parameters and the Japanese Orthopedic Association score, postoperative pelvic incidence (PI)-LL and pelvic tilt changes correlated with changes in Japanese Orthopedic Association score (PI-LL; P = 0.0001, pelvic tilt; P = 0.04). However, after 5 years of surgery, LL decreased and PI-LL increased (LL; P = 0.08, PI-LL; P = 0.03). Sagittal balance began to deteriorate but was not significant (P = 0.31). At 5 years postoperatively, 18 of 52 patients (34.6%) were found to have L3/4 adjacent segment disease. Cases with adjacent segment disease showed significantly worse SVA and PI-LL (SVA; P = 0.01, PI-LL; P < 0.01). CONCLUSIONS: In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases.
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Lordosis , Estenosis Espinal , Humanos , Anciano , Estudios de Seguimiento , Constricción Patológica , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/cirugía , Lordosis/diagnóstico por imagen , Lordosis/cirugía , Descompresión , Canal MedularRESUMEN
Few-shot image classification aims at exploring transferable features from base classes to recognize images of the unseen novel classes with only a few labeled images. Existing methods usually compare the support features and query features, which are implemented by either matching the global feature vectors or matching the local feature maps at the same position. However, few labeled images fail to capture all the diverse context and intraclass variations, leading to mismatch issues for existing methods. On one hand, due to the misaligned position and cluttered background, existing methods suffer from the object mismatch issue. On the other hand, due to the scale inconsistency between images, existing methods suffer from the scale mismatch issue. In this article, we propose the bilaterally normalized scale-consistent Sinkhorn distance (BSSD) to solve these issues. First, instead of same-position matching, we use the Sinkhorn distance to find an optimal matching between images, mitigating the object mismatch caused by misaligned position. Meanwhile, we propose the intraimage and interimage attentions as the bilateral normalization on the Sinkhorn distance to suppress the object mismatch caused by background clutter. Second, local feature maps are enhanced with the multiscale pooling strategy, making the Sinkhorn distance possible to find a consistent matching scale between images. Experimental results show the effectiveness of the proposed approach, and we achieve the state-of-the-art on three few-shot benchmarks.
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BACKGROUND: Solid-papillary carcinoma (SPC) of the breast is a rare variant of low-grade in situ and invasive carcinoma but there are only a few of the cytologic studies. METHODS: We examined 44 cases of SPC of the breast to define the cytologic features. We also made a systemic review of reported cases of SPC and neuroendocrine tumor (NET) of the breast. RESULTS: Both of our and the reviewed cases with SPC were very similar in the cytologic finding. It included hypercellularity, highly discohesive clusters, numerous isolated cells, small nuclei, finely granular chromatin of salt-and-pepper appearance, inconspicuous nucleoli, low nuclear-cytoplasmic ratio, and a plasmacytoid appearance. Moreover, SPC and NET had frequently all of these features in common. Capillary vessels structures and mucinous substance were not frequently seen in our and the reviewed cases with SPC. Rosette and pseudorosette were very rare in the cytologic specimen. The immunocytochemistry with our 9 cases with SPC indicated diffuse positivity for chromogranin A and/or synaptophysin. CONCLUSION: Many cytologic features are frequently shared by SPC and NET of the breast. However, the vascular structure may not be a precise criterion for SPC. Rosette and pseudorosette are rarely helpful for the cytologic diagnosis.
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Neoplasias de la Mama , Carcinoma Ductal de Mama , Carcinoma Neuroendocrino , Carcinoma Papilar , Tumores Neuroendocrinos , Femenino , Humanos , Mama/patología , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Neuroendocrino/patología , Carcinoma Papilar/patología , Tumores Neuroendocrinos/patologíaRESUMEN
We present a network-based protocol to discover susceptibility genes in case-control genome-wide association studies (GWASs). In short, this protocol looks for biomarkers that are informative of disease status and interconnected in an underlying biological network. This boosts discovery and interpretability. Moreover, the protocol tackles the instability of network methods, producing a stable set of genes most likely to replicate in external cohorts. To apply the procedure to a provided GWAS dataset, install the required software and execute our command-line tool. For complete details on the use and execution of this protocol, please refer to Climente-González et al.1.
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Estudio de Asociación del Genoma Completo , Programas Informáticos , Estudio de Asociación del Genoma Completo/métodosRESUMEN
The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the diversity of patient backgrounds. The purpose of this study was to compare the impact of 3 treatment modalities for the management of OVF: orthotic treatment, percutaneous vertebroplasty (PVP), and balloon kyphoplasty (BKP). The method was based on an analysis of the latest RCTs, meta-analyses, and systematic reviews on these topics. No study showed a benefit of bracing with high level of evidence. Trials were found that showed comparable outcomes without orthotic treatment. Only 1 randomized controlled trial (RCT) showed an improvement in pain relief up to 6 months compared with no orthosis. Rigid and nonrigid orthoses were equally effective. Four of 5 RCTs comparing vertebroplasty and sham surgery were equally effective, and one RCT showed superior pain relief with vertebroplasty within 3 weeks of onset. In open trials comparing vertebroplasty with nonoperative management, vertebroplasty was superior. PVP and BKP were comparable in terms of pain relief, improvement in quality of life, and adjacent vertebral fractures. BKP does not affect global sagittal alignment, although BKP may restore vertebral body height. An RCT was published showing that PVP was effective in chronic cases without pain relief. Vertebroplasty improved life expectancy by 22% at 10 years. The superiority of orthotic therapy for OVF was seen only in short-term pain relief. Soft orthoses proved to be a viable alternative to rigid orthoses. Vertebroplasty within 3 weeks may be useful. There is no significant difference in clinical efficacy between PVP and BKP. Vertebroplasty improves life expectancy.
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OBJECTIVE: Whether the use of a balloon or stent in vertebroplasty for vertebral fractures, such as balloon kyphoplasty (BKP) or vertebral body stenting (VBS), actually contributes to the restoration of postoperative vertebral height is unclear. The aim of the current study was to compare the effectiveness of percutaneous vertebroplasty (PVP), BKP, and VBS in the correction of collapsed vertebrae in patients with painful vertebral fractures. METHODS: The cases studied involved 34 vertebrae in 28 patients treated with PVP, 43 vertebrae in 38 patients treated with BKP, and 20 vertebrae in 20 patients treated with VBS at Izinkai Takeda General Hospital. Changes in the vertebral height and local kyphosis angle were measured based on standing lumbar radiographs before and after surgery and were compared among the treatment groups. RESULTS: There were no differences in changes in the height of the anterior wall, middle body, or posterior wall of the treated vertebrae among the 3 treatment groups. The same was true for changes in the local kyphosis angle. The effectiveness of vertebral height restoration depended heavily upon preoperative vertebral instability in all the treatment groups. Correction loss due to balloon deflation effect or balloon sinking was noted with VBS or BKP. CONCLUSION: BKP and VBS have the advantage of reducing the risk of extravertebral leakage of injected bone cement, but they have a disadvantage in that they are no more effective than PVP in restoring collapsed vertebrae despite the use of a balloon or metal stent.
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Golf is one of the most popular sports among seniors. Here, we report the case of a 76-year-old woman who developed a vertebral fracture while playing golf. The patient had been suffering from leg pain for several years but developed sudden back pain after her golf swing. Because magnetic resonance imaging demonstrated a new vertebral fracture of the L1 vertebral body and canal stenosis at the L4/5 level, she successfully underwent L1 vertebroplasty and L4/5 decompression. For older golfers, a classical swing that twists the pelvis and shoulders at the same time may be recommended.