Methodological insights into ChatGPT's screening performance in systematic reviews.

BACKGROUND: The screening process for systematic reviews and meta-analyses in medical research is a labor-intensive and time-consuming task. While machine learning and deep learning have been applied to facilitate this process, these methods often require training data and user annotation. This study aims to assess the efficacy of ChatGPT, a large language model based on the Generative Pretrained Transformers (GPT) architecture, in automating the screening process for systematic reviews in radiology without the need for training data. METHODS: A prospective simulation study was conducted between May 2nd and 24th, 2023, comparing ChatGPT's performance in screening abstracts against that of general physicians (GPs). A total of 1198 abstracts across three subfields of radiology were evaluated. Metrics such as sensitivity, specificity, positive and negative predictive values (PPV and NPV), workload saving, and others were employed. Statistical analyses included the Kappa coefficient for inter-rater agreement, ROC curve plotting, AUC calculation, and bootstrapping for p-values and confidence intervals. RESULTS: ChatGPT completed the screening process within an hour, while GPs took an average of 7-10 days. The AI model achieved a sensitivity of 95% and an NPV of 99%, slightly outperforming the GPs' sensitive consensus (i.e., including records if at least one person includes them). It also exhibited remarkably low false negative counts and high workload savings, ranging from 40 to 83%. However, ChatGPT had lower specificity and PPV compared to human raters. The average Kappa agreement between ChatGPT and other raters was 0.27. CONCLUSIONS: ChatGPT shows promise in automating the article screening phase of systematic reviews, achieving high sensitivity and workload savings. While not entirely replacing human expertise, it could serve as an efficient first-line screening tool, particularly in reducing the burden on human resources. Further studies are needed to fine-tune its capabilities and validate its utility across different medical subfields.

Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications.

PURPOSE: This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS: A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS: This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION: This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.

Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years.

Introduction: This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. Materials and Methods: In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Results: Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). Conclusion: The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.

Outcome after Neuro-interventional Treatment of Intracranial Aneurysm (as a First Treatment Modality).

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P<0.001). Similar to previous studies, the present study demonstrates that neurovascular intervention can treat ruptured aneurysms as the first therapeutic modality with favourable outcomes. A double-blind, randomized clinical trial is needed to eliminate the confounding factors and better demonstrate the outcome.

Bilateral inferior petrosal sinus sampling: validity, diagnostic accuracy in lateralization of pituitary microadenoma, and treatment in eleven patients with Cushing's syndrome - a single-center retrospective cohort study.

BACKGROUND: This single-center retrospective cohort study aimed to describe the findings and validity of Bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of patients with ACTH-dependent Cushing's syndrome (CS). METHODS: Eleven patients underwent BIPSS due to equivocal biochemical tests and imaging results. Blood samples were taken from the right inferior petrosal sinus (IPS), left IPS, and a peripheral vein before and after stimulation with desmopressin (DDAVP). ACTH and prolactin levels were measured. The diagnosis was based on the ACTH ratio between the IPS and the peripheral vein. Also, lateralization of pituitary adenoma in patients with Cushing's disease (CD) was predicted. No significant complications were observed with BIPSS. RESULTS: Based on the pathology report, eight patients had CD, and three had ectopic ACTH syndrome (EAS). Unstimulated BIPSS resulted in a sensitivity of 87.5%, specificity of 100%, PPV of 100%, NPV of 75%, and accuracy of 91%. Stimulated BIPSS resulted in a sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and accuracy of 100%. However, pituitary magnetic resonance imaging (MRI) had a lower diagnostic accuracy (sensitivity:62.5%, specificity:33%, PPV:71%, NPV:25%, accuracy:54%). BIPSS accurately demonstrated pituitary adenoma lateralization in 75% of patients with CD. CONCLUSIONS: This study suggests that BIPSS may be a reliable and low-complication technique in evaluating patients with ACTH-dependent CS who had inconclusive imaging and biochemical test results. The diagnostic accuracy is improved by DDAVP stimulation. Pituitary adenoma lateralization can be predicted with the aid of BIPSS.

Treatment of a calcaneal unicameral bone cyst by percutaneous CT-guided cement injection using a double-needle technique: A case report.

Simple bone cysts (SBCs) are benign cavitary lesions that most commonly affect adolescent males in the first 2 decades of life. They are mainly asymptomatic but can manifest with pain or pathological fractures. Despite numerous proposed methods for managing calcaneal SBCs, the optimal approach toward these lesions remains controversial. Herein, we report a case of a 16-year-old girl with a calcaneal SBC. On local examination, tenderness was the only noteworthy sign. In an outpatient setting, under conscious sedation, 2 interosseous needles were simultaneously inserted into the cyst under the guidance of CT fluoroscopy. Without aspiration, a radiopaque bone cement mixture was injected into the cyst from 1 needle until serosanguineous fluid efflux from the second needle ceased. Over a 2-year follow-up period, the patient recovered without any complications. This novel technique has the potential to be used as a feasible and minimally invasive approach in the management of symptomatic unicameral calcaneal bone cysts.

Outcomes of the Fluoroscopically-Guided vs. Computed-Tomography-Guided Transforaminal Epidural Steroid Injection in Low Back Pain: A Propensity-matched Prospective Cohort.

Background: Low back pain (LBP), the most common musculoskeletal condition, imposes a significant burden on healthcare and triggers mental and physical disorders. Before surgery, patients are eligible for minimally-invasive treatments, including transforaminal epidural steroid injection (TFESI). We aimed to compare fluoroscopically- and CT-guided TFESI in patients with subacute (4-12 weeks) and chronic (≥12 weeks) LBP. Methods: In this prospective cohort study, 121 adults with subacute or chronic LBP were recruited. Using propensity score matching (PSM), we created two age, sex, and body mass index (BMI) matched groups of fluoroscopically- and CT-guided TFESI, each including 38 patients. The outcomes of interest were the Oswestry disability index (ODI) and numerical rating scale (NRS), which were measured in all patients before the procedure and at the three-month follow-up. Then, the ODI and NRS mean changes were compared between Fluoroscopy and CT groups using repeated measures ANOVA. All analyses were performed with IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY, USA). Results: Of the total 76 matched patients with a mean (SD) age of 66.22 (13.49), 81 (66.9%) were female. ODI and NRS scores significantly decreased from baseline to the three-month follow-up in both treatment groups. The ODI score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): 1.092 (-0.333-2.518), P = 0.131). Similarly, the NRS score mean change from baseline to follow-up compared between the two groups was insignificant (fluoroscopy vs. CT mean difference (95% CI): -0.132 (-0.529-0.265), P = 0.511). Conclusion: Fluoroscopically- and CT-guided TFESI show similar therapeutic effectiveness in patients with subacute and chronic LBP.

Pregnancy Rate and Outcomes following Uterine Artery Embolization for Uterine Arteriovenous Malformations: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically review published studies on the pregnancy rate and outcomes after uterine artery embolization (UAE) for uterine arteriovenous malformations (UAVMs). MATERIALS AND METHODS: International medical databases were searched for all English-language studies published between 2000 and 2022 on patients with UAVMs who had undergone embolization and had a subsequent pregnancy. Data on the pregnancy rate, pregnancy complications, and physiologic status of newborns were extracted from the articles. Ten case series were included in the meta-analysis, and 18 case reports on pregnancy following UAE were reviewed. RESULTS: In the case series, 44 pregnancies were reported in 189 patients. The pooled estimate of pregnancy rate was 23.3% (95% confidence interval [CI], 17.3%-29.3%). The pregnancy rate was higher in studies of women with a mean age of ≤30 years (50.6% vs 22.2%; P < .05). The pooled estimate of live birth rate was 88.6% (95% CI, 78.6%-98.7%). CONCLUSIONS: All published series report preservation of fertility and successful pregnancies after embolization of UAVMs. The live birth rate in these series does not differ substantially from that of the general population.

Can Preoperative Diffusion Tensor Imaging Tractography Predict the Visual Outcomes of Patients with Pituitary Macroadenomas? A Prospective Pilot Study.

OBJECTIVE: Visual impairment has been reported as the most common clinical manifestation of pituitary adenoma (PA) due to the compressive effect of the tumor. This prospective study aimed to evaluate the predictive role of diffusion tensor imaging (DTI) in the visual improvement of patients with PA, who were candidates for endoscopic endonasal surgery. METHODS: A total of 13 patients (male, 8; female, 5) with visual impairment due to pituitary macroadenoma were enrolled in this study. The DTI findings and visual parameters, including visual acuity (VA), visual field (VF), and visual evoked potential (VEP), were recorded for all participants before and 3 months after surgery. RESULTS: Significant recovery was reported in both VA and VF following PA surgery (P < 0.001). The results of perimetry indicated recovery in all quadrants, except for the lower nasal quadrant of the right eye. The tumor volume showed no significant association with the preoperative optic nerve, optic tract, and chiasm fractional anisotropy (FA) or mean diffusivity (MD). The VA and VF recoveries were more likely in patients with a lower preoperative optic nerve MD. Besides, increased preoperative FA of the optic nerve was associated with a higher probability of VA recovery. No significant correlation was found between the optic tract MD and FA values and visual improvement. Overall, MD values below 0.0021 and FA values above 0.1689 could predict a good prognosis of VA recovery after surgery. CONCLUSIONS: DTI may have a predictive value in estimating visual improvement in patients with PA preoperatively.

Computed Tomography Fluoroscopy-Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma.

PURPOSE: To determine the safety and efficacy of computed tomography (CT) fluoroscopy-guided percutaneous transhepatic sclerotherapy with a bleomycin/ethiodized oil emulsion for symptomatic giant hepatic hemangiomas. MATERIALS AND METHODS: The procedure was performed on 22 patients with symptomatic giant hepatic hemangiomas in an outpatient setting between 2018 and 2020. All patients were followed clinically and underwent contrast-enhanced magnetic resonance imaging after 1 month and again at a mean time of 15 months ± 2. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0), in which a severe adverse event was defined as an adverse event with a grade of ≥3. The desired radiologic response (volume and index size) and improvement of pain intensity (visual analog scale [VAS]) and other symptoms were recorded as outcomes. RESULTS: Overall, patients showed a 36.4% ± 8.6 reduction in volume and a 14% ± 1.6 reduction in index size after 1 month, with P values of .002 and .001, respectively. The final follow-up volume and index size were 194.7 cm3 ± 25.8 and 77 mm ± 36, respectively. Moreover, a 53.0% ± 7 reduction in volume and 22% ± 3.7 reduction in index size during the final imaging were reported, with the P values of .001 and .001, respectively. Significant reductions in the mean pain intensity (90% of patients with lower VAS scores after intervention) and symptoms were reported. Four patients were classified as clinically unsuccessful, and were recommended further procedures for residual pain. CONCLUSIONS: CT fluoroscopy-guided transhepatic sclerotherapy is an effective, safe, and minimally invasive method to manage giant hepatic hemangiomas in an outpatient setting.

Fertility Outcomes After Uterine Artery Embolization for Symptomatic Uterine Arteriovenous Malformations: A Single-Center Retrospective Study in 33 Women.

PURPOSE: To describe the clinical and fertility outcomes after uterine artery embolization (UAE) for symptomatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: This single-center retrospective study included 33 patients with uterine AVMs who underwent UAE at our institution between May 2013 and May 2021. The inclusion criteria were diagnostic features of uterine AVM as detection of the nidus and early venous drainage on angiography. The exclusion criteria were high levels of beta-human chorionic gonadotropin indicative of gestational trophoblastic neoplasia. Polyvinyl alcohol (PVA) with a diameter of 500-700 µm (with or without Gelfoam/Glue) was used in 32 procedures and, Glue (with lipiodol) was used in one. The patients were followed up for 31 months (range, 6-90 months). Angiograms, medical records, and phone interviews were used to describe the technical and clinical success, complications, and pregnancy outcomes. RESULTS: Thirty-three patients with a mean age of 31.2 ± 5.4 years (range, 21-42 years) were included in this case series. Technical success was reported in all patients (100%). Bleeding control was also achieved in 32 (96%) patients. Pelvic and puncture site pain and groin hematoma were reported as minor complications (grade 1 according to CIRSE classification). Six pregnancies (33%) occurred after uterine artery embolization. Four women had full-term pregnancies without complications and delivered healthy newborns. Another two women were in the second trimester of pregnancy with a favorable fetal condition. No post-embolization miscarriage was reported. CONCLUSION: The UAE is safe and effective in controlling vaginal bleeding caused by uterine AVMs, allowing successful future pregnancies.

A review of applying transarterial chemoembolization (TACE) method for management of hepatocellular carcinoma.

Liver cancer is one of the most ordinary reasons for death among cancers. Hepatocellular carcinoma (HCC) is the most common type of liver cancer. In spite of the fact that various remedial methods have been approved particularly the survival effects of the transcatheter arterial chemoembolization (TACE) method have been accomplished widely in the HCC treatment. By applying the TACE method correctly, good survival outcomes can be achieved without harmfully affecting the hepatic functions. Transarterial chemoembolization mixes the effect of avascular necrosis (AVN) with the effect of regional chemotherapy those are under the influence of arterial embolization. By knowing the fact that the metastases of liver cancer and also perfusion indices in hepatocellular carcinoma (HCC) are via hepatic arteries, doctors chose the TACE method for the treatment of liver cancer. On the other hand, in this method, the radiologists can easily convey antitumor remedies via the arteries. Anyway, medium-level HCC is a sensitive stage of the heterogeneous disease that many patients suffer from, so specialists must consider it as a hazardous syndrome. The TACE procedure could be applied just in cases that the liver function of patients is appropriate yet, the patient liver portal vein do not have any problems and the patients do not have ascites disorder. This review is aimed to figure out the evident advantages of TACE especially by a comprehensive view on the medium level HCC. Because of that this treatment method is suggested as a first-line remedy. At last, the future landscape of the initial factors of research in managing HCC disorders have been summarized.

The Effect of Contrast Enhanced Abdominopelvic Magnetic Resonance Imaging on Expression and Methylation Level of ATM and AKT Genes.

OBJECTIVE: To evaluate the effect of contrast enhanced abdominopelvic magnetic resonance imaging (MRI), using a 3 Tesla scanner, on expression and methylation level of ATM and AKT genes in human peripheral blood lymphocytes. MATERIALS AND METHODS: In this prospective in vivo study, blood samples were obtained from 20 volunteer patients with mean age of 43 ± 8 years (range 32-68 years) before contrast enhanced MRI, 2 hours and 24 hours after contrast enhanced abdominopelvic 3 Tesla MRI. After separation of mononuclear cells from peripheral blood, using Ficoll-Hypaque, we analyzed gene expression changes of ATM and AKT genes 2 hours and 24 hours after MRI using quantitative reverse transcription polymerase chain reaction (qRT-PCR). We also evaluated methylation percentage of the above mentioned genes in before, 2 hours and 24 hours after MRI, using MethySYBR method. RESULTS: Fold change analysis, in comparison with the baseline, respectively showed 1.1 ± 0.7 and 0.8 ± 0.5 mean of gene expressions in 2 and 24 hours after MRI for ATM, while the results were 1.4 ± 0.6 and 1.4 ± 1 for AKT (P>0.05). Methylation of the ATM gene promoter were 8.8 ± 1.5%, 9 ± 0.6% and 9 ± 0.8% in before contrast enhanced MRI, 2 and 24 hours after contrast enhanced MRI, respectively (P>0.05). Methylation of AKT gene promoter in before contrast enhanced MRI, 2 hours and 24 hours after contrast enhanced MRI was 5.4 ± 2.5, 5 ± 3.2, 4.9 ± 2.9 respectively (P>0.05). CONCLUSION: Contrast enhanced abdominopelvic MRI using 3 Tesla scanner apparently has no negative effect on the expression and promoter methylation level of ATM and AKT genes involved in the repair pathways of genome.

Multi-organ infarction following percutaneous transhepatic esophageal variceal obliteration with glue injection: a case report.

Percutaneous transhepatic variceal obliteration (PTVO) is currently one of the best treatment options for controlling acute recurrent bleeding in cirrhotic patients. Nevertheless, this procedure is associated with major and minor complications such as fever, pain, fatal intraperitoneal hemorrhage, and rarely, embolization of embolic agents to the systemic circulation. Only one study has reported systemic emboli following the use of glue-lipiodal mixture for percutaneous transhepatic embolization of esophageal varices and here we report another case of this complication. Here, we report a 44-year-old man presenting with multi-organ infarction following PTVO with glue-Lipiodol mixture. He was a known case of liver cirrhosis who was admitted for recurrent bleeding from esophageal varices. The patient became a candidate for transjugular intrahepatic portosystemic shunt surgery; however, he did not provide consent for this procedure. the patient eventually decided to undergo PTVO as an alternative option. Twelve hours after the procedure, the patient developed neurological symptoms such as left side weakness, dysarthria, and fecal incontinence. Further investigation showed glue particles in brain, liver, spleen and both lungs. Contrast echocardiography and splenoportography did not show any evidence of right-to-left shunt. Thus, conservative management was initiated for the patient, which resulted in the gradual improvement after three weeks. Prior evaluation with splenoportography and contrast echocardiography before performing PTVO may help in the early detection of any connection with systemic circulation. Also, based on the desired procedure, the most appropriate glue/Lipiodol ratio and injection technique should be selected to minimize the risk of adverse events.

The Effects of Human Reoviruses on Cancer Cells Derived from Hepatocellular Carcinoma Biopsies.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of liver cancer around the world. Since this cancer is highly resistant to the existing treatments, we used a novel method, which selectively targets HCC cancer cells to improve the treatment process. As normal cells are resistant to reovirus replication, we used oncolytic reoviruses, which can infect, replicate in, and destroy cancer cells. In this study, the effects of oncolytic human reoviruses on cancer cells, derived from HCC biopsies, were investigated. METHODS: First, reoviruses were purified. Then a plaque assay was performed to estimate the number of viruses and determine the multiplicity of infection (MOI). To evaluate the effects of reoviruses on cancer cells derived from HCC biopsies, replication of reovirus RNA, viral protein production, cytopathic effects (CPE), and cancer cell viability were assessed at different intervals post-infection. RESULTS: Replication of reovirus RNA and viral protein production were detected in cancer cells. Also, different levels of viral protein production, CPE, cytotoxicity, and cancer cell viability were observed at different intervals post-infection with human reoviruses. In contrast, normal human fibroblasts, which were used as negative control, remained unchanged. CONCLUSIONS: For the first time, the effects of human reoviruses on HCC biopsies were investigated. The results showed that human reoviruses could replicate in and destroy cancer cells derived from HCC biopsies. Overall, human reoviruses can be potentially used for the treatment of HCC.

Interpretation of Hematological, Biochemical, and Immunological Findings of COVID-19 Disease: Biomarkers Associated with Severity and Mortality.

The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) spread rapidly all over the world in late 2019 and caused critical illness and death in some infected patients. This study aimed at examining several laboratory factors, especially inflammatory and immunological mediators, to identify severity and mortality associated biomarkers. Ninety-three hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) were classified based on disease severity. The levels of biochemical, hematological, immunological, and inflammatory mediators were assessed, and their association with severity and mortality were evaluated. Hospitalized patients were mostly men (77.4%) with an average (standard deviation) age of 59.14 (14.81) years. The mortality rate was significantly higher in critical patients (85.7%). Increased serum levels of blood sugar, urea, creatinine, uric acid, phosphorus, total bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, C-reactive protein, ferritin, and procalcitonin were significantly prevalent (p=0.002, p<0.001, p<0.001, p=0.014, p=0.047, p=0.003, p<0.001, p<0.001, p<0.001, p<0.001, P<0.001, and p<0.001, respectively) in COVID-19 patients. Decreased red blood cell, hemoglobin, and hematocrit were significantly prevalent among COVID-19 patients than healthy control subjects (p<0.001 for all). Troponin-I, interleukin-6, neutrophil/lymphocyte ratio (NLR), procalcitonin, and D-dimer showed a significant association with the mortality of patients with specificity and sensitivity more than 60%. Age, sex, underlying diseases, blood oxygen pressure, complete blood count along with C-reactive protein, lactic dehydrogenase, procalcitonin, D-dimer, and interleukin-6 evaluation help to predict the severity and required management for COVID-19 patients. Further investigations are highly recommended in a larger cohort study for validation of the present findings.

Clinical and chest CT features as a predictive tool for COVID-19 clinical progress: introducing a novel semi-quantitative scoring system.

OBJECTIVE: Proposing a scoring tool to predict COVID-19 patients' outcomes based on initially assessed clinical and CT features. METHODS: All patients, who were referred to a tertiary-university hospital respiratory triage (March 27-April 26, 2020), were highly clinically suggestive for COVID-19 and had undergone a chest CT scan were included. Those with positive rRT-PCR or highly clinically suspicious patients with typical chest CT scan pulmonary manifestations were considered confirmed COVID-19 for additional analyses. Patients, based on outcome, were categorized into outpatient, ordinary-ward admitted, intensive care unit (ICU) admitted, and deceased; their demographic, clinical, and chest CT scan parameters were compared. The pulmonary chest CT scan features were scaled with a novel semi-quantitative scoring system to assess pulmonary involvement (PI). RESULTS: Chest CT scans of 739 patients (mean age = 49.2 ± 17.2 years old, 56.7% male) were reviewed; 491 (66.4%), 176 (23.8%), and 72 (9.7%) cases were managed outpatient, in an ordinary ward, and ICU, respectively. A total of 439 (59.6%) patients were confirmed COVID-19 cases; their most prevalent chest CT scan features were ground-glass opacity (GGO) (93.3%), pleural-based peripheral distribution (60.3%), and multi-lobar (79.7%), bilateral (76.6%), and lower lobes (RLL and/or LLL) (89.1%) involvement. Patients with lower SpO2, advanced age, RR, total PI score or PI density score, and diffuse distribution or involvement of multi-lobar, bilateral, or lower lobes were more likely to be ICU admitted/expired. After adjusting for confounders, predictive models found cutoffs of age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 (15) for ICU admission (death). A combination of all three factors showed 89.1% and 95% specificity and 81.9% and 91.4% accuracy for ICU admission and death outcomes, respectively. Solely evaluated high PI score had high sensitivity, specificity, and NPV in predicting the outcome as well. CONCLUSION: We strongly recommend patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score to be considered as high-risk patients for further managements and care plans. KEY POINTS: • Chest CT scan is a valuable tool in prioritizing the patients in hospital triage. • A more accurate and novel 35-scale semi-quantitative scoring system was designed to predict the COVID-19 patients' outcome. • Patients with age ≥ 53, SpO2 ≤ 91, and PI score ≥ 8 or even only high PI score should be considered high-risk patients.

Five-Year Experience in Treatment of Retinoblastoma with Intra-Arterial Chemotherapy: A Single-Center Analysis.

PURPOSE: To report our 5-year experience in treating retinoblastoma (RB) with intra-arterial chemotherapy (IAC) as a primary or secondary therapy, without adjuvant intravitreal chemotherapy. METHODS: A retrospective study was conducted on 70 eyes with intraocular RB that were treated with primary or secondary IAC from December 2010-2015. Demographic characteristics, clinical features, tumor control, and treatment complications were compared and reported. RESULTS: Thirty-seven eyes had received IAC as a secondary therapy after failed/incomplete response to systemic chemotherapy, and 33 eyes had received IAC as a primary treatment. The mean age of patients was 25 ± 8.9 months, and the patients were followed for a mean of 24.5 ± 16.26 months. Overall, enucleation rates were significantly higher in advanced tumors (Group D and E) in both groups (both P < 0.05). The main reason for enucleation in this study group was being unresponsive to treatment (27.4%), with 76% of latter patients having vitreous seeds at the time of enucleation. Enucleation rates did not differ significantly between patients receiving primary (18/33, 54%) or secondary IAC (18/37, 48%) (P = 0.06). In addition, recurrence and complication rates did not differ significantly between eyes receiving IAC as their primary or secondary treatment (P > 0.05). CONCLUSION: In primary and secondary treatment of RB with IAC, the main findings that are globe salvage, recurrence, and complication rates were comparable when no adjuvant intravitreal chemotherapy was used.

Pregnancy and its Outcomes in Patients After Uterine Fibroid Embolization: A Systematic Review and Meta-Analysis.

Uterine artery embolization (UAE) has been introduced for uterine fibroid treatment for two decades. Most of the patients are in reproductive age and many want future pregnancy. In this study, we will assess fertility, pregnancy and its outcomes in patients who have undergone UAE. In this systematic review, a systematic search was performed on important databases including PubMed and Medline, Web of Knowledge, Google Scholar, EMBASE and Scopus. Studies reported enough data about pregnancy after UAE were considered to be enrolled in the review. We assessed obstetric indices (pregnancy and delivery rates, pregnancy losses, complications and fetal outcomes). Study evaluation was done based on STROBE checklist by two reviewers. Totally, 24 original papers were included. Data were analyzed by Stata and MedCalc softwares. Among women wishing fertility, totally 40.5% experienced at least one pregnancy after UAE (95% confidence interval [CI]: 33.3%-48.2%). Pooled estimate of pregnancy loss rate was 33.5% (95% CI: 26.3-41%). Most pregnancy losses were due to spontaneous abortion (81.3% of all losses (95% CI = 76%-86.1%)). Rate of obstetrical complications was 25.4% (95% CI = 13-40.2%) among all finished pregnancies. Pooled estimate of preterm labor was 12.8% (95% CI = 8.7%-17.5%), and pooled estimate of low birth weight (LBW) was 10% (95% CI = 6.2-14.6%). Considering the findings of the study, a safe pregnancy after UAE is obviously possible resulting to a healthy and normal baby delivery. In addition, pooled obstetrical complication rates, pregnancy losses, preterm labor and LBW seem to be mostly similar to the general population. Registration: The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) on Nov 3, 2017, and was confirmed with a registration code of CRD42017076074.