Automatic Spine Segmentation and Parameter Measurement for Radiological Analysis of Whole-Spine Lateral Radiographs Using Deep Learning and Computer Vision.

Radiographic examination is essential for diagnosing spinal disorders, and the measurement of spino-pelvic parameters provides important information for the diagnosis and treatment planning of spinal sagittal deformities. While manual measurement methods are the golden standard for measuring parameters, they can be time consuming, inefficient, and rater dependent. Previous studies that have used automatic measurement methods to alleviate the downsides of manual measurements showed low accuracy or could not be applied to general films. We propose a pipeline for automated measurement of spinal parameters by combining a Mask R-CNN model for spine segmentation with computer vision algorithms. This pipeline can be incorporated into clinical workflows to provide clinical utility in diagnosis and treatment planning. A total of 1807 lateral radiographs were used for the training (n = 1607) and validation (n = 200) of the spine segmentation model. An additional 200 radiographs, which were also used for validation, were examined by three surgeons to evaluate the performance of the pipeline. Parameters automatically measured by the algorithm in the test set were statistically compared to parameters measured manually by the three surgeons. The Mask R-CNN model achieved an average precision at 50% intersection over union (AP50) of 96.2% and a Dice score of 92.6% for the spine segmentation task in the test set. The mean absolute error values of the spino-pelvic parameters measurement results were within the range of 0.4° (pelvic tilt) to 3.0° (lumbar lordosis, pelvic incidence), and the standard error of estimate was within the range of 0.5° (pelvic tilt) to 4.0° (pelvic incidence). The intraclass correlation coefficient values ranged from 0.86 (sacral slope) to 0.99 (pelvic tilt, sagittal vertical axis).

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease.

BACKGROUND: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. METHODS: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD. RESULTS: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825-(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12-64.78 in the early group versus mean 45.34 min; 95% CI, 42.45-48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups. CONCLUSION: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

Identification of Missing Proteins in Human Olfactory Epithelial Tissue by Liquid Chromatography-Tandem Mass Spectrometry.

We performed proteomic analyses of human olfactory epithelial tissue to identify missing proteins using liquid chromatography-tandem mass spectrometry. Using a next-generation proteomic pipeline with a < 1.0% false discovery rate at the peptide and protein levels, we identified 3731 proteins, among which five were missing proteins (P0C7M7, P46721, P59826, Q658L1, and Q8N434). We validated the identified missing proteins using the corresponding synthetic peptides. No olfactory receptor (OR) proteins were detected in olfactory tissue, suggesting that detection of ORs would be very difficult. We also identified 49 and 50 alternative splicing variants mapped at the neXtProt and GENCODE databases, respectively, and 2000 additional single amino acid variants. This data set is available at the ProteomeXchange consortium via PRIDE repository (PXD010025).

Single-Center Pharmacokinetic Study and Simulation of a Low Meropenem Concentration in Brain-Dead Organ Donors.

Meropenem is an ultrabroad-spectrum antibiotic of the carbapenem family. In brain-dead organ donors, administration of standard meropenem dosages does not reach therapeutic levels. Our objectives were to determine the plasma concentration of meropenem after the administration of standard meropenem dose and to estimate an improved dosage regimen for these patients. One gram of meropenem was administered as a 1-h infusion every 8 h for 1 to 3 days, and blood samples were collected. The plasma concentration of meropenem was measured and subjected to pharmacokinetic analysis. Simcyp simulation was performed to predict the optimum plasma levels and dosage based on the patients' individual pharmacokinetic parameters. The maximum plasma concentration of meropenem was 3.29 µg/ml, which was lower than four times the MIC of 8 µg/ml. Although the mean creatinine clearance of patients was moderately low (67.5 ml/min), the apparent volume of distribution at steady state (Vss) and time-averaged total body clearance (CL) of meropenem were markedly elevated (4.97 liters/kg and 2.06 liters/h/kg, respectively), owing to massive fluid loading to decrease the high sodium levels and to treat shock or dehydration. The simulation revealed that dose and infusion time of meropenem should be increased based on patients' Vss and CL, and a loading dose is recommended to reach rapidly the target concentration. In conclusion, a standard meropenem regimen is insufficient to achieve optimal drug levels in brain-dead patients, and an increase in dose and extended or continuous infusion with intravenous bolus administration of a loading dose are recommended for these patients.

Satellite cell activation and mTOR signaling pathway response to resistance and combined exercise in elite weight lifters.

PURPOSE: Our aim was to compare the effects of a single exercise training mode (resistance exercise) with a combined exercise training (resistance and plyometric exercise) mode on satellite cell activity and anabolic signaling at the molecular level. METHODS: Eighteen male weight lifters (20 ± 4 years, BMI 27 ± 6 kg/m2) were randomly assigned to either a series of resistance exercise or a series of combined exercise group. The intensity of the exercise was set at 60% of their 1 RM weight and subjects completed three sets each of six repetitions. The combined exercise group performed three different types of resistance exercise alternating with three different types of plyometric exercise, whereas the resistance exercise group performed only the three different types of resistance exercise which was repeated twice. Muscle biopsies were obtained the vastus lateralis muscle immediately before and 3 h after one bout of exercise. RESULTS: Exercise induced increases in satellite cell activation and myofibrillar protein synthesis following both exercise modes, but the resistance exercise group was superior compared to the combined exercise group in satellite cell activity expressed by Ki67/CD56 (165 vs 232%) and PI3K/Akt protein expression (121 vs 157%), mTOR protein expression (117 vs 288%), p70S6K protein expression (253 vs 809%), and 4E-BP1 protein expression (70 vs 139%) of anabolic signaling pathway. CONCLUSIONS: These results suggest that the previous findings showing a greater effect of combined as opposed to a single exercise mode could be the effect of a greater training volume rather than a true-training effect of a combined exercise program.

Acute simulated soccer-specific training increases PGC-1α mRNA expression in human skeletal muscle.

The aim of the current study was to quantify oxygen uptake, heart rate and molecular responses of human skeletal muscle associated with mitochondrial biogenesis following an acute bout of simulated soccer training. Muscle biopsies (vastus lateralis) were obtained from nine active men immediately pre-completion, post-completion and 3 h post-completion of a laboratory-based soccer-specific training simulation on a motorised treadmill. The soccer-specific simulation was a similar intensity (55 ± 6% [Formula: see text]) and duration (60 min) as that observed in professional soccer training (e.g. standing 41%, walking 37%, jogging 11%, high-speed running 9% and sprinting 2%). Post-exercise, muscle glycogen decreased (Pre; 397 ± 86 mmol∙kg(-1) dw, Post; 344 ± 64 mmol∙kg(-1) dw; P = 0.03), plasma lactate increased (P < 0.001) up to ~4-5 mmol∙L(-1), non-esterified fatty acids and glycerol increased (P < 0.001) to values of 0.6 ± 0.2 mmol∙L(-1) and 145 ± 54 µmol∙L(-1), respectively. PGC-1α mRNA increased (P = 0.009) fivefold 3 h post-exercise. We provide novel data by demonstrating that soccer-specific training is associated with increases in PGC-1α mRNA. These data may have implications for practitioners in better understanding the metabolic and muscle responses to soccer-specific training protocols in the field.

Epidemiology and Outcomes of Severe Traumatic Brain Injury: Regional Trauma Center in Incheon, Korea, 2018-2022.

Objective: This study aims to explore the epidemiology and outcomes of severe traumatic brain injury (TBI) in Incheon, focusing on regional characteristics using data from a local trauma center. Methods: From January 2018 to December 2022, 559 patients with severe TBI were studied. We analyzed factors related to demography, prehospitalization, surgery, complications, and clinical outcomes, including intensive care unit stay, ventilator use, hospital stay, mortality, and Glasgow outcome scale (GOS) scores at discharge and after 6 months. Results: In this study, most severe TBI patients were in the 60-79 age range, constituting 37.4% of cases. Most patients (74.1%) used public emergency medical services for transportation, and 75.3% arrived directly at the hospital, a significantly higher proportion compared to transferred patients. Timewise, 40.0% reached the hospital within an hour of injury. Complication rates stood at 16.1%, with pneumonia being the most common. The mortality rate was 44.0%, and at discharge, 81.2% of patients had unfavorable outcomes (GOS 1-3), reducing to 70.1% at 6 months. Conclusion: As a pioneering study at Incheon's trauma center, this research provides insights into severe TBI outcomes, enhancing understanding by contrasting local and national data.

Automated Segmentation and Diagnostic Measurement for the Evaluation of Cervical Spine Injuries Using X-Rays.

Accurate assessment of cervical spine X-ray images through diagnostic metrics plays a crucial role in determining appropriate treatment strategies for cervical injuries and evaluating surgical outcomes. Such assessment can be facilitated through the use of automatic methods such as machine learning and computer vision algorithms. A total of 852 cervical X-rays obtained from Gachon Medical Center were used for multiclass segmentation of the craniofacial bones (hard palate, basion, opisthion) and cervical spine (C1-C7), incorporating architectures such as EfficientNetB4, DenseNet201, and InceptionResNetV2. Diagnostic metrics automatically measured using computer vision algorithms were compared with manually measured metrics through Pearson's correlation coefficient and paired t-tests. The three models demonstrated high average dice coefficient values for the cervical spine (C1, 0.93; C2, 0.96; C3, 0.96; C4, 0.96; C5, 0.96; C6, 0.96; C7, 0.95) and lower values for the craniofacial bones (hard palate, 0.69; basion, 0.81; opisthion, 0.71). Comparison of manually measured metrics and automatically measured metrics showed high Pearson's correlation coefficients in McGregor's line (r = 0.89), space available cord (r = 0.94), cervical sagittal vertical axis (r = 0.99), cervical lordosis (r = 0.88), lower correlations in basion-dens interval (r = 0.65), basion-axial interval (r = 0.72), and Powers ratio (r = 0.62). No metric showed adjusted significant differences at P < 0.05 between manual and automatic metric measuring methods. These findings demonstrate the potential of multiclass segmentation in automating the measurement of diagnostic metrics for cervical spine injuries and showcase the clinical potential for diagnosing cervical spine injuries and evaluating cervical surgical outcomes.

Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience.

Objective: To compare preventable trauma death rates (PTDRs) in patients with traumatic brain injury before and after the establishment of a regional trauma center (RTC) at a single center. Methods: Our institution established an RTC in 2014. A total of 709 patients were enrolled from January 2011 to December 2013 (before RTC) and 672 from January 2019 to December 2021 (after RTC). The revised trauma score, injury severity score, and trauma and injury severity score (TRISS) were evaluated. Definitive preventable (DP), possibly preventable (PP), and non-preventable deaths were defined as TRISS >0.5, TRISS 0.25-0.5, and TRISS <0.25, respectively. PTDR was the proportion of deaths from DP+PP out of all deaths, and the preventable major trauma death rate (PMTDR) was the proportion of deaths from DP+PP out of all DP+PP. Results: The overall mortality rates before and after the establishment of RTC were 20.3 and 13.1%, respectively. PTDR was lower after the establishment of RTC than before (90.3% vs. 79.5%). The PMTDR was also lower after the establishment of RTC than before (18.8% vs. 9.7%). The ratio of direct hospital visits was higher in patients before the establishment of RTC than in those after (74.9% vs. 61.3%, p<0.001). Conclusion: Establishing the RTC reduced PTDRs. Additional studies on factors associated with PTDR reduction are required.

Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury.

OBJECTIVE: Traumatic brain injury (TBI) is one of the most common injuries in patients with multiple trauma, and it associates with high post-traumatic mortality and morbidity. A trauma center was established to provide optimal treatment for patients with severe trauma. This study aimed to compare the treatment outcomes of patients with severe TBI between non-trauma and trauma centers based on data from the Korean Neuro-Trauma Data Bank System (KNTDBS). METHODS: From January 2018 to June 2021, 1122 patients were enrolled in the KNTDBS study. Among them, 253 patients from non-traumatic centers and 253 from trauma centers were matched using propensity score analysis. We evaluated baseline characteristics, the time required from injury to hospital arrival, surgery-related factors, neuromonitoring, and outcomes. RESULTS: The time from injury to hospital arrival was shorter in the non-trauma centers (110.2 vs. 176.1 minutes, p=0.012). The operation time was shorter in the trauma centers (156.7 vs. 128.1 minutes, p0.003). Neuromonitoring was performed in nine patients (3.6%) in the non-trauma centers and 67 patients (26.5%) in the trauma centers (p<0.001). Mortality rates were lower in trauma centers than in non-trauma centers (58.5% vs. 47.0%, p=0.014). The average Glasgow coma scale (GCS) at discharge was higher in the trauma centers (4.3 vs. 5.7, p=0.011). For the Glasgow outcome scale-extended (GOSE) at discharge, the favorable outcome (GOSE 5-8) was 17.4% in the non-trauma centers and 27.3% in the trauma centers (p=0.014). CONCLUSION: This study showed lower mortality rates, higher GCS scores at discharge, and higher rates of favorable outcomes in trauma centers than in non-trauma centers. The regional trauma medical system seems to have a positive impact in treating patients with severe TBI.

Automatically Diagnosing Skull Fractures Using an Object Detection Method and Deep Learning Algorithm in Plain Radiography Images.

OBJECTIVE: Deep learning is a machine learning approach based on artificial neural network training, and object detection algorithm using deep learning is used as the most powerful tool in image analysis. We analyzed and evaluated the diagnostic performance of a deep learning algorithm to identify skull fractures in plain radiographic images and investigated its clinical applicability. METHODS: A total of 2026 plain radiographic images of the skull (fracture, 991; normal, 1035) were obtained from 741 patients. The RetinaNet architecture was used as a deep learning model. Precision, recall, and average precision were measured to evaluate the deep learning algorithm's diagnostic performance. RESULTS: In ResNet-152, the average precision for intersection over union (IOU) 0.1, 0.3, and 0.5, were 0.7240, 0.6698, and 0.3687, respectively. When the intersection over union (IOU) and confidence threshold were 0.1, the precision was 0.7292, and the recall was 0.7650. When the IOU threshold was 0.1, and the confidence threshold was 0.6, the true and false rates were 82.9% and 17.1%, respectively. There were significant differences in the true/false and false-positive/false-negative ratios between the anteriorposterior, towne, and both lateral views (p=0.032 and p=0.003). Objects detected in false positives had vascular grooves and suture lines. In false negatives, the detection performance of the diastatic fractures, fractures crossing the suture line, and fractures around the vascular grooves and orbit was poor. CONCLUSION: The object detection algorithm applied with deep learning is expected to be a valuable tool in diagnosing skull fractures.

Comparison of Long-Term Follow-Up Outcomes Between Minimally Invasive and Open Surgery for Single-Level Lumbar Fusion.

AIM: To evaluate, and to compare the clinical outcomes of minimally invasive surgery (MIS), and open surgery for single-level lumbar fusion over a minimum of 10-year follow-up. MATERIAL AND METHODS: We included 87 patients who underwent spinal fusion at the L4 - L5 level between January 2004 and December 2010. Based on the surgical method, the patients were divided into the open surgery (n=44) and MIS groups (n=43). We evaluated baseline characteristics, perioperative comparisons, postoperative complications, radiologic findings, and patientreported outcomes. RESULTS: The mean follow-up period was > 10 years in both groups (open surgery, 10.50 years; MIS, 10.16 years). The operative time was longer in the MIS group (4.37 h) than that in the open surgery group (3.34 h) (p=0.001). Estimated blood loss was lower in the MIS group (281.40 mL) than in the open surgery group (440.23 mL) (p < 0.001). Postoperative complications, including surgical site infection, adjacent segment disease, and pseudoarthrosis, did not differ between the groups. Plain radiographic findings of the lumbar spine did not differ between the two groups. Visual scores for back/leg pain and the Oswestry disability index did not differ between the two groups, preoperatively and at 6 months, 1, 5, and 10 years after surgery. CONCLUSION: After a minimum of the 10-year follow-up, postoperative complications and clinical outcomes did not differ significantly between patients who underwent open fusion and MIS fusion at the L4 - L5 level.

The Relationship Between Trauma Scoring Systems and Outcomes in Patients With Severe Traumatic Brain Injury.

Objective: This study investigated the relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury (TBI). Methods: From January 2018 to June 2021, 1,122 patients with severe TBI were registered in the Korean Neuro-Trauma Data Bank System. Among them, 697 patients with data on trauma scoring systems were included in the study. According to the Glasgow Outcome Scale-Extended score, the patients were divided into unfavorable and favorable outcome groups. The abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS), and trauma and injury severity score (TRISS) were evaluated. Results: The AIS head score was higher in the unfavorable outcome group than in the favorable outcome group (4.39 vs. 4.06, p<0.001). ISS was also higher in the unfavorable outcome group (27.27 vs. 24.22, p=0.001). The RTS and TRISS were higher in the favorable outcome group (RTS, 4.74 vs. 5.45, p<0.001; TRISS, 48.05 vs. 71.02, p<0.001). In comparing the survival and death groups, the ISS was lower in the survival group (25.76 vs. 27.29, p=0.036). Furthermore, RTS was higher in the survival group (5.26 vs. 4.54, p<0.001), as was TRISS (62.11 vs. 44.91, p<0.001). Conclusion: Trauma scoring systems, including ISS, RTS, and TRISS, provide tools for quantifying posttraumatic risk and can be used to predict prognosis. Among these, TRISS is an indicator of the predicted survival rate and is considered a clinically useful tool for predicting unfavorable and favorable outcomes in patients with severe TBI.

Clinical Outcome of Patients Diagnosed Traumatic Intracranial Epidural Hematoma With Severe Brain Injury (Glasgow Coma Scale ≤8) Who Undergo Surgery: A Report From the Korean Neuro-Trauma Data Bank System.

Objective: To evaluate the clinical outcomes and prognostic factors in surgically treated patients with severe brain injury (Glasgow Coma Scale [GCS] score ≤8) diagnosed with traumatic epidural hematoma (EDH). Methods: From January 2018 to June 2021, 1,122 patients with an initial GCS score ≤8 were retrospectively enrolled in the Korean Neuro-Trauma Data Bank System. Clinical data of 79 surgically treated patients with EDH were compared between the unfavorable (scores of 1-4 on the Glasgow Outcome Scale-Extended [GOSE]) and favorable (score of 5-8 on the GOSE) outcome groups. Results: The overall mortality rate was 13.9%, and 60.8% of the patients had good outcomes at six months post-trauma. In the univariate analysis, increasing age (p=0.010), lower initial GCS score (p=0.001), higher Rotterdam computed tomography (CT) score (p=0.012), craniotomy rather than craniectomy (p=0.032), larger EDH volume (p=0.007), and loss of pupillary reactivity (unilateral unreactive pupil, p=0.026; bilateral unreactive pupils, p<0.001), were significantly correlated with unfavorable outcomes. Of these factors, increasing age (p=0.011) and bilateral unreactive pupils (p=0.002) were the most significant risk factors in the multivariate logistic regression analysis. The interval from admission to the brain CT scan was not correlated with the outcome; however, it was significantly longer in the unfavorable outcome group. Conclusion: Despite severe brain injury, more than half of the patients with EDH had favorable outcomes after surgical treatment. Our findings suggest that prompt diagnosis and surgical treatment should be considered for such cases.

Endoscopic lumbar foraminotomy for foraminal stenosis in stable spondylolisthesis.

Background: Open decompression with fusion is the gold-standard surgical technique for spondylolisthesis. However, it may be too extensive for patients with foraminal stenosis with stable spondylolisthesis. The endoscopic lumbar foraminotomy (ELF) technique was developed as a minimally invasive surgical option for foraminal stenosis. Some authors have reported the outcomes of ELF for various spondylolistheses. However, few studies have demonstrated foraminal stenosis in advanced stable spondylolisthesis. This study aimed to describe the surgical technique and results of ELF for radiculopathy due to foraminal stenosis in patients with stable spondylolisthesis. Methods: Consecutive 22 patients who suffered from radiculopathy with spondylolisthesis underwent ELF. The inclusion criterion was unilateral radicular leg pain due to foraminal stenosis in stable spondylolisthesis. After the percutaneous transforaminal approach, foraminal decompression was performed using various surgical devices under endoscopic visualization. Surgical outcomes were measured using the visual analog pain score, Oswestry disability index, and modified MacNab criteria. Results: Pain scores and functional outcomes improved significantly during the 12-month follow-up periods. The rate of clinical improvement was 95.5% (21 of 22 patients). One patient experienced a dural tear and subsequent open surgery. Conclusion: ELF can be effective in foraminal stenosis in stable spondylolisthesis. Technical points specializing in foraminal decompression in spondylolisthesis are required for clinical success.

Comparison of adjacent segment disease after minimally invasive versus open lumbar fusion: a minimum 10-year follow-up.

OBJECTIVE: The object of this study was to compare, after a long-term follow-up, the incidence and features of adjacent segment disease (ASDis) following lumbar fusion surgery performed via an open technique using conventional interbody fusion plus transpedicular screw fixation or a minimally invasive surgery (MIS) using a tubular retractor together with percutaneous pedicle screw fixation. METHODS: The authors conducted a retrospective chart review of patients with a follow-up period > 10 years who had undergone instrumented lumbar fusion at the L4-5 level between January 2004 and December 2010. The patients were divided into an open surgery group and MIS group based on the surgical method performed. Baseline characteristics and radiological findings, including factors related to ASDis, were compared between the two groups. Additionally, the incidence of ASDis and related details, including diagnosis, time to diagnosis, and treatment, were analyzed. RESULTS: Among 119 patients who had undergone lumbar fusion at the L4-5 level in the study period, 32 were excluded according to the exclusion criteria. The remaining 87 patients were included as the final study cohort and were divided into an open group (n = 44) and MIS group (n = 43). The mean follow-up period was 10.50 (range 10.0-14.0) years in the open group and 10.16 (range 10.0-13.0) years in the MIS group. The overall facet joint violation rate was significantly higher in the open group than in the MIS group (54.5% vs 30.2%, p = 0.022). However, in terms of adjacent segment degeneration, there were no significant differences in corrected disc height, segmental angle, range of motion, or degree of listhesis of the adjacent segments between the two groups during follow-up. The overall incidence of ASDis was 33.3%, with incidences of 31.8% in the open group and 34.9% in the MIS group, showing no significant difference between the two groups (p = 0.822). Additionally, detailed diagnosis and treatment factors were not different between the two groups. CONCLUSIONS: After a minimum 10-year follow-up, the incidence of ASDis did not differ significantly between patients who had undergone open fusion and those who had undergone MIS fusion at the L4-5 level.

Evaluation of U-Net models in automated cervical spine and cranial bone segmentation using X-ray images for traumatic atlanto-occipital dislocation diagnosis.

Segmentation of the cervical spine in tandem with three cranial bones, hard palate, basion, and opisthion using X-ray images is crucial for measuring metrics used to diagnose traumatic atlanto-occipital dislocation (TAOD). Previous studies utilizing automated segmentation methods have been limited to segmenting parts of the cervical spine (C3 ~ C7), due to difficulties in defining the boundaries of C1 and C2 bones. Additionally, there has yet to be a study that includes cranial bone segmentations necessary for determining TAOD diagnosing metrics, which are usually defined by measuring the distance between certain cervical (C1 ~ C7) and cranial (hard palate, basion, opisthion) bones. For this study, we trained a U-Net model on 513 sagittal X-ray images with segmentations of both cervical and cranial bones for an automated solution to segmenting important features for diagnosing TAOD. Additionally, we tested U-Net derivatives, recurrent residual U-Net, attention U-Net, and attention recurrent residual U-Net to observe any notable differences in segmentation behavior. The accuracy of U-Net models ranged from 99.07 to 99.12%, and dice coefficient values ranged from 88.55 to 89.41%. Results showed that all 4 tested U-Net models were capable of segmenting bones used in measuring TAOD metrics with high accuracy.

Quantification of the physiological loading of one week of "pre-season" and one week of "in-season" training in professional soccer players.

The aim of this study was to quantify the physiological loads of programmed "pre-season" and "in-season" training in professional soccer players. Data for players during each period were included for analysis (pre-season, n = 12; in-season, n = 10). We monitored physiological loading of training by measuring heart rate and rating of perceived exertion (RPE). Training loads were calculated by multiplying RPE score by the duration of training sessions. Each session was sub-categorized as physical, technical/tactical, physical and technical/tactical training. Average physiological loads in pre-season (heart rate 124 ± 7 beats · min(-1); training load 4343 ± 329 Borg scale · min) were higher compared with in-season (heart rate 112 ± 7 beats · min(-1); training load 1703 ± 173 Borg scale · min) (P < 0.05) and there was a greater proportion of time spent in 80-100% maximum heart rate zones (18 ± 2 vs. 5 ± 2%; P < 0.05). Such differences appear attributable to the higher intensities in technical/tactical sessions during pre-season (pre-season: heart rate 137 ± 8 beats · min(-1); training load 321 ± 23 Borg scale · min; in-season: heart rate 114 ± 9 beats · min(-1); training load 174 ± 27 Borg scale · min; P < 0.05). These findings demonstrate that pre-season training is more intense than in-season training. Such data indicate that these adjustments in load are a direct attempt to deliver training to promote specific training adaptations.

Outcomes of epiduroscopic laser ablation in patients with lumbar disc herniation.

ABSTRACT: Recently, trans-sacral epiduroscopic laser decompression (SELD) using flexible epiduroscopy and laser system is 1 of the options for minimally invasive surgery in herniated lumbar disc. However, outcomes after SELD in patients with disc herniation of lumbar spine are not proven worldwide. The authors reported clinical, surgical, and radiological outcome after SELD in patients with mild to moderate disc herniation.Between 2015 and 2018, eighty-two patients who underwent SELD for single level disc herniation with a minimum follow-up of 6.0 months were investigated retrospectively. Clinical outcomes were assessed using the visual analog scale for low back and leg pain and Odom's criteria for patient satisfaction. Also, surgical outcomes, including complications, recurrences, and revision surgeries, and radiological outcomes using regular simple radiograph were analyzed.The mean visual analog scale score of low back pain and leg pain improved from 5.43 ±â€Š1.73 and 6.10 ±â€Š1.67 to 2.80 ±â€Š1.43 and 3.58 ±â€Š2.08 at the final follow-up (p < 0.001). On the other hand, according to Odom's criteria, the success rate (excellent or good results at 6 months after surgery) was 58.5%. Surgical complications occurred in 7 patients (8.5%), including dura puncture during the procedure, transient headache or nuchal pain, and transient mild paralysis. The rate of additional procedures after SELD was 17.1% (6 patients of revision surgery and 8 patients of an additional nerve block).Our findings demonstrated that SELD for lumbar disc herniation achieved less favorable patient satisfaction compared with previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

Efficacy and safety of decompressive craniectomy with non-suture duraplasty in patients with traumatic brain injury.

BACKGROUND: Decompressive craniectomy is an important surgical treatment for patients with severe traumatic brain injury (TBI). Several reports have been published on the efficacy of non-watertight sutures in duraplasty performed in decompressive craniectomy. This study sought to determine the safety and feasibility of the non-suture dural closure technique in decompressive craniectomy. METHODS: A total of 106 patients were enrolled at a single trauma center between January 2017 and December 2018. We retrospectively collected data and classified the patients into non-suture and suture duraplasty craniectomy groups. We compared the characteristics of patients and their intra/postoperative findings such as operative time, blood loss, imaging findings, complications, and Glasgow Outcome Scale scores. RESULTS: There were 37 and 69 patients in the non-suture and suture duraplasty groups, respectively. There were no significant differences between the two groups concerning general characteristics. The operative time was significantly lower in the non-suture duraplasty group than in the suture duraplasty group (150 min vs. 205 min; p = 0.002). Furthermore, blood loss was significantly less severe in the non-suture duraplasty group than in the suture duraplasty group (1000 mL vs. 1500 mL; p = 0.028). There were no other significant differences. CONCLUSION: Non-suture duraplasty involved shorter operative times and less severe blood losses than suture duraplasty. Other complications and prognoses were similar across groups. Therefore, the non-suture duraplasty in decompressive craniectomy is a safe and feasible surgical technique.