Artificial intelligence diagnostic accuracy in fracture detection from plain radiographs and comparing it with clinicians: a systematic review and meta-analysis.

PURPOSE: Fracture detection is one of the most commonly used and studied aspects of artificial intelligence (AI) in medicine. In this systematic review and meta-analysis, we aimed to summarize available literature and data regarding AI performance in fracture detection on plain radiographs and various factors affecting it. METHODS: We systematically reviewed studies evaluating AI algorithms in detecting bone fractures in plain radiographs, combined their performance using meta-analysis (a bivariate regression approach), and compared it with that of clinicians. We also analyzed the factors potentially affecting algorithm performance using meta-regression. RESULTS: Our analysis included 100 studies. In 83 studies with confusion matrices, AI algorithms showed a sensitivity of 91.43% and a specificity of 92.12% (Area under the summary receiver operator curve = 0.968). After adjustment and false discovery rate correction, tibia/fibula (excluding ankle) fractures were associated with higher (7.0%, p=0.004) AI sensitivity, while more recent publications (5.5%, p=0.003) and Xception architecture (6.6%, p<0.001) were associated with higher specificity. Clinicians and AI showed similar specificity in fracture identification, although AI leaned to higher sensitivity (7.6%, p=0.07). Radiologists, on the other hand, were more specific than AI overall and in several subgroups, and more sensitive to hip fractures before FDR correction. CONCLUSIONS: Currently available AI aids could result in a significant improvement in care where radiologists are not readily available. Moreover, identifying factors affecting algorithm performance could guide AI development teams in their process of optimizing their products.

Qualitative and quantitative DECT pulmonary angiography in COVID-19 pneumonia and pulmonary embolism.

AIM: To assess differences in qualitative and quantitative parameters of pulmonary perfusion from dual-energy computed tomography (CT) pulmonary angiography (DECT-PA) in patients with COVID-19 pneumonia with and without pulmonary embolism (PE). MATERIALS AND METHODS: This retrospective institutional review board-approved study included 74 patients (mean age 61±18 years, male:female 34:40) with COVID-19 pneumonia in two countries (one with 68 patients, and the other with six patients) who underwent DECT-PA on either dual-source (DS) or single-source (SS) multidetector CT machines. Images from DS-DECT-PA were processed to obtain virtual mono-energetic 40 keV (Mono40), material decomposition iodine (MDI) images and quantitative perfusion statistics (QPS). Two thoracic radiologists determined CT severity scores based on type and extent of pulmonary opacities, assessed presence of PE, and pulmonary parenchymal perfusion on MDI images. The QPS were calculated from the CT Lung Isolation prototype (Siemens). The correlated clinical outcomes included duration of hospital stay, intubation, SpO2 and death. The significance of association was determined by receiver operating characteristics and analysis of variance. RESULTS: One-fifth (20.2%, 15/74 patients) had pulmonary arterial filling defects; most filling defects were occlusive (28/44) located in the segmental and sub-segmental arteries. The parenchymal opacities were more extensive and denser (CT severity score 24±4) in patients with arterial filling defects than without filling defects (20±8; p=0.028). Ground-glass opacities demonstrated increased iodine distribution; mixed and consolidative opacities had reduced iodine on DS-DECT-PA but increased or heterogeneous iodine content on SS-DECT-PA. QPS were significantly lower in patients with low SpO2 (p=0.003), intubation (p=0.006), and pulmonary arterial filling defects (p=0.007). CONCLUSION: DECT-PA QPS correlated with clinical outcomes in COVID-19 patients.

The effects of hypogonadism on quality of life in survivors of germ cell tumors treated with surgery alone versus surgery plus platinum-based chemotherapy.

BACKGROUND: It is important to assess the prevalence of hypogonadism and to identify the correlation between hypogonadism and cancer treatment with quality of life (QoL) in germ cell tumor (GCT) survivors. METHODS: This is a single-center, non-randomized, prospective observational study in GCT survivors 18-50 years of age previously treated with surgery and chemotherapy (S+C) or surgery alone (S). Patients completed a validated QoL questionnaire at baseline, 3, and 6 months. Patients received supplemental testosterone as clinically indicated. Mean QoL scores were compared between two treatment groups (S+C vs. S) and within each group between survivors with hypogonadism (serum testosterone level < 300 ng/dL) versus without. A two-sided independent-groups t test was used to compare means. RESULTS: We evaluated 199 GCT survivors. At baseline, the prevalence of biochemical hypogonadism was 48% overall, 51% in S+C group, and 45% in S group (p = .4). Overall, there was no statistically significant difference in QoL scores between S+C and C groups, except the S+C group exhibited greater modified Aging Male Symptoms (AMS) at baseline and 6 months. Patients with hypogonadism reported more fatigue, poor sleep quality, and worse general health at baseline. There were no statistical differences in mean QOL scores between patients with testosterone < 300 ng/dL who received testosterone supplementation and who did not. CONCLUSION: A significant proportion of GCT survivors have low testosterone levels after platinum-based chemotherapy and surgery as well as with just surgery alone. GCT survivors treated with platinum-based chemotherapy exhibited more symptoms related to male aging compared with survivors treated with surgery alone.

Pott's paraplegia secondary to Scrofuloderma is a rare association.

STUDY DESIGN: Spinal tuberculosis as all other osteoarticular tuberculosis occurs as a result of hematogenous dissemination of Mycobacterium tuberculosis from a primarily infected visceral focus mainly lungs, but Pott's paraplegia occurring secondarily to Scrofuloderma has not been reported till date. PURPOSE: To document such an association of Pott's paraplegia and Scrofuloderma. METHODS: A 29-year-old female presented to us with low backache and paraplegia of 1 month duration. Clinical examination showed multiple healed Scrofuloderma lesions over sterum and neck (Figure 1). Magnetic resonance imaging (Figure 4), computed tomography (Figure 3) and X-ray (Figure 2) showed Pott's spine involving dorsal vertebrae (D8-10) with pre and paravetebral abscess with intraspinal extension. She was treated by minimally invasive surgery to drain pus and granulation tissue by resecting transverse process of D9 vertebra. Drained material was sent for histopathological examination, Zielh-neelsen (ZN) staining, culture and sensitivity for M. tuberculosis. Patient completely recovered neurologically after 1 month of surgery. RESULTS: Patient completely recovered neurologically after surgery and is presently on multidrug chemotherapy and spinal brace. CONCLUSIONS: Pott's paraplegia can occur secondary to Scrofuloderma and it can be managed by multidrug antitubercular therapy and minimally invasive surgical procedure.

The effect of proanthocyanidins on the bond strength and durability of resin sealer to root dentine.

AIM: To investigate the effect of proanthocyanidins (PAs)-rich grape seed extract on the biodegradation resistance of demineralized root dentine and on the bond strength and durability between resin-based sealer and root dentine. METHODOLOGY: Single-rooted premolars (n = 28) were divided into PAs-treated and nontreated specimens. Root canals were instrumented to apical size 40, filled with RealSeal SE sealer/Core, sectioned into slices of 1 mm thickness from middle and coronal thirds and stored for 1 week or 3 months in distilled water. Specimens were subjected to push-out strength testing with the load applied perpendicularly in an apical to coronal direction using a universal testing machine. Remaining apical thirds were viewed by scanning electron microscopy after 3-months storage. Additional root canals were filled with rhodamine-B-labelled sealer and viewed by confocal laser scanning microscopy. Unfilled roots (n = 6) were sliced, demineralized, PAs-treated or left untreated and exposed to 24 h collagenase to determine hydroxyproline release in the supernatant. Two-way anova was used to test the effect of both dentine treatment with PAs and anatomical locations on bond strength and hydroxyproline release. Tukey-Kramer multiple comparison post hoc test was used to compare between groups. RESULTS: No difference in bond strength was found after 1-week storage between both PAs-treated (crosslinked) and untreated (noncrosslinked) groups in the coronal thirds. However, treatment with PAs revealed higher 1-week bond strength values (P ≤ 0.05) in the middle thirds. Generally, 3-month storage decreased the bond strength compared to 1-week within each of the crosslinked and noncrosslinked groups. However, the decrease in the bond strength after 3 months was less for the crosslinked specimens compared to the noncrosslinked specimens. Confocal images revealed a relatively uniform fluorescent interfacial layer and tubular penetration after 1 week in both groups. SEM images revealed more intact resin sealer/dentine interfaces with PAs crosslinking after 3 months. In addition, hydroxyproline release was significantly less (P ≤ 0.05) with crosslinked specimens. CONCLUSION: Treating root dentine with PAs-rich grape seed extracts improved the biodegradation resistance of demineralized root dentine and enhanced the bond strength and durability between resin-based sealer and root dentine after short-term water storage.

The role of mast cells on angiogenesis in oral squamous cell carcinoma.

OBJECTIVE: Angiogenesis or neovascularization has long been known to aid in progression and metastasis of malignant tumors. Tumor angiogenesis is a complex event mediated by angiogenic factors released from cancer cells and or by host immune cells. Mast cells may induce tumor progression and potentiate metastasis by stimulating angiogenesis. The purpose of the present study was to validate topographic distribution of micro vessel density (MVD) and mast cell density (MCD) and help to elucidate the possible role of mast cells in tumor angiogenesis and correlating this with advanced disease parameters. . STUDY DESIGN: MVD and MCD were investigated in tumor specimens from 30 patients diagnosed with different histologic grades of oral squamous cell carcinoma (OSCC). Intratumor vessels were stained with collagen Type IV antibody and mast cells with Toluidine blue before being measured by light microscopy. RESULTS: There was a significant correlation between MVD and disease progression and number of blood vessels increased from well to poorly differentiated OSCC where as MCD decreased. CONCLUSIONS: These findings suggest that angiogenesis indeed occur in OSCC and might be used as an index to inflect the aggression of the disease however mast cells make up only a part of complex process of angiogenesis along with other factors secreted by tumor.

Effect of surgical weight loss on sleep architecture in adolescents with severe obesity.

OBJECTIVES: Sleep duration and sleep fragmentation have been proposed to play a role in the development and progression of obesity-associated morbidity. Weight loss results in resolution of obesity-associated morbidity. Our aim was to determine the effect of weight loss on sleep architecture in adolescents with severe obesity. METHODS: Retrospective analysis of polysomnograhic data from all adolescents who underwent overnight sleep study before and after weight loss surgery was performed. Polysomnographic variables of sleep architecture after weight loss were compared to baseline by paired Student's t test (normally distributed data) or Wilcoxon test (variables not meeting normality criteria). RESULTS: The mean (+/-SEM) age of 19 subjects meeting inclusion criteria was 16.5 +/- 0.35 years, mean body mass index was 60.3 +/- 2.11 kg/m2, and 66% were female. Obstructive sleep apnea was present in 14 subjects (74%). The average interval between the baseline and repeat polysomnograms was 0.91 +/- 0.16 years, and average weight loss was 66.4 +/- 8.8 kg. Surgical weight loss resulted in increased sleep efficiency (80.2% vs 73.1%, p = 0.01), reduced time in stage 1 sleep (3.0% vs 6.0%, p = 0.02), and reduced arousal index (7.6 +/- 0.6/h vs 11.3 +/- 1.2, p = 0.01). CONCLUSION: Our data demonstrate a marked improvement in sleep efficiency and sleep fragmentation with surgical weight loss. Given the emerging evidence that surgical weight loss results in resolution of obesity-associated psychosocial, metabolic, and cardiovascular morbidity, these results suggest that correction of sleep fragmentation could be an important but as yet underappreciated factor influencing changes in these other major comorbidities of obesity.

Optimization of Z-axis automatic exposure control for multidetector row CT evaluation of neck and comparison with fixed tube current technique for image quality and radiation dose.

BACKGROUND AND PURPOSE: Z-axis automatic exposure control (AEC) technique automatically adjusts tube current based on size of body region scanned. The purpose of the current study was to compare diagnostic acceptability, noise, and radiation exposure of multidetector row CT (MDCT) of neck performed with z-axis AEC and with fixed current. MATERIALS AND METHODS: Two study groups of 26 patients each underwent MDCT of neck using z-axis AEC with 8 noise index (NI), 150-440 mA, and 10 NI, 75-440 mA, respectively. A control group consisting of another 26 patients underwent MDCT of neck with fixed-current technique (300 mA). Objective noise and mean tube current-time products (mA . s) were recorded. Two radiologists evaluated images for diagnostic acceptability and subjective noise on a 5-point scale. RESULTS: All CT examinations of study and control groups were diagnostically acceptable, though objective noise was significantly more with z-axis AEC (shoulder: NI 8, 20.6 +/- 6.2 HU; NI 10, 22.2 +/- 4.6 HU) than with fixed current (16.2 +/- 6 HU) (P = .01). There was no significant difference between AEC and fixed current in diagnostic acceptability and subjective noise (P = .22-.42). AEC resulted in significant radiation dose reduction (NI 8, 186.3 +/- 20.5 mA . s; NI 10, 158.1 +/- 21.2 mA x s), compared with fixed current (235 +/- 21.8 mA x s). CONCLUSION: Z-axis AEC resulted in similar subjective noise and diagnostic acceptability, with radiation dose reduction of 21% for NI of 8 and 33% for NI of 10, respectively, for MDCT evaluation of neck, compared with those of fixed current technique.

State-of-the-art imaging of pancreatic neoplasms.

Pancreatic imaging with multidetector CT allows multiphase acquisition of thin slices in a single breath-hold and is especially valuable in obtaining isotropic three-dimensional reformations that improves our ability to provide accurate pre-operative vascular mapping. Advanced MR technology allows faster imaging of pancreas, thus facilitating MR cholangiopancreatography. Use of tissue-specific MR contrast agents, endoscopic ultrasound and PET in pancreatic imaging has evolved considerably. This review article discusses the role of CT, MR, endoscopic ultrasound and PET imaging in pancreas.

Virulence & pathogenicity of Yersinia enterocolitica under different test systems.

Eight clinical isolates of Y. enterocolitica were tested for various pathogenicity and virulence markers. Seven of the eight strains gave positive results for Congo red magnesium oxalate (CRMOX) agar test and autoagglutination test at 37 degrees C. Seven strains bound crystal violet (CV) completely at 37 degrees C but not at 25 degrees C. One strain (Y1) bound CV partially. None of the strains showed pyrazinamidase activity indicating these strains to be virulent. Cells of all but one strains were aggregated by 1.8 M and 3.2M concentration of ammonium sulphate. A good correlation between these tests and virulence was observed.

Antibiotic prophylaxis in surgery of the intervertebral disc. A comparison between gentamicin and cefuroxime.

Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. It is still not known which antibiotics are able to penetrate the intervertebral disc effectively. In a prospective, randomised, double-blind clinical study, we examined the penetration of the intervertebral discs of two commonly used antibiotics, cefuroxime and gentamicin. The patients, randomised into two groups, received either 1.5 g of cefuroxime or 5 mg/kg of gentamicin prophylactically two hours before their intervertebral discs were removed. A specimen of blood, from which serum antibiotic levels were determined, was obtained at the time of discectomy. Therapeutic levels of antibiotic were detectable in the intervertebral discs of the ten patients who received gentamicin. Only two of the ten patients (20%) who received cefuroxime had a quantifiable level of antibiotic in their discs although therapeutic serum levels of cefuroxime were found in all ten patients. Our results show that cefuroxime does not diffuse into human intervertebral discs as readily as gentamicin. It is possible that the charge due to ionisable groups on the antibiotics can influence the penetration of the antibiotics. We therefore recommend the use of gentamicin in a single prophylactic dose for all spinal procedures in order to reduce the risk of discitis.

An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts.

PURPOSE: To compare 2 techniques for optimizing joint congruency for miniature osteochondral autografting in the knee: intrinsic postoperative forces acting on overdrilled autografts protruding from the femur versus alignment by a surgeon at the time of grafting. TYPE OF STUDY: Controlled animal model experiment. METHODS: A full-thickness cartilage defect was created on the weight-bearing surface of the medial femoral condyle of 13 mature sheep. Three 4.5 x 10 mm cylindrical autografts were inserted into 14-mm deep recipient holes such that the grafts were held in place by side-wall friction alone. One treatment group received grafts that were delivered flush with the surrounding cartilage and the second group received grafts that were left 2-mm proud of the joint surface. RESULTS: Three months postoperatively, the proud grafts had been repositioned by weight bearing but perigraft fissuring and fibroplasia, and subchondral cavitations were serious complications. It is suspected that these complications were caused by excessive motion between the graft and recipient site in the proud grafts. CONCLUSIONS: Grafts should be delivered flush with the joint surface when performing osteochondral transfers to avoid graft micromotion and the consequent interference with graft integration and function.

Comparison between Conventional and Minimally Invasive Dynamic Hip Screws for Fixation of Intertrochanteric Fractures of the Femur.

Background. Intertrochanteric fractures of the proximal femur are one of the most common fractures encountered, and dynamic hip screw with a side plate is the standard treatment. We compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw (DHS) device. Methods. Thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique. Patients in both groups were followed up for 1 year. Results. There was less blood loss, minimal soft tissue destruction, shorter hospital stay, and early mobilization with the minimally invasive technique. Conclusion. The present study finds minimally invasive technique superior to conventional (open) DHS.

Open and hybrid deep vein reconstructions: to do or not to do?

Endovascular reconstruction has become the standard treatment of chronic obstruction of large veins. Stenting is done with increasing frequency to treat iliac venous obstructions, with or without associated inferior vena caval or femoral vein occlusions. Open reconstruction with venous bypass is performed today in patients who fail attempts at venous stenting or who are not candidates for endovascular reconstructions. Patients with primary or secondary malignancies invading the vena cava undergo open caval reconstruction at the time of tumour excision. Open venous reconstructions are still preferred in patients with large vein injuries due to blunt or penetrating trauma or in those who suffer iatrogenic venous injuries. Hybrid reconstruction can be performed with endophlebectomy of the common femoral or femoral veins combined with iliofemoral stenting.

Occupational traumatic amputation of distal part of thumb caused by constriction effect of nylon rope: a case report with review of literature.

A 60-year-old farmer came to the accident and emergency department complaining of traumatic amputation of distal part of right thumb. On examination, there was a circumferential wound located at the base of right thumbnail with injury to both neurovascular bundles and fracture of distal part of distal phalanx with the distal part hanging by volar skin only. The wound was irrigated and the distal part terminalised with direct loose skin closure. Discussion with the patient about the scenario of trauma revealed a mechanism of injury which may appear unique.

Solitary odontodysplasia: a rare entity.

Odontodysplasia is a rare, non-hereditary developmental anomaly affecting dental tissues derived from both the mesoderm and ectoderm which results in a bizarre clinical and radiographic appearance. Regional odontodysplasia describes the segmental and localized nature of the condition. Odontodysplasia occurring in a single tooth is a rare occurrence. A case of Solitary odontodysplasia in an eleven year and half old male whose chief complaint was the absence of eruption of permanent maxillary right central incisor teeth is presented. Clinical, radiographic and histological findings of a single tooth, odontodysplasia are described in this case report.