Explainable Model Using Shapley Additive Explanations Approach on Wound Infection after Wide Soft Tissue Sarcoma Resection: "Big Data" Analysis Based on Health Insurance Review and Assessment Service Hub.

Background and Objectives: Soft tissue sarcomas represent a heterogeneous group of malignant mesenchymal tissues. Despite their low prevalence, soft tissue sarcomas present clinical challenges for orthopedic surgeons owing to their aggressive nature, and perioperative wound infections. However, the low prevalence of soft tissue sarcomas has hindered the availability of large-scale studies. This study aimed to analyze wound infections after wide resection in patients with soft tissue sarcomas by employing big data analytics from the Hub of the Health Insurance Review and Assessment Service (HIRA). Materials and Methods: Patients who underwent wide excision of soft tissue sarcomas between 2010 and 2021 were included. Data were collected from the HIRA database of approximately 50 million individuals' information in the Republic of Korea. The data collected included demographic information, diagnoses, prescribed medications, and surgical procedures. Random forest has been used to analyze the major associated determinants. A total of 10,906 observations with complete data were divided into training and validation sets in an 80:20 ratio (8773 vs. 2193 cases). Random forest permutation importance was employed to identify the major predictors of infection and Shapley Additive Explanations (SHAP) values were derived to analyze the directions of associations with predictors. Results: A total of 10,969 patients who underwent wide excision of soft tissue sarcomas were included. Among the study population, 886 (8.08%) patients had post-operative infections requiring surgery. The overall transfusion rate for wide excision was 20.67% (2267 patients). Risk factors among the comorbidities of each patient with wound infection were analyzed and dependence plots of individual features were visualized. The transfusion dependence plot reveals a distinctive pattern, with SHAP values displaying a negative trend for individuals without blood transfusions and a positive trend for those who received blood transfusions, emphasizing the substantial impact of blood transfusions on the likelihood of wound infection. Conclusions: Using the machine learning random forest model and the SHAP values, the perioperative transfusion, male sex, old age, and low SES were important features of wound infection in soft-tissue sarcoma patients.

Postoperative Computed Tomographic Assessment of the Complete Resection of an Infiltrative Lipoma Compressing the Spinal Cord in a Dog.

Infiltrative lipomas, which are locally invasive tumors composed of well-differentiated adipocytes, are histologically identical to lipomas but have a tendency to infiltrate adjacent muscle and fibrous tissue without metastasis, such as muscle; connective tissue; bone; and, in rare cases, peripheral nerves and the spinal cord. They differ from liposarcomas yet also exhibit neoplastic cell infiltration and often recur despite surgical removal. A 10-year-old spayed Maltese female dog presented with hindlimb paresis and back pain for two months. Computed tomography and magnetic resonance imaging revealed an extensive fatty mass impinging on the vertebral canal, compressing the spinal cord, and extending into the surrounding muscle layers and thoracic cavity. The mass was surgically removed, and subsequent postoperative computed tomography confirmed complete removal of the mass using Vitrea® advanced visualization fat measurement. Histopathological analysis confirmed that the mass was an infiltrative lipoma. The patient's symptoms completely resolved after surgery, with no recurrence reported at the 2-year follow-up. This case highlights the benefits of using postoperative computed tomography combined with the automated fat measurement technique to determine whether reoperation is necessary or to predict patient prognosis by identifying potential residual lipoma post-surgery.

Diagnostic assessment of two-dimensional shear wave elastography in relation to dimethyl arginine levels in dogs with chronic kidney disease.

BACKGROUND: In veterinary medicine, previous studies regarding the diagnostic performance of shear wave elastography (SWE) in chronic kidney disease (CKD) are not consistent with each other. Moreover, there has been no study evaluating the relationship between symmetric dimethyl arginine (SDMA) concentration and renal shear wave velocity (SWV) using two-dimensional SWE (2D SWE) in dogs with CKD. OBJECTIVES: This study aimed to evaluate the diagnostic capability of 2D SWE in dogs with CKD and to assess the relationship between renal SWV and SDMA concentration. METHODS: Dogs with healthy kidneys and dogs with CKD underwent 2D SWE and SDMA assay. Renal stiffness was estimated as renal SWV in m/s. RESULTS: SDMA concentration had a weak positive correlation with the left (r = 0.338, p = 0.022) and right renal SWV (r = 0.337, p = 0.044). Renal SWV was not significantly different between healthy kidney and CKD groups in the left (p = 0.085) and right (p = 0.171) kidneys. CONCLUSIONS: 2D SWE may could not distinguish between dogs with healthy kidney and dogs with early stage of CKD, but it would be useful for assessing the serial change of renal function in dogs.

Radiographic assessment of splenic size and correlation with splenic measurements estimated by use of computed tomography in healthy cats.

OBJECTIVE: To investigate radiographic variables for correlation with splenic size as estimated with CT in cats. ANIMALS: 38 healthy adult cats. PROCEDURES: The width and height of the splenic head and total length, segmental length, and width of the spleen were measured on radiographic and CT images obtained from 10 cats in prospective, exploratory experiments. Distance between the splenic head and left kidney, anatomic locations of the head and tail of the spleen, and CT-derived splenic volume were also assessed. Correlation and agreement between radiographic and CT measurements and interobserver agreement for measurements with each method were determined. A retrospective evaluation of radiographs obtained without sedation or anesthesia for 28 cats was performed to establish preliminary guidelines for the measurement deemed the most reliable estimator of splenic size. RESULTS: Radiographic measurements of total and segmental splenic length were significantly correlated with the respective CT measurements and with splenic volume. Agreement between radiographic and CT measurements of segmental length was good; interobserver agreement was excellent for all variables. In retrospective evaluations, median segmental length of the spleen was 57.87 mm (range, 34.72 to 105.44 mm) on radiographs; the caudal border of the splenic head on lateral views was located from the cranial part of L1 to the caudal part of L2, and the caudal border of the splenic tail on ventrodorsal views was located from the caudal part of L2 to the caudal part of L5. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that segmental length of the spleen on radiographs is a reliable estimator of splenic size in healthy cats.

Diet-Related Mobile Apps to Promote Healthy Eating and Proper Nutrition: A Content Analysis and Quality Assessment.

Dietary mobile applications (apps) continue to hold promise for facilitating a healthy diet and managing nutrition. However, few studies have objectively evaluated the content and quality of such apps in Korea. The present study assessed the content and quality of dietary mobile apps using the Mobile App Rating Scale (MARS). We selected 29 dietary apps based on keywords and eligibility criteria for inclusion in the analyses. We conducted regression analyses to examine the association between app content and MARS scores. Most of the apps featured a tracking tool, while few featured rewards or follow-up management. Our quality assessment revealed that the top-rated apps have distinct levels of quality in terms of MARS scores. The regression analyses showed that the ways in which the apps provide information and motivate the users are statistically significant predictors of app quality. Our findings may facilitate the selection of dietary apps in Korea and provide guidelines for app developers regarding potential improvements in terms of content and quality.

Assessment of neovascularization during bone healing using contrast-enhanced ultrasonography in a canine tibial osteotomy model: a preliminary study.

Blood perfusion of skeletal muscle and callus was evaluated using contrast-enhanced ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.

Assessment of a split-bolus computed tomographic enterography technique for simultaneous evaluation of the intestinal wall and mesenteric vasculature of dogs.

OBJECTIVE: To investigate the diagnostic usefulness of split-bolus CT enterography in dogs. ANIMALS: 6 healthy Beagles. PROCEDURES: CT enterography was performed in all dogs in a nonrandomized crossover study design involving 3 techniques: a dual-phase technique and 2 techniques involving splitting of the administered contrast agent dose (ie, split technique and split-bolus tracking technique). For the 2 techniques involving dose splitting (ie, split CT enterography), contrast agent was injected twice, with the first injection consisting of 60% of the total dose, followed by injection of the remaining 40%. Then, a single set of CT images was obtained when the arterial and venous phases matched (dual-phase and split techniques) or when enhancement of the abdominal aorta reached 100 HU (split-bolus tracking technique). Enhancement of the intestinal wall and mesenteric vessels was assessed qualitatively and quantitatively. RESULTS: The total number of images required for interpretation was significantly lower for the split technique than for the dual-phase technique. The amount of time needed to complete CT enterography was significantly less for the split-bolus tracking technique than for the other 2 techniques. For all 3 techniques, adequate contrast enhancement of the mesenteric vessels and intestinal wall was achieved. The split technique provided contrast enhancement of the intestinal wall and mesenteric vessels similar to that provided with the dual-phase technique, whereas contrast enhancement of these structures was lowest for the split-bolus tracking technique. CONCLUSIONS AND CLINICAL RELEVANCE: Split-bolus CT enterography at a contrast agent allocation ratio of 60:40 enabled simultaneous evaluation of the enhanced intestine wall and mesenteric vessels and yielded image quality similar to that of dual-phase CT enterography in healthy dogs.

Effect of radiographic technique on assessment of liver size in Beagles.

OBJECTIVE To investigate the effects of respiratory phase, body position, beam center location, and gastric distention on radiographic assessment of liver size in dogs. ANIMALS 12 Beagles. PROCEDURES Liver length and the ratio of liver length to T11 length were determined on lateral radiographic views obtained with various techniques. Images were acquired at maximal expiration or maximal inspiration, with dogs in right or left recumbency, with the beam centered on the caudal border of the scapula or the 13th rib, and after food was withheld or with gastric distention. Effects on organs adjacent to the liver were assessed with CT. Changes of the thoracic cavity during the respiratory cycle were investigated with fluoroscopy. RESULTS Liver length was significantly greater on radiographs obtained at maximal expiration than at maximal inspiration, but there was no increase in the ratio of liver length to T11 length. Body position, beam center location, and gastric distention did not significantly affect liver size. For CT, location of the spleen and stomach and location or size of the liver did not change markedly between right and left recumbency. Fluoroscopy revealed that thoracic width was less at maximal expiration than maximal inspiration. CONCLUSIONS AND CLINICAL RELEVANCE Liver length was greater at maximal expiration than at maximal inspiration because of a smaller thoracic width. Body position, beam center location, and gastric distention did not affect liver length. The ratio of liver length to T11 length was not significantly affected by any of the factors investigated.

Comparison of elastography, contrast-enhanced ultrasonography, and computed tomography for assessment of lesion margin after radiofrequency ablation in livers of healthy dogs.

OBJECTIVE To assess by use of various diagnostic imaging modalities acute changes in livers of healthy dogs after radiofrequency ablation (RFA) and determine the capability of each imaging modality to monitor ablation lesion changes. ANIMALS 6 healthy Beagles. PROCEDURES 12 ablation lesions were created in the liver of the dogs (2 lesions/dog). Ablation lesions were evaluated by use of conventional ultrasonography, strain elastography, and contrast-enhanced ultrasonography immediately after (time 0), 30 to 60 minutes after, and 3 days after RFA, and by use of CT 30 minutes and 3 days after RFA. Three dogs were euthanized shortly after RFA, and the other 3 dogs were euthanized on day 3. Lesion size measured by each imaging modality was compared with necropsy findings. RESULTS Immediately after RFA, clear margins were more visible with elastography and contrast-enhanced ultrasonography than with conventional ultrasonography, which had acoustic shadowing. On triphasic contrast CT, the ablation zone, which indicated necrosis and hemorrhage, was not enhanced and could be measured. Marked enhancement of the periablation rim was observed during the venous phase and was identified as granulation tissue. Size of the ablation area measured on enhanced CT images was strongly correlated with actual lesion size. CONCLUSIONS AND CLINICAL RELEVANCE For dogs of this study, CT was the most reliable method for lesion size determination. Although ultrasonographic imaging measurements underestimated lesion size, all modalities could be used to provide additional real-time guidance for RFA procedures of the liver as well as for other RFA procedures.

Repetitive ultrasonographic assessment of adrenal size and shape changes: a clue for an asymptomatic sex hormone-secreting adenoma.

Diagnosis of an adrenal tumor without typical clinical signs related to hyperadrenocorticism and elevated alkaline phosphatase is challenging. This report describes a sex hormone-secreting adrenal tumor in a 10-year-old castrated male Shih Tzu evaluated through repetitive ultrasonographic examination. An adrenocorticotropic hormone stimulation test revealed elevated concentrations of androstenedione and 17-hydroxyprogesterone but a normal cortisol concentration. A mass was surgically excised and adenoma was diagnosed histopathologically. In the present case, adrenal tumor was strongly suspected based on a gradual increase in adrenal size and a change from peanut shape to an irregular mass on repetitive ultrasonography. Repetitive ultrasonographic examination of the adrenal gland is recommended when an abnormal ultrasonographic appearance of adrenal gland is identified, even in an asymptomatic dog.

Quantitative computed tomographic assessment of bone mineral density changes associated with administration of prednisolone or prednisolone and alendronate sodium in dogs.

OBJECTIVE: To evaluate whether a low-dosage regimen of prednisolone induces bone loss and whether administration of alendronate sodium prevents glucocorticoid-induced osteopenia in dogs by measuring trabecular bone mineral density (BMD) with quantitative CT. ANIMALS: 8 healthy Beagles. PROCEDURES: In 4 dogs, prednisolone was administered PO at a dosage of 2 mg/kg once daily for 2 weeks, 1 mg/kg once daily for 4 weeks, and 0.5 mg/kg once daily for 3 weeks. In the other 4 dogs, alendronate sodium (2 mg/kg, PO, q 24 h) was whether administered for 9 weeks in addition to the same dosage of prednisolone used in the prednisolone-treated dogs. Before (day 0 [baseline]) and 21, 42, 63, and 150 days after the start of treatment, BMD of the lumbar vertebrae was measured by quantitative CT. RESULTS: BMD in the prednisolone treatment group decreased to 84.7% of the baseline value on day 42, increased to 87.9% on day 63, and recovered to 91.6% on day 150. In the prednisolone-alendronate treatment group, BMD decreased to 91% of the baseline value on day 21, increased to 93.8% on day 63, and then recovered to 96.7% on day 150. Bone mineral density in the prednisolone treatment group was generally lower, albeit not significantly, than that of the prednisolone-alendronate treatment group on each examination day. CONCLUSIONS AND CLINICAL RELEVANCE: BMD temporarily decreased after low-dosage prednisolone administration; however, it gradually improved during tapering of the prednisolone dosage. These results have suggested that a low dosage of prednisolone can be used with little concern for development of osteopenia in dogs.