Deep Learning Method for Precise Landmark Identification and Structural Assessment of Whole-Spine Radiographs.

This study measured parameters automatically by marking the point for measuring each parameter on whole-spine radiographs. Between January 2020 and December 2021, 1017 sequential lateral whole-spine radiographs were retrospectively obtained. Of these, 819 and 198 were used for training and testing the performance of the landmark detection model, respectively. To objectively evaluate the program's performance, 690 whole-spine radiographs from four other institutions were used for external validation. The combined dataset comprised radiographs from 857 female and 850 male patients (average age 42.2 ± 27.3 years; range 20-85 years). The landmark localizer showed the highest accuracy in identifying cervical landmarks (median error 1.5-2.4 mm), followed by lumbosacral landmarks (median error 2.1-3.0 mm). However, thoracic landmarks displayed larger localization errors (median 2.4-4.3 mm), indicating slightly reduced precision compared with the cervical and lumbosacral regions. The agreement between the deep learning model and two experts was good to excellent, with intraclass correlation coefficient values >0.88. The deep learning model also performed well on the external validation set. There were no statistical differences between datasets in all parameters, suggesting that the performance of the artificial intelligence model created was excellent. The proposed automatic alignment analysis system identified anatomical landmarks and positions of the spine with high precision and generated various radiograph imaging parameters that had a good correlation with manual measurements.

Inhibition of the clinical isolates of Acinetobacter baumannii by Pseudomonas aeruginosa: In vitro assessment of a case-based study.

BACKGROUND: The global rise in nosocomial infections associated with gram-negative bacteria and the spread of multi-drug resistant Acinetobacter baumannii (MDR-AB) pose public health concerns. This study investigates the inhibitory effects and possible inhibitory mechanism of Pseudomonas aeruginosa (PA) on selected clinical strains of A. baumannii (AB) isolated from Taiwanese patients. METHODS: Four and eight clinical strains of AB and PA, respectively, were randomly selected from the bacterial collection of Feng-Yuan Hospital, Taiwan. Antimicrobial-susceptibility was performed on the AB strains. Inhibition potential of the PA strains against AB was assessed by measuring the inhibition zones. In vitro analysis using phenazine-1-carboxamide (PCN) was conducted to assess the possible inhibitory mechanism of PA, which was later confirmed in the clinical isolates by liquid chromatography-mass spectrometry. RESULTS: All the clinical AB strains showed resistance to the eleven antibiotics and were classified as MDR-AB. The nine PA strains exert either a high (PA3596, PA3681, PA3772, and ATCC27853) or a low (PA3613, PA3625, PA3712, PA3715, and PA3744) degree of inhibition against AB strains. 0.25 mg/ml PCN had a clearer inhibition zone than 0.05 mg/ml PCN, suggesting a dose-dependent inhibition of PCN on the AB strains. The four PA strains that demonstrated a high degree of inhibition had a relatively high amount of PCN. CONCLUSION: Selected strains of PA exert inhibitory actions on MDR-AB with PCN being a possible inhibitory agent. This finding raises the possibility of developing effective therapeutic antibiotics and disinfectant from specific components of PA for the treatment and control of Acinetobacter-associated infections in hospital settings.

Assessment of Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry.

Importance: Several randomized clinical trials have recently established the safety and efficacy of endovascular treatment (EVT) of acute ischemic stroke in the anterior circulation. However, it remains uncertain whether patients with acute basilar artery occlusion (BAO) benefit from EVT. Objective: To evaluate the association between EVT and clinical outcomes of patients with acute BAO. Design, Setting, and Participants: This nonrandomized cohort study, the EVT for Acute Basilar Artery Occlusion Study (BASILAR) study, was a nationwide prospective registry of consecutive patients presenting with an acute, symptomatic, radiologically confirmed BAO to 47 comprehensive stroke centers across 15 provinces in China between January 2014 and May 2019. Patients with acute BAO within 24 hours of estimated occlusion time were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Main Outcomes and Measures: The primary outcome was the improvement in modified Rankin Scale scores (range, 0 to 6 points, with higher scores indicating greater disability) at 90 days across the 2 groups assessed as a common odds ratio using ordinal logistic regression shift analysis, adjusted for prespecified prognostic factors. The secondary efficacy outcome was the rate of favorable functional outcomes defined as modified Rankin Scale scores of 3 or less (indicating an ability to walk unassisted) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage and 90-day mortality. Results: A total of 1254 patients were assessed, and 829 patients (of whom 612 were men [73.8%]; median [interquartile] age, 65 [57-74] years) were recruited into the study. Of these, 647 were treated with standard medical treatment plus EVT and 182 with standard medical treatment alone. Ninety-day functional outcomes were substantially improved by EVT (adjusted common odds ratio, 3.08 [95% CI, 2.09-4.55]; P < .001). Moreover, EVT was associated with a significantly higher rate of 90-day modified Rankin Scale scores of 3 or less (adjusted odds ratio, 4.70 [95% CI, 2.53-8.75]; P < .001) and a lower rate of 90-day mortality (adjusted odds ratio, 2.93 [95% CI, 1.95-4.40]; P < .001) despite an increase in symptomatic intracerebral hemorrhage (45 of 636 patients [7.1%] vs 1 of 182 patients [0.5%]; P < .001). Conclusions and Relevance: Among patients with acute BAO, EVT administered within 24 hours of estimated occlusion time is associated with better functional outcomes and reduced mortality.

Epidemiology and Medication Trends in Patients with Psoriasis: A Nationwide Population-based Cohort Study from Korea.

This study investigated the prevalence of psoriasis and trends in prescription of medications for patients with psoriasis using the Korean National Health Insurance Claims Database from 2006 to 2015. The prevalence of psoriasis and psoriatic arthritis per 10,000 people increased from 47.4 to 61.5 and from 0.04 to 0.23 respectively. The prescription of topical agents was a mean of 73.3%. For systemic agents, prescription of acitretin decreased from 74.8 to 44.5%, methotrexate showed a fluctuation, with a mean of 14.9% and cyclosporine increased from 9.0 to 41.2%. The prescription of biological agents increased sharply from 18 to 1,127 patients. Use of ustekinumab increased from 4.1 to 82.4%; use of infliximab decreased from 20.7 to 6.7% and etanercept decreased from 100 to 6.1%. This study showed an increasing trend in the prevalence of psoriasis. We also reported a rapid increase in the use of biologics in recent years.