An intrinsically interpretable neural network architecture for sequence-to-function learning.

MOTIVATION: Sequence-based deep learning approaches have been shown to predict a multitude of functional genomic readouts, including regions of open chromatin and RNA expression of genes. However, a major limitation of current methods is that model interpretation relies on computationally demanding post hoc analyses, and even then, one can often not explain the internal mechanics of highly parameterized models. Here, we introduce a deep learning architecture called totally interpretable sequence-to-function model (tiSFM). tiSFM improves upon the performance of standard multilayer convolutional models while using fewer parameters. Additionally, while tiSFM is itself technically a multilayer neural network, internal model parameters are intrinsically interpretable in terms of relevant sequence motifs. RESULTS: We analyze published open chromatin measurements across hematopoietic lineage cell-types and demonstrate that tiSFM outperforms a state-of-the-art convolutional neural network model custom-tailored to this dataset. We also show that it correctly identifies context-specific activities of transcription factors with known roles in hematopoietic differentiation, including Pax5 and Ebf1 for B-cells, and Rorc for innate lymphoid cells. tiSFM's model parameters have biologically meaningful interpretations, and we show the utility of our approach on a complex task of predicting the change in epigenetic state as a function of developmental transition. AVAILABILITY AND IMPLEMENTATION: The source code, including scripts for the analysis of key findings, can be found at https://github.com/boooooogey/ATAConv, implemented in Python.

Diagnostic value of machine learning-based computed tomography texture analysis for differentiating multiple myeloma from osteolytic metastatic bone lesions in the peripheral skeleton.

OBJECTIVES: To report the diagnostic performance of machine learning-based CT texture analysis for differentiating multiple myeloma from osteolytic metastatic bone lesions in the peripheral skeleton. METHODS: We retrospectively evaluated 172 patients with multiple myeloma (n = 70) and osteolytic metastatic bone lesions (n = 102) in the peripheral skeleton. Two radiologists individually used two-dimensional manual segmentation to extract texture features from non-contrast CT. In total, 762 radiomic features were extracted. Dimension reduction was performed in three stages: inter-observer agreement analysis, collinearity analysis, and feature selection. Data were randomly divided into training (n = 120) and test (n = 52) groups. Eight machine learning algorithms were used for model development. The primary performance metrics were the area under the receiver operating characteristic curve and accuracy. RESULTS: In total, 476 of the 762 texture features demonstrated excellent interobserver agreement. The number of features was reduced to 22 after excluding those with strong collinearity. Of these features, six were included in the machine learning algorithms using the wrapper-based classifier-specific technique. When all eight machine learning algorithms were considered for differentiating multiple myeloma from osteolytic metastatic bone lesions in the peripheral skeleton, the area under the receiver operating characteristic curve and accuracy were 0.776-0.932 and 78.8-92.3%, respectively. The k-nearest neighbors model performed the best, with the area under the receiver operating characteristic curve and accuracy values of 0.902 and 92.3%, respectively. CONCLUSION: Machine learning-based CT texture analysis is a promising method for discriminating multiple myeloma from osteolytic metastatic bone lesions.

Comparison of retinal and choroidal changes in Fuchs' uveitis syndrome.

PURPOSE: The assessment of retinal and choroidal changes in eyes with unilateral Fuchs uveitis syndrome (FUS) with the fellow eye and healthy control group. METHODS: Thirty-nine unilateral FUS patients and 42 healthy control subjects were enrolled. Spectralis domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering GmbH, Heidelberg, Germany) was used to evaluate retinal and choroidal structures. Retinal and choroidal thicknesses were recorded from OCT images. Choroidal images were binarized to calculate choroidal vascularity index (CVI) with ImageJ 1.52 s (National Institutes of Health, Bethesda, MD, USA) program. RESULTS: CVI was found to be significantly lower in the FUS group compared to the fellow eyes and healthy control groups (p = 0.039 and p = 0.046, respectively). There was no significant difference in central choroidal thickness in the FUS group compared to the fellow eyes and control groups (p = 0.552 and p = 0.321, respectively). There was no statistically significant difference between the 3 groups in terms of macular thickness in all quadrants (p > 0.05 for all quadrants). CONCLUSIONS: Affected eyes tend to decrease in CVI, while there is no difference in retinal and central choroidal thicknesses in patients with FUS compared to eyes of other unaffected eyes and healthy individuals. It may be because the chronic inflammation associated with the disease affects the vascular structure of the choroid.

Evaluation of the reliability, utility, and quality of the lid loading videos on YouTube.

PURPOSE: It is aimed to determine the utility, reliability and quality of the lid loading videos on YouTube, a video sharing platform. METHODS: A YouTube searches were made with the keywords 'Eyelid Loading,' 'Gold Weight Implantation,' 'Lid Loading for Lagophthalmos' (without user login, cleared search history, in incognito tab). A total of 75 videos were recorded. Length of videos (seconds), number of views, uploaded source (doctor/health institution/medical channel), number of subscribers, number of likes, time since uploading (days), video content (surgical/theoretical information), type of narration (verbal narration/subtitle) were recorded. DISCERN, The Journal of the American Medical Association (JAMA), and Global Quality Scores of the videos were evaluated and recorded by two experienced oculoplastic surgeons (KSC, HT). RESULTS: After the exclusion criteria, the remaining 46 videos were included in the study. The mean DISCERN score was 25.17 ± 6.88 (very poor quality), the JAMA score was 0.79 ± 0.63 (very poor quality), and GQS was 2.84 ± 1.03 (medium quality). Thirty videos (65.2%) had verbal narration, and 16 videos (34.8%) had subtitled narration. The DISCERN score and GQS were significantly higher in the videos with verbal narration compared to the narration with subtitles (p < 0.05). All three scores were positively correlated with each other. There was also a positive correlation between video length, number of subscribers, and DISCERN score. CONCLUSIONS: The videos about lid loading on YouTube are of poor reliability, accuracy, and educational quality. The duration of the video and the type of narration can be kept in the foreground when choosing the video. Experts must review the content that is uploaded to websites like YouTube.

The Effect of Abdominal Anatomy on the Measurement of Bone Mineral Density With Dual-Energy X-Ray Absorptiometry.

OBJECTIVE: This study aimed to assess the effects of abdominal fat content and anatomical changes on the measurement of bone mineral density using dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS: The bone mineral density measurements were performed with quantitative computed tomography for patients who underwent DXA and abdominal CT on the same day. The effects of abdominal fat content and anatomic changes on the results of DXA were assessed. RESULTS: Of the 43 patients, 88.3% were women, 11.7% were men, and the mean age was 55.6 years (range, 32-72). There was a significant relationship between the error in the measurement of T-scores with DXA and osteophytic new bone formation (P = 0.011). There were significant relationships between the error in detecting osteoporosis with DXA and osteophytic new bone formation, facet joint degeneration, and aortic calcification (P < 0.05). CONCLUSIONS: Abdominal fat content does not significantly affect T-scores. However, DXA can give false-negative results in detecting osteoporosis, especially in patients with osteophyte new bone formation, facet joint degeneration, and aortic calcifications, all conditions primarily in elderly patients. In these cases, it is more appropriate to use quantitative computed tomography instead of DXA.

Computed tomography characteristics of multiple myeloma and other osteolytic metastatic bone lesions.

BACKGROUND: Differentiation of multiple myeloma (MM) from osteolytic metastatic (OM) bone lesions may be critical in patients with lytic bone lesions but can be challenging for radiologists. PURPOSE: To determine whether computed tomography (CT) can be used to distinguish between MM and other OM bone lesions. MATERIAL AND METHODS: In this retrospective study, 320 lesions of 207 patients diagnosed with MM or OM, based on biopsy or clinical examination, were evaluated. Eight qualitative features were evaluated by two radiologists blinded to the diagnoses. The chi-square and Fisher exact tests, and logistic regression analysis, were used to evaluate the relationships between the CT findings and diagnoses. RESULTS: High-density areas were more common in OM than MM lesions (85.2% and 19%, P < 0.001), as were perilesional sclerosis (38.9% vs. 13.2%, P < 0.001), heterogeneity (on non-contrast CT images, 60% vs. 19.1%, P < 0.001; on contrast enhanced CT images, 80.6% vs. 28.2%, P < 0.001), and ill-defined margins (34.6% vs. 9.1%, P < 0.001). Similarly, OM lesions showed high-density areas more than MM in evaluation of skeletal system subgroups (vertebrae, 93.8% vs. 29.8%, P < 0.0001; thoracic cage bones, 69.6% vs. 19.2%, P < 0.001; pelvic bones and sacrum, 84.8% vs. 7.7%, P < 0.001; peripheral skeletal bones, 81.5% vs. 8.3%, P < 0.001). Logistic regression analysis revealed that the presence of a high-density area in the lesion increased the probability of a metastasis 25.88-fold (R2 = 0.516, P < 0.001). CONCLUSION: MM and OM lesions can be differentiated by CT; OM lesions exhibit high- density areas.

Estimation of sex using morphometric measurements performed on cranial computerized tomography scans.

We aimed to evaluate the usefulness of morphometric measurements performed on cranial computerized tomography (CT) images for the estimation of sex. A retrospective study was performed in the radiology department of a tertiary care center using data collected from cranial CT scans of 616 Caucasian cases (307 women, 309 men) with an average age of 44.70 ± 16.43. The parameters under investigation consisted of maximum cranial length (MCL), minimum frontal breadth, bi-zygomatic breadth (BZB), parietal chord, maximum cranial breadth, bi-mastoid diameter (BIM) and the length of cranial base. Any statistically significant difference in terms of these parameters was found between males and females. In our series, women were remarkably older than men (47.56 ± 15.87 vs. 41.39 ± 16.43; p < 0.001). We observed that there was a statistically significant difference between males and females concerning all morphometric measurements and males displayed higher values in terms of all parameters (p < 0.001, for all). The variables with the most successful performance for discrimination of gender were BZB (89.2%), MCL (87.4%) and BIM (84.8%). The concomitant use of these morphometric measurements seems to improve the accuracy of sex estimation. We suggest that morphometric measurements performed on cranial CT images can be useful for the estimation of sex.

Evaluation of computed tomography images of calcaneus for estimation of sex.

Estimation of sex from bone remnants after medicolegal issues or mass disasters constitute a challenge. Our objective was to investigate if morphometric measurements performed on computed tomography (CT) images of the calcaneus can be useful for sex estimation. The measurements were performed on CT images of calcaneus bones of 489 patients (203 women, 286 men). The parameters under investigation were maximum length (MAXL), load arm length (LAL), minimum breadth (MINB), body height (BH), maximum height (MAXH), dorsal articular facet length (DAFL), dorsal articular facet breadth (DAFB), and cuboidal facet height (CFH). All parameters were remarkably increased in men compared to women (p < 0.001, for all). The highest performances for sex estimation were displayed by DAFL (92.8%) and BH (92.6%). The concomitant use of variables MAXL, BH, CFH, and DAFL revealed accuracy as high as 96% for gender discrimination. We suggest that morphometric measurements performed on CT images of the calcaneus can provide useful data for the estimation of sex.

Inflammatory rheumatic diseases in patients with ochronotic arthropathy.

BACKGROUND: Ochronotic arthropathy (OcA) refers to excessive homogentisic acid (HGA) deposition in the musculoskeletal system. Our current understanding of OcA is limited, as there are less than a thousand alkaptonuria (AKU) cases reported in the literature. Herein, we investigated the rheumatological manifestations of OcA in a group of adult AKU patients. METHODS: Adult AKU patients with symptoms suggestive of OcA were included. Patients underwent a detailed rheumatological assessment. Laboratory testing, including autoantibodies and radiological investigations such as conventional X-rays, and magnetic resonance imaging (MRI) were performed. RESULTS: Eight out of 12 (66%) patients had symptoms consistent with OcA. The median age at OcA symptoms was 36 (27-48) years, and the presenting symptom was back pain in 87.5% of the patients. All patients had chronic back pain, and three (37.5%) had an inflammatory type of pain character. Radiographic sacroiliitis based on X-rays was present in 2 (25%) cases. MRI of the sacroiliac joints documented bone marrow edema in five (62.5%), and spinal MRI identified corner inflammatory lesions in three patients (37.5%). One patient (12.5%) had rheumatoid arthritis. Extra-articular involvement, including enthesitis (n = 1; 12.5%), interstitial lung disease (n = 1; 12.5%), and scleritis (n = 1; 12.5%), was also noted. CONCLUSION: The frequent occurrence of OcA-related inflammatory manifestations in our patients contradicts the conventional concept of OcA as a non-inflammatory disorder. The activation of inflammatory pathways, possibly by the HGA products, may responsible for this condition.Significance and innovationsAbout three-fourths of adult ochronotic arthropathy (OcA) patients in our group had associated inflammatory disease.OcA associated inflammatory diseases were showing a severe phenotypeNearly half of the OcA patients required early prosthesis operations compared to their healthy counterparts.

Pyomyositis and muscle abscess due to Salmonella enteritidis in a patient with Behçet's syndrome: a case report.

Salmonella infections usually present with gastrointestinal manifestations including enterocolitis especially in immunocompromised patients. Haematogenous dissemination and abscesses are very rare complications of Salmonella species. This case report documents a patient with Behçet's syndrome (BS) who has pyomyositis due to Salmonella species. A 43-year-old male patient with BS presented to the outpatient rheumatology clinic with bilateral acute-onset lower extremity pain. However, over a short time the pain gradually increased and was accompanied by fever. The magnetic resonance scans demonstrated pyomyositis and muscle abscess in the adductor and obturator muscles. The cultures showed Salmonella enteritidis infection. The patient was successfully treated with antibiotic therapy. This case is important since it is one of the first in the literature to report an adult patient with BS and Salmonella pyomyositis.

Evaluation of vertebral bone mineral density in scoliosis by using quantitative computed tomography.

PURPOSE: Scoliosis is described as a lateral curvature of the spine. We aimed to evaluate bone mineral density (BMD) in patients with scoliosis by using quantitative computed tomography (QCT) and compare the BMD of idiopathic and congenital scoliosis patients. MATERIAL AND METHODS: Forty-three patients aged 1 to 40 years with idiopathic, congenital, or neuromuscular scoliosis and 41 matched controls of the same sex and approximate age were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5, and mean BMD was calculated for each case. RESULTS: Twenty-two of the patients with scoliosis were idiopathic, 15 were congenital, four were neuromuscular, and two were neurofibromatosis. The mean BMD values of patients with scoliosis were significantly lower compared with the control group (106.8 ± 33.4 mg/cm3 vs. 124.9 ± 29.1 mg/cm3, p = 0.009). No significant difference in BMD values was found between idiopathic and congenital scoliosis patients (p > 0.05). CONCLUSIONS: This study illustrated that the vertebral body BMD values of the patients with scoliosis were significantly lower than those seen in the control group.

Measurement of regional trabecular bone attenuation of the knee following anterior cruciate ligament rupture.

INTRODUCTION: The purpose of this study was to determine regional trabecular bone attenuation changes of the knee using computed tomography after anterior cruciate ligament rupture. MATERIALS AND METHODS: Thirty one patients'-computed tomography images of the injured knees were used to measure trabecular bone attenuation in seven predetermined regions. RESULTS: Trabecular bone attenuation at four of seven regions (anteromedial area of the proximal tibia, anterolateral area of the proximal tibia, posteromedial area of the proximal tibia, and posterocentral area of the proximal tibia) was negatively correlated with the duration after injury. Independent negative correlation between the duration after injury and the density in anteromedial area of the proximal tibia was detected. CONCLUSIONS: After anterior cruciate ligament injury, trabecular bone attenuation of the knee decreases by time in certain regions of proximal tibia. Anteromedial region is the most significantly effected of all, which it is the anterior cruciate ligament fixation area.

Cardiac function and cardiac events 1-year postpartum in women with congenital heart disease.

BACKGROUND: Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in women with CHD. METHODS: From our national, prospective multicenter cohort study, 172 women were studied. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement were performed during pregnancy and 12 months postpartum. Cardiovascular events were defined as need for an urgent invasive cardiovascular procedure, heart failure, arrhythmia, thromboembolic events, myocardial infarction, cardiac arrest, cardiac death, endocarditis, and aortic dissection. RESULTS: Cardiovascular events were observed after 11 pregnancies (6.4%). Women with cardiovascular events postpartum had significant higher NT-proBNP values at 20-week gestation (191 [137-288] vs 102.5 [57-167]; P = .049) and 1-year postpartum compared with women without cardiovascular events postpartum (306 [129-592] vs 105 [54-187] pg/mL; P = .014). Women with cardiovascular events during pregnancy were at higher risk for late cardiovascular events (HR 7.1; 95% CI 2.0-25.3; P = .003). In women with cardiovascular events during pregnancy, subpulmonary end-diastolic diameter had significantly increased 1-year postpartum (39.0 [36.0-48.0] to 44.0 [40.0-50.0]; P = .028). No other significant differences were found in cardiac function or size 1-year postpartum compared with preconception values. CONCLUSIONS: Cardiovascular events are relatively rare 1 year after pregnancy in women with CHD. Women with cardiovascular events during pregnancy are prone to develop cardiovascular events 1-year postpartum and have increased subpulmonary ventricular diameter compared with preconception values.

N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease.

AIMS: In women with congenital heart disease (CHD), cardiovascular complications during pregnancy are common, but the risk assessment of these patients remains difficult. This study sought to determine the independent role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in addition to other parameters in predicting adverse cardiovascular events during pregnancy in women with CHD. METHODS AND RESULTS: We conducted a national, prospective multicentre cohort study. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement was performed at 20-week gestation. Adverse cardiovascular events occurred in 10.3% of 213 pregnancies. N-terminal pro-B-type natriuretic peptide levels >128 pg/mL at 20-week gestation, the presence of a mechanical valve, and subpulmonary ventricular dysfunction before conception were independently associated with events [odds ratio (OR) 10.6 (P = 0.039), OR 12.0 (P = 0.016), and OR 4.2 (P = 0.041), respectively]. The negative predictive value of NT-proBNP levels <128 pg/mL was 96.9%. N-terminal pro-B-type natriuretic peptide levels >128 pg/mL at 20 weeks of gestation had an additional value in predicting the occurrence of adverse cardiovascular events on the top of the other identified predictors (area under the curve 0.90 vs. 0.78, P = 0.035). CONCLUSION: Increased NT-proBNP levels at 20 weeks of gestation are an independent risk predictor of cardiovascular events during pregnancy in women with CHD.

Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT.

The aims of this study are to evaluate diagnostic performance of conventional radiographs for wrist fractures using multidetector computerized tomography (MDCT) as a reference standard, to determine prevalence, demographic risk factors including age and sex, and associations among various wrist fractures. A retrospective study was performed, finding a total 455 patients (457 wrists) who had wrist trauma and who had undergone a radiography and subsequent MDCT examination during a 45-month period. The MDCT and radiographs of the patients were reviewed by two radiologists, and a consensus was obtained for the presence of fracture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of radiographs were calculated using MDCT findings as reference standard. The correlation of both age and sex between the presence of fracture was also analyzed. Of the 455 patients, 223 (49.0 %) had one or more fractures in wrist. A total of 302 (160 patients had one, 50 had two, 10 had three, and 3 had four) fractures were diagnosed in the wrist region. In 457 wrists, MDCT revealed 128 occult fractures missed by radiography. The overall sensitivity, specificity, PPV, and NPV of radiography for the detection of all wrist fractures were 57.8, 99.5, 87.4, and 97.4 %, respectively. The sensitivities of radiography ranged 0-41.2 % for other carpal bone except scaphoid (66 %) fractures and 66.7-80 % for the proximal metacarpus, distal ulna, and radius fractures. Wrist fractures appear to be overlooked on radiography. Further imaging should be warranted for patients who are clinically suspicious for wrist fracture in emergency rooms.

Uteroplacental blood flow, cardiac function, and pregnancy outcome in women with congenital heart disease.

BACKGROUND: Pregnant women with congenital heart disease (CHD) are susceptible to cardiovascular, obstetric, and offspring complications. In women with CHD, cardiac dysfunction may compromise uteroplacental flow and contribute to the increased incidence of obstetric and offspring events. METHODS AND RESULTS: We performed a prospective multicenter cohort study of pregnant women with CHD and healthy pregnant women. We compared clinical, laboratory, echocardiographic, and uteroplacental Doppler flow (UDF) parameters at 20 and 32 weeks gestation, and pregnancy outcome. We related cardiovascular parameters to UDF parameters and pregnancy outcome in women with CHD. We included 209 women with CHD and 70 healthy women. Cardiovascular parameters (N-terminal pro-B-type natriuretic peptide, left and right ventricular function) differed between both groups. UDF parameters were impaired in CHD women (umbilical artery pulsatility and resistance index at 32 weeks in CHD versus healthy women, P=0.0085 and P=0.017). The following cardiovascular parameters prepregnancy and at 20 weeks gestation were associated with UDF (umbilical artery resistance index) at 32 weeks at multivariable analysis: (1) right ventricular function (tricuspid annular plane systolic excursion) (P=0.002), (2) high N-terminal pro-B-type natriuretic peptide (P=0.085), (3) systemic (P=0.001), and (4) pulmonary (P=0.045) atrioventricular valve regurgitation. Women with CHD had more obstetric (58.9% versus 32.9%, P<0.0001) and offspring events (35.4% versus 18.6%, P=0.008) than healthy women. Impaired UDF was associated with adverse obstetric and offspring outcome. CONCLUSIONS: UDF parameters are abnormal in pregnant women with CHD. Cardiovascular function is associated with an abnormal pattern of UDF. Compromised UDF may be a key factor in the high incidence of offspring and obstetric complications in this population.

The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear.

Subcoracoid impingement leads to anterior shoulder pain, and arthroscopic subcoracoid decompression (coracoplasty) is the preferred treatment in recalcitrant cases. The purpose of the present study was to evaluate the effect of coracoplasty on the severity of anterior shoulder pain and the strength of the subscapularis muscle and to correlate it with the preoperative and postoperative coracohumeral distance (CHD) (t:transverse, s:sagittal). Sixteen patients without any subscapularis tendon tears who underwent arthroscopic subcoracoid decompression and rotator cuff repair with 2 years follow-up were included. Preoperative and postoperative 2-year assessments of function and pain were performed using the modified Kennedy-Hawkins test, power grading of various subscapularis muscle tests, and ASES scores. Preoperative and postoperative coracohumeral distance (tCHD, sCHD) and coracoid overlap (CO) were measured using MRIs before and after surgery. The Mean Hawkins pain score and coracoid overlap were decreased. The strength scores for subscapularis strength testing, ASES score, maximum degree of internal rotation, and coracohumeral distance increased (P < .05). Changes in belly press strength were negatively correlated with postoperative tCHD (r = -0.6, P = .04) and postoperative sCHD (r = -0.7, P = .008). A significant increase in the internal rotation range of the shoulder, subscapularis strength, and relief of anterior shoulder pain was observed. However, this increase was inversely proportional to the postoperative CHD, indicating the mechanical effect of the coracoid on subscapularis strength.

Factors affecting medium-term patient satisfaction after arthroscopic repair of small to medium-sized rotator cuff tears: An observational study.

This study aimed to assess the effect of the status of the tendon and patient factors on patient satisfaction after rotator cuff repair. Forty-six patients treated for tears with a minimum of 5-year follow-up were included. Gender, age, and active smoking status were recorded. Pain visual analogue scale, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Simple Shoulder Test, and Single Assessment Numeric Evaluation were recorded preoperatively and at the last follow-up. Patients were divided into groups of highly satisfied (HS) and vaguely satisfied (VS) patients. Patients were evaluated with MRI both preoperatively and at their last follow-up. Of the 46 patients, 17 were HS and 29 were VS. The HS group had 7 re-ruptures, 4 of which were progressed tears, whereas the VS group had 15 re-ruptures, 4 of which were progressed tears. There was no difference in the rate of re-ruptures or progressed tears between groups. The HS group had a higher frequency of males. However, frequencies of active smoking or osteoarthritis of grade 2 or higher were lower in the HS group. It was shown that patient satisfaction after repair depends on patient-related factors like gender and smoking rather than tendon healing or degeneration.

Long-Term Outcomes of Adalimumab Treatment in Conventional Treatment-Resistant Serpiginous Choroiditis.

BACKGROUND/OBJECTIVES: To investigate the long-term efficacy and safety of adalimumab(ADA) in the treatment of patients with serpiginous choroiditis (SC) refractory to conventional therapy through quantitative parameters. SUBJECTS/METHODS: A retrospective analysis was conducted on patients diagnosed with SC clinically and through fundus autofluorescence(FAF). Patients receiving ADA treatment were included. Demographic and clinical characteristics of the patients, association with tuberculosis (TB) infection, number of immunosuppressive therapies, recurrences, best corrected visual acuity (BCVA) change, and ADA-related side effects were recorded. The progression rate before and after ADA was calculated based on the area involved by FAF. RESULTS: Sixteen eyes of 8 patients (3 female/5 male) were enrolled to the study. The median (IQR) age was 53.5 (16.5) years. Diagnosis was SC in 4, ampiginous choroiditis in 3, and TB-related serpiginous-like choroiditis in 1 patient. Peripapillary involvement was present in 10 of 16 eyes. The area involved by FAF continued to progress under ADA treatment, however the progression rate was decreased (p = 0.143).The BCVA was preserved (p = 0.772). The number of systemic and local treatments decreased with ADA (p = 0.025 and 0.019, respectively). Additionally, the number of recurrences was reduced with ADA (p = 0.002). Median (IQR) follow-up was 45(28.75) months. Two patients experienced ADA-related side effects (pulmonary TBand rash). CONCLUSIONS: Our findings suggest a promising role for ADA in halting the progression of SC and have implications for improving outcomes. Despite the evidence in the literature at the level of case reports, ADA can be used effectively with close monitoring for potential risks.

Effect of cam resection depth on clinical outcomes after primary hip arthroscopy.

BACKGROUND: The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. AIM: The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. PATIENTS AND METHODS: All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (''D''mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view. RESULTS: We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years.Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). CONCLUSIONS: A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04).Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.