Artificial intelligence in the management and treatment of burns: A systematic review and meta-analyses.

INTRODUCTION AND AIM: Artificial Intelligence (AI) is already being successfully employed to aid the interpretation of multiple facets of burns care. In the light of the growing influence of AI, this systematic review and diagnostic test accuracy meta-analyses aim to appraise and summarise the current direction of research in this field. METHOD: A systematic literature review was conducted of relevant studies published between 1990 and 2021, yielding 35 studies. Twelve studies were suitable for a Diagnostic Test Meta-Analyses. RESULTS: The studies generally focussed on burn depth (Accuracy 68.9%-95.4%, Sensitivity 90.8% and Specificity 84.4%), burn segmentation (Accuracy 76.0%-99.4%, Sensitivity 97.9% and specificity 97.6%) and burn related mortality (Accuracy >90%-97.5% Sensitivity 92.9% and specificity 93.4%). Neural networks were the most common machine learning (ML) algorithm utilised in 69% of the studies. The QUADAS-2 tool identified significant heterogeneity between studies. DISCUSSION: The potential application of AI in the management of burns patients is promising, especially given its propitious results across a spectrum of dimensions, including burn depth, size, mortality, related sepsis and acute kidney injuries. The accuracy of the results analysed within this study is comparable to current practices in burns care. CONCLUSION: The application of AI in the treatment and management of burns patients, as a series of point of care diagnostic adjuncts, is promising. Whilst AI is a potentially valuable tool, a full evaluation of its current utility and potential is limited by significant variations in research methodology and reporting.

Free functioning gracilis transfer for brachial plexus reconstruction using the internal mammary vessels as recipients: A case report.

Adult brachial plexus injuries are often associated with concomitant trauma to the axillary or subclavian vessels. In patients planned for free functioning gracilis transfer (FFGT) this poses a challenge to reconstructive surgeons where using the standard donor vessels can lead to endangering the circulation in the affected extremity or risk flap loss due to the poor perfusion pressures. This case report describes the use of a FFGT for upper limb reconstruction in a 22-year-old patient with a pan plexus injury and concomitant axillary artery injury following a high energy motorcycle accident. Ipsilateral internal mammary vessels were used as donor vessels after removing the 3rd and 4th costal cartilages. The gracilis muscle was harvested in its whole length, including a small transverse skin paddle, and transferred to the upper extremity. It was secured to the clavicle proximally, weaved into the Flexor Digitorum Profundus tendons distally and neurotised by the spinal accessory nerve. The procedure and postoperative course were uneventful and the follow up at 18 months showed MRC grade 4 in elbow flexion with only a slight contour deformity at the donor chest site. This is the first report demonstrating the use of internal mammary vessels for FFGT reconstruction in the upper extremity after removing two costal cartilages to achieve sufficient pedicle length.

Opsoclonus-myoclonus syndrome associated with a nasopharyngeal tumor in an adult: a case report.

INTRODUCTION: Opsoclonus-myoclonus syndrome is a rare autoimmune syndrome usually seen in children and very rarely in adults. It typically presents with a triad of opsoclonus, myoclonus and ataxia, and is most often associated with a tumor or after an infection or vaccination. Around half of all adult cases are paraneoplastic in origin, and isolated case reports include associations with lung, breast and ovarian cancers. To the best of our knowledge, this is the first-ever reported case of paraneoplastic opsoclonus-myoclonus syndrome occurring in association with a nasopharyngeal carcinoma. CASE PRESENTATION: A 50-year-old British Caucasian woman presented with left-sided otalgia and subjective hearing loss. Over the coming weeks she developed subacute confusion and dizziness, leading to recurrent falls. Her clinical examination revealed opsoclonus, myoclonus and signs of cerebellar dysfunction. Subsequent magnetic resonance imaging revealed a left-sided nasopharyngeal carcinoma, which was confirmed on biopsy. A tapering dose of steroids and a five-day course of intravenous immunoglobulins, followed by a combination of chemo-radiotherapy for the nasopharyngeal carcinoma, led to a significant clinical improvement. At six months follow-up she had no signs of focal neurological deficit, apart from the inability to tandem walk. We believe that the typical clinical features, presence of a tumor and response to treatment support a paraneoplastic aetiology. CONCLUSIONS: We show that a nasopharyngeal carcinoma can be associated with adult onset opsoclonus-myoclonus syndrome. Both neurologists and otorhinolaryngologists must be aware of such a presentation. Prognosis of the syndrome depends on early and adequate management of the tumor, therefore prompt identification of the syndrome and the underlying tumor is essential.