Search Results (18,075)

Severe adult-acquired flatfoot deformity is widely addressed surgically via the Grice–Green subtalar arthrodesis. Standard radiographic measurements have been reported, but these are limited to planar views. These complex deformities and the relevant corrections after surgery should be assessed in weight-bearing using 3D analyses now enabled by modern cone-beam CT scans. The present study is aimed at reporting these 3D radiographical foot bone alignments and the clinical results for this surgery. Ten patients were treated with the Grice–Green procedure. This implies inserting an autologous bone graft from the proximal tibial into the extra-articular sinus-tarsi to perform a subtalar arthrodesis. Before and after surgery, the patients were assessed based on the clinical range-of-motion and Foot-Function and Posture Indexes. Three-dimensional models of the tibia, calcaneus, talus, navicular, and 1st metatarsus were reconstructed from cone-beam CT scans in a single-leg up-right posture. Relevant longitudinal axes were defined to calculate ten spatial angles. Post-operatively, a significant realignment was observed for seven angles, including corrections lift-up of the talus (on average by 15°) and subtalar joint (13° in 3D), as well as the Meary’s angle (21°). Only few correlations were found between traditional clinical and novel 3D radiographical measurements, suggesting the former only limitedly represent the corresponding real skeletal status, and the latter thus offer the physician a more comprehensive evaluation. The present original analysis from modern cone-beam CT scans shows precisely the correction of foot and ankle bone alignments achieved using the Grice–Green surgical procedure, finally in 3D and in weight-bearing. For the first time, traditional clinical and score system evaluations are reported together with bone orientation and joint angles in the three anatomical planes. Full article

Background: Transcutaneous auricular vagus nerve stimulation (taVNS) is effective in regulating mood and high-level cognition in patients with major depressive disorder (MDD). This study aimed to investigate the efficacy of taVNS treatment in patients with MDD and an altered brain topological organization of functional networks. Methods: Nineteen patients with MDD were enrolled in this study. Patients with MDD underwent 4 weeks of taVNS treatments; resting-state functional magnetic resonance imaging (rs-fMRI) data of the patients were collected before and after taVNS treatment. The graph theory method and network-based statistics (NBS) analysis were used to detect abnormal topological organizations of functional networks in patients with MDD before and after taVNS treatment. A correlation analysis was performed to characterize the relationship between altered network properties and neuropsychological scores. Results: After 4 weeks of taVNS treatment, patients with MDD had increased global efficiency and decreased characteristic path length (Lp). Additionally, patients with MDD exhibited increased nodal efficiency (NE) and degree centrality (DC) in the left angular gyrus. NBS results showed that patients with MDD exhibited reduced connectivity between default mode network (DMN)–frontoparietal network (FPN), DMN–cingulo-opercular network (CON), and FPN–CON. Furthermore, changes in Lp and DC were correlated with changes in Hamilton depression scores. Conclusions: These findings demonstrated that taVNS may be an effective method for reducing the severity of depressive symptoms in patients with MDD, mainly through modulating the brain’s topological organization. Our study may offer insights into the underlying neural mechanism of taVNS treatment in patients with MDD. Full article

Background: The concurrent presence of chronic hepatitis B virus (CHB) infection and metabolic dysfunction-associated steatotic liver disease (MASLD) presents a unique clinical scenario with implications that are not yet fully understood. This study aims to characterize the distinct clinical and virological features of CHB in the context of MASLD and evaluate its impact on disease progression and outcomes. Methods: Utilizing a comprehensive health maintenance organization database, this study included 1186 patients with CHB from 2000–2020. Patients were categorized into two groups: CHB-MASLD (n = 188) and CHB alone (n = 998). CHB diagnosis was confirmed by serological markers, while MASLD was diagnosed based on imaging and cardiometabolic risk factors. Comparative analysis and multiple regression models were applied to assess variables related to viral parameters and clinical outcomes. Results: The CHB-MASLD group was older (mean age of 45.2 vs. 39.1, p < 0.001) with higher rates of obesity (46.8% vs. 23.8%, p < 0.001), diabetes (36.2% vs. 17.3%, p < 0.001), and dyslipidemia. Distinct viral profiles included higher HBeAg negativity (96.2%), a higher rate of HBeAg-negative infection (70.4% vs. 63.8%; p < 0.001), and increased HBeAg seroconversion under treatment. Cirrhosis was more prevalent in the CHB-MASLD group (9.6% vs. 4.4%, p = 0.007), while HCC rates were comparable. Multivariate analysis identified age, male gender, chronic active hepatitis, and diabetes as predictors of cirrhosis. Conclusions: CHB-MASLD patients were distinguished by a higher prevalence of metabolic features, along with a distinct viral profile marked by increased chronic HBeAg infection, higher rates of HBeAg seroconversion, and a potential association with worse disease outcomes. Full article

Brain metastases or primary brain tumours had poor prognosis until the use of high dose radiotherapy. However, radionecrosis is a complex challenge in the post-radiotherapy management of these patients due to the difficulty of distinguishing this complication from local tumour recurrence. MRI alone has a variable specificity and sensibility, as does PET-CT imaging. We aimed to investigate the diagnostic performance of dual-phase ¹⁸F-FDG PET-mpMRI to distinguish cerebral radionecrosis from local tumour recurrence after cranial radiotherapy. A retrospective analysis was conducted between May 2021 and September 2022. Inclusion criteria encompassed patients with inconclusive MRI findings post-radiotherapy and history of cerebral radiotherapy for primary or metastatic brain lesions. Lesions are assessed qualitatively and semi-quantitatively. The gold standard to assess radionecrosis was histopathology or a composite criterion at three months. The study evaluated 24 lesions in 23 patients. Qualitative analysis yielded 85.7% sensitivity and 75% specificity. Semi-quantitative analysis, based on contralateral background noise, achieved 100% sensitivity and 50% specificity. Moreover, using contralateral frontal lobe background noise resulted in higher performances with 92% sensitivity and 63% specificity. Stratification by lesion type demonstrated 100% sensitivity and specificity rates for metastatic lesions. The diagnostic performance of dual-phase ¹⁸F-FDG PET-mpMRI shows promising results for metastatic lesions. Full article

Background: Hip osteoarthritis (HOA) is a disease with globally rising incidence that leads to disability and morbidity, overall, in older populations, and might be primary or secondary to numerous risk factors. The most common idiopathic HOA is generally a diagnosis of exclusion, with pathogenetic mechanisms largely still misunderstood. We aimed to investigate the correlation between femoral–acetabular and spinopelvic anatomical and computed tomography (CT) characteristics, and the presence of primary OA. Methods: We retrospectively analyzed CT scans from 2019 to 2021, excluding patients under 45 years or with conditions affecting the pelvis, sacrum, or lower limbs. Femoral, acetabular, and spinopelvic parameters were measured; signs of OA were analyzed in the hip and knee joints. Patients were categorized into two groups: A (isolated hip OA) and B (no OA); patients with hip OA, also presenting knee OA, were excluded from this study. Results: In total, 232 cases were examined; statistical analyses compared CT parameters between 129 subjects from Group A and 103 patients of Group B. Group A showed a mean femoral version of 16 ± 4.53 degrees, significantly higher than Group B’s 13.16 ± 4.37 degrees (p = 0.0001). Other parameters showed no significant differences. Conclusion: This study highlights an association between femoral version and primary hip OA. Full article

Computed tomography (CT) imaging is vital for diagnosing and monitoring diseases in both humans and animals, yet radiation exposure remains a significant concern, especially in animal imaging. Low-dose CT (LDCT) minimizes radiation exposure but often compromises image quality due to a reduced signal-to-noise ratio (SNR). Recent advancements in deep learning, particularly with CycleGAN, offer promising solutions for denoising LDCT images, though challenges in preserving anatomical detail and image sharpness persist. This study introduces a novel framework tailored for animal LDCT imaging, integrating deep learning techniques within the CycleGAN architecture. Key components include BlurPool for mitigating high-resolution image distortion, PixelShuffle for enhancing expressiveness, hierarchical feature synthesis (HFS) networks for feature retention, and spatial channel squeeze excitation (scSE) blocks for contrast reproduction. Additionally, a multi-scale discriminator enhances detail assessment, supporting effective adversarial learning. Rigorous experimentation on veterinary CT images demonstrates our framework’s superiority over traditional denoising methods, achieving significant improvements in noise reduction, contrast enhancement, and anatomical structure preservation. Extensive evaluations show that our method achieves a precision of 0.93 and a recall of 0.94. This validates our approach’s efficacy, highlighting its potential to enhance diagnostic accuracy in veterinary imaging. We confirm the scSE method’s critical role in optimizing performance, and robustness to input variations underscores its practical utility. Full article

Background and Aims: Low back pain is a prevalent condition affecting 60–85% of individuals during their lifetime. Despite various proposed mechanisms, the etiology of low back pain remains unclear. This study aims to evaluate the effectiveness of combining ultrasound-guided infiltrations with early rehabilitation in reducing pain and improving functional limitations in patients with chronic nonspecific low back pain. Methods: A retrospective observational study was conducted, reviewing data from January to April 2024 involving 40 patients with chronic nonspecific low back pain. Each patient received two cycles of ultrasound-guided lidocaine and corticosteroid infiltrations at the level of the posterior lower iliac spine, followed by 10 rehabilitation sessions. Patients were assessed at baseline (T0), after the first treatment cycle (T1), and after the second cycle (T2) using the Oswestry Disability Index, Quebec Back Pain Disability Scale, Roland Disability Questionnaire, and Numeric Rating Scale. Results: Significant improvements were observed across all assessment scales. The ODI scores decreased from 33.5 at baseline to 3.5 after treatment (p < 0.001). Similar reductions were noted in the QBPDS (from 61.5 to 10.3), RDQ (from 18 to 3.4), and NRS (from 7.4 to 1.3). The combination of ultrasound-guided infiltrations and early rehabilitation resulted in a significant reduction in pain and disability, with the most notable improvements occurring after the second treatment cycle. Conclusions: The integration of ultrasound-guided infiltrations with early rehabilitation is highly effective in managing chronic nonspecific low back pain, significantly reducing both pain and functional limitations. Full article

To release medical images that can be freely used in downstream processes while maintaining their utility, it is necessary to remove personal features from the images while preserving the lesion structures. Unlike previous studies that focused on removing lesion structures while preserving the individuality of medical images, this study proposes and validates a new framework that maintains the lesion structures while diffusing individual characteristics. In this framework, we apply local differential privacy techniques to provide theoretical guarantees of privacy protection. Additionally, to enhance the utility of protected medical images, we perform denoising using a diffusion model on the noise-contaminated medical images. Numerous chest X-rays generated by the proposed method were evaluated by physicians, revealing a trade-off between the level of privacy protection and utility. In other words, it was confirmed that increasing the level of personal information protection tends to result in relatively lower utility. This study potentially enables the release of certain types of medical images that were previously difficult to share. Full article

Background: The workload of musculoskeletal radiologists has come under pressure. Our objective was to estimate the reading times of common musculoskeletal MRI examinations. Methods: A total of 144 radiologists were asked to estimate reading times (including interpretation and reporting) for MRI of the shoulder, elbow, wrist, hip, knee, and ankle. Multivariate linear regression analyses were performed. Results: Reported median reading times with interquartile range (IQR) for the shoulder, elbow, wrist, hip, knee, and ankle were 10 (IQR 6–14), 10 (IQR 6–14), 11 (IQR 7.5–14.5), 10 (IQR 6.6–13.4), 8 (IQR 4.6–11.4), and 10 (IQR 6.5–13.5) min, respectively. Radiologists aged 35–44 years reported shorter reading times for the shoulder (β coefficient [β] = B-3.412, p = 0.041), hip (β = −3.596, p = 0.023), and knee (β = −3.541, p = 0.013) than radiologists aged 45–54 years. Radiologists not working in an academic/teaching hospital reported shorter reading times for the hip (β = −3.611, p = 0.025) and knee (β = −3.038, p = 0.035). Female radiologists indicated longer reading times for all joints (β of 2.592 to 5.186, p ≤ 0.034). Radiologists without musculoskeletal fellowship training indicated longer reading times for the shoulder (β = 4.604, p = 0.005), elbow (β = 3.989, p = 0.038), wrist (β = 4.543, p = 0.014), and hip (β = 2.380, p = 0.119). Radiologists with <5 years of post-residency experience indicated longer reading times for all joints (β of 5.355 to 6.984, p ≤ 0.045), and radiologists with 5–10 years of post-residency experience reported longer reading time for the knee (β = 3.660, p = 0.045) than those with >10 years of post-residency experience. Conclusions: There is substantial variation among radiologists in reported reading times for common musculoskeletal MRI examinations. Several radiologist-related determinants appear to be associated with reading speed, including age, gender, hospital type, training, and experience. Full article

Background: Alzheimer’s disease (AD) is a leading cause of dementia, and it is significantly influenced by the apolipoprotein E4 (APOE4) gene and gender. This study aimed to use machine learning (ML) algorithms to predict brain age and assess AD risk by considering the effects of the APOE4 genotype and gender. Methods: We collected brain volumetric MRI data and medical records from 1100 cognitively unimpaired individuals and 602 patients with AD. We applied three ML regression models—XGBoost, random forest (RF), and linear regression (LR)—to predict brain age. Additionally, we introduced two novel metrics, brain age difference (BAD) and integrated difference (ID), to evaluate the models’ performances and analyze the influences of the APOE4 genotype and gender on brain aging. Results: Patients with AD displayed significantly older brain ages compared to their chronological ages, with BADs ranging from 6.5 to 10 years. The RF model outperformed both XGBoost and LR in terms of accuracy, delivering higher ID values and more precise predictions. Comparing the APOE4 carriers with noncarriers, the models showed enhanced ID values and consistent brain age predictions, improving the overall performance. Gender-specific analyses indicated slight enhancements, with the models performing equally well for both genders. Conclusions: This study demonstrates that robust ML models for brain age prediction can play a crucial role in the early detection of AD risk through MRI brain structural imaging. The significant impact of the APOE4 genotype on brain aging and AD risk is also emphasized. These findings highlight the potential of ML models in assessing AD risk and suggest that utilizing AI for AD identification could enable earlier preventative interventions. Full article

Background: Bone hemangiomas are rare benign vascular tumors, comprising less than 1% of all bone tumors. They are predominantly found in the vertebral body or skull; rib hemangiomas are particularly rare and are often misdiagnosed as malignant tumors. Given the high malignancy rate of primary rib tumors, understanding rib hemangiomas is crucial to avoid misdiagnosis. Methods: A systematic review was conducted according to PRISMA standards. A comprehensive literature search was performed in PubMed, EMBASE, Web of Science, and Scopus. Data on patient demographics, tumor characteristics, and clinical presentation were analyzed using STATA/SE 17. Results: From 306 articles, 40 studies including 43 patients met the inclusion criteria. Rib hemangiomas showed a bimodal age distribution, with peaks in patients younger than 30 years (mean age 21.43 ± 5.60 years) and ≥30 years (mean age 59.96 ± 9.70 years). Females were more affected (62.79%) than males (37.21%), with a ratio of 1.69:1. The tumors were most frequently located in mid-thoracic ribs (4–8) and predominantly on the left side of the thorax. The mean tumor size was 7.27 cm, with 76.19% exhibiting osteolytic changes. Clinically, 63.41% of cases were asymptomatic, while symptomatic cases mainly presented with pain. Conclusions: Rib hemangiomas, though rare, should be considered in the differential diagnosis of thoracic tumors. They present as well-demarcated lytic lesions with distinct imaging features, and they typically require complete surgical excision, which may be aided with preoperative embolization. Their accurate diagnosis involves a combination of radiologic and clinical evaluation. Further studies are needed to understand the disease’s pathophysiology and to refine diagnostic and treatment protocols. Full article

Background: Osteosarcoma, a primary bone malignancy in children and adolescents, frequently metastasizes to the lungs, contributing significantly to morbidity and mortality. Lung Metastases: At diagnosis, 15–20% of patients present with detectable lung metastases. Chest computed tomography (CT) is vital for the early detection and monitoring of these metastases. Lung involvement typically presents as multiple nodules of varying sizes and can include atypical features such as cavitation, cystic lesions, ground-glass halos, intravascular tumor thrombi, and endobronchial disease. Additional Findings: Pleural metastasis often occurs alongside pulmonary disease, and complications like spontaneous pneumothorax may arise. Additional findings may include thoracic lymphadenopathy, cardiac tumor thrombus, and chest wall deposits. Conclusion: Familiarity with these imaging patterns is essential for radiologists to ensure timely diagnosis and effective management. This review highlights the critical role of chest CT in detecting and characterizing osteosarcoma metastasis. Full article

Radiotherapy is one of the risk factors for radiation-induced premature ovarian failure and infertility in cancer patients. The development of methods for ovarian radioprotection remains relevant. Moreover, electrons are a little-studied and promising method of radiation with the least toxic effect on normal tissues. The assessment of intracellular mechanisms regulating the protective effects of leukocyte-poor platelet-rich plasma in a model of radiation-induced premature ovarian failure caused by electron irradiation. Wistar rats were divided into four groups, namely a control group, irradiation group (electron exposure), irradiation + leukocyte-poor platelet-rich plasma group, and only leukocyte-poor platelet-rich plasma group. Fragments of ovaries were removed and hormonal, oxidant, histological, and morphometric studies were carried out. The cell cycle of ovarian follicles and the inflammatory and vascular response were assessed using immunohistochemistry. The activity of MAPK, ERK, and PI3K pathways was also assessed using the RT-qPCR. We found that electron irradiation causes a decrease in the functional activity of the ovaries and the death of follicular cells through apoptosis. The administration of LP-PRP led to a partial restoration of the cytokine balance. In addition, minor ovarian damage and mild inflammation were observed in this group. Leukocyte-poor platelet-rich plasma components have anti-inflammatory, angiogenetic, and radioprotective effects, reducing the activation of the NOX4, caspase and cytokine cascades, and inflammatory response severity through the MAPK/p38/JNK signaling pathway. This leads to the induction of endogenous antioxidant protection, the repair of post-radiation follicular damage, and slowing down the development of radiation-induced premature ovarian failure after electron irradiation. Full article

Objectives: To assess the impact of an Artificial Intelligence (AI) limb bone fracture diagnosis software (AIS) on emergency department (ED) workflow and diagnostic accuracy. Materials and Methods: A retrospective study was conducted in two phases—without AIS (Period 1: 1 January 2020–30 June 2020) and with AIS (Period 2: 1 January 2021–30 June 2021). Results: Among 3720 patients (1780 in Period 1; 1940 in Period 2), the discrepancy rate decreased by 17% (p = 0.04) after AIS implementation. Clinically relevant discrepancies showed no significant change (−1.8%, p = 0.99). The mean length of stay in the ED was reduced by 9 min (p = 0.03), and expert consultation rates decreased by 1% (p = 0.38). Conclusions: AIS implementation reduced the overall discrepancy rate and slightly decreased ED length of stay, although its impact on clinically relevant discrepancies remains inconclusive. Key Point: After AI software deployment, the rate of radiographic discrepancies decreased by 17% (p = 0.04) but this was not clinically relevant (−2%, p = 0.99). Length of patient stay in the emergency department decreased by 5% with AI (p = 0.03). Bone fracture AI software is effective, but its effectiveness remains to be demonstrated. Full article

Colorectal cancer is a major cause of cancer-related mortality, with liver metastases occurring in over a third of patients, and is correlated with poor prognosis. Despite surgical resection being the primary treatment option, only about 20% of patients qualify for surgery. Current guidelines recommend thermal ablation either alone or combined with surgery to treat limited hepatic metastases, provided that all visible disease can be effectively eradicated. Several ablation modalities, including radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation and histotripsy, are part of the percutaneous ablation armamentarium. Thermal ablation, including radiofrequency, microwave ablation and cryoablation, can offer local tumor control rates comparable to limited resection for selected tumors that can be ablated with margins. This review aims to encapsulate the current clinical evidence regarding the efficacy and oncologic outcomes after percutaneous ablation for the treatment of colorectal liver metastatic disease. Full article