Study Design Comparative study Objective To compare manual and deep learning-based automated measurement of Cobb angle in adolescent idiopathic scoliosis. Methods We proposed a fully automated framework to measure the Cobb angle of AIS patients. Whole-spine images of 500 AIS individuals were collected. 200 digital radiographic (DR) images were labeled manually as training set, and the remaining 300 images were used to validate by mean absolute error (MAE), Pearson or spearman correlation coefficients, and intra/interclass correlation coefficients (ICCs). The relationship between accuracy of vertebral boundary identification and the subjective image quality score was evaluated. Results The PT, MT, and TL/L Cobb angles were measured by the automated framework within 300 milliseconds. Remarkable 2.92° MAE, .967 ICC, and high correlation coefficient (r = .972) were obtained for the major curve. The MAEs of PT, MT, and TL/L were 3.04°, 2.72°, and 2.53°, respectively. The ICCs of these 3 curves were .936, .977, and .964, respectively. 88.7% (266/300) of cases had a difference range of ±5°, with 84.3% (253/300) for PT, 89.7% (269/300) for MT, and 93.0% (279/300) for TL/L. The decreased bone/soft tissue contrast (2.94 vs 3.26; P=.039) and bone sharpness (2.97 vs 3.35; P=.029) were identified in the images with MAE exceeding 5°. Conclusion The fully automated framework not only identifies the vertebral boundaries, vertebral sequences, the upper/lower end vertebras and apical vertebra, but also calculates the Cobb angle of PT, MT, and TL/L curves sequentially. The framework would shed new light on the assessment of AIS curvature.
Background This study assesses performance and utility of motor evoked potentials and somatosensory evoked potentials during corrective surgery to thoracic tuberculosis with kyphosis (TTK), as well as corresponding risk factors. Methods Patients diagnosed with TTK and underwent TTK corrective surgery from 2012 to 2018 were included. Relevant Data were retrospectively collected. Measures of intraoperative neurophysiological monitoring (IONM) performance were calculated. A receiver operating characteristic (ROC) curve and area under ROC curve (AUC) were deployed to identify the diagnostic accuracy of potential recovery. Univariate and multivariate analysis were performed to determine risk factors correlated with IONM alerting. Results 68 patients were included. The mean age was 31.7±20.3 years (3-78 years). IONM alerting occurred in 12 surgeries (12/68, 17.6%), of which 6 were somatosensory evoked potential (SSEP) alerting, 2 motor evoked potential (MEP) alerting, and 4 combinations of both SSEP and MEP. There were 10 posterior vertebral column resections (PVCRs) and 2 pedicle subtraction osteotomies (PSOs) with 1.83±1.19 vertebra resected. Four (4/68, 5.89%) patients were identified with presence of postoperative neurological deficits (PNDs). Calculated measures of performance of MEP and SSEP were as follows: sensitivity of 0.75, specificity of 0.86, positive predictive value (PPV) of 0.25, and negative predictive value (NPV) of 0.98 respectively. The AUC of evoked potential recovery in diagnosing a PND was 0.884. On logistic regression analysis, sever kyphosis was determined as the independent risk factor for IONM alerting. Conclusions Multimodal IONM can benefit 66.7% participants from neural impingement under appropriate intervention after IONM alerting. Corrective surgery in TTK is at risk of spinal injury, especially in severe kyphosis requiring three-column osteotomy.
BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery; however, it is one of the rare complications in orthopedic surgery. This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery. The etiology, diagnosis, and treatment were analyzed and discussed. CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain. She was diagnosed with L4 degenerative spondylolisthesis, L4/L5 and L5/S1 intervertebral disc herniation and L5 instability, and underwent successful posterior L4-S1 instrumentation and fusion surgery. Unfortunately, thoracic effusion was identified 2 d after operation. The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests. The patient was discharged after 12-d persisting drainage, 3-d total parenteral nutrition and fasting, and other supportive treatments. No recurring symptoms were observed within 12 mo follow-up. CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion. Comprehensive diagnosis and treatment of chylothorax are necessary. Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.
The incidence of type 2 diabetes mellitus is growing in epidemic proportions and has become one of the most critical public health concerns. Cardiovascular complications associated with diabetes are the leading cause of morbidity and mortality. The cardiovascular diseases that accompany diabetes include angina, myocardial infarction, stroke, peripheral artery disease, and congestive heart failure. Among the various risk factors generated secondary to hyperglycemic situations, advanced glycation end products (AGEs) are one of the important targets for future diagnosis and prevention of diabetes. In the last decade, AGEs have drawn a lot of attention due to their involvement in diabetic patho-physiology. AGEs can be derived exogenously and endogenously through various pathways. These are a nonhomogeneous, chemically diverse group of compounds formed nonenzymatically by condensation between carbonyl groups of reducing sugars and free amino groups of protein, lipids, and nucleic acid. AGEs mediate their pathological effects at the cellular and extracellular levels by multiple pathways. At the cellular level, they activate signaling cascades via the receptor for AGEs and initiate a complex series of intracellular signaling resulting in reactive oxygen species generation, inflammation, cellular proliferation, and fibrosis that may possibly exacerbate the damaging effects on cardiac functions in diabetics. AGEs also cause covalent modifications and cross-linking of serum and extracellular matrix proteins; altering their structure, stability, and functions. Early diagnosis of diabetes may prevent its progression to complications and decrease its associated comorbidities. In the present review, we recapitulate the role of AGEs as a crucial mediator of hyperglycemia-mediated detrimental effects in diabetes-associated complications. Furthermore, this review presents an overview of future perspectives for new therapeutic interventions to ameliorate cardiovascular complications in diabetes.
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