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Detection of Confounders and Potential Confounders in Computed Tomography Lung Datasets.
No full textMachine learning models trained on computed tomography (CT) images are highly sensitive to variations in imaging acquisition parameters. Even subtle inconsistencies, often unnoticeable to human radiologists, can significantly degrade model accuracy. In clinical practice, datasets frequently exhibit heterogeneity due to variations in imaging protocols and scanner characteristics, which makes associated metadata a valuable but often underutilized resource for identifying sources of bias. To address this, we propose a novel unsupervised method that systematically identifies confounding and potentially confounding factors embedded in metadata. The key strengths of our method include automated detection of influential metadata attributes, minimal reliance on manual input, and the capability to proactively flag variables that could induce model drift post-deployment. Empirical evaluation in two distinct CT datasets demonstrates that controlling for factors identified by our method drastically improves model performance, increasing classification accuracy by 5 to 15% compared to datasets where these factors remain uncontrolled. These comparative results underscore the potential of our approach to substantially improve the robustness, consistency, and clinical applicability of radiomic machine learning models
CLT-21 COMBAT-ALS phase 2b/3 trial of MN-166 (ibudilast) in ALS: trial update and baseline characteristics
No full textA Systematic Review of Retrospective Evidence on Patient and Surgical Factors in Recurrent Cubital Tunnel Syndrome.
No full textOBJECTIVES: There is much debate regarding which patient-related risk factors and surgical techniques contribute to recurrent cubital tunnel syndrome (CuTS). This systematic review aimed to identify preoperative risk factors and surgical techniques associated with symptom recurrence or revision surgery following cubital tunnel release.
METHODS: We searched PubMed, Scopus, Cochrane Library, and clinicaltrials.gov databases for potentially eligible articles published between January 2009 and November 2024. Using Covidence, four reviewers screened based on predefined inclusion criteria: studies examining recurrent CuTS following surgery, reporting patient characteristics and/or surgical techniques, and published in English. A standardized Excel sheet was utilized to extract patient demographics, recurrence rates, and revision outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity in outcomes, no formal metaanalysis was performed, and a narrative synthesis was done.
RESULTS: Fourteen studies were included, totaling 49,492 patients with idiopathic CuTS treated with ulnar nerve surgery. Revision rates ranged 1.2-23.8%. Younger age was described as a risk factor in ten studies, although one study identified older age as a predictive risk factor. In contrast, another study described it as a protective factor. Diabetes was associated with recurrence risk in two studies, while sex, BMI, and smoking showed inconsistent associations. Severe preoperative symptoms or higher McGowan scores were associated with poorer outcomes in two studies. Overall, recurrence and revision rates were low across all techniques.
CONCLUSION: The retrospective nature and limited power of included studies increase risk of selection and Type II errors. Regardless, there seems to be no significant difference in recurrence/revision rates based on surgical techniques. CuTR was often recommended as an initial procedure while ulnar nerve transposition (UNT) was reserved for revisions or patients with nerve subluxation
ACR Appropriateness Criteria® Dementia: 2024 Update.
No full textDementia is defined by significant chronic or acquired impairment in a single domain or loss of two or more cognitive functions by brain disease or injury. It is a common chronic syndrome in adults and constitutes the fifth leading cause of death in patients \u3e65 years of age. Multiple etiologies of dementia exist, most notably Alzheimer disease, frontotemporal dementia, and dementia with Lewy bodies, as well as other neurologic diseases such as vascular dementia and normal pressure hydrocephalus. In addition to aiding clinicians in selecting the most appropriate imaging test for patients suspected of one of these dementia syndromes, this document highlights the most appropriate initial imaging tests for patients with suspected mild cognitive impairment and rapidly progressive dementia, as well as the most appropriate pre- and posttreatment imaging tests for patients undergoing therapy with antiamyloid monoclonal antibodies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation
Impact of COVID-19 on a medium-sized travel medicine clinic in eastern Pennsylvania, USA
No full textMetastasis-free survival outcomes of uveal melanoma based on The Cancer Genome Atlas classification in 1585 cases.
No full textBACKGROUND: Genetic testing for uveal melanoma and tumour size is important in prognostication.
METHODS: A review of 1 585 patients with uveal melanoma who had cytogenetic testing and classification, according to The Cancer Genome Atlas (TCGA), was performed. Kaplan-Meier (KM) metastasis-free survival at 1-, 3-, 5-, and 10-years were explored.
RESULTS: The findings revealed TCGA Group A (n = 781; 49%), Group B (n = 215; 14%), Group C (n = 329; 21%), or Group D (n = 260; 16%). The median patient age at diagnosis was 60 years, sex was male in 51%, and race was White in 95%. A comparison (TCGA Group A vs Group B vs Group C vs Group D) revealed a difference in median patient age at tumour diagnosis (59 vs 59 vs 63 vs 65 years; p \u3c 0.01), and initial visual acuity (20/20-20/50: 80% vs 68% vs 69% vs 64%; p \u3c 0.01). The median tumour thickness was 4 mm, and the median diameter was 12 mm. A comparison (TCGA Group A vs Group B vs Group C vs Group D) revealed differences in median tumour thickness (3 vs 5 vs 6 vs 7 mm; p \u3c 0.01), tumour diameter (10 vs 13 vs 13 vs 16 mm; p \u3c 0.01), distance to foveola (3 vs 3 vs 4 vs 5 mm; p \u3c 0.01), and distance to optic disc (3 vs 4 vs 5 vs 4 mm; p \u3c 0.01). The KM metastasis-free survival estimates (TCGA Group A vs Group B vs Group C vs Group D) revealed differences at 1 year, 3 years, 5 years, and 10 years (p \u3c 0.01) for any metastasis and specific survival rates at 5 years (96% vs 86% vs 62% vs 37%; p \u3c 0.01), and 10 years (93% vs 78% vs 50% vs not available; p \u3c 0.01) significantly decreased from Group A to Group D. By multivariate analysis, the hazard ratio for metastasis-free survival revealed differences in Groups B vs A (3.67), Groups C vs B (5.73), and Groups D vs C (3.20) (p \u3c 0.01), as well as differences per tumour thickness (1.06) and diameter (1.13) (p \u3c 0.01).
CONCLUSIONS: Genetic prognostication for metastatic risk from uveal melanoma using TCGA in this large cohort revealed that increasing TCGA category reduced the rate for metastasis-free survival
Motivation and experiences of individuals with opioid use disorder and chronic pain using medical cannabis for 12 months.
No full textBACKGROUND: The objective of this qualitative study was to better understand the experiences of individuals living with opioid use disorder (OUD) and chronic pain using medical cannabis (MC) for 12 months.
METHODS: Perspectives were captured via 10 key informant interviews conducted after 12 months of treatment with MC RESULTS: Key themes identified regarding the reasons for initially pursuing MC included: (1) cannabis supply safety; (2) a desire to reduce or eliminate prescription medication usage for pain, OUD and mood; (3) to induce feelings of calm or relaxation; and (4) to improve levels of chronic pain. At 12 months, key themes identified surrounding their lived experiences with MC use were: (1) reductions in pain levels; (2) positive changes in emotional regulation and mood; (3) improvements in sleep quality and duration; and (4) reductions in cravings to use illicit drugs. The primary concerns expressed by interviewees surrounding MC use at 12 months related to changes in weight and appetite, and the cost of MC products.
CONCLUSIONS: These qualitative data provide targets for future quantitative investigations of the potential mechanisms by which MC can impact recovery in the context of OUD
