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Deep Learning for Automated Spinopelvic Parameter Measurement From Radiographs: A Meta-Analysis
Get PDFAim: Quantitative measurement of spinopelvic parameters from radiographs is important for assessing spinal disorders but is limited by the subjectivity and inefficiency of manual techniques. Deep learning may enable automated measurement with accuracy rivaling human readers.
Methods: PubMed, Embase, Scopus, and Cochrane databases were searched for relevant studies. Eligible studies were published in English, used deep learning for automated spinopelvic measurement from radiographs, and reported performance against human raters. Mean absolute errors and correlation coefficients were pooled in a meta-analysis.
Results: Fifteen studies analyzing over 10,000 radiographs met the inclusion criteria, employing convolutional neural networks (CNNs) and other deep learning architectures. Pooled mean absolute errors were 4.3° [95% confidence interval (CI) 3.2-5.4] for Cobb angle, 3.9° (95%CI 2.7-5.1) for thoracic kyphosis, 3.6° (95%CI 2.8-4.4) for lumbar lordosis, 1.9° (95%CI 1.3-2.5) for pelvic tilt (PT), 4.1° (95%CI 2.7-5.5) for pelvic incidence (PI), and 1.3 cm (95%CI 0.9-1.7) for sagittal vertical axis (SVA). Intraclass correlation coefficients exceeded 0.81, indicating strong agreement between automated and manual measurements.
Conclusion: Deep learning demonstrates promising accuracy for automated spinopelvic measurement, potentially rivaling experienced human readers. However, further optimization and rigorous multicenter validation are required before clinical implementation. These technologies may eventually improve the efficiency and reliability of quantitative spine image analysis
Reconstruction of a Large Defect at the Junction of the Medial Canthus and the Superior Nasal Sidewall
Get PDFA 66-year-old female active smoker with a history of nonmelanoma skin cancer underwent Mohs micrographic surgery for a basal cell carcinoma located at the junction of the superior nasal sidewall and medial canthus. The cancer was completely excised in two stages of Mohs surgery; however, the resulting surgical defect, measuring 1.5 x 1.6 cm, posed a challenging reconstruction. Several factors contributed to the complexity of the repair, including the lesion\u27s large size, involvement of multiple cosmetic subunits, proximity to the free margin of the eye, and the patient’s smoking status. Common Mohs surgery repair techniques include direct approximation, secondary intention healing, advancement or rotational flaps, and full-thickness skin grafts. Each case requires an individualized approach, considering its unique characteristics. In this instance, a novel variation of an advancement flap was developed. An advancement flap is a surgical technique that moves adjacent tissue over a defect linearly. The island pedicle, a type of advancement flap, remains attached to its underlying blood supply to enhance survival. This technique relies on subcutaneous fat, limiting its use. A myocutaneous V-to-Y flap is a variant utilizing the vascular supply of an underlying muscle, making it suitable for areas with minimal subcutaneous tissue. The nasalis sling, commonly used for distal nose defects, exemplifies this approach. We report a novel myocutaneous V-to-Y flap variant using the glabellar musculature to repair a defect in the superior nasal sidewall and medial canthus. This technique demonstrates reliability in active smokers, leveraging the vascular supply of underlying muscles for improved survival. Additionally, it offers a superior tissue and texture match, as it uses adjacent tissue. This report aims to assist surgeons facing similar reconstructive challenges, as this technique yielded an excellent cosmetic outcome in our patient
A Novel Variant of Suprascapular Neurovascular Morphology: Clinical and Surgical Implications
Get PDFIntroduction: The suprascapular neurovascular structures traverse the suprascapular notch in a variety of morphologies. However, the suprascapular nerve has always been described as coursing under the superior transverse scapular ligament (STSL) at the level of the notch. This report aims to describe a novel variant of suprascapular neurovascular structures found in a cadaver.
Case report: During the dissection of a cadaveric upper extremity in an 85-year-old Caucasian male, the suprascapular nerve, artery, and vein were found to course above the STSL, with no structures passing through the foramen of the notch itself. A total of 94 upper extremities from 52 different cadavers were subsequently examined for the morphology of the suprascapular nerve, artery, and vein at the level of the suprascapular notch. No other cadavers were found to have this morphology, thereby resulting in an estimated prevalence of 1.1%.
Conclusion: This case study describes this unique unilateral shoulder anomaly, reviews the relevant literature, and discusses the potential clinical significance of this variant, which should be considered during various posterior shoulder surgeries or peripheral nerve blocks wherein aberrant morphology can increase the risk of neurovascular complications
Biomarkers of Secondhand Smoke and Vaping Exposure Among U.S. Adolescents
No full textBackground
Despite reductions in smoking use among adults and adolescents, e-cigarette use has increased, raising a new public health concern.
Methods
We analyzed Wave 4 (2016–2018) data from the Population Assessment of Tobacco and Health (PATH) Study to assess biomarkers of exposure to secondhand smoke and vaping aerosols among U.S. adolescents (age range 12–17). Participants with no current tobacco use in the past 30 days were divided into four mutually exclusive groups: no exposure, exposure to secondhand smoke (SHS) only, exposure to secondhand aerosol (SHA) only, and dual exposure to both (SHD).
Results
Among 2,379 adolescents (mean[SD] of age = 14.4[0.02]), 1.5 % reported SHA, 18.3 % reported SHS, and 2.8 % reported SHD. Mean concentrations of cotinine were significantly higher among those exposed to SHA only (0.5 ng/mg creatinine, p = 0.04), SHS (3.0,p \u3c 0.0001), or SHD (2.5,p \u3c 0.0001) than among those with no exposure (0.2). As compared to the no-exposure group, both SHS and SHD groups also had higher mean concentrations of carcinogen, NNAL (4.1 and 2.8 pg/mg creatinine, respectively, vs. 0.9, p \u3c 0.0001) and exposure to SHS had a higher level of CYMA (1.8 vs. 1.1 ng/mg creatinine, p \u3c 0.0001). In comparison with the SHA group, the SHS and SHD groups had 6.8 and 3.6 times higher levels of cotinine and 4.6 and 2.2 times higher levels of NNAL, respectively; the SHS group also had higher levels of AAMA and CYMA.
Conclusions
Secondhand vaping aerosol poses a lower exposure risk to youth non-tobacco users than combustible cigarette smoke. The distinct exposure patterns emphasize the importance of implementing tobacco-free policies to reduce youth exposure to environments where combustible tobacco or e-cigarette use occurs