bluuebunny/crossref_metadata_2025 huggingface dataset:
Borderline personality disorder features and their relationship with trauma and dissociation in a sample of community health service users
Authors: Fung Hong Wang , Wong Ming Yu Claudia , Lam Stanley Kam Ki , Wong Emily Nga Man , Chien Wai Tong , Hung Suet Lin , Lee Kun-Hua , Cui Jialiang , Ross Colin A.
Published: July 2023

Background

Previous studies have indicated that borderline personality disorder (BPD) is closely associated with trauma and dissociation. Nevertheless, BPD is a heterogeneous condition, and not all people with BPD have severe dissociation. This study examined whether the relationship of BPD features with trauma and dissociation would remain significant after controlling for some general non-specific mental health distress. We also made the first attempt to explore which specific BPD features would be particularly associated with dissociation.

Methods

We analyzed survey data from a sample of community health service users in Hong Kong (N = 376). Hierarchical multiple regression and data-driven network analysis were used.

Results

The lifetime prevalence of DSM-5 BPD was 16.0% in our sample. Of participants who met criteria for BPD, 43.3% scored above cutoff on the dissociation measures, thus possibly having clinically significant dissociative symptoms. BPD features were associated with adulthood trauma and psychoform dissociation even after controlling for age, depression and self-esteem. Network analysis showed that some BPD features – including impulsivity, identity disturbance and suicidal/self-mutilation behaviors – were particularly associated with dissociation; other BPD features such as interpersonal-related problems had relatively weak to no connection with dissociation.

Conclusions

Our results suggested that some particular BPD features might be dissociative in nature, although further longitudinal research is required. We argue that a trauma-informed perspective should be employed when working with clients presenting with BPD features despite these features being commonly stigmatized. Further research on the intervention needs of the people with BPD who suffer from high levels of dissociation is required.
Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures
Authors: Rousseau Anne-Françoise , Dardenne Nadia , Kellens Isabelle , Bornheim Stephen , Misset Benoit , Croisier Jean-Louis
Published: July 2023

Background

The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one.

Methods and results

Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland–Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59–0.94) and the bias was − 0.49 N/Kg (limits of agreement: − 1.76–0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24–0.78), and the bias was − 0.53 N/Kg (limits of agreement: − 1.01–2.07 N/kg).

Conclusions

As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.
Safety and efficacy of cataract surgery performed with a low-energy femtosecond laser compared with conventional phacoemulsification in Chinese patients: a randomized clinical trial
Authors: Zhou Kai-Jing , Huang Yusen , Wang Yong , Pan An-Peng , Shao Xu , Tu Rui-Xue , Yu A-Yong
Published: July 2023

Background

To compare the safety and efficacy of femtosecond laser-assisted cataract surgery (FLACS) performed with the low-energy FEMTO LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) laser compared with conventional phacoemulsification (CP) in Chinese patients.

Methods

This prospective, multicenter, interventional study included 126 patients who were randomized (1:1) to undergo either FLACS or CP followed by intraocular lens (IOL) implantation between January 2019 and April 2020. The primary endpoint included the comparison of the endothelial cell loss (ECL) between the two groups at 3 months. Secondary endpoints included the comparison of cumulative dissipated energy (CDE), change in central corneal thickness (CCT) from baseline, and postoperative uncorrected and corrected distance visual acuities (UDVA and CDVA) in the two groups.

Results

At all postoperative time points, the FLACS group was found to be non-inferior to CP for the mean ECL (− 409.3 versus − 436.9 cells/mm2 at 3 months) and mean CDE (4.1 versus 4.5 percent-seconds). The increase in CCT was significantly lower in the FLACS group compared with the CP group at Day 7 (4.9 versus 9.2 µm; P = 0.04); however, the difference was not statistically significant at 1 and 3 months. Postoperatively, mean UDVA and CDVA were comparable between the two groups. No intraoperative complications occurred.

Conclusions

Cataract surgery performed with a low-energy femtosecond laser was non-inferior to CP; however, the FLACS group had a statistically significantly lower increase in CCT at Day 7 compared with CP.

Trial registration This trial is registered at ClinicalTrials.gov on May 15, 2019, with trial registration number: NCT03953053.
Risk factors for thromboembolism during first-line treatment of patients with unresectable advanced or recurrent colorectal cancer: a retrospective short study
Authors: Takada Ryo , Fujiwara Miki , Maki Masatoshi , Takahashi Yoko , Tamura Koji
Published: July 2023

Background

While cancer is a risk factor for developing thromboembolism, so is the use of molecularly targeted therapies. This study aimed to determine whether thromboembolism incidence differed between vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) inhibitor use in patients with unresectable advanced or recurrent colorectal cancer, and to compare the risk of thromboembolism caused by cancer and the use of molecular targeted therapy drugs.

Main body

We retrospectively evaluated patients with unresectable advanced or recurrent colorectal cancer who were treated with a cytotoxic anticancer drug and a VEGF or EGFR inhibitor combination between April 2016 and October 2021. Patients were compared in terms of the regimen administered, thromboembolism occurrence during the first-line treatment period, patient background, and clinical laboratory values. Of the 179 included patients, 12 of 134 (8.9%) in the VEGF-inhibitor group and 8 of 45 (17.8%) in the EGFR-inhibitor group developed thromboembolism, with no significant difference between the groups (P = 0.11). There was no significant difference in time to thromboembolism between patients in the VEGF- inhibitor group and patients in the EGFR-inhibitor group (P = 0.206). The cutoff value determined by a receiver operating characteristic analysis for the occurrence of thromboembolism was one point. Multivariate analysis using the occurrence of thromboembolism as the response variable identified at least one risk factor for thromboembolism (odds ratio = 4.17, P = 0.006, 95% confidence interval = 1.51–11.50). Molecular targeted therapies were not identified as a risk factor.

Conclusions

Although the small sample size, there was no difference in the incidence of thromboembolism between the two molecular-targeted therapies in first-line treatment of patients with unresectable advanced or recurrent colorectal cancer. Our results suggest that risk factors for thromboembolism may be more strongly influenced by cancer itself than by the use of molecularly targeted therapies.
Going online? Does transferring to online university increase the likelihood of graduation among students from lower social background?
Authors: Sánchez-Gelabert Albert , Elias Marina
Published: July 2023

The increase in university participation has led to greater complexity in terms of students' trajectories, with the option of changing degree course or higher education institution or, more recently, the mode of study (face-to-face and online learning). These transitions can be strategic moves that facilitate greater continuity in educational trajectories and increase equity within the education system. Online universities offer greater flexibility in terms of time and location, providing new opportunities for students with specific profiles to pursue higher education. This article aims to delve into the complex trajectories of change and to analyse whether there are differences in educational outcomes based on students' social backgrounds. Using registry data from the Catalan university system (n = 42,370), we identify and characterise the trajectories of change and analyse the effect of the interaction between them and social origin on educational outcomes. The results indicate that students from lower social backgrounds and those who also work are most likely to transition to virtual education. However, social background continues to have an effect on the probability of graduating, dropping out or pursuing further studies.
Are our clone detectors good enough? An empirical study of code effects by obfuscation
Authors: Huang Weihao , Meng Guozhu , Lin Chaoyang , Yan Qiucun , Chen Kai , Ma Zhuo
Published: July 2023

Clone detection has received much attention in many fields such as malicious code detection, vulnerability hunting, and code copyright infringement detection. However, cyber criminals may obfuscate code to impede violation detection. To date, few studies have investigated the robustness of clone detectors, especially in-fashion deep learning-based ones, against obfuscation. Meanwhile, most of these studies only measure the difference between one code snippet and its obfuscation version. However, in reality, the attackers may modify the original code before obfuscating it. Then what we should evaluate is the detection of obfuscated code from cloned code, not the original code. For this, we conduct a comprehensive study evaluating 3 popular deep-learning based clone detectors and 6 commonly used traditional ones. Regarding the data, we collect 6512 clone pairs of five types from the dataset BigCloneBench and obfuscate one program of each pair via 64 strategies of 6 state-of-art commercial obfuscators. We also collect 1424 non-clone pairs to evaluate the false positives. In sum, a benchmark of 524,148 code pairs (either clone or not) are generated, which are passed to clone detectors for evaluation. To automate the evaluation, we develop one uniform evaluation framework, integrating the clone detectors and obfuscators. The results bring us interesting findings on how obfuscation affects the performance of clone detection and what is the difference between traditional and deep learning-based clone detectors. In addition, we conduct manual code reviews to uncover the root cause of the phenomenon and give suggestions to users from different perspectives.
Value of next-generation sequencing in inherited arrhythmia syndromes
Authors: Kim Min Jae , Kim You Ri , Lee Ki Hong , Yoon Namsik , Park Hyung Wook
Published: July 2023

Background

Genetic studies are clinically recommended in some cases of inherited arrhythmia syndromes. Next-generation sequencing (NGS) would be helpful because of its high analytical throughput and relative speed. This study aimed to assess the mutation-detection yield obtained by NGS compared with conventional Sanger sequencing method.

Methods

Patients with aborted sudden cardiac death and their families who underwent gene sequencing tests for inherited arrhythmia syndromes were retrospectively and enrolled in this study from 2017 to 2022 at Chonnam National University Hospital. We evaluated NGS study results of 17 patients (NGS group) and Sanger study results of 19 patients (Sanger group).

Results

64.7% of NGS and 94.7% of Sanger group were probands. Type 1 Brugada pattern ECG was more frequent in NGS group (64.7% vs. 21.1%; p = 0.007). BrS was the most common disorder in NGS group (76.5%), and idiopathic ventricular fibrillation was the most common one in Sanger group (63.2%). Mutations with uncertain significance were the most common ones in NGS group (89.5%), and pathogenic or likely pathogenic mutations were the most common ones in Sanger group (45.7%). When positive yield was defined as the ratio of pathogenic or likely pathogenic mutations that were detected by sequencing, the yields were 10.5% and 45.7% in NGS and Sanger groups, respectively. The NGS arrhythmia panel did not cover two inherited arrhythmia-related mutations (RYR1, APOA5) that were detected by the Sanger method. The extended NGS arrhythmia panel was able to detect 84.8% of inherited arrhythmia-related mutations that were detected in Sanger group.

Conclusions

NGS study has some limitations in obtaining the full genetic data of probands. Well-designed NGS panels are needed to increase the efficiency of the NGS study. With the well-designed panels, large-scale gene sequencing can efficiently and rapidly be applied in real clinical practices, especially in inherited fatal arrhythmia syndromes that have a high detection yield in genetic analyses.
Assistive technology: opportunities for societal inclusion of persons with disabilities and independence of the elderly
Authors: Rehan Youssef Aliaa , Morsy Ahmed
Published: July 2023

Assistive technology (AT) development worldwide aims to enhance the quality of life for persons with disabilities and elderly, yet its development and commercialization may face challenges. This collection aims at obtaining a better understanding of the hurdles that various stakeholders may face in the successful development and commercialization of AT.
Improved performance of machine learning models in predicting length of stay, discharge disposition, and inpatient mortality after total knee arthroplasty using patient-specific variables
Authors: Zalikha Abdul K. , Court Tannor , Nham Fong , El-Othmani Mouhanad M. , Shah Roshan P.
Published: July 2023

Background

This study aimed to compare the performance of ten predictive models using different machine learning (ML) algorithms and compare the performance of models developed using patient-specific vs. situational variables in predicting select outcomes after primary TKA.

Methods

Data from 2016 to 2017 from the National Inpatient Sample were used to identify 305,577 discharges undergoing primary TKA, which were included in the training, testing, and validation of 10 ML models. 15 predictive variables consisting of 8 patient-specific and 7 situational variables were utilized to predict length of stay (LOS), discharge disposition, and mortality. Using the best performing algorithms, models trained using either 8 patient-specific and 7 situational variables were then developed and compared.

Results

For models developed using all 15 variables, Linear Support Vector Machine (LSVM) was the most responsive model for predicting LOS. LSVM and XGT Boost Tree were equivalently most responsive for predicting discharge disposition. LSVM and XGT Boost Linear were equivalently most responsive for predicting mortality. Decision List, CHAID, and LSVM were the most reliable models for predicting LOS and discharge disposition, while XGT Boost Tree, Decision List, LSVM, and CHAID were most reliable for mortality. Models developed using the 8 patient-specific variables outperformed those developed using the 7 situational variables, with few exceptions.

Conclusion

This study revealed that performance of different models varied, ranging from poor to excellent, and demonstrated that models developed using patient-specific variables were typically better predictive of quality metrics after TKA than those developed employing situational variables.

Level of Evidence

III.
Grains production in high climate change impacted regions and its potential for the supply of critical nutrients for humans nutritional well being
Authors: Souho Tiatou , Bomboma Damipie , Compaoré Ella W. R. , Essowèréou Abel Abli , Ouadja Batcha , Kabassina Marcelle , Pilo Mikemina , Epse Yao Rebecca Rachel Assa , Amouzou Kou’santa Sabiba
Published: July 2023

Climate change affects most remarkably Savannah regions in ways that alter agricultural productivity. In addition, these regions are marked by high prevalence of malnutrition and mortality related to undernourishment in children under 5 years old. One of the most promising solutions to sustainably fight malnutrition is to design programs that will consider locally produced foods and production approaches that protect the soil. The present study was designed to evaluate the nutritional quality of grains produced in the Savannah in order to provide data that will be used to make recommendations for nutrition and sustainable farming. Farmers in the Savannah region in Togo were interviewed about their productions and their produced grains were sampled for biochemical characterization. All producers exploit family lands and mainly produce grains. More than 98% of producers breed poultry by only at the family level. Biochemical characterization of the sampled foods shows that pulses present a relative high level of sand, fatty matters and proteins. Results show that both cereals and pulses contain sufficient energy, fatty matters, vitamins and minerals that are necessary for human wellbeing. Foods formulations could be made especially for children under food substitution. In addition, pulses production is encouraged for sustainable soil preservation.

Graphical abstract
Self-esteem and assertiveness in medical students in Casablanca, Morocco
Authors: Hamraoui Yousra , Attouche Nadia , Housbane Samy , Agoub Mohamed
Published: July 2023

Background

Self-esteem is a determining factor of good mental health. Medical students need assertiveness in interpersonal interactions with colleagues, patients, and families. This study aims to assess self-esteem and assertiveness in medical students in Casablanca, Morocco; the relationship between these two concepts, on the one hand, and with anxiety and depression on the other hand.

Materials and methodology

A cross-sectional study was conducted at the Faculty of Medicine in Casablanca, Morocco. The study used an anonymous self-questionnaire that included Rosenberg Scale and Rathus Scale in order to assess self-esteem and assertiveness, respectively, and HADS Scale to assess depression and anxiety.

Results

A percentage of 54% of students in our study showed low-to-very low-self-esteem and 70% of students were not assertive. We found a strong relationship between self-esteem and assertiveness (p <0.001), self-esteem and depression (p <0.001), self-esteem and anxiety (p <0.001), assertiveness and depression (p <0.001), and assertiveness and anxiety (p <0.001).

Conclusions

Globally, self-esteem and assertiveness of Moroccan medical students were low in more than half of the students. Moreover, there was a significant relation between these concepts, on the one hand, and between them and anxiety and depression on the other hand. Students need to be valued and their efforts recognized during their studies. Therapeutic strategies should be used when necessary.
Comparative efficacy of micro-erythrocyte sedimentation rate (m-ESR) and C-reactive protein (CRP) as a neonatal septic screening marker—a single-center, retrospective observational study
Authors: Arun Babu Thirunavukkarasu , Shankaralingappa Arundhathi , Vijayadevagaran Vijayasankar , Sharmila Vijayan , Kalidoss Vinoth Kumar
Published: July 2023

Background

Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in neonatal period. Most of neonatal sepsis-related morbidity and mortality can be prevented by early diagnosis and treatment with appropriate antimicrobial agents. Micro-erythrocyte sedimentation rate (m-ESR) is a simple, inexpensive, and rapid screening test for neonatal sepsis that can be done even in resource limited setups.

Objectives

To compare the efficacy of m-ESR with C-reactive protein (CRP) as a screening tool in neonatal sepsis.

Methodology

A retrospective chart-based analysis was done in division of neonatology, of our tertiary care hospital over a period of 21 months. A total of 202 suspected cases of neonatal sepsis with documented CRP and micro-ESR values were included. We evaluated the role of micro-ESR as a screening tool in neonatal sepsis in comparison with CRP. The validity and reliability of micro-ESR in comparison to CRP were estimated and its sensitivity, specificity, positive, and negative predictive value to diagnose sepsis were calculated.

Results

There was a significant correlation between micro-ESR and CRP with a moderate degree of agreement, especially in ‘late onset sepsis’ group. The overall sensitivity, specificity, positive predictive value and negative predictive value of micro-ESR were 67%, 84%, 58%, and 89% respectively.

Conclusion

Micro-ESR is a simple, inexpensive test comparable to CRP in screening for neonatal sepsis.
Tyre and road wear particles from source to sea
Authors: Mattsson Karin , de Lima Juliana Aristéia , Wilkinson Tim , Järlskog Ida , Ekstrand Elisabet , Sköld Yvonne Andersson , Gustafsson Mats , Hassellöv Martin
Published: July 2023

Tyre and road wear particles (TRWP) are an important microplastics contributor to the environment, although direct observations along suggested pathways are virtually absent. There are concerns for both human health and ecosystems from TRWP exposure and leached chemicals. Due to great analytical challenges in detection and characterization, almost nothing is known about the physicochemical characteristics, occurrence, fate and transport of TRWP in the environment. Diverse tyre types exist for different seasons and vehicle profiles, and their formulations are undisclosed proprietary information.

Here we show TRWP dispersion in marine sediments, and a direct link between tyre formulation, tread hardness and TRWP emissions. Softer tyres with higher natural rubber and carbon black content generate higher particle wear. Sediment TRWP dominates the microplastics assemblage close to the city, while showing a much more steeply reducing concentration gradient with distance from the source, suggesting different transport behaviour compared to lower density microplastics. This implies that urbanized coastal ecosystems are impacted by the accumulating TRWP, with consequences for sediment ecosystems.

One-sentence summary

Tyre and road wear particles—The link between tyre formulation, emissions and their spread in the marine environment.
Esophageal reconstruction as the first step for treating secondary aortoesophageal fistula due to thoracic endovascular aortic stent infection
Authors: Fukunaga Naoto , Shimoji Akio , Maeda Toshi , Mori Otohime , Yoshizawa Kosuke , Minatoya Kenji , Tamura Nobushige
Published: July 2023

Background

The surgical strategy for aortoesophageal fistula (AEF) depends on the experience of each surgeon, and there is no consensus on the strategy to be adopted. We propose our two-stage operation compromising esophagectomy and reconstruction as the first step and in situ aortic graft replacement as the second step after 7 days for treating AEF secondary to thoracic aortic stent graft infection.

Case presentation

A diagnosis of AEF was made in a 70-year-old man with a history of multiple aortic interventions. The patient underwent esophageal resection and reconstruction with a pedicled stomach roll endoscopically in the right thoracic cavity. Postoperatively, enteral feeding was resumed via a feeding tube placed in the jejunum to maintain adequate nutritional status. There was no evidence of either anastomotic leakage or necrosis. Seven days later, the patient underwent removal of the infected stent graft and in situ graft replacement via a redo left thoracotomy. After the surgery, the patient was able to start oral intake relatively early. Although more than 6 months has passed since the patient was discharged, no recurrence of infection has been observed.

Conclusions

The benefit of our strategy is the radical treatment for secondary AEF and the early resumption of oral intake.
Rapid enlargement of a traumatic pulmonary pseudocyst following an intraoperative leak test: a case report
Authors: Matsumiya Hiroki , Tanaka Kanji , Tahara Yuki , Mori Masataka , Kanayama Masatoshi , Taira Akihiro , Shinohara Shinji , Takenaka Masaru , Kuroda Koji , Tanaka Fumihiro
Published: July 2023

Background

Traumatic pulmonary pseudocysts are a rare complication resulting from pulmonary contusion associated with blunt chest trauma.

Case presentation

A 17-year-old male patient underwent emergency surgery for hemostasis of a traumatic lung injury caused by a car accident. Because the bleeding was from the peripheral lung, partial resection was performed with an automated suture machine. A routine leak test (positive pressure ventilation at 20 cm H2O) was performed as a precautionary measure. Postoperative imaging revealed rapid enlargement of a comorbid traumatic pulmonary pseudocyst. The collapse of the obliterating bronchus due to the accident and the intraoperative positive pressure ventilation for the air leak test were considered to have caused the rapid enlargement of the traumatic pulmonary pseudocyst. A thoracoscopic right lower lobectomy was performed on postoperative day 5. The patient had an uneventful postoperative course.

Conclusions

To our knowledge, this is the first report of a rapidly enlarging traumatic pulmonary pseudocyst captured on preoperative and postoperative computed tomography. It would serve as a learning point for respiratory surgeons. These results suggest that when patients with traumatic pulmonary pseudocysts are operated on under general anesthesia, excessive positive pressure ventilation may cause a rapid expansion of the pulmonary pseudocyst.
Application value of 3D pCASL in early assessment of potential radiation encephalopathy in nasopharyngeal carcinoma patients undergoing radiotherapy
Authors: He Yujie , Guo Jingjing , Ding Yongjun , Zhou Leyuan , Jiang Xinyu , Zhen Chendao , Wu Qinghua
Published: July 2023

Objective:

The study explores the application value of three-dimensional arterial spin labeling magnetic resonance imaging (3D pCASL) in early assessment of radiation encephalopathy (REP) in patients with nasopharyngeal carcinoma (NPC).

Methods:

A retrospective analysis of 39 cases of NPC was performed. Routine enhanced MRI scan and 3D pCASL imaging were used to examine the apparent diffusion coefficient (ADC) and brain blood flow (CBF) before and after treatment with intensity-modulated radiotherapy (IMRT). Dosimetric analysis of irradiation was performed. Receiver operating characteristic curve (ROC) was used to analyze diagnostic performance of two imaging methods.

Results:

There was no statistically significant difference between the two methods for the measurement of temporal white matter ADC, but statistically significant difference was found in CBF. 3D pCASL imaging showed more sensitivity, specificity and higher accuracy than conventional MRI enhanced scan in showing REP. The maximum dose of the temporal lobe was at the enhanced area.

Conclusion:

The present study demonstrates that 3D pCASL scan at month 3 can reflect blood flow perfusion differences in NPC patients after IMRT and can accurately assess the possibility of REP at early stage. Enhanced areas have a higher probability of REP than the surrounding areas.

Advances in knowledge:

There is few magnetic resonance angiography studies used to evaluate arterial circulation on its application on potential REP after radiotherapy for NPC. In our study, we evaluate the application value of 3D pCASL in the early assessment of potential REP in patients with NPC after radiotherapy. The study was to provide an improved understanding of the early specific characteristics on MRI imaging and evolution of potential radiation encephalopathy using 3D pCASL technique, which can quantitatively evaluate the changes of blood flow in tissues at early stage and help to diagnose and treat potential radiation encephalopathy as early as possible.
The role of clinical imaging in oncology drug development: progress and new challenges
Authors: Murphy Philip Stephen , Galette Paul , van der Aart Jasper , Janiczek Robert L , Patel Neel , Brown Andrew P
Published: July 2023

In 2008, the role of clinical imaging in oncology drug development was reviewed. The review outlined where imaging was being applied and considered the diverse demands across the phases of drug development. A limited set of imaging techniques was being used, largely based on structural measures of disease evaluated using established response criteria such as response evaluation criteria in solid tumours. Beyond structure, functional tissue imaging such as dynamic contrast-enhanced MRI and metabolic measures using [18F]flourodeoxyglucose positron emission tomography were being increasingly incorporated. Specific challenges related to the implementation of imaging were outlined including standardisation of scanning across study centres and consistency of analysis and reporting. More than a decade on the needs of modern drug development are reviewed, how imaging has evolved to support new drug development demands, the potential to translate state-of-the-art methods into routine tools and what is needed to enable the effective use of this broadening clinical trial toolset. In this review, we challenge the clinical and scientific imaging community to help refine existing clinical trial methods and innovate to deliver the next generation of techniques. Strong industry–academic partnerships and pre-competitive opportunities to co-ordinate efforts will ensure imaging technologies maintain a crucial role delivering innovative medicines to treat cancer.
Manual aspiration of a pneumothorax after CT-guided lung biopsy: outcomes and risk factors
Authors: Chan Michael Vinchill , Afraz Zahra , Huo Ya Ruth , Kandel Sonja , Rogalla Patrik
Published: July 2023

Objective:

Quantify the outcomes following pneumothorax aspiration and influence upon chest drain insertion.

Methods:

This was a retrospective cohort study of patients who underwent aspiration for the treatment of a pneumothorax following a CT percutaneous transthoracic lung biopsy (CT-PTLB) from January 1, 2010 to October 1, 2020 at a tertiary center. Patient, lesion and procedural factors associated with chest drain insertion were assessed with univariate and multivariate analyses.

Results:

A total of 102 patients underwent aspiration for a pneumothorax following CT-PTLB. Overall, 81 patients (79.4%) had a successful pneumothorax aspiration and were discharged home on the same day. In 21 patients (20.6%), the pneumothorax continued to increase post-aspiration and required chest drain insertion with hospital admission. Significant risk factors requiring chest drain insertion included upper/middle lobe biopsy location [odds ratio (OR) 6.46; 95% CI 1.77–23.65, p = 0.003], supine biopsy position (OR 7.06; 95% CI 2.24–22.21, p < 0.001), emphysema (OR 3.13; 95% CI 1.10–8.87, p = 0.028), greater needle depth ≥2 cm (OR 4.00; 95% CI 1.44–11.07, p = 0.005) and a larger pneumothorax (axial depth ≥3 cm) (OR 16.00; 95% CI 4.76–53.83, p < 0.001). On multivariate analysis, larger pneumothorax size and supine position during biopsy remained significant for chest drain insertion. Aspiration of a larger pneumothorax (radial depths ≥3 cm and ≥4 cm) had a 50% rate of success. Aspiration of a smaller pneumothorax (radial depth 2–3 cm and <2 cm) had an 82.6% and 100% rate of success, respectively.

Conclusion:

Aspiration of pneumothorax after CT-PTLB can help reduce chest drain insertion in approximately 50% of patients with larger pneumothoraces and even more so with smaller pneumothoraces (>80%).

Advances in knowledge:

Aspiration of pneumothoraces up to 3 cm was often associated with avoiding chest drain insertion and allowing for earlier discharge.
Evaluation of tumour motion and internal/external correlation in lung SABR
Authors: Ali Asmaa M , Greenwood Jason B , Walls Gerard M , Belshaw Louise , Agnew Christina E , McAleese Jonathan , Whitten Glenn , Irvine Denise M , Hounsell Alan R , McGarry Conor K
Published: July 2023

Objective:

This study aims to analyse lung tumour motion and to investigate the correlation between the internal tumour motion acquired from four-dimensional computed tomography (4DCT) and the motion of an external surrogate.

Methods:

A data set of 363 4DCT images was analysed. Tumours were classified based on their anatomical lobes. The recorded gross tumour volume (GTV) information included the centroid GTV motion in the superior–inferior, anteroposterior and left-right directions, and in three-dimensions (3D). For the internal/external correlation, the RPM surrogate breathing signals of 260 patients were analysed via an in-house script. The external motion was correlated with the 3D centroid motion, and the maximum tumour motion via Spearman’s correlation. The effect of tumour volume on the amount of motion was evaluated.

Results:

The greatest 3D tumour amplitude was found for tumours located in the lower part of the lung, with a maximum of 26.7 mm. The Spearman’s correlation of the internal 3D motion was weak in the upper (r = 0.21) and moderate in the middle (r = 0.51) and the lower (r = 0.52) lobes. There was no obvious difference in the correlation coefficients between the maximum tumour displacement and the centroid motion. No correlation was found between the tumour volume and the magnitude of motion.

Conclusion:

Our results suggest that tumour location can be a good predictor of its motion. However, tumour size is a poor predictor of the motion.

Advances in knowledge:

This knowledge of the distribution of tumour motion throughout the thoracic regions will be valuable to research groups investigating the refinement of motion management strategies.
The usefulness of machine-learning-based evaluation of clinical and pretreatment 18F-FDG-PET/CT radiomic features for predicting prognosis in patients with laryngeal cancer
Authors: Nakajo Masatoyo , Nagano Hiromi , Jinguji Megumi , Kamimura Yoshiki , Masuda Keiko , Takumi Koji , Tani Atsushi , Hirahara Daisuke , Kariya Keisuke , Yamashita Masaru , Yoshiura Takashi
Published: July 2023

Objective:

To examine whether machine learning (ML) analyses involving clinical and 18F-FDG-PET-based radiomic features are helpful in predicting prognosis in patients with laryngeal cancer.

Methods:

This retrospective study included 49 patients with laryngeal cancer who underwent18F-FDG-PET/CT before treatment, and these patients were divided into the training (n = 34) and testing (n = 15) cohorts.Seven clinical (age, sex, tumor size, T stage, N stage, Union for International Cancer Control stage, and treatment) and 40 18F-FDG-PET–based radiomic features were used to predict disease progression and survival. Six ML algorithms (random forest, neural network, k-nearest neighbors, naïve Bayes, logistic regression, and support vector machine) were used for predicting disease progression. Two ML algorithms (cox proportional hazard and random survival forest [RSF] model) considering for time-to-event outcomes were used to assess progression-free survival (PFS), and prediction performance was assessed by the concordance index (C-index).

Results:

Tumor size, T stage, N stage, GLZLM_ZLNU, and GLCM_Entropy were the five most important features for predicting disease progression.In both cohorts, the naïve Bayes model constructed by these five features was the best performing classifier (training: AUC = 0.805; testing: AUC = 0.842). The RSF model using the five features (tumor size, GLZLM_ZLNU, GLCM_Entropy, GLRLM_LRHGE and GLRLM_SRHGE) exhibited the highest performance in predicting PFS (training: C-index = 0.840; testing: C-index = 0.808).

Conclusion:

ML analyses involving clinical and 18F-FDG-PET–based radiomic features may help predict disease progression and survival in patients with laryngeal cancer.

Advances in knowledge:

ML approach using clinical and 18F-FDG-PET–based radiomic features has the potential to predict prognosis of laryngeal cancer.
Pancreatic neuroendocrine tumor: prediction of tumor grades by radiomics models based on ultrasound images
Authors: Dong Yi , Yang Dao-Hui , Tian Xiao-Fan , Lou Wen-Hui , Wang Han-Zhang , Chen Sheng , Qiu Yi-Jie , Wang Wenping , Dietrich Christoph F.
Published: July 2023

Objective

We aimed to investigate whether the radiomics analysis based on B-mode ultrasound (BMUS) images could predict histopathological tumor grades in pancreatic neuroendocrine tumors (pNETs).

Methods

A total of 64 patients with surgery and histopathologically confirmed pNETs were retrospectively included (34 male and 30 female, mean age 52.4 ± 12.2 years). Patients were divided into training cohort (n = 44) and validation cohort (n = 20). All pNETs were classified into Grade 1 (G1), Grade 2 (G2), and Grade 3 (G3) tumors based on the Ki-67 proliferation index and the mitotic activity according to WHO 2017 criteria. Maximum relevance minimum redundancy, least absolute shrinkage and selection operator were used for feature selection. Receiver operating characteristic curve analysis was used to evaluate the model performance.

Results

Finally, 18 G1 pNETs, 35 G2 pNETs, and 11 G3 pNETs patients were included. The radiomic score derived from BMUS images to predict G2/G3 from G1 displayed a good performance with an area under the receiver operating characteristic curve of 0.844 in the training cohort, and 0.833 in the testing cohort. The radiomic score achieved an accuracy of 81.8% in the training cohort and 80.0% in the testing cohort, a sensitivity of 0.750 and 0.786, a specificity of 0.833 and 0.833 in the training/testing cohorts. Clinical benefit of the score also exhibited superior usefulness of the radiomic score, as shown by the decision curve analysis.

Conclusions

Radiomic data constructed from BMUS images have the potential for predicting histopathological tumor grades in patients with pNETs.

Advances in knowledge

The radiomic model constructed from BMUS images has the potential for predicting histopathological tumor grades and Ki-67 proliferation indexes in patients with pNETs.
Comparison of the diagnostic value of contrast-enhanced ultrasound combined with conventional ultrasound versus magnetic resonance imaging in malignant non-mass breast lesions
Authors: Zhang Fan , Wang Jing , Jin Lifang , Jia Chao , Shi Qiusheng , Wu Rong
Published: July 2023

Objective:

To compare the diagnostic value of contrast-enhanced ultrasound (CEUS)+conventional ultrasound vs MRI for malignant non-mass breast lesions (NMLs).

Methods:

A total of 109 NMLs detected by conventional ultrasound and examined by both CEUS and MRI were retrospectively analysed. The characteristics of NMLs in CEUS and MRI were noted, and agreement between the two modalities was analysed. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and area under the curve (AUC) of the two methods for diagnosing malignant NMLs were calculated in the overall sample and subgroups of different sizes(<10 mm, 10–20 mm, >20 mm).

Results:

A total of 66 NMLs detected by conventional ultrasound showed non-mass enhancement in MRI. Agreement between ultrasound and MRI was 60.6%. Probability of malignancy was higher when there was agreement between the two modalities. In the overall group, the sensitivity, specificity, PPV, and NPV of the two methods were 91.3%, 71.4%, 60%, 93.4% and 100%, 50.4%, 59.7%, 100%, respectively. The diagnostic performance of CEUS+conventional ultrasound was better than that of MRI (AUC: 0.825 vs 0.762, p = 0.043). The specificity of both methods decreased as lesion size increased, but sensitivity did not change. There was no significant difference between the AUCs of the two methods in the size subgroups (p > 0.05).

Conclusion:

The diagnostic performance of CEUS+conventional ultrasound may be better than that of MRI for NMLs detected by conventional ultrasound. However, the specificity of both methods decrease significantly as lesion size increases.

Advances in knowledge:

This is the first study to compare the diagnostic performance of CEUS+conventional ultrasound vs that of MRI for malignant NMLs detected by conventional ultrasound. While CEUS+conventional ultrasound appears to be superior to MRI, subgroup analysis suggests that diagnostic performance is poorer for larger NMLs.
Computed diffusion-weighted imaging with a low-apparent diffusion coefficient-pixel cut-off technique for breast cancer detection
Authors: Kazama Toshiki , Takahara Taro , Endo Jun , Yamamuro Hiroshi , Sekiguchi Tatsuya , Niwa Tetsu , Niikura Naoki , Okamura Takuho , Kumaki Nobue , Hashimoto Jun
Published: July 2023

Objective:

This study aimed to compare the image quality and diagnostic performance of computed diffusion-weighted imaging (DWI) with low-apparent diffusion coefficient (ADC)-pixel cut-off technique (cDWI cut-off) and actual measured DWI (mDWI).

Methods:

Eighty-seven consecutive patients with malignant breast lesions and 72 with negative breast lesions who underwent breast MRI were retrospectively evaluated. Computed DWI with high b-values of 800, 1200, and 1500 s/mm2 and ADC cut-off thresholds of none, 0, 0.3, and 0.6 (×10−3 mm2/s) were generated from DWI with two b-values (0 and 800 s/mm2). To identify the optimal conditions, two radiologists evaluated the fat suppression and lesion reduction failure using a cut-off technique. The contrast between breast cancer and glandular tissue was evaluated using region of interest analysis. Three other board-certified radiologists independently assessed the optimised cDWI cut-off and mDWI data sets. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis.

Results:

When an ADC cut-off threshold of 0.3 or 0.6 (× 10−3 mm2/s) was applied, fat suppression improved significantly (p < .05). The contrast of the cDWI cut-off with a b-value of 1200 or 1500 s/mm2 was better than the mDWI (p < .01). The ROC area under the curve for breast cancer detection was 0.837 for the mDWI and 0.909 for the cDWI cut-off (p < .01).

Conclusion:

The cDWI cut-off provided better diagnostic performance than mDWI for breast cancer detection.

Advances in knowledge:

Using the low-ADC-pixel cut-off technique, computed DWI can improve diagnostic performance by increasing contrast and eliminating un-suppressed fat signals.
Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion
Authors: Kim Chan Kyo , Kang Kyung A , Oh Young Lyun , Park Sung Yoon
Published: July 2023

Objectives:

To investigate performance of adrenal CT-derived multivariate prediction models in differentiating adenomas with cortisol hypersecretion from the other subtypes.

Methods:

This retrospective study included 127 patients who underwent adrenal CT and had a surgically proven adrenal adenoma. Adenoma subtypes were defined according to biochemical test results: Group A, overt cortisol hypersecretion; Group B, mild cortisol hypersecretion; Group C, aldosterone hypersecretion; and Group D, non-function. Two independent readers analyzed size, attenuation, and washout properties of adenomas, and performed quantitative and qualitative analyses for assessing contralateral adrenal atrophy. Actual and internally validated areas under the curves (AUCs) of adrenal CT-derived multivariate prediction models for differentiating adenomas with cortisol hypersecretion from the other subtypes were assessed

Results:

In differentiating Group A from the other groups, the actual and internally validated AUCs of the prediction model were 0.856 (95% confidence interval [CI]: 0.786, 0.926) and 0.847 (95% CI: 0.695, 0.999) for Reader 1, respectively, and 0.901 (95% CI: 0.845, 0.956) and 0.897 (95% CI: 0.783, 1.000) for Reader 2, respectively. In differentiating Group B from groups C and D, the actual and internally validated AUCs of the prediction model were 0.777 (95% CI: 0.687, 0.866) and 0.760 (95% CI: 0.552, 0.969) for Reader 1, respectively, and 0.783 (95% CI: 0.690, 0.875) and 0.765 (95% CI: 0.553, 0.977) for Reader 2, respectively.

Conclusion:

Adrenal CT may be useful in differentiating adenomas with cortisol hypersecretion from the other subtypes.

Advances in knowledge:

Adrenal CT may benefit in adrenal adenoma subtyping.
Assessing four-dimensional CT stress maps derived from patient-specific biomechanical models of the lung with pulmonary function test data in lung cancer patients
Authors: Shiinoki Takehiro , Fujimoto Koya , Kawazoe Yusuke , Yuasa Yuki , Kajima Miki , Manabe Yuki , Hirano Tsunahiko , Matsunaga Kazuto , Tanaka Hidekazu
Published: July 2023

Objective:

This study aims to retrospectively compare the stress map of the lung with pulmonary function test (PFT) results in lung cancer patients and to evaluate the potential of the stress map as an imaging biomarker for chronic obstructive pulmonary disease (COPD).

Methods:

25 lung cancer patients with pre-treatment four-dimensional CT (4DCT) and PFT data were retrospectively analysed. PFT metrics were used to diagnose obstructive lung disease. For each patient, forced expiratory volume in 1 s (FEV1 % predicted) and the ratio of FEV1 and forced vital capacity (FEV1/FVC) were recorded. 4DCT and biomechanical model-deformable image registration (BM-DIR) were used to obtain the lung stress map. The relationship between the mean of the total lung stress and PFT data was evaluated, and the COPD classification grade was also evaluated.

Results:

The mean values of the total lung stress and FEV1 % predicted showed a significant strong correlation [R = 0.833, (p < 0.001)]. The mean values and FEV1/FVC showed a significant strong correlation [R = 0.805, (p < 0.001)]. For the total lung stress, the area under the curve and the optimal cut-off value were 0.94 and 510.8 Pa for the classification of normal or abnormal lung function, respectively.

Conclusion:

This study has demonstrated the potential of lung stress maps based on BM-DIR to accurately assess lung function by comparing them with PFT data.

Advances in knowledge:

The derivation of stress map directly from 4DCT is novel method. The BM-DIR-based lung stress map can provide an accurate assessment of lung function.