BACKGROUND: Spontaneous pneumothorax recurs in 30 to 54% of patients without surgery. Identifying individuals likely to suffer a recurrence, who might benefit from pre-emptive surgery, is challenging. Previous meta-analysis suggested a relationship between contralateral recurrence and specific computed tomography (CT) findings.
METHODS: We analysed CT images and recurrence rates 243 patients seen by our tertiary referral pneumothorax service.
RESULTS: We validated the meta-analysis observation that contralateral lung cysts are associated with a higher risk of contralateral recurrence in younger individuals. Furthermore, we observed the size of contralateral cysts to be associated with increased contralateral recurrence in younger patients.
CONCLUSIONS: The detection of contralateral lung cysts might therefore help identify younger patients more likely to benefit from pre-emptive surgery.

This manuscript seeks to describe diagnostic considerations in individuals with diabetes mellitus presenting to the ED with abdominal pain. It highlights the importance of early investigation with computerised tomography to differentiate aetiologies that compel early surgical intervention from those which may be treated conservatively.

Kidney stones require surgical removal when they grow too large to be broken up externally or to pass on their own. Upper tract urothelial carcinoma is also sometimes treated endoscopically in a similar procedure. These surgeries are difficult, particularly for trainees who often miss tumours, stones or stone fragments, requiring re-operation. Furthermore, there are no patient-specific simulators to facilitate training or standardized visualization tools for ureteroscopy despite its high prevalence. Here a system ASSIST-U is proposed to create realistic ureteroscopy images and videos solely using preoperative computerized tomography (CT) images to address these unmet needs. A 3D UNet model is trained to automatically segment CT images and construct 3D surfaces. These surfaces are then skeletonized for rendering. Finally, a style transfer model is trained using contrastive unpaired translation (CUT) to synthesize realistic ureteroscopy images. Cross validation on the CT segmentation model achieved a Dice score of 0.853 ± 0.084. CUT style transfer produced visually plausible images; the kernel inception distance to real ureteroscopy images was reduced from 0.198 (rendered) to 0.089 (synthesized). The entire pipeline from CT to synthesized ureteroscopy is also qualitatively demonstrated. The proposed ASSIST-U system shows promise for aiding surgeons in the visualization of kidney ureteroscopy.

OBJECTIVE: It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation.
METHODS: All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured.
RESULTS: A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321.
CONCLUSIONS: Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.

暂无摘要。

UNASSIGNED: It is not clearly defined in the literature how the lowest instrumented vertebra (LIV) selection effects the rotation of lumbar vertebrae at fused and unfused levels in thoracolumbar/lumbar (TL/L) curves. The aim of this study was to evaluate the rotational profile of structural TL/L curves, corrected with rod derotation manoeuvre, according to LIV level.
UNASSIGNED: 82 consecutive AIS patients with structural TL/L curves who were treated with long segment posterior instrumentation and fusion were retrospectively evaluated. Patients were divided into three groups according to LIV level: lower end vertebra (LEV) group (32 patients), LEV-1 group (23 patients) and LEV + 1 group (27 patients). Cobb angles of structural curves, coronal and sagittal balance were evaluated with direct roentgenograms. Rotation of upper end vertebra, apical vertebra, LIV-1, LIV and LIV + 1 was evaluated with computerised tomography. Clinical outcomes were assessed using SRS-22 questionnaire.
UNASSIGNED: Mean follow-up time was 31 months (range 24-42 months). Preoperative LIV rotation was measured as 16.03°, 16.08° and 12.68° in LEV, LEV-1 and LEV + 1 groups, which changed postoperatively as 13.36°, 16.52° and 9.74° respectively. Postoperative LIV-1, LIV and LIV + 1 rotation values were significantly higher in LEV-1 group compared to LEV + 1 group. None of the patients developed coronal or sagittal imbalance. No significant differences were observed between the groups in terms of SRS-22 scores.
UNASSIGNED: Axial rotation of LIV and vertebrae adjacent to LIV is higher when the fusion is stopped at LEV-1. However, higher rotation does not seem to cause poor radiologic and clinical outcomes in the last follow-up.

OBJECTIVE: To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research.
BACKGROUND: Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years.
METHODS: A scoping review based on the steps suggested by the Joanna Briggs Institute.
METHODS: A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms \'nurse practitioner\', \'medical imaging\', \'diagnostic imaging\', \'scan\' and \'radiography\'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021.
RESULTS: Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging.
CONCLUSIONS: There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this.
CONCLUSIONS: Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States.
UNASSIGNED: No patient or public contribution.

The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is greatly improved by an early and accurate diagnosis. Several studies have created automated methods to forecast PDAC development utilising various medical imaging modalities. These papers give a general overview of the classification, segmentation, or grading of many cancer types utilising conventional machine learning techniques and hand-engineered characteristics, including pancreatic cancer. This study uses cutting-edge deep learning techniques to identify PDAC utilising computerised tomography (CT) medical imaging modalities. This work suggests that the hybrid model VGG16-XGBoost (VGG16-backbone feature extractor and Extreme Gradient Boosting-classifier) for PDAC images. According to studies, the proposed hybrid model performs better, obtaining an accuracy of 0.97 and a weighted F1 score of 0.97 for the dataset under study. The experimental validation of the VGG16-XGBoost model uses the Cancer Imaging Archive (TCIA) public access dataset, which has pancreas CT images. The results of this study can be extremely helpful for PDAC diagnosis from computerised tomography (CT) pancreas images, categorising them into five different tumours (T), node (N), and metastases (M) (TNM) staging system class labels, which are T0, T1, T2, T3, and T4.

UNASSIGNED: To analyse the computerised tomography (CT) imaging features and diagnostic value of seminal duct tuberculosis (TB).
UNASSIGNED: The imaging data of male patients with ejaculatory duct TB who underwent surgical treatment in our hospital from 1 January 2019 to 31 December 2019 were retrospectively analysed. Through CT images, seminal duct TB was divided into different types, and the CT image features of different types of TB were analysed. The differences in diagnosis between CT and pathological results were compared.
UNASSIGNED: According to the CT manifestations of TB of the intrapelvic segment of seminal duct TB, this disease could be divided into an intra-tubular calcification type, a lumen dilatation and effusion type and a wall thickening type, among which 6 cases (15.8%) were intra-tubular calcification types, 14 cases (36.8%) were lumen dilatation and effusion types and 18 cases (47.4%) were wall thickening types. The diagnostic efficacy of CT in the diagnosis of ejaculatory duct TB: sensitivity = 63.89% (23/36), specificity = 80.01% (44/53), accuracy = 75.28% (67/89), positive predictive value = 51.87% (43/109), negative predictive value = 77.19% (44/57) and kappa = 0.558.
UNASSIGNED: CT has high sensitivity and specificity in the diagnosis of seminal duct TB. The classification of seminal duct TB using CT images is of great significance for the diagnosis and treatment of the disease.

Spontaneous or post-traumatic CSF (cerebrospinal-fluid) rhinorrhea occurs when there is a skull-base defect. In our study, we tried endoscopic approach, exclusively as surgical modality. To study feasibility of trans-nasal endoscopic approach for repair of skull-base defects and success rates at each anatomical subsite, with complications. Patients, who underwent endoscopic repair of CSF rhinorrhea between 2016 and 2019 were recruited into study. Details of investigative work-up, aetiology, surgery done, site of leak, number of surgical procedures done, post-operative complications and their management, success rate for each anatomical sub-site, was retrieved retrospectively and analyzed. All patients were initially managed with conservative measures before taking up for surgery. Eighteen-patients (male-11, female-7, mean age-40.3 years) with CSF rhinorrhea {spontaneous-5(27.7%), traumatic-13(62.3%)} were found. Sites of leak were cribriform-plate (CP), fovea-ethmoidalis (FE) and posterior-table of frontal-sinus (FS) in 8(44.4%), 5(27.7%) and 5(27.7%) respectively. Twelve (66.6%) patients had no postoperative complications. No patients with defects in CP had post-operative complication. Two (11.1%) patients with FS defect had meningitis, one (5.5%) patient with FS defect developed pneumocephalus. One (5.5%) patient developed frontal sinusitis at end of 4-months. Two (11.1%) patients, each with defects in FE and FS needed a revision repair on postoperative day 0 and 90-till date, none of the patients have any delayed procedure related complications or recurrences. Endoscopic repair of CSF leaks is the norm of the current day due to its minimally invasive nature. However, endoscopic repair of leaks through the frontal sinus were challenging and was associated with a high rate of complications.