Search Results (399)

Background/Objectives: Disorganization of retinal inner layers (DRIL) is an important and supportive biomarker in optical coherence tomography (OCT) imaging for diagnosing the extent of diabetic macular edema (DME) in patients and anticipating visual outcomes. But the manual DRIL identification is subject to interobserver bias and requires a lot of time and effort from the experts. This research presents a novel, computerized, and clinically guided approach for the classification of DRIL that leverages the central 1 mm foveal region extracted through the annotations provided by the expert ophthalmologists and investigates the effectiveness of a transformer and Masked Auto Encoder (MAE) based foundation model (RETFound) as the primary approach. Methods: We fine-tuned and validated the RETFound model, utilizing accurate foveal center coordinates provided by the experienced ophthalmologists. Our approach emphasizes the macular region that is significant diagnostically, where DME biomarkers manifest more predominantly. To guarantee robust evaluation, the dataset was divided into 85% training and 15% held-out test sets. We performed 5-fold cross-validation exclusively on the training dataset with baseline, conservative, and moderate fine-tuning strategies, and the final model was evaluated on the independent, unseen test set. Convolutional neural network (CNN)-based transfer learning (TL) models (MobileNetV2, EfficientNetB0, InceptionV3, DenseNet121, and DenseNet169) were also assessed for comparative evaluation. Results: The RETFound model yielded the best outcomes under the conservative fine-tuning strategy, achieving a mean test accuracy (AC) of 0.9339 ± 0.0036 and an area under the curve (AUC) of 0.9660 ± 0.0028 on the independent held-out test set across the five fold-trained models. The moderate and baseline evaluations achieved comparatively lower outcomes, highlighting the effectiveness of the conservative approach. The RETFound model consistently outperformed CNN models, exhibiting stability and superior generalization for DRIL classification. We performed statistical validation using the Wilcoxon signed-rank test and 95% confidence intervals to confirm the robustness of the proposed method, and an ablation analysis showed that the fovea-centered region of interest (ROI) guidance consistently improved results when compared with whole OCT analysis. Conclusions: This research demonstrates that the deep-learning (DL) methods assisted by expert clinical knowledge with an anatomically aligned ROI could provide remarkable results in DRIL detection applications. This work attempts to establish an anatomically relevant framework for computerized DRIL identification that focuses on the highly crucial macular region, possibly helping in faster intervention and improved diagnosis in the management of DME. Full article

The coarctation of the aorta is a congenital anomaly characterized by a local narrowing of the aortic lumen localized near the ductus arteriosus. Typically diagnosed in childhood, but it can remain until symptoms become evident. This aortic anomaly can also coexist with aortic valve stenosis. In our case report, we present a 46-year-old male with chest pain, dyspnea, and a significant blood pressure gradient between upper and lower extremities. Diagnostic examination included transthoracic echocardiography and computerized tomography. This diagnostic imaging showed narrowing of the aortic lumen with a residual lumen dimension of 3 mm and severe aortic stenosis. The patient underwent a complex surgical procedure, replacement of the aortic valve and reconstruction of the aorta. An extra-anatomic ascending-to-descending aortic bypass was constructed using a 20 mm Dacron graft, combined with mechanical aortic valve replacement. The operation was performed through median sternotomy with two arterial canula in the femoral artery and in the aorta, and one venous canula in the right atrium. Two canulae are placed for the safe performance of cardiopulmonary bypass. The patient was discharged at home without complication. This case highlights that a single surgical procedure may represent a definitive treatment of a complex problem with good short-term results. Full article

Invasive pulmonary mold infections (IPMIs) are critical complications in immunocompromised patients, contributing significantly to morbidity and mortality. Diagnosing pathogens like Aspergillus species (spp.) and the Mucorales remains challenging due to non-specific clinical presentations and the limitations of traditional culture methods. This review provides an up-to-date synopsis of IPMI diagnostic tools, focusing on their diagnostic performance, turnaround time (TAT), and cost-effectiveness. We conducted a narrative review of the current literature regarding clinical evaluation, radiographic findings, invasive diagnostics, and non-invasive assays, including next-generation sequencing (NGS) and volatile organic compounds (VOCs). Chest computerized tomography (CT) remains a vital first step, though classic signs like the “halo” or “reverse halo” are neither sensitive nor specific. Traditional diagnostics are limited by low sensitivity and delayed results. While plasma microbial cell-free DNA (mcfDNA) NGS offers rapid TAT (24–48 h) and high specificity, its suboptimal sensitivity for Aspergillus spp. (<50%) and high cost remain significant barriers. Investigational VOC “breath tests” show promising sensitivity (77–96%) but lack standardization. Future research must prioritize the standardization of non-invasive microbiologic testing modalities, particularly those with rapid TAT such as bedside “breath tests” and high-throughput mcfDNA NGS. Development of clinical algorithms that balance cost-effectiveness with timely pathogen diagnosis based on the patient’s degree of immunosuppression is essential to improve survival in high-risk populations. Full article

Background/objectives: In this study, we aimed to investigate acute infarct volume on magnetic resonance diffusion-weighted imaging (MRI DWI), chronic infarct volume on FLAIR (fluid-attenuated inversion recovery), hypoperfused area volume on PWI (perfusion-weighted imaging), stenosis locations and rates on CT (computerized tomography) angiography, CT angiography collateral scoring, and correlation of background data and etiological factors with neurological clinical findings in patients with acute middle cerebral infarction. Methods: A total of 117 patients with MCA (middle cerebral artery) infarction were hospitalized for diagnosis and treatment after undergoing CT angiography within 9 h of symptom onset. Comparative results of Souza’s collateral score system, MRI parameters, and clinical outcomes were determined. Results: According to the Souza CS system, 23 patients were in the malignant profile and 94 in the good profile. There was a statistically significant difference between the malignant and benign profiles in terms of DWI volume, hypoperfused area volume on PWI sequence, white matter assessment using the Fazekas scale, and supratentorial and infratentorial chronic infarct volume on the FLAIR sequence (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). Conclusions: Patients with a malignant profile on CTA may have a larger infarct volume and worse functional outcome. This should be recognized, and these patients should be followed up more carefully and attentively than those with good collateral scores. Full article

Accurate estimation of Body Carcass Fat (BCF) is essential for evaluating the physiological condition of ewes. Traditional assessment via Body Condition Score (BCS) through palpation is inaccurate and subjective. BCF can now be predicted more precisely using objective measurements. This study presents a comparative analysis of eight machine learning (ML) models for predicting BCF in Coopworth ewes, using weight and RGB-image-based body measurements. Four non-linear regression methods and four neural network architectures were evaluated using a dataset of 74 ewes with 13 independent variables. The dataset was partitioned into training (52 ewes), validation (11 ewes), and testing (11 ewes) sets. The Gradient Boosting Regression achieved the highest predictive accuracy with an R² value of 0.9434 using body weight and width, followed by Ensemble Neural Network (R² = 0.9371) using body weight. The findings demonstrate the effectiveness of the Gradient Boosting Regression, Ensemble Neural Network and Random Forest tree-based approaches for morphometric prediction tasks in biological applications. BCF values obtained from image analysis were validated against those derived from computerized tomography (CT), considered the gold standard. These findings highlight the potential of image-guided, ML-driven models for objective, non-invasive, cost-effective assessment of ewe body composition in modern livestock systems. Full article

While advanced imaging techniques and ordered porous materials like MOFs have gained prominence, gas sorption remains the indispensable tool for characterizing the multiscale heterogeneity of industrially important disordered solids, such as catalysts and shales. This review examines recent developments in gas sorption methodologies specifically tailored for rigid, disordered porous media. We discuss experimental advances, including the choice of adsorbate and the utility of the overcondensation method for probing macroporosity and ensuring saturation. Furthermore, we critically evaluate theoretical approaches for determining pore size distributions (PSDs), contrasting classical methods with Density Functional Theory (DFT) and Grand Canonical Monte Carlo (GCMC) simulations. Special emphasis is placed on the impact of pore-to-pore cooperative effects, such as advanced condensation, cavitation, and pore-blocking, on the interpretation of sorption isotherms. We highlight how complementary techniques, including integrated mercury porosimetry, NMR, and computerized X-ray tomography (CXT), are essential for deconvolving these complex network effects and validating void space descriptors. We conclude that, while “brute force” molecular simulations on image-based reconstructions are progressing, “minimalist” pore network models, which incorporate cooperative mechanisms, currently offer the most empirically adequate approach. Ultimately, gas sorption remains unique in its ability to statistically characterize void spaces from Angstroms to millimeters in a single experiment. Full article

Objective: To evaluate the three-dimensional (3D) angular displacement (Roll, Yaw, and Pitch) of the upper cervical vertebrae (C1, C2, and C3) in patients with severe mandibular deviation (MD) due to condylar hyperplasia (CH), utilizing a computed tomography (CT)-based segmentation approach. Methods: This retrospective cross-sectional study included 50 patients with MD ≥ 6 mm caused by hemimandibular elongation (HE) or a hybrid form (HF) of CH. The skull, mandible, and cervical vertebrae (C1–C3) were segmented using 3D Slicer software. Angular deviations (Pitch, Yaw, Roll) were measured relative to the Frankfurt plane. Patients were categorized by the side of CH (right or left), and intergroup comparisons were performed using Kruskal–Wallis and Mann–Whitney U tests. Spearman’s correlation analyses assessed associations between MD magnitude and cervical angles. Results: CH was significantly more prevalent in females (58%; p = 0.021). C2 and C3 exhibited significantly increased lateral Roll inclination toward the side of deviation (p = 0.006 and p = 0.045, respectively). C2 Pitch negatively correlated with MD severity bilaterally (r ≈ −0.51, p = 0.02 right; r ≈ −0.50, p = 0.02 left). Strong intra-vertebral correlations between Pitch and Yaw were observed in C1 and C2, indicating synchronized vertical and rotational motion. No significant intergroup differences were found in Yaw angles (p > 0.05). Conclusions: Patients with CH and severe MD exhibit consistent patterns of 3D cervical displacement, particularly in lateral inclination and vertical movement, suggesting compensatory postural adaptations in the upper cervical spine. Full article

Objective: We aimed to evaluate the morphometric characteristics of the internal acoustic meatus (IAM) using high-resolution computed tomography (CT), with emphasis on sex- and age-related differences, with particular emphasis on the IAM orientation angle as a less-studied spatial parameter and its potential clinical and forensic relevance. Methods: Temporal bone CT scans of 162 patients (94 females, 68 males; age 1–77 years) were retrospectively analyzed. Measurements included the IAM inlet diameter, length, mid-diameter, lateral angle (LA), and orientation angle. Inter-observer agreement was assessed in 30 randomly selected cases. Morphometric parameters were compared by sex and age using t-tests and Mann–Whitney U tests. Results: Mean IAM lengths were 11.0 mm (right) and 11.1 mm (left), and the mean mid-diameter was 4.2 mm bilaterally. IAM lengths and diameters showed no significant sex- or age-related differences (p > 0.05). In contrast, LA and orientation angle differed significantly by sex (p < 0.05), with females showing higher LA values, which may influence posterior fossa surgical exposure. Conclusions: IAM size parameters are largely independent of sex and age, whereas lateral and orientation angles exhibit sex-related variation. Preoperative evaluation of IAM orientation on CT can support skull base surgical planning, and LA may provide supportive morphometric information in forensic contexts, although it should not be considered a standalone sex classification parameter. Full article

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients treated at the Clinic for Pulmonology at the University Clinical Center of Serbia (February 2019–February 2025). Diagnosis of IPF was made according to the guidelines of the American Thoracic Society and the European Respiratory Society. Demographic features, comorbidities, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), high-resolution computerized tomography (HRCT) patterns, 6-min walk test distance (6MWTD), echocardiography, and survival outcomes were analyzed. Disease progression was defined as a ≥10% decline in FVC and/or DLCO after 12 months. Results: Of the 76 patients, 31 received nintedanib and 45 pirfenidone. Baseline characteristics, comorbidities, and HRCT patterns were comparable between groups. Mean annual decline in FVC was −1.74% with pirfenidone and −2.38% with nintedanib, without a statistical difference. DLCO declined by −4.25% and −6.29%, respectively, with similar downward trends over time in both groups. Progression was recorded in 35 (46.1%) patients, of whom 18 (58.06%) were in the nintedanib group and 17 (37.77%) in the pirfenidone group, with no difference between therapies (p = 0.81). Definite and probable usual interstitial pneumonia (UIP) were evenly represented on HRCT, although progression correlated significantly with the probable UIP pattern (p = 0.006). 6MWTD decreased in both groups over 12 months, again without treatment-related differences (p = 0.566). During up to 6 years of follow-up, overall survival was 4.18 years, with no significant difference between the nintedanib (4.55 years) and pirfenidone (3.81 years) groups (p = 0.159). No association was found between disease stage (FVC or DLCO) and progression. Conclusions: This study demonstrates that pirfenidone and nintedanib are equally effective in the management of IPF in real-world settings. The absence of significant differences in functional decline, progression rates, and survival indicates that treatment choices should be guided by individual clinical profiles rather than efficacy alone, reinforcing antifibrotic therapy as the primary approach to alter the course of IPF. Importantly, disease progression was strongly associated with a probable UIP pattern on HRCT, supporting current guidelines suggesting that probable UIP has a natural history and prognosis similar to those of definite UIP. Full article

Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. On the other hand, this procedure affects the musculoskeletal system, and investigating skeletal muscle is not routinely recommended for bariatric surgery. This study aimed to evaluate the psoas muscle in patients in the preoperative period of sleeve gastrectomy and six months after the procedure using abdominal computed tomography scans. Materials and Methods: This clinical, exploratory, and observational study, with a prospective longitudinal observational study design, was conducted at a single center with 31 women who underwent sleeve gastrectomy. The evaluations were performed before and after six months of the procedures. Results: Anthropometric, muscle strength, hepatic ultrasound, and psoas computerized tomography evaluations were performed. A significant reduction in body weight, body mass index, waist, neck, and calf circumference was observed. There was also a substantial reduction in right-hand strength and the area and index of the psoas muscle (but with an increase in density). Most presented a routine abdominal ultrasound. Conclusions: Our results suggest that muscle evaluation provides valuable information for clinical monitoring before and after bariatric surgery, helping to identify potential risks and guide multidisciplinary follow-up. Psoas muscle area and psoas muscle index decreased, but psoas muscle density increased, all significantly. These results indicate that conducting a muscle evaluation is helpful for patients undergoing bariatric surgery, supporting the use of the clinical approach before and after the procedure, predicting possible complications, and providing more accurate prognoses. Full article

Background/Objectives: Disorganization of the retinal inner layers (DRIL) is an important biomarker of diabetic macular edema (DME) that has a very strong association with visual acuity (VA) in patients. But the unavailability of annotated training data from experts severely limits the adaptability of models pretrained on real-world images owing to significant variations in the domain, posing two primary challenges for the design of efficient computerized DRIL detection methods. Methods: In an attempt to address these challenges, we propose a novel, self-supervision-based learning framework that employs a huge unlabeled optical coherence tomography (OCT) dataset to learn and detect clinically applicable interpretations before fine-tuning with a small proprietary dataset of annotated OCT images. In this research, we introduce a spatial Bootstrap Your Own Latent (BYOL) with a hybrid spatial aware loss function aimed to capture anatomical representations from unlabeled OCT dataset of 108,309 images that cover various retinal abnormalities, and then adapt the learned interpretations for DRIL classification employing 823 annotated OCT images. Results: With an accuracy of 99.39%, the proposed two-stage approach substantially exceeds the direct transfer learning models pretrained on ImageNet. Conclusions: The findings demonstrate the efficacy of domain-specific self-supervised learning for rare retinal pathological detection tasks with limited annotated data. Full article

Objectives: Real-world evidence that supports decision-making must meet numerous criteria, including validated identification of clinical outcomes. This study aimed to develop and validate a method for identifying new cases of myocardial infarction (MI) and ischemic stroke (IS) within real-world clinical data in China. Methods: Algorithms to identify MI and IS events were developed using ICD-10-CM codes and Chinese diagnosis keywords within the Tianjin Regional Healthcare Database. Validation followed predefined criteria: MI required cardiac troponin elevation and ischemic symptoms or cardiac troponin elevation and electrocardiogram changes; IS required clinical symptoms and neuroimaging confirmation of cerebral Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) reports. Positive predictive value (PPV) with 95% confidence intervals (CI) was calculated for each outcome. Results: Among 304 MI and 302 IS cases randomly selected, approximately half were identified using ICD-10-CM codes and half through Chinese diagnosis keywords. Overall PPV for MI was 69% (95% CI: 63–74%), with similar PPVs across identification methods. PPV increased to 88% for inpatient MI and 97% for primary inpatient MI. For IS, overall PPV was 65% (95% CI: 58–71%), with higher PPV for cases identified by ICD-10-CM codes (76%) compared to keyword-only cases (56%). PPV increased to 76% for inpatient IS and 91% for primary inpatient IS. Conclusions: The use of ICD-10-CM codes and Chinese diagnosis keywords in primary inpatient diagnoses provides a validated approach for the identification of clinical outcomes of MI and IS within real-world clinical data in China. Full article

Background/Objectives: Patients undergoing antiresorptive therapy were evaluated, focusing on clinical and radiological features and their relationship with medication-related osteonecrosis of the jaw (MRONJ). Methods: Patients were allocated to two groups: MRONJ (n = 27) and non-MRONJ (n = 139). Clinical evaluation included decayed, missing, and filled teeth (DMFT), number of teeth, periodontal status, prosthesis use, and preventive/therapeutic measures. Imaging analysis included panoramic radiography (PAN) and cone beam computerized tomography (CBCT) to assess MRONJ-related signs. Results: The sample showed high levels of DMFT and prosthesis use. There was a tendency of higher prevalence of deeper periodontal pockets in the MRONJ group, with greater need for oral hygiene reinforcement and chlorhexidine prescription. PAN showed higher frequency of osteolysis, persistent alveolar socket, bone sequestration, mandibular canal involvement, periosteal reaction, and sinus involvement in the MRONJ group. Still on PAN, all cases in both groups exhibited a sclerotic trabecular bone pattern. CBCT showed higher frequency of a sclerotic trabecular bone pattern, mandibular canal involvement, and bone sequestration in the MRONJ group. Composite radiographic index modified (CRIm) was higher in the MRONJ group for PAN and CBCT, with low-grade cases in the non-MRONJ and medium-/high-grade cases in the MRONJ group. A positive correlation was found between CRIm and MRONJ staging. Conclusions: This study underscores the role of preventive oral care in patients undergoing antiresorptive therapy, highlighting the need for regular periodontal monitoring. Also emphasized is the importance of integrating clinical and radiographic examinations of these patients. Accordingly, CRIm seems to be a reliable tool for MRONJ staging and monitoring. Full article

Objectives: Maxillary nerve block via the greater palatine canal (GPC) offers the potential for profound regional anesthesia of the maxilla but remains underutilized due to anatomical variability and technical complexity. The aim of this study was to explore the clinical feasibility, accuracy, and anesthetic effectiveness of a computer-guided approach by using CBCT-based surgical guides to access the pterygopalatine fossa via the GPC. Methods: Thirty-one patients underwent the procedure with patient-specific guides designed from cone-beam computerized tomography (CBCT) and intraoral scans. A 27G needle was directed through the guide to deliver 1.8 mL of 2% lidocaine with epinephrine 1:80.000. Pulpal anesthesia was assessed via electric pulp testing (EPT), and soft tissue anesthesia via pressure algometry at predefined oral and facial sites. Success was defined as absence of EPT response at maximum output and pressure pain threshold ≥ 700 g. To assess variations in anesthetic efficacy among multiple related groups, Cochran’s Q test and McNemar’s test were employed. Results: Successful needle placement was achieved in 30 out of 31 patients (96.7%) using the computer-guided approach, with a mean of 1.45 insertion attempts per case. Complete palatal soft tissue anesthesia was achieved in all subjects across the tested sites (100%). Pulpal anesthesia was most effective in posterior teeth, with success rates of 96.7% for first molars and 93.3% for first premolars, while the central incisor showed a reduced success rate of 50%. Transient visual disturbances occurred in three patients (10%), with no other adverse effects reported. Conclusions: These findings support the use of computer-guided GPC block as a method for achieving maxillary nerve anesthesia. Although anesthetic spread to anterior and buccal regions was limited, the technique demonstrated consistent effectiveness in the posterior maxilla, highlighting its potential utility in complex dental and surgical interventions requiring deep and long-lasting regional anesthesia. Full article

Background: Hollow posts have been introduced in clinical practice, providing the possibility of injecting luting resin directly into the post. The aim of our study was to compare quartz fiber hollow posts with solid posts. Methods: In total, 20 human teeth with straight single root canals were utilized for this study, divided into two groups with 10 elements each, one restored with radiopaque quartz fiber hollow posts and the other with radiopaque quartz fiber solid posts. In total, two micro-CT (micro-computerized tomography) analyses allowed us to evaluate both the presence of air voids in the luting resin and the different capacities of posts to penetrate until full depth into the post space. Results: The authors observed that hollow quartz fiber posts create a smaller volume of air voids in the luting resin (p < 0.01) and better fit (p < 0.05) the post space compared to the solid posts. Conclusions: Hollow posts can promote retention. Future studies with larger samples are encouraged to confirm these findings and provide possible better long-term results for post-endodontic reconstructions in vivo. Full article