Deep Learning-Based Analysis of Efficiency and Surgical Timing for Patients with Cervical Insufficiency Using Transvaginal Ultrasound Images

Objective. This work aims to analyze the surgical timing and clinical efficacy of transvaginal cervical ring ligation based on the ultrasound image focus detection of patients with cervical insufficiency (CIC) under the ultrasound image theme generation model. Methods. 134 CIC patients who came to the hospital for ultrasound imaging diagnosis were collected. Observation group was treated with cervical cerclage (CC) and the pregnancy outcome was followed up. Control group was treated conservatively. Results. For patients in the control group, average gestational age was 21.12 ± 2.18 weeks, average cervical length (CL) was 15.54 ± 0.42 mm, and average uterine opening width was 3.06 ± 0.63 mm. In the observation group, average gestational age was 24.45 ± 4.12 weeks, average CL was 17.32 ± 4.09 mm, and average uterine opening width was 0.21 mm. There were significant differences between the two groups ( P < 0.05 ). There were also significant differences in the degree of uterine orifice dilation between the two groups ( P < 0.05 ). Pregnancy outcomes of the two groups were compared, and χ2 and P < 0.05 indicated significant differences. Conclusion. Convolution neural network (CNN) and long short-term memory model (LSTM) algorithm were used to classify patients' ultrasound images, which could effectively improve diagnosis and treatment efficiency. Surgical success rate, clinical outcomes, neonatal survival rate, and clinical effect of observation group were better than those of control group. Cervical ligation was best performed before 17 weeks of pregnancy in CIC.

Effect of Surgical Timing on the Refracture Rate after Percutaneous Vertebroplasty: A Retrospective Analysis of at Least 4-Year Follow-Up

Introduction. The effect of surgical timing on vertebral refracture rate and mortality remains elusive after percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP), and we aim to assess the impact of surgical timing on vertebral refracture rate and mortality in patients undergoing percutaneous vertebroplasty. Methods. We did a retrospective cohort study of patients who underwent PKP or PVP because of osteoporotic vertebral compression fracture (OVCF) between April 1, 2014 and March 31, 2016. The primary outcome measure was the incidence of vertebral refracture. Secondary outcomes included the mortality and chronic back pain. Results. The rate of vertebral refracture was significantly lower in early surgical timing group than that in late surgical timing group (HR 2.415, 95% CI 1.318–4.427; P = 0.004 ). We found that the bone mineral density (BMD) was only the risk factor to increase the vertebral refracture rate after vertebroplasty ( P = 0.001 ). In addition, there was similar mortality between the two groups (15.7% in early surgical timing group versus 10% in late surgical timing group). Male patients (27.3%, 12/44) had higher mortality compared to female patients (10.6%, 20/189), while the mortality was higher in patients with cerebral infarction (25%, 3/12) than those without cerebral infarction (12.1%, 17/140). Conclusions. Surgical timing significantly affects the vertebral refracture rate after PKP or PVP, which is also influenced by BMD. The mortality after the surgery is not affected by the surgical timing, but gender and cerebral infarction may be the risk factors of mortality.

In cats and dogs with traumatic diaphragmatic rupture, does surgical timing affect outcome?

PICO question In cats and dogs with traumatic diaphragmatic rupture undergoing herniorrhaphy does surgical timing affect outcome? Clinical bottom line Category of research question Prognosis The number and type of study designs reviewed Ten studies were critically appraised. All of these were retrospective case series Strength of evidence Zero Outcomes reported Overall, there is not sufficient evidence reporting if timing of surgical intervention has an effect on the mortality rate in dogs and cats with traumatic diaphragmatic rupture. Mortality rate was 6.8–50% in all cases Conclusion There is no statistically significant information available with only several retrospective studies published that are a low quality of evidence. Clinical practice can be reviewed based upon current evidence assessing timing of herniorrhaphy of traumatic diaphragmatic rupture. However, there are no clear recommendations and future studies are warranted How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Global constructive myocardial work predicts left ventricular disfunction onset beyond longitudinal strain in patients with significant primary mitral regurgitation

Accurate surgical timing for significant primary mitral regurgitation (PMR) still remains an issue despite of several ways of left ventricular (LV) hidden disfunction detection, including LV global longitudinal strain (GLS). Since novel modalities such as myocardial work (MW) or area strain (AS) are currently available we assumed that they might predict surgical timing beyond known parameters. Methods 58 patients (31 female) 63±8 years, asymptomatic and with pulmonary systolic pressure (PSP) ≤45 mmHg on exercise echo test (ET), with PMR, in sinus rhythm, with ejection fraction (EF) ≥65% and GLS &lt;−19.5% were enrolled into the study along with 23 healthy subjects matched by age and sex and followed up for 1 year. Comprehensive echocardiography (EchoCG) was performed with offline analysis including MW and AS by one experienced specialist. GW index (GWI) was obtained from pressure-strain loops derived from speckle tracking analysis multiplied by brachial systolic blood pressure.Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) aa energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were obtained by the dedicated software. Results 13 (22%) patients with PMR became symptomatic or increase PSP &gt;50 mmHg on ET in 1 year follow up. EF, GLS, AS and GWI did not differ between symptomatic patients and those who remained asymptomatic during follow up, however these patients had significantly lower values of GCW, and higher values of GWW (EF 68.3±6.1% vs 69.2±6.5%, p=NS; GLS –22.4±2.3% vs 23.1±3.2%, p=NS, GWI 2452±161 mmHg% vs 2479±147 mmHg%, p=NS; GCW 1875±119 mmHg% vs 2321±124 mmHg%, p&lt;0.01; GWW 118±9 mmHg% vs 88±7 mmHg%, p&lt;0.03; GWE 93±8% vs 96±9%, p=NS; AS −32.5±5.4% vs −34.3±6.1%, p=NS;). Patients with subsequent symptoms development had significantly lower values of GCW and higher values of GWW. Among all parameters GCW was the predictor of MR clinical course worsening (AUC 0.769). Conclusion MR GCW is able to predict clinical course of patients with PMR beyond known conventional parameters. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): City Hall resources

The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results

BACKGROUND In the absence of a viable proximal nerve stump, damaged after surgical procedures around the skull base, numerous techniques for facial reanimation have been developed over time, aiming to restore baseline symmetry and active mimicry. OBJECTIVE To report experience using the masseteric nerve as a direct transfer to the facial nerve rerouted after intratemporal translocation. This paper illustrates the main steps of the technique and the quality of results. METHODS Eleven patients were treated with a masseteric direct transfer to the facial nerve. Its extratemporal rerouting toward the zygoma allowed tension-free coaptation between donor and recipient nerves. RESULTS Of the 11 patients, 8 had a good to excellent recovery, showing different patterns of time and scores, according to age, surgical timing, and masseteric nerve function quality. The return of activity in the frontalis muscle, never obtained after reinnervation via the hypoglossal nerve, is of particular interest. The quality of the smile can be improved with re-education and practice but remains under volitional control. A true emotional response is still lacking. CONCLUSION The masseteric nerve is an excellent alternative to the hypoglossal nerve and can reinnervate the whole territory of the facial nerve rerouted after intratemporal translocation. The overall results are remarkable, but the low quality of the trigeminal nerve, eventually affected by the first surgery, may be an important limitation. Even if the patients appear more at ease in re-education than with other techniques, a fully natural facial expression remains impossible to obtain.