Currently, various materials are routinely used for cranioplasty after decompressive craniectomy, each with their own features, potential benefits, and harms.
To systematically review available ...literature about safety (infection, resorption, and removal) of different materials used for cranioplasty for any indication.
A comprehensive search in MEDLINE, EMBASE, and the Cochrane library was performed for relevant studies published up to January 2017. Study quality was assessed according to the Cochrane Collaboration risk of bias assessment tool, and a set of 27 predetermined parameters was extracted by 2 investigators independently for further analysis.
The search yielded 2 randomized, 14 prospective, and 212 retrospective studies, totaling 10,346 cranioplasties in which 1952 (18.9%) complications were reported in patients between 0 and 90 years old. Overall, study quality was low and heterogeneity was large. Graft infections and resorption were most prevalent: overall infection rate was 5.6%. Autologous cranioplasties showed an infection rate of 6.9% versus 5.0% in combined alloplastic materials, including poly(methyl methacrylate) with 7.8%. Resorption occurred almost exclusively in autologous cranioplasties (11.3%). The greatest removal rate was reported for autologous cranioplasties (overall: 10.4%), which was significantly greater than that of combined alloplastic materials (overall: 5.1%; risk difference = 0.052 95% confidence interval: 0.039–0.066; NNT = 19 95% confidence interval: 15–25).
Available evidence on the safety of cranioplasty materials is limited due to a large diversity in study conduct, patients included, and outcomes reported. Autografts appear to carry a greater failure risk than allografts. Future publications concerning cranioplasties will benefit by a standardized reporting of surgical procedures, outcomes, and graft materials used.
•Autologous bone grafts appear to carry a greater failure risk than allografts.•Autologous bone grafts appear to carry a greater infection rate than allografts.•Reports on surgical procedures, outcomes, and graft materials should be standardized.
to determine if the tumor marker squamous cell carcinoma antigen (SCC-Ag) observed over time may contribute to the early detection of recurrence, metastasis, and second primary tumors in the ...follow-up of patients with head and neck squamous cell carcinoma (HNSCC).
A retrospective analysis of patients with HNSCC and at least one SCC-Ag measurement was conducted. Hazard ratios (HRs) were used to determine the correlation between SCC-Ag and an event.
patients with HNSCC, treated in the Antoni van Leeuwenhoek Hospital in The Netherlands between 2010 and 2020 were used for the analysis.
Data from 789 patients were used on event-free survival (EFS) with time-dependent Cox models. In addition to current (most recent) SCC-Ag (also dichotomized into high and low as done for clinical practice), average SCC-Ag and change between SCC-Ag measurements (delta SCC-Ag) were considered, using restricted cubic splines to explore nonlinear relationships.
Dichotomized SCC-Ag values (HR = 3.01, 95% confidence interval CI: 2.17-4.18) and the delta SCC-Ag (HR = 1.15, 95% CI: 1.07-1.22) predicted EFS better than models using the cumulative average or current value of SCC-Ag, also after adjusting for tumor site, stage, age, and gender. A strong association was observed when using delta SCC-Ag as a linear predictor in the subgroup of oropharynx patients (HR = 4.88, 95% CI: 2.71-8.79).
Dichotomized and delta SCC-Ag values can be important markers for EFS, during the follow-up of patients treated for HNSCC. These results were more evident in patients with oropharyngeal cancer.
The reuse of healthcare data for various purposes will become increasingly important in the future. To enable the reuse of clinical data, structured and standardized documentation is conditional. ...However, the primary purpose of clinical documentation is to support high-quality patient care. Therefore, this study investigated the effect of increased structured and standardized documentation on the quality of notes in the Electronic Health Record. A multicenter, retrospective design was used to assess the difference in note quality between 144 unstructured and 144 structured notes. Independent reviewers measured note quality by scoring the notes with the Qnote instrument. This instrument rates all note elements independently using and results in a grand mean score on a 0–100 scale. The mean quality score for unstructured notes was 64.35 (95% CI 61.30–67.35). Structured and standardized documentation improved the Qnote quality score to 77.2 (95% CI 74.18–80.21), a 12.8 point difference (p < 0.001). Furthermore, results showed that structured notes were significantly longer than unstructured notes. Nevertheless, structured notes were more clear and concise. Structured documentation led to a significant increase in note quality. Moreover, considering the benefits of structured data recording in terms of data reuse, implementing structured and standardized documentation into the EHR is recommended.
Purpose The objective of this review and meta-analysis was to determine the existence and extent of the predominance of women among patients with unilateral condylar hyperplasia (UCH). Furthermore, ...we examined the laterality of UCH in women and men from international study populations. Materials and Methods We performed a review using a standardized search strategy and meta-analysis. Results We included 10 studies in this review, with a total of 275 UCH patients. The meta-analysis showed a clear predominance of female patients in the UCH study populations; the pooled proportion of female patients was 0.64 (95% confidence interval CI, 0.58-0.70; n = 275 patients). The pooled percentage of female patients with left-sided UCH was 42% (95% CI, 34%-51%; n = 138), whereas 45% (95% CI, 33%-57%; n = 74) of male patients had left-sided UCH ( P = .69 for female patients vs male patients). Conclusions Female UCH patients outnumber male UCH patients in international study populations; therefore female gender may be considered a risk factor for UCH. We found no evidence of an association between laterality of UCH and gender: male patients and female patients have an almost equal distribution of left- and right-sided UCH.
Surgery for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) results in 30‒50% five-year overall survival. In IMCISION (NCT03003637), a non-randomized phase Ib/IIa trial, 32 ...HNSCC patients are treated with 2 doses (in weeks 1 and 3) of immune checkpoint blockade (ICB) using nivolumab (NIVO MONO, n = 6, phase Ib arm A) or nivolumab plus a single dose of ipilimumab (COMBO, n = 26, 6 in phase Ib arm B, and 20 in phase IIa) prior to surgery. Primary endpoints are feasibility to resect no later than week 6 (phase Ib) and primary tumor pathological response (phase IIa). Surgery is not delayed or suspended for any patient in phase Ib, meeting the primary endpoint. Grade 3‒4 immune-related adverse events are seen in 2 of 6 (33%) NIVO MONO and 10 of 26 (38%) total COMBO patients. Pathological response, defined as the %-change in primary tumor viable tumor cell percentage from baseline biopsy to on-treatment resection, is evaluable in 17/20 phase IIa patients and 29/32 total trial patients (6/6 NIVO MONO, 23/26 COMBO). We observe a major pathological response (MPR, 90‒100% response) in 35% of patients after COMBO ICB, both in phase IIa (6/17) and in the whole trial (8/23), meeting the phase IIa primary endpoint threshold of 10%. NIVO MONO's MPR rate is 17% (1/6). None of the MPR patients develop recurrent HSNCC during 24.0 months median postsurgical follow-up. FDG-PET-based total lesion glycolysis identifies MPR patients prior to surgery. A baseline AID/APOBEC-associated mutational profile and an on-treatment decrease in hypoxia RNA signature are observed in MPR patients. Our data indicate that neoadjuvant COMBO ICB is feasible and encouragingly efficacious in HNSCC.
A multicenter cross-sectional diagnostic study was carried out including 45 children with nontuberculous mycobacterial cervicofacial lymphadenitis and controls. The tested immunoassay, detecting M. ...avium– specific anti-glycopeptidolipid-core immunoglobulin A antibodies, had inadequate diagnostic performance in the studied population and seems to be of no additional value in detecting cases of nontuberculous mycobacterial cervicofacial lymphadenitis.
To evaluate the potential of synthetic radiomic data generation in addressing data scarcity in radiomics/radiogenomics models.
This study was conducted on a retrospectively collected cohort of 386 ...colorectal cancer patients (n = 2570 lesions) for whom matched contrast-enhanced CT images and gene TP53 mutational status were available. The full cohort data was divided into a training cohort (n = 2055 lesions) and an independent and fixed test set (n = 515 lesions). Differently sized training sets were subsampled from the training cohort to measure the impact of sample size on model performance and assess the added value of synthetic radiomic augmentation at different sizes. Five different tabular synthetic data generation models were used to generate synthetic radiomic data based on “real-world” radiomics data extracted from this cohort. The quality and reproducibility of the generated synthetic radiomic data were assessed. Synthetic radiomics were then combined with “real-world” radiomic training data to evaluate their impact on the predictive model's performance.
A prediction model was generated using only “real-world” radiomic data, revealing the impact of data scarcity in this particular data set through a lack of predictive performance at low training sample numbers (n = 200, 400, 1000 lesions with average AUC = 0.52, 0.53, and 0.56 respectively, compared to 0.64 when using 2055 training lesions). Synthetic tabular data generation models created reproducible synthetic radiomic data with properties highly similar to “real-world” data (for n = 1000 lesions, average Chi-square = 0.932, average basic statistical correlation = 0.844). The integration of synthetic radiomic data consistently enhanced the performance of predictive models trained with small sample size sets (AUC enhanced by 9.6%, 11.3%, and 16.7% for models trained on n_samples = 200, 400, and 1000 lesions, respectively). In contrast, synthetic data generated from randomised/noisy radiomic data failed to enhance predictive performance underlining the requirement of true signal data to do so.
Synthetic radiomic data, when combined with real radiomics, could enhance the performance of predictive models. Tabular synthetic data generation might help to overcome limitations in medical AI stemming from data scarcity.
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•Synthetic tabular data generation methods could generate data statistically similar to real-world radiomic features.•Augmenting radiogenomic models by combining real and synthetic radiomics could overcome data scarcity challenges.•When labels were randomised, synthetic data could not boost performance, indicating that this method amplifies true signals.
Unilateral condylar hyperplasia or hyperactivity (UCH) is a bone overgrowth disorder affecting the mandible. The purpose of this study was to determine the relations among age, condylar bone ...structure, condylar bone volume, and condylar bone activity on single-photon emission computed tomographic (SPECT) scans in patients with UCH.
This study included 20 patients with a clinical presentation of progressive mandibular asymmetry and a positive bone SPECT scan. A bone SPECT-derived standardized uptake value (bSUV) for the condylar region was determined. All patients underwent condylectomy to arrest further progression of the disease. The resected condyles were scanned with a micro-computed tomographic scanner (18-μm resolution). Bone architectural parameters were calculated with routine morphometric software.
The mean bSUV of the condyle on the affected side was 15.32 (standard deviation SD, 8.98) compared with 9.85 (SD, 4.40) on the nonaffected side (P = .0007). For trabecular bone structure, there was a nonsignificant correlation between the SUV of the affected condyle and the measured bone volume fraction (r = 0.13; P = .58) and trabecular thickness (r = 0.03; P = .90).
No meaningful relation was found between condylar bone volume fraction and condylar activity on bone scan; therefore, the impact of bone volume fraction on the results of bone scans is limited. The measured condylar activity on SPECT scan seems to be primarily a reflection of the remodeling rate of bone.
Objective This study assessed the quantitative evaluation of the region of interest (ROI) by mean and maximum pixel counts of single-photon emission computed tomography (SPECT) scans in patients with ...clinical suspicion of unilateral condylar hyperactivity (UCH); the interobserver reliability and the correlation of condylar activity with patient age was determined. Methods Two independent observers analyzed 67 bone SPECT scans. Maximum and mean activity values within an ROI on the mandibular condyle were analyzed; a cutoff value of 55% was used to determine the qualitative outcome. Results Excellent interobserver agreement was seen for both maximum (kappa 1.0) and mean activity analysis (kappa 0.94). Maximum and mean condylar activities were strongly correlated ( r > 0.98). Maximum and mean condylar activity of the normal condyle decreased significantly with increasing age. Conclusions Maximum and mean condylar activity levels were highly correlated in patients with mandibular asymmetry. An excellent interobserver agreement was found with either maximum or mean condylar activity.
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