Classification of Multiple Diseases on Body CT Scans Using Weakly Supervised Deep Learning.

The long-term sequelae of COVID-19 remain a growing concern; however, a limited study targeting individuals with preexisting type 2 diabetes mellitus (T2DM) and Asian populations has been conducted. This large-scale, binational cohort study with extended follow-up aimed to evaluate the risk of post-acute sequelae of COVID-19 across multiple organ systems in individuals with T2DM. This study used binational, population-based cohorts in South Korea (K-COV-N; discovery cohort; n = 3,002,271) and Japan (JMDC; validation cohort; n = 1,125,045). All individuals aged >19 years were included from January 1, 2020, to December 31, 2022. We estimated the long-term risk of post-acute sequelae following SARS-CoV-2 infection. We defined the primary outcome as the onset of 65 diseases across 9 organ systems beyond the first 30 days after SARS-CoV-2 infection. After applying propensity score-based overlap weighting, we utilized Cox proportional hazards models to estimate adjusted hazard ratios (HRs) with 95% CIs for post-acute sequelae of COVID-19 within the weighted population. We further examined how the risk of sequelae changed over time following COVID-19 diagnosis. We also conducted multiple subgroup analyses on the severity of COVID-19, COVID-19 vaccination status, and T2DM-related complications. In the overlap-weighted discovery cohort, 1,056,277 individuals with preexisting T2DM were analyzed (mean age: 58.06 years [SD, 10.02]; 39.41% females). Compared with non-infected individuals, those with SARS-CoV-2 infection showed an increased long-term risk of sequelae across eight organ systems, including cardiovascular diseases (aHR, 1.11 [95% CI, 1.09-1.13]), dermatologic conditions (aHR, 1.20 [1.10-1.31]), endocrine disorders (aHR, 1.04 [1.01-1.08]), gastrointestinal diseases (aHR, 1.11 [1.07-1.14]), hepato-biliary-pancreatic disorders (aHR, 1.07 [1.03-1.11]), kidney disorders (aHR, 1.09 [1.03-1.16]), neurological disorders (aHR, 1.11 [1.03-1.20]), and pulmonary diseases (aHR, 1.11 [1.04-1.18]). Specifically, of 65 diseases, 45 showed a significantly elevated incident risk following a COVID-19 diagnosis. The risk of sequelae was higher in individuals with moderate-to-severe COVID-19 and persisted up to 12 months post-infection, with attenuation thereafter. COVID-19 vaccination was associated with reduced sequelae risk of developing some sequelae; however, the risk was still generally higher than in non-infected individuals. Similar trends were observed in the validation cohort, where all 65 specific diseases showed significant associations with long-term sequelae. Among individuals with preexisting T2DM, SARS-CoV-2 infection was associated with an increased risk of long-term sequelae across multiple organ systems, particularly in moderate-to-severe cases. Risks peaked within 12 months and gradually subsided thereafter, highlighting the enduring impact of COVID-19 and the need for sustained monitoring and preventive care in this high-risk population.

Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children. Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and t-tests. We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, p > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, p = 0.026), minor (26.1% vs. 7.4%, p = 0.032), and systemic (14.2% vs. 0%, p = 0.047) complications. Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.

IntroductionSince the NICE guidelines in 2004 and introduction of the Quality and Outcomes Framework (QOF) in 2004, the prevalence of COPD seen in general practice has increased (Smith 2008).1 We...

The objective was to retrospectively evaluate the contribution of fluorodeoxyglucose [18F] positron emission tomography/computed tomography (18FDG-PET/CT) to the re-staging of adrenocortical carcinoma (ACC). A total of 16 patients (10 males and 6 females), who underwent adrenalectomy due to adrenocortical carcinoma and 18FDG-PET/CT scan to re-stage the tumor between July 2007 and April 2013, were included in the present study. The mean age was 53.37 ± 13.91 years (min: 30, max: 74) The patients were required to fast for six hours prior to scanning, and whole-body PET scanning from the skull base to the upper thighs was performed approximately 1 h after the intravenous injection of 555 MBq of F-18 FDG. Whole body CT scanning was performed in the cranio-caudal direction. FDG-PET images were reconstructed using CT data for attenuation correction. Suspicious recurrent or metastatic lesions were confirmed by histopathology or clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18FDG-PET/CT were 100%, 83.3%, 90.9%, 83.3%, and 93.7%, respectively. 18FDG-PET/CT detects local recurrence and/or distant metastases with high accuracy in the re-staging of operated adrenocortical carcinoma. It is considered that the procedure could play an important role in treatment decision after the operation and post-operative follow-up and could influence the entire decision-making process.

Identifying subtypes of Long COVID: a systematic review

The high prevalence of metabolic syndrome in persons with schizophrenia has spurred investigational efforts to study the mechanism beneath its pathophysiology. Early psychosis dysfunction is present across multiple organ systems. On this account, schizophrenia may be a multisystem disorder in which one organ system is predominantly affected and where other organ systems are also concurrently involved. Growing evidence of the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, such as an association with cognitive dysfunction, altered autonomic nervous system regulation, desynchrony in the resting-state default mode network, and shared genetic liability, suggest that metabolic syndrome and schizophrenia are connected via common pathways that are central to schizophrenia pathogenesis, which may be underpinned by oxytocin system dysfunction. Oxytocin, a hormone that involves in the mechanisms of food intake and metabolic homeostasis, may partly explain this piece of the puzzle in the mechanism underlying this association. Given its prosocial and anorexigenic properties, oxytocin has been administered intranasally to investigate its therapeutic potential in schizophrenia and obesity. Although the pathophysiology and mechanisms of oxytocinergic dysfunction in metabolic syndrome and schizophrenia are both complex and it is still too early to draw a conclusion upon, oxytocinergic dysfunction may yield a new mechanistic insight into schizophrenia pathogenesis and treatment.

Corresponding author: Ronney L. Ferguson, MD , Navapache Regional Medical Center, 4371 South White Mountain Road, Show Low, AZ 85901. , E-mail address: [email protected]

The extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) can be classified as the following: (a) true EIMs due to reactive IBD affecting organ systems, (b) complications secondary to IBD activity, (c) non–IBD-specific autoimmune disease which occurs in increased frequency in individuals with IBD. Overlap is frequent between EIMs and extraintestinal complications, and it is increasingly evident that multiple organ systems may be involved. This review covers EIMs through their epidemiology, etiology/genetics/pathogenesis, prognosis, complications, and treatment. Also detailed are the organ systems involved with reactive IBD, including musculoskeletal, pulmonary, dermatological, ophthalmic, and hepatobiliary manifestations. Figures show the classification, etiology, and pathogenesis of EIMs of IBD, musculoskeletal and pulmonary manifestations of IBD, metastatic Crohn disease of the intergluteal cleft, pyoderma gangrenosum, oral apthous ulcers, Sweet syndrome, leucocytoclastic vasculitis, anti-tumor necrosis factor–induced psoriasis, uveitis, episcleritis, and primary sclerosing cholangitis. Tables list the modified New York criteria for ankylosing spondylitis, pulmonary manifestations of IBD and IBD-related treatment, diagnostic techniques in lung disorders associated with IBD, dermatologic manifestations of IBD based on classifications, specific cutaneous manifestations or granulomatous cutaneous lesions with the same histological features as the underlying bowel disease, reactive cutaneous manifestation of IBD with immunological mechanisms triggered by common antigens shared by gut bacteria and skin, cutaneous disorders or dermatosis associated with IBD, secondary cutaneous manifestations due to complications of IBD and adverse effects of IBD treatment, treatment of dermatological manifestations of IBD, diagnosis of ophthalmological manifestations of IBD, and other hepatobiliary manifestations of IBD. This review contains 13 highly rendered figures, 12 tables, and 79 references.

To investigate a method for selecting a protocol for body CT scan to acquire monochromatic images (MIs) by gemstone spectral imaging (GSI) with or without adaptive statistical iterative reconstruction (ASiR). We subjected a phantom to conventional scanning at 120 kVp and 50-700 mAs and GSI at 165-600 mAs; reconstructed MIs at 65 keV with ASiR 0-100 % for GSI; placed 5 regions of interest on each of 3 consecutive reconstructed slices to obtain the averaged standard deviation (SD) as image noise for conventional scan and GSI. Linear regression analysis yielded the mAs by conventional scan that could be used to achieve similar image noise by GSI. To achieve similar noise, we found excellent linear correlation of mAs between GSI with ASiR 0-100 % and conventional scan (r = 1.00, P < 0.0001), and obtained a table of equivalent mAs between MIs at 65 keV and conventional CT at 120 kVp. We can select a protocol for body CT scan for MIs at 65 keV with or without ASiR with results comparable to those of conventional CT at 120 kVp.

Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease

Despite anatomy and physiology being foundational courses in medical, nursing and allied ‐ health care programs, there is growing concern that the essential bioscience knowledge in these courses is not being retained by students over time. Numerous studies have demonstrated the difficulty of medical, nursing and allied health care students to retain and apply anatomical knowledge as they progress through their programs of study (Doomernik et al., 2017). However, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, with very few studies focusing on nursing students (Aari et al., 2004). Of those studies most are carried out after graduation (Aari et al., 2004), or are focused on a single or limited number of organ systems (Pourshanazari et al., 2013). The present study aims to determine the level of physiological knowledge retained by nursing students in the four month time period between the completion of their physiology course in first‐year nursing and enrollment in the second‐year pathophysiology course. To answer this question, nursing students were quizzed on eight organ systems using the on‐line quizzing system Kahoot. Each Kahoot quiz included nine to eleven knowledge and comprehension level multiple‐choice questions. These scores were compared to first year quiz scores on the same content to determine overall knowledge retention over time. Data were statistically analyzed using SPSS II, and means were compared using 2‐sample t‐tests. The scores are described for each organ system by reporting the mean and standard deviation (SD). Statistical significance was set at P ≤ 0.05 for all tests. The mean score of questions from all organ systems in year one was 64.72 ± 9.3 (SD). Comparing that score to matched test items evaluated in the pathophysiology course, there is a decrease in the overall mean score from 64.72 ± 9.3 (SD) to 53.33 ± 25.8 (SD). This equates to an 86.6% retention rate, or 13.6% knowledge loss within four months. Organ‐specific knowledge retention was highest for renal physiology (99.0%), digestive physiology (97.8%), immunity (89.9%), vascular physiology (88.6%), and reproductive physiology (84.2%). Retention was comparatively lower for endocrine physiology (80.7%), inflammation (79.8%), and blood (79.4%). These results demonstrate a high level of knowledge retention overall with variations in retention being system specific. The level of knowledge retention in this study was significantly higher than previous rates reported in medical and allied‐health students (Pourshanazari et al., 2013) and is significantly higher than anatomical knowledge retention levels in the same population (Narnaware and Neumeier, 2019 a,b).Support or Funding InformationNone

Ras p21 protein levels in human plasma from patients with chronic obstructive pulmonary disease (COPD) compared with lung cancer patients and healthy controls

Treating keratinocyte carcinomas with a combination of imiquimod, 5-fluorouracil, and tretinoin using store-and-forward telemedicine in the age of coronavirus disease 2019 to promote social distancing

EE422 Healthcare Costs Associated with Severe VS Moderate and Mild COVID-19 - a US Payer Perspective

Background Interstitial lung abnormalities (ILAs) are present at CT in about 10% of individuals undergoing lung cancer screening. The relationship between histologic findings of ILAs and their influence on patient prognosis remains unknown. Purpose To evaluate the percentage of ILAs at preoperative CT, as measured by radiologists and a computer-aided detection (CAD) software, as a predictor of disease-free survival in patients with lung cancer. Materials and Methods This retrospective study evaluated 217 consecutive patients who underwent complete resection of lung cancer from April 2010 to December 2015. Two radiologists, blinded to the patients' clinical information, scored percentage fibrosis extent and determined whether ILAs and the usual interstitial pneumonia (UIP) pattern were present. They assessed ILA progression at follow-up CT. Two pathologists determined the presence of an UIP pattern. Percentage fibrosis extent was also measured by using CAD. Binary logistic regression analysis was performed to determine whether the CAD percentage fibrosis extent was associated with ILA at CT. Multivariable Cox regression analysis was used to evaluate the significance of CAD percentage fibrosis extent as a predictor of prognosis. Results The radiologists classified 47 patients with ILAs and 24 patients with a UIP pattern at chest CT. The pathologists detected a UIP pattern in 25 patients. CT abnormalities showed progression over a 2-year period in all patients with histologic evidence of UIP. After adjustment for age, sex, and smoking index, the CAD percentage fibrosis extent was independently associated with ILA (odds ratio: 3.1; 95% confidence interval [CI]: 2.1, 4.7; P < .001). After adjustment for age, forced expiratory volume in 1 second (percentage predicted) radiologist-assessed percentage fibrosis extent, and pathologic stage, CAD percentage fibrosis extent was independently associated with worse disease-free survival (hazard ratio: 1.3; 95% CI: 1.1, 1.6; P < .001). Conclusion Greater computer-aided detection percentage fibrosis extent at preoperative CT independently predicted worse disease-free survival in patients with lung cancer. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Goo in this issue.