Detecting schizophrenia with 3D structural brain MRI using deep learning.

Schizophrenia is a chronic neuropsychiatric disorder that causes distinct structural alterations within the brain. We hypothesize that deep learning applied to a structural neuroimaging dataset could detect disease-related alteration and improve classification and diagnostic accuracy. We tested this hypothesis using a single, widely available, and conventional T1-weighted MRI scan, from which we extracted the 3D whole-brain structure using standard post-processing methods. A deep learning model was then developed, optimized, and evaluated on three open datasets with T1-weighted MRI scans of patients with schizophrenia. Our proposed model outperformed the benchmark model, which was also trained with structural MR images using a 3D CNN architecture. Our model is capable of almost perfectly (area under the ROC curve = 0.987) distinguishing schizophrenia patients from healthy controls on unseen structural MRI scans. Regional analysis localized subcortical regions and ventricles as the most predictive brain regions. Subcortical structures serve a pivotal role in cognitive, affective, and social functions in humans, and structural abnormalities of these regions have been associated with schizophrenia. Our finding corroborates that schizophrenia is associated with widespread alterations in subcortical brain structure and the subcortical structural information provides prominent features in diagnostic classification. Together, these results further demonstrate the potential of deep learning to improve schizophrenia diagnosis and identify its structural neuroimaging signatures from a single, standard T1-weighted brain MRI.

Color Match Following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis.

BACKGROUND: Many options for free tissue transfer have been described for head and neck reconstruction. While functional outcomes remain paramount, aesthetic considerations like color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction. METHODS: A retrospective review was performed of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November 2012 and November 2020. Patients with documented pictures of their reconstruction and external skin paddles were considered. Patient demographics and surgery specific factors were recorded. Objective differences in color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score. Standard univariate descriptive statistics and multivariable statistical analyses were performed. RESULTS: Lateral arm, parascapular, and medial sural artery perforator (MSAP) free tissue transfer performed favorably compared to other donor sites, whereas anterolateral thigh flaps had the highest average dE2000 scores. Differences in dE2000 scores were mitigated by post-operative radiation to the flap site and with increasing time beyond 6 months post-operatively. CONCLUSIONS: We provide an objective assessment of external skin color match in patients undergoing free tissue transfer for head and neck cancer by donor site. MSAP, lateral arm, and parascapular free flaps performed well compared to traditional donor sites. These differences are more significant at the face and mandible when compared to the neck, but diminish 6 months after surgery and with post-operative radiation to the free flap skin paddle.

Surgical factors affecting regionally metastatic cutaneous squamous cell carcinoma to the parotid gland.

BACKGROUND: Understanding the impact of surgical treatment on regionally metastatic cutaneous squamous cell carcinoma (cSCC). METHODS: Retrospective series of 145 patients undergoing parotidectomy and neck dissection for regionally metastatic cSCC to the parotid. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analyzed over 3 years. Multivariate analysis was completed using Cox proportional hazard models. RESULTS: OS was 74.5%, DSS was 85.5% and DFS was 64.8%. On multivariate analysis, immune status (HR = 3.225[OS], 5.119[DSS], 2.071[DFS]) and lymphovascular invasion (HR = 2.380[OS], 5.237[DSS], 2.595[DFS]) were predictive for OS, DSS, and DFS. Margin status (HR = 2.296[OS], 2.499[DSS]) and ≥18 resected nodes (HR = 0.242[OS], 0.255[DSS]) were predictive of OS and DSS, while adjuvant therapy was predictive of DSS (p = 0.018). CONCLUSIONS: Immunosuppression and lymphovascular invasion portended worse outcomes in patients with metastatic cSCC to the parotid. Microscopically positive margins and <18 nodes resected are associated with worse OS and DSS, while patients receiving adjuvant therapy had improved DSS.

Design, development, and face validation of an intubation simulation device using real-time force data feedback.

Objectives: To develop a novel laryngoscope device capable of dynamically measuring force and torque measurements in real-time during intubation and to explore the efficacy of such a device through a face validation simulation. Methods: The torque sensor laryngoscope is designed for use during intubation and is modeled after a standard, single-use plastic laryngoscope. After device calibration, a face validation study was performed with intubation experts in the field. Quantitative data (intubation force metrics) and qualitative data (expert feedback on the device) were collected from three intubations using a Mac blade and three intubations with the Miller blade. Results: Three experts (two anesthesiologists and one otolaryngologist) participated in the study. The mean maximum force exerted with the Mac blade was 24.5 N (95% confidence interval [CI], 22.3-26.8). The average force exerted was 13.6 N (95% CI, 11.7-15.5). The average total suspension time was 13.1 s (95% CI, 10.4-15.8). The average total impulse was 164.6 N·s (95% CI, 147.9-181.4). The mean maximum force exerted with the Miller blade was 31.6 N (95% CI, 26.4-36.8). The average force exerted was 15.8 N (95% CI, 13.8-17.9). The average total suspension time was 11.3 s (95% CI, 9.9-12.6). The average total impulse was 216.2 N·s (95% CI, 186.5-245.9). The mean maximum force (p = .0265) and total impulse (p = .009) were significantly higher in the Miller blade trials than in the Mac blade trials. Survey results found that this device, while bulky, intubated similarly to standard-use models and has potential as an intubation teaching tool. Conclusion: The torque sensor laryngoscope can measure and display real-time intubation force metrics for multiple laryngoscope blades. Initial validation studies showed a significantly lower maximum force and total impulse when intubating with the Mac blade than with the Miller blade. Face validation survey results were positive and suggested the potential for this device as a teaching tool. Level of Evidence: Level 5.

Improving across-dataset brain tissue segmentation for MRI imaging using transformer.

Brain tissue segmentation has demonstrated great utility in quantifying MRI data by serving as a precursor to further post-processing analysis. However, manual segmentation is highly labor-intensive, and automated approaches, including convolutional neural networks (CNNs), have struggled to generalize well due to properties inherent to MRI acquisition, leaving a great need for an effective segmentation tool. This study introduces a novel CNN-Transformer hybrid architecture designed to improve brain tissue segmentation by taking advantage of the increased performance and generality conferred by Transformers for 3D medical image segmentation tasks. We first demonstrate the superior performance of our model on various T1w MRI datasets. Then, we rigorously validate our model's generality applied across four multi-site T1w MRI datasets, covering different vendors, field strengths, scan parameters, and neuropsychiatric conditions. Finally, we highlight the reliability of our model on test-retest scans taken in different time points. In all situations, our model achieved the greatest generality and reliability compared to the benchmarks. As such, our method is inherently robust and can serve as a valuable tool for brain related T1w MRI studies. The code for the TABS network is available at: https://github.com/raovish6/TABS.

Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial.

OBJECTIVES: The laryngeal force sensor (LFS) provides real-time force data for suspension microlaryngoscopy. This study investigates whether active use of the LFS can prevent the development of complications. STUDY DESIGN: Prospective controlled trial. SETTING: Academic tertiary center. METHODS: The LFS and custom software were developed to track intraoperative force metrics. A consecutive series of 100 patients had force data collected with operating surgeons blinded to intraoperative readings. The subsequent 100 patients had surgeons actively use the LFS monitoring system. Patients were prospectively enrolled, completing pre- and postoperative surveys to assess the development of tongue pain, paresthesia, paresis, dysgeusia, or dysphagia. RESULTS: On univariate analysis, the active monitoring group had lower total impulse (P < .001) and fewer extralaryngeal complications (P < .01). On multiple logistic regression, maximum force (odds ratio [OR], 1.08; 95% CI, 1.01-1.16; P = .02) was a significant predictive variable for the development of postoperative complications. Similarly, active LFS monitoring showed a 29.1% (95% CI, 15.7%-42.4%; P < .001) decrease in the likelihood of developing postoperative complications. These effects persisted at the first postoperative visit for maximum force (P = .04) and active LFS monitoring (P = .01). Maximum force (OR, 1.11; 95% CI, 1.04-1.18; P < .01) and active LFS monitoring (16.6%; 95% CI, 2.7%-30.5%; P = .02) were also predictive for the development of an abnormal 10-item Eating Assessment Tool score. These effects also persisted at the first postoperative visit for maximum force (P = .01) and active LFS monitoring (P = .01). CONCLUSION: Maximum force is predictive of the development postoperative complications. Active monitoring with the LFS is able to mitigate these forces and prevent postoperative complications. LEVEL OF EVIDENCE: 2.

Force Metrics and Suspension Times for Microlaryngoscopy Procedures.

OBJECTIVE: To determine the difference in force metrics measured by the laryngeal force sensor for various suspension microlaryngoscopy (SML) procedures and their perioperative narcotic requirements. STUDY DESIGN: Prospective observational study. SETTING: Academic tertiary center. METHODS: The laryngeal force sensoris a force sensor designed for SML procedures. Prospectively enrolled patients had dynamic recordings of maximum force, average force, suspension time, and total impulse. Procedures were grouped into excision of striking zone lesions, nonstriking zone lesions, endoscopic cancer surgery with margin control, and airway dilation. Narcotic administration in the intraoperative period and postanesthesia care unit was also recorded and converted into IV morphine equivalents. Surgeons were blinded to the force recordings during surgery to prevent operator bias. RESULTS: In total, 110 patients completed the study. There was no significant difference in average force across different procedures, however, a significant difference was seen for maximum force (P = 0.025), suspension time (P < 0.001), and total impulse (P = 0.002). The highest values were seen for endoscopic cancer surgeries with margin control with a mean maximum force of 49.4 lbf (95%CI, 37.1-61.7), mean suspension time of 60.2 minutes (95%CI, 40.5-79.9), and mean total impulse of 31.3 ton*s (95%CI, 15.2-47.3). A significant difference (P < 0.01) in perioperative narcotic requirements was also seen, with endoscopic cancer surgery cases having the highest requirements at 27.6 mg of ME (95%CI, 16.1-39.2 mg). CONCLUSION: Significant differences in force metrics exist between various SML procedures. Endoscopic cancer surgery is associated with higher force metrics and perioperative narcotic requirements.