Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely...Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types： tight ilium terminale （53 cases）, lipomyelome- ningocele （55 cases）, lipomatous malformation （124 cases）, postoperative adhesions （56 cases）, and split cord malformation （38 cases）. All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight ilium terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal- formation. Binary logistic regression analysis revealed that types of tethered cord syndrome （lipoma-type or not） and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR1800016464）.展开更多
Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultra...Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.展开更多
基金supported by the Science Foundation of Military Medical Research and Clinical Research Foundation of PLA General Hospital in China,No.2016FC-CXYY-1006(to AJS)a grant from the Application of Clinical Features of Capital City of Science and Technology Commission in China,No.Z171100001017140(to AJS)
文摘Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types： tight ilium terminale （53 cases）, lipomyelome- ningocele （55 cases）, lipomatous malformation （124 cases）, postoperative adhesions （56 cases）, and split cord malformation （38 cases）. All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight ilium terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal- formation. Binary logistic regression analysis revealed that types of tethered cord syndrome （lipoma-type or not） and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry （registration number： ChiCTR1800016464）.
基金supported by the SFYF at SJTU(24X010500175)the Interdisciplinary Program of Shanghai jiao Tong University(YG2024QNA02)+5 种基金Neil Shen's SJTU Medical Research Fund,SJTU Transmed Awards Research(STAR)Grant No.20210106 the Science and Technology Commission of Shanghai Municipality(STCSM)(grant no.23JS1400700)the Innovative Research Team of High-Level Local Universities in Shanghai(SHSMU-ZDCX20212200),NSFC81903417Scientific Project of Huangpu District(grant no.HKQ201810)Shanghai Huangpu District Health Commission(Grant No.2023XD02)Xuzhou Municipal Bureau of Science and Technology Key R&D Projects Social Development Projects(KC23178)Science and Technology Special Fundation of Jiangsu Province(BE2023657).
文摘Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.
