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Landmark detection in flatfoot radiographs is crucial in analyzing foot deformity. Here, we evaluated the accuracy and efficiency of the automated identification of flatfoot landmarks using a newly developed cascade convolutional neural network (CNN) algorithm, Flatfoot Landmarks AnnoTating Network (FlatNet). A total of 1200 consecutive weight-bearing lateral radiographs of the foot were acquired. The first 1050 radiographs were used as the training and tuning, and the following 150 radiographs were used as the test sets, respectively. An expert orthopedic surgeon (A) manually labeled ground truths for twenty-five anatomical landmarks. Two orthopedic surgeons (A and B, each with eight years of clinical experience) and a general physician (GP) independently identified the landmarks of the test sets using the same method. After two weeks, observers B and GP independently identified the landmarks once again using the developed deep learning CNN model (DLm). The X- and Y-coordinates and the mean absolute distance were evaluated. The average differences (mm) from the ground truth were 0.60 ± 0.57, 1.37 ± 1.28, and 1.05 ± 1.23 for the X-coordinate, and 0.46 ± 0.59, 0.97 ± 0.98, and 0.73 ± 0.90 for the Y-coordinate in DLm, B, and GP, respectively. The average differences (mm) from the ground truth were 0.84 ± 0.73, 1.90 ± 1.34, and 1.42 ± 1.40 for the absolute distance in DLm, B, and GP, respectively. Under the guidance of the DLm, the overall differences (mm) from the ground truth were enhanced to 0.87 ± 1.21, 0.69 ± 0.74, and 1.24 ± 1.31 for the X-coordinate, Y-coordinate, and absolute distance, respectively, for observer B. The differences were also enhanced to 0.74 ± 0.73, 0.57 ± 0.63, and 1.04 ± 0.85 for observer GP. The newly developed FlatNet exhibited better accuracy and reliability than the observers. Furthermore, under the FlatNet guidance, the accuracy and reliability of the human observers generally improved., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Robust labeling for semantic segmentation in radiographs is labor-intensive. No study has evaluated flatfoot-related deformities using semantic segmentation with U-Net on weight-bearing lateral radiographs. Here, we evaluated the robustness, accuracy enhancement, and efficiency of automated measurements for flatfoot-related angles using semantic segmentation in an active learning manner. A total of 300 consecutive weight-bearing lateral radiographs of the foot were acquired. The first 100 radiographs were used as the test set, and the following 200 radiographs were used as the training and validation sets, respectively. An expert orthopedic surgeon manually labeled ground truths. U-Net was used for model training. The Dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to evaluate the segmentation results. In addition, angle measurement errors with a minimum moment of inertia (MMI) and ellipsoidal fitting (EF) based on the segmentation results were compared between active learning and learning with a pooled dataset. The mean values of DSC, HD, MMI, and EF of the average of all bones were 0.967, 1.274 mm, 0.792°, and 1.147° in active learning, and 0.964, 1.292 mm, 0.828°, and 1.186° in learning with a pooled dataset, respectively. The mean DSC and HD were significantly better in active learning than in learning with a pooled dataset. Labeling of all bones required 0.82 min in active learning and 0.88 min in learning with a pooled dataset. The accuracy and angle errors generally converged in both learning. However, the accuracies based on DSC and HD were significantly better in active learning. Moreover, active learning took less time for labeling, suggesting that active learning could be an accurate and efficient learning strategy for developing flatfoot classifiers based on semantic segmentation., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Eight new naphtho[1,2-c]furan derivatives (1-8) along with six known analogues (9-14) were isolated from culture medium of the basidiomycete Basidioradulum radula. The structures of these compounds were identified using spectroscopic analysis, and their absolute configurations were resolved using X-ray diffraction, ECD, and VCD. Compounds 7 and 14 inhibited the cell viability of human prostate cancer DU-145 cells with IC 50 values of 7.54 ± 0.03 μM and 5.04 ± 0.03 μM, respectively. At 8 μM, compounds 7 and 14 increased the percentage of apoptotic cells and upregulated the protein expression related to the apoptosis caspase pathways in DU-145 cells. Furthermore, the hallmarks of cells undergoing apoptosis, such as chromatin condensation, were also observed at this concentration. However, compound 7 and 14 showed no effect on the proliferation of splenocytes isolated from cyclophosphamide-induce immunosuppressed mice., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The consumption of sprouts has been steadily increasing due to their being an excellent source of nutrition. It is known that the bioactive constituents of legumes can be increased after germination. In this study, the extract from Senna tora sprouts is shown to exhibit improved radical scavenging activities and better neuroprotective effects in HT22 hippocampal neuronal (HT22) and R28 retina precursor (R28) cells than those from seeds due to an increased content of phenolic constituents, especially compounds 1 and 3-6. A phytochemical investigation of S. tora sprouts resulted in the isolation of two new naphthopyrone glycosides (1-2) with 27 previously reported compounds. Their structures were determined via interpreting spectroscopic data. Compounds 1 and 3-6 were found to possess radical scavenging activities and neuroprotective effects against oxidative stress in both neuronal cells. Hence, Senna tora sprouts and their constituents may be developed as natural neuroprotective agents via antioxidative effects., (Copyright © 2021. Published by Elsevier Inc.)

Inflammation is a vital process that maintains tissue homeostasis. However, it is widely known that uncontrolled inflammation can contribute to the development of various diseases. This study aimed to discover anti-inflammatory metabolites from Penicillium bialowiezense. Seven spiroditerpenoids, including two new compounds, breviones P and Q (1 and 2), were isolated and characterized by various spectroscopic and spectrometric methods. All isolated compounds were initially tested for their inhibitory effects against lipopolysaccharide-induced nitric oxide (NO) production in RAW 264.7 macrophages. Of these, brevione A (3) exhibited this activity with a half-maximal inhibitory concentration value of 9.5 μM. Further mechanistic studies demonstrated that 3 could suppress the expression of pro-inflammatory cytokines and mediators, such as NO, prostaglandin E 2 , interleukin (IL)-1β, tumor necrosis factor-α, IL-6, and IL-12 by inhibiting the activation of nuclear factor-kappa B and c-Jun N-terminal kinase., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Currently, radiologic predictors for the resectability of cervical dumbbell schwannomas remain unknown. To identify radiologic predictors for resectability, we retrospectively reviewed data from 72 patients., Methods: From January 1995 to June 2017, 72 patients who underwent surgical treatment for cervical dumbbell schwannomas were enrolled. We focused on the relationship between preoperative magnetic resonance imaging (MRI) features and the extent of tumor removal. The MRI features evaluated were tumor size, tumor level, Eden classification, degree of vertebral artery (VA) involvement, and signal intensity (SI) on T2-weighted images (WIs)., Results: Among the 72 patients, gross total resection (GTR) and subtotal resection (STR) were achieved in 37 (51.4%) and 35 (48.6%) patients, respectively. Mean maximal tumor size (P = 0.011), mean size of foraminal and extraforaminal portion (P = 0.017), tumor level (P < 0.001), VA involvement (P < 0.001), and SI on T2-WIs (P = 0.006) were significantly different between the GTR and STR groups. Univariate analyses demonstrated that maximal tumor size (odds ratio [OR]: 0.93, P = 0.012), high cervical level (OR: 11.37, P < 0.001), pushed VA (OR: 0.11, P = 0.002), encased VA (OR: 0.02, P < 0.001), and hyper-SI on T2-WIs (OR: 12.46, P = 0.020) were significant predictors for GTR. In the multivariate analysis, only high cervical level (OR: 5.48, P = 0.033) and encased VA (OR: 0.07, P = 0.014) were significant predictors for GTR., Conclusions: The resectability of cervical dumbbell schwannomas may be predicted by MRI features, including tumor size, tumor level, and degree of VA involvement., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: This study was conducted to understand the clinical and demographic factors influencing the overall survival (OS) of patients with spinal ependymoma and to predict the OS with machine learning (ML) algorithms., Methods: We compiled spinal ependymoma cases diagnosed between 1973 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) registry. To identify the factors influencing survival, statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression model. In addition, we implemented ML algorithms to predict the OS of patients with spinal ependymoma., Results: In the multivariate analysis model, age ≥65 years, histologic subtype, extraneural metastasis, multiple lesions, surgery, radiation therapy, and gross total resection (GTR) were found to be independent predictors for OS. Our ML model achieved an area under the receiver operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.72-0.75) for predicting a 5-year OS of spinal ependymoma and an AUC of 0.81 (95% CI, 0.80-0.83) for predicting a 10-year OS. The stepwise logistic regression model showed poorer performance by an AUC of 0.71 (95% CI, 0.70-0.72) for predicting a 5-year OS and an AUC of 0.75 (95% CI, 0.73-0.77) for predicting a 10-year OS., Conclusions: With SEER data, we reaffirmed that therapeutic factors, such as surgery and GTR, were associated with improved OS. Compared with statistical methods, ML techniques showed satisfactory results in predicting OS; however, the dataset was heterogeneous and complex with numerous missing values., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Studies on resuming anticoagulation after burr-hole drainage for chronic subdural hematoma (CSDH) are limited. To evaluate the safety for early warfarin resumption after burr-hole drainage, we conducted a retrospective matched cohort study., Methods: Between January 2008 and April 2015, 36 patients with warfarin-related unilateral CSDH and 151 patients with ordinary unilateral CSDH were enrolled in this study. Patients taking warfarin were managed homogeneously according to the study protocol, and the usual dosage of warfarin was resumed within 2 or 3 days of burr-hole drainage to reach a target international normalized ratio (INR) of 2.1. The primary outcome, defined as recurrent CSDH requiring repeated burr-hole drainage within 3 months of the initial surgery, was compared between the two groups., Results: The primary outcome was observed in 4 (11%) of the 36 patients taking warfarin and in 18 (12%) of the 151 ordinary patients. After propensity score matching, the primary outcome was observed in 3 of 33 patients (9%) in the matched warfarin cohort and 11 of 74 patients (15%) in the matched ordinary cohort. When the results were analyzed using the generalized estimating equation, no significant difference was observed in the rate of recurrent CSDH between the 2 groups (P = 0.411). In addition, we found that recurrent CSDH was not related to postoperative international normalized ratio levels (P = 0.332)., Conclusions: There was no definitive association between postoperative early warfarin resumption and the recurrence rate of CSDH. Patients with warfarin-related CSDH and a strong indication for anticoagulation can be managed by resuming warfarin within 3 days of burr-hole drainage., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Infectious aortitis is a rare disease in the antibiotic era. Only a small number of cases of nonaneurysmal infectious aortitis are discussed in literature, and its true incidence and natural history are not well defined. We present here a case of typical nonaneurysmal infectious aortitis with literature review of 19 cases of aortic infection in which the aorta is initially normal in caliber., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Since the Nuss procedure was introduced in 1998, many complications have been reported, but not thoracic outlet syndrome. Here we report a 13-year-old boy with pectus excavatum who had thoracic outlet syndrome develop after a modified Nuss procedure. The major modification from the original technique was the use of an additional bar to resolve his long, asymmetric deformity. The patient showed clinical features of brachial plexus compression. The abrupt structural and spatial changes induced by the marked elevation of the upper depressed chest might have given rise to this condition. Thoracic outlet syndrome is a possible complication of the Nuss procedure., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)