Citations

OBJECTIVE In this study, the authors aimed to establish a supervised machine learning (ML) model based on multiple tree-based algorithms to predict long-term biochemical outcomes and intervention-free survival (IFS) after endonasal transsphenoidal surgery (ETS) in patients with Cushing’s disease (CD). METHODS The medical records of patients who underwent ETS for CD between 2013 and 2023 were reviewed. Data were collected on the patient’s baseline characteristics, intervention details, histopathology, surgical outcomes, and postoperative endocrine functions. The study’s primary outcome was IFS, and the therapeutic outcomes were labeled as "under control" or "treatment failure," depending on whether additional therapeutic interventions after primary ETS were required. The decision tree and random forest classifiers were trained and tested to predict long-term IFS based on unseen data, using an 80/20 cohort split. RESULTS Data from 150 patients, with a median follow-up period of 56 months, were extracted. In the cohort, 42 (28%) patients required additional intervention for persistent or recurrent CD. Consequently, the IFS rates following ETS alone were 83% at 3 years and 78% at 5 years. Multivariable Cox proportional hazards analysis demonstrated that a smaller tumor diameter that could be detected by MRI (hazard ratio 0.95, 95% CI 0.90–0.99; p = 0.047) was significantly associated with greater IFS. However, the lack of tumor detection on MRI was a poor predictor. The ML-based model using a decision tree model displayed 91% accuracy (95% CI 0.70–0.94, sensitivity 87.0%, specificity 89.0%) in predicting IFS in the unseen test dataset. Random forest analysis revealed that tumor size (mean minimal depth 1.67), Knosp grade (1.75), patient age (1.80), and BMI (1.99) were the four most significant predictors of long-term IFS. CONCLUSIONS The ML algorithm could predict long-term postoperative endocrinological remission in CD with high accuracy, indicating that prognosis may vary not only with previously reported factors such as tumor size, Knosp grade, gross-total resection, and patient age but also with BMI. The decision tree flowchart could potentially stratify patients with CD before ETS, allowing for the selection of personalized treatment options and thereby assisting in determining treatment plans for these patients. This ML model may lead to a deeper understanding of the complex mechanisms of CD by uncovering patterns embedded within the data.

Background: The number of medial ulnar collateral ligament (MUCL) reconstructions is increasing. The epidemiology surrounding revision MUCL reconstructions in professional baseball players has not been well defined. Purpose/Hypothesis: The purpose was to report the epidemiology of revision MUCL reconstruction in professional baseball players. The authors hypothesized that the number of revision MUCL reconstructions has increased over time and that the rate of return to sport at the same level of play is <70%. Study Design: Case series; Level of evidence, 4. Methods: All professional baseball pitchers who underwent revision MUCL reconstruction between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Rates of return to play, time to return to play, and return to same level of play were recorded and analyzed for pitchers with a minimum follow-up of 2 years. Surgical variables, including technique and graft choice, were also recorded. Results: Overall 191 pitchers (mean age, 26.0 years) underwent revision MUCL reconstruction. The mean time between primary and revision surgery was 1381 days (45 months). Of these players, 130 (68%) were Minor League Baseball pitchers. Hamstring tendon autograft was the most commonly used graft source (n = 90; 47%) when compared with palmaris longus autograft (n = 67; 35%). In terms of tunnel configuration, the modified Jobe and docking techniques were used in equal occurrence (n = 70; 37%). After revision MUCL reconstruction, only 72% of professional baseball pitchers were able to return to play at any level at a mean 556 days (18 months), and only 58% were able to return to the same level of play at a mean 604 days (20 months). The mean time between primary and revision MUCL reconstruction was 45 months (3.75 years). Conclusion: Revision MUCL surgery continues to be a challenging problem, where the procedure is complex, rehabilitation timelines are prolonged, and outcomes are not always optimal. Accordingly, the authors recommend that these procedures be performed by surgeons with high levels of experience.

OBJECTIVE Stereotactic radiosurgery (SRS) offers excellent tumor control for pituitary adenoma (PA); however, treatment failure occasionally necessitates salvage surgery. Comprehensive studies on salvage surgical outcomes for recurrent PA after SRS remain scarce. This study aimed to elucidate the outcomes of salvage endonasal transsphenoidal surgery (sETS) for progressive PA failing SRS. METHODS This retrospective, two institution–based cohort study analyzed data from patients who underwent sETS for progressive PA failing SRS. Progression-free survival (PFS), disease-specific survival (DSS), and neurological and endocrinological outcomes in the sETS group were analyzed and compared with those in the primary ETS (pETS) group after propensity score matching using the following variables: age at surgery, maximum tumor diameter, highest Knosp–Steiner classification, and tumor type. RESULTS Thirteen sETS patients (8 males [62%], median age at surgery of 56 years) with 5 nonfunctioning (39%), 6 corticotropic (46%), and 2 other functioning (15%) PAs who received median (range) follow-up of 125 ( 23–169) months were included. None of the patients experienced new neurological deficits or death after sETS. The median (range) tumor resection rate was 90% (80%–100%). The 5-year PFS and DSS rates were 55% and 77%, respectively. All 4 patients (31%) who experienced recurrence after sETS had corticotropic tumors. In the matched cohort analysis between the sETS group with 12 patients and the pETS group with 12 patients, no significant differences were observed in surgical outcomes. PFS rates were marginally higher in the sETS group than in the pETS group (80% vs 49% at 3 years, p = 0.216, log-rank test), and DSS was similar between the two groups (p = 0.543, log-rank test). CONCLUSIONS The authors’ results indicate that ETS can be safely performed as a salvage treatment after failed SRS with low complication rates and satisfactory tumor control in treatment-resistant PA.

AbstractThis article investigates the performance of a commercial BeO optically stimulated luminescent (OSL) dosimetry system (myOSLchip, RadPro GmbH International, Remscheid, Germany) through the application of the commissioning framework for luminescent dosimeters as described in the American Association of Physicists in Medicine Task Group 191 (AAPM TG191) report. Initial clinical experiences and dosimetric results are also presented. The following properties of the system were characterized: linearity correction factors ranged from ‐0.5% to +3% for dose levels spanning 0.1 to 20 Gy. Beam quality correction factors (relative to 6 MV) ranged from ‐4.5% (2.5FFF) to +4.5% (15MV) for photon beams and +1.9% (6 MeV) to +4.3% (20 MeV) for electron beams. An average (µ) signal loss per reading of ‐2.13% ± 0.20% was measured, however greater signal loss was observed in the first reading (µ = ‐2.6% ± 0.46%). An initial decline in individual element sensitivity relative to baseline was observed from 0–15 Gy cumulative dose (µ = ‐1.98% ± 0.55%), with negligible further deterioration from 15–32 Gy (µ = ‐2.38% ± 0.85%). Post‐irradiation, there was a transient OSL signal which faded with a half‐life of 1.8 min; this signal enhancement was +5% at 5 min post‐irradiation and +1% at 15 min relative to 24 h. Dosimeter response was not dependent on average dose rate in the range of 100–2500 MU/min. With respect to clinical testing, equal or superior performance compared with aluminum oxide OSLs (nanoDots) is shown for a range of clinical techniques and modalities including TSET, TBI, en‐face electrons, and pacemaker/out‐of‐field measurements. The feasibility of myOSLchip to serve as a primary clinical in vivo dosimetry system and direct replacement for Landauer's microStar system is demonstrated.

To examine the association between post-stroke depression (PSD) and macrostructural and microstructural brain measures, and to explore whether changes in accelerometer-measured physical activity (PA) are associated with PSD, we conducted an exploratory study in UK Biobank with dementia-free participants diagnosed with at least one prior stroke. Eligible participants (n = 1186) completed an MRI scan. Depression was classified based on positive depression screening scores (PHQ-2 ≥ 3). Multivariate linear regression models assessed the relationships between depression and structural and diffusion measures generated from brain MRI scans. Logistic regression models were used to examine the relationship between accelerometer-measured daily PA and future depression (n = 367). Depression was positively associated with total white matter hyperintensities (WMHs) volume (standardized β [95% CI]—0.1339 [0.012, 0.256]; FDR-adjusted p-value—0.039), periventricular WMHs volume (standardized β [95% CI]—0.1351 [0.020, 0.250]; FDR-adjusted p-value—0.027), and reduced MD for commissural fibers (standardized β [95% CI]—−0.139 [−0.255, −0.024]; adjusted p-value—0.045). The odds of depression decreased by 0.3% for each daily minute spent in objectively measured light PA, while each minute spent in sleep from midnight to 6:00 AM was associated with a 0.9% decrease in the odds of depression. This early-stage analysis using a population cohort offers a scientific rationale for researchers using multimodal data sources to investigate the heterogenous nature of PSD and, potentially, identify stroke patients at risk of poor outcomes.