Cureus最新文献

To enhance patient outcomes in pediatric cancer, a better understanding of the medical and biological risk variables is required. With the growing amount of data accessible to research in pediatric cancer, machine learning (ML) is a form of algorithmic inference from sophisticated statistical techniques. In addition to highlighting developments and prospects in the field, the objective of this systematic study was to methodically describe the state of ML in pediatric oncology. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for relevant studies on four distinct databases (Scopus, Web of Science, PubMed, and Cochrane Library). A total of 1536 relevant studies were retrieved to the EndNote library (Clarivate, Philadelphia, USA) where duplicates were removed and the rest of the studies were assessed for eligibility based on titles, abstracts, and the availability of full-text articles. After assessing the studies for eligibility, we found 42 studies eligible for inclusion in this systematic review. We found nine studies on liquid tumors, 13 on solid tumors, and 20 on central nervous system (CNS) tumors. ML goals included classification, treatment response prediction, and dose optimization. Neural networks, k-nearest neighbors, random forests, support vector machines, and naive Bayes were among the techniques employed. The identified studies' strengths included treatment response prediction and automated analysis that matched or outperformed physician comparators. Significant variation in clinical applicability, criteria for reporting, limited sample numbers, and the absence of external validation cohorts were among the common issues. We found places where ML can improve clinical care in manners that would not be possible otherwise. Even though ML has great promise for enhancing pediatric cancer diagnosis, decision-making, and monitoring, the discipline is still in its infancy, and standards and recommendations will support future research to guarantee robust methodologic design and maximize therapeutic applicability.

Background Sarcopenia is the progressive and generalized loss of skeletal muscle and its associated function. Whilst it is typically associated with advanced age, it is also prevalent in patients with chronic diseases including cancer. Patients with esophageal cancer are at high risk of developing malnutrition and sarcopenia due to impaired oral intake, the effects of neoadjuvant treatment, and cancer-related cachexia. Sarcopenia has been associated with worse postoperative outcomes. The aim of this study was to investigate the impacts sarcopenia had on the short- and long-term outcomes of patients undergoing esophagectomy in a regional Australian context. Methods A single-center retrospective analysis was performed for 48 patients who underwent esophagectomy, most of which were for esophageal cancer. All eligible patients received neoadjuvant treatment prior to surgery. Patients were classified as sarcopenic based on their calculated skeletal muscle index (SMI) on a preoperative computed tomography scan. SMI criteria for sarcopenia were <52.4 cm²/m² for males and <38.5 cm²/m² for females. Outcomes measured included overall and disease-free survival, postoperative complications, and length of hospital stay. Results Of the 44 patients who met inclusion criteria and underwent esophagectomy, 27 were sarcopenic based on preoperative computed tomography skeletal muscle measurements at L3. The average overall survival for the sarcopenic group was 20.1 months (95% CI 13.3-26.9) with a one-, two-, and three-year overall survival rate of 59.3%, 29.6%, and 22.2%, respectively. The non-sarcopenic group had an average overall survival rate of 28.8 months (95% CI 19.6-38.1) with a one-, two-, and three-year overall survival rate of 82.4%, 41.2%, and 29.4%, respectively. The average disease-free survival for the sarcopenic group was 14.1 months (95% CI 8.4-19.8) with a one-, two-, and three-year disease-free survival rate of 37.0%, 18.5%, and 11.1%, respectively. The average disease-free survival rate for the non-sarcopenic group was 27.2 months (95% CI 19.7-34.7) with a one-, two-, and three-year disease-free survival rate of 76.5%, 41.2%, and 29.4%, respectively. The sarcopenic group had an increased average length of hospital stay (23.9 days (CI 95% 16.5-31.3) vs. 14.6 days (95% CI 12.2-17.0)). A higher proportion of the sarcopenic patients had restricted dietary intake and required either pureed or enteral feeding (36% vs. 9%). No difference in postoperative complications was detected between the groups. Conclusions Patients with preoperative sarcopenia had a lower overall and disease-free survival and an increased length of hospital stay when compared with non-sarcopenic patients. Additionally, sarcopenic patients had a higher likelihood of requiring pureed or enteral feeds preoperatively.

Pediatric spinal tumors include a variety of developmental lesions and uncommon neoplasms that differ significantly from those seen in adults. These conditions are underreported in the sub-Saharan medical literature. We present the case of a 10-year-old girl brought by her family to the University Teaching Hospital of Kinshasa in the Democratic Republic of Congo with progressive lower limb functional impairment. On admission, the patient was alert, with normal vital signs, pink palpebral conjunctiva, anicteric sclerae, unremarkable cardiopulmonary and spinal examinations, and no spinal deformities. However, palpation revealed tenderness along the dorsal spinous processes from T1 to T10, and a sensory level corresponding to the T4 dermatome was noted. The patient was paraplegic and wheelchair-bound, with a lower limb American Spinal Injury Association (ASIA) motor score of 20/50. A CT scan of the thoracolumbar spine revealed no disc or vertebral abnormalities. An MRI demonstrated an extensive extradural, intracanal mass from T1 to T10 causing spinal cord compression. The mass exhibited signal characteristics suggestive of a fat-containing lesion. A posterior surgical approach was performed for tumor excision 20 days after admission. Histopathological analysis confirmed an inflammatory fibrolipomatous tumor. Postoperatively, the patient showed significant neurological improvement after three months of physiotherapy. This report highlights the diagnostic and therapeutic challenges associated with rare spinal lesions in children.

[This retracts the article DOI: 10.7759/cureus.72872.].

[This retracts the article DOI: 10.7759/cureus.51256.].

Introduction Total hip arthroplasty (THA) is rarely indicated in the skeletally immature population. In these instances, there is concern for implant survival compared to the traditional older population. There has been a steady rise in the use of THA in the pediatric population due to improvements in surgical techniques. While the outcomes in THA for skeletally immature patients have been described in the literature, there are no population studies looking at this procedure in a skeletally immature individual. Therefore, the purpose of this study was to compare 10-year implant survivability following primary THA in skeletally mature versus skeletally immature patients. Methods Patients who underwent primary THA were identified using a large national database (PearlDiver). THA patients were then divided into presumed skeletally immature male patients (0-16 years), presumed skeletally mature male patients (17-21 years), presumed skeletally immature females (0-14 years), and presumed skeletally mature females (15-21 years). Multivariable analysis was conducted using Cox proportional hazards modeling to determine differences in the risk of revision for periprosthetic joint infection (PJI), mechanical loosening, dislocation/instability, and periprosthetic fracture (PPF). Results In total, 352 male patients (244 skeletally mature and 108 skeletally immature) and 409 female patients (350 skeletally mature and 59 skeletally immature) were identified. Compared to skeletally immature females, skeletally mature females had no higher risk of 10-year revision for all-cause, PJI, mechanical loosening, dislocation/instability, or PPF (P > 0.05 for all). Compared to skeletally immature males, skeletally mature males had no higher risk of 10-year revision for all-cause, PJI, mechanical loosening, dislocation/instability, or PPF (P > 0.05 for all). Conclusion Although THA occurred more commonly in patients above the presumed age of skeletal maturity, the lack of significantly different surgical outcomes suggests that younger age and presumed skeletal immaturity may not put patients at any further risk of implant failure. While further research is needed to understand the impact of age and skeletal maturity on outcomes of THA, these results indicate that the initial age of a THA may not be a factor in optimizing outcomes, and suggests that orthopedic surgeons need not delay surgery based on age or skeletal maturity alone.

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. It usually lies on the antimesenteric side of the ileum, about 60 cm from the ileocecal valve. Histologically, it is a true diverticulum comprising all four layers of the intestinal tract. Complications associated with MD include bleeding, bowel obstruction, intussusception, and inflammation (diverticulitis). A 12-year-old boy presented to the emergency department with a one-day history of right iliac fossa pain. He had rebound tenderness and localized peritonism. The inflammatory markers were raised. He was listed for an emergency laparoscopic appendicectomy. Intraoperatively, a large necrotic MD was identified, twisted on its pedicle. In addition, a fibrous band extended from the tip of the diverticulum to the posterior aspect of the anterior abdominal wall. A closed-loop, discoloured terminal ileal volvulus with proximal small bowel dilatation was noted. The band was released by sharp dissection, and the terminal ileum volvulus was freed with the return of normal colour and circulation. The gangrenous Meckel's diverticulum was excised at its pedicle by ECHELON FLEX™ ENDOPATH® staplers (Ethicon, Inc., a Johnson & Johnson company, Raritan, NJ). The postoperative recovery was uneventful. Early laparoscopic intervention prevented irreversible small bowel ischaemia that may have resulted in resection of the terminal ileum in a child.

Persistent hypotony following Tanito microhook trabeculotomy (TMH) is rare but may occur due to the development of cyclodialysis clefts. We report a case of a Japanese man in his 40s who developed persistent hypotony and hypotony maculopathy after TMH in the left eye. Fourteen months after the surgery, the patient was referred to our institution due to prolonged hypotony that remained undiagnosed and untreated despite evaluations with gonioscopy and anterior segment optical coherence tomography (AS-OCT) at the referring clinic. At our institution, default AS-OCT scans and gonioscopy also failed to identify the cleft due to anterior iris rotation caused by ciliary body detachment. However, manual AS-OCT scans successfully revealed angle detachment and irido-trabecular contact at 203°. The patient underwent combined cataract surgery and direct internal cyclopexy to repair the cyclodialysis cleft. While the surgery successfully resolved hypotony, it resulted in elevated intraocular pressure, necessitating Ahmed glaucoma valve implantation. This case emphasizes the importance of detailed AS-OCT scanning in detecting subtle cyclodialysis clefts and highlights direct internal cyclopexy as an effective treatment option for prolonged hypotony after TMH.

Myelolipoma of the adrenal gland is a rare, benign, non-functioning tumor characterized by the presence of adipose tissue and bone marrow elements. We present the case of a 48-year-old woman with intermittent left flank pain and an incidental finding of an adrenal tumor on computed tomography. The patient underwent laparoscopic tumor resection due to the large size of the tumor. The decision to perform surgery was based on the tumor size and the patient's symptoms. Laparoscopic adrenalectomy is a safe surgical technique with low complication rates and shorter hospital stays.

[This corrects the article DOI: 10.7759/cureus.74810.].