Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.
Yang Yoon-Soo;Kim Beom-Kyu;Kim Yeon-Woo;Kwon Sam-Hyun;Yoon Yong-Joo;Hong Ki-Hwan
Korean Journal of Head & Neck Oncology
/
v.20
no.1
/
pp.24-28
/
2004
Background and Objectives: Salivary gland tumors are relatively rare and constitute 3% to 4% of all head and neck neoplasms. Their relative infrequency, inconsistent classification, and highly variable biologic behavior make some difficulty, but some general features can be drawn regarding the incidence, pathology, and pattern of behavior of the various benign and malignant tumors of salivary glands. The present study aims to provide a clinical characteristics of salivary gland tumors. Materials and Methods: We analyzed retrospectively clinical features of the 138 patients who were treated surgically at Chonbuk National University Hospital from 1992 through 2002. Results: We found 107 benign and 31 malignant tumors. Among the patients, 58 were males and 80 were females. The most common age group was the fifties. The most common site of both benign and malignant was parotid gland in major salivary glands and palatal region in minor salivary glands. The most common presenting symptom was palpable mass in both benign and malignant tumor. Histopathologically, the most common type was pleomorphic adenoma in benign tumor and mucoepidermoid carcinoma in malignant tumor. All cases were treated surgically and the most common postoperative complications was transient facial nerve weakness. Conclusion: 138 cases of salivary gland tumors were presented with respect to their clinical features.
Purpose: The aim of this study was to investigate the clinical features and extraintestinal manifestations (EIMs) of Crohn disease (CD) in Korean pediatric patients. Methods: The medical records of 73 children diagnosed with CD were retrospectively reviewed. Data regarding baseline demographic and clinical characteristics, including CD phenotype at diagnosis based on the Montreal classification, and clinical features and course of EIMs were investigated. Results: Fifty-two (71.2%) of the patients were males. The mean age of the patients was 12.5 years. The mean follow-up period was 3.4 years. The disease location was ileal in 3 (4.1%) of the patients, colonic in 13 (17.8%), ileocolonic in 56 (76.7%). The clinical behavior was inflammatory in 62 (84.9%) of the patients, stricturing in 8 (11.0%), and penetrating in 3 (4.1%). Perianal abscesses or fistulas were found in 37 (50.7%) of the patients. EIMs observed during the study period were anal skin tag in 25 patients (34.2%), hypertransaminasemia in 20 (27.4%), peripheral arthritis in 2 (2.7%), erythema nodosum in 2 (2.7%), vulvitis in 1 (1.4%), uveitis in 1 (1.4%), and pulmonary thromboembolism in 1 (1.4%). Conclusion: Perianal diseases and manifestations were present in more than half of Korean pediatric CD patients at diagnosis. Inspection of the anus should be mandatory in Korean children with suspicious CD, as perianal fistulas, abscesses, and anal skin tags may be the first clue to the diagnosis of CD.
Purpose: To clarify the clinical features of appendicitis in preschool children and to explore clinical appendicitis scoring systems in this age group. Methods: We retrospectively collected data on 142 children, aged 10 years or younger, with confirmed diagnosis of appendicitis based on surgical and pathologic findings. Enrolled subjects were divided into two groups: Group 1 (preschool children aged ${\leq}5$ years, n=41) and Group 2 (school children aged >5 to ${\leq}10$ years, n=101). Data analyzed included clinical presentation, laboratory findings, the pediatric appendicitis score (PAS), and the modified Alvarado score (MAS). Results: The most common presenting symptom was abdominal pain in both groups (92.7% vs. 97.0%). Other presenting symptoms were as follows: fever (65.9%), vomiting (68.3%), right lower quadrant (RLQ) localization (24.4%), anorexia (14.6%), and diarrhea (7.3%) in Group 1, and RLQ localization (74.3%), vomiting (71.3%), anorexia (52.5%), fever (47.5%), and diarrhea (11.9%) in Group 2. Perforation and abscess occurred more frequently in Group 1 than in Group 2 (43.9% vs. 12.9%, p<0.001; 34.1% vs. 5.0%, p<0.001; respectively). PAS and MAS were lower in Group 1 than in Group 2 ($4.09{\pm}1.97$ vs. $6.91{\pm}1.61$, p=0.048; $4.65{\pm}1.79$ vs. $6.51{\pm}1.39$, p=0.012; respectively). Conclusion: In preschool children, appendicitis often presents with atypical features, more rapid progression, and higher incidence of complications. This age group is more likely to have lower PAS and MAS than those of school children.
Background: The clinical course of the neoplasm may vary due to both patient and tumor cell characteristics. Aim: The aim of this study was to research the influence of certain clinical and pathological features on the prognosis of early stage breast cancer. Materials and Methods: This study included 117 women that were treated and followed-up in between the years 2001-2011. The demographic, clinical and histopathological features of the cases were reviewed retrospectively. Statistical analysis: In categorical comparisons between groups, cross-tab statistics were provided and significance levels were estimated using chi-square test. Cox regression analysis, Pearson and Spearman correlation tests, and the Kaplan-Meier test were also used. Results: With an average of 35-months follow-up, the mean disease-free survival of patients was 91 months and the mean overall survival time was 132 months. In the whole study group, the disease-free survival rates were 88, 84, 83 and 52%, while the overall survival rates 95, 94, 83, and 83% within the first, third, fifth and tenth years, respectively. The disease-free and overall survival rates were decreased with increasing tumor grades, though this was not statistically significant. The presence of lymphovascular invasion, positive staining with Ki67 and postmenopausal status were associated with shorter disease-free and overall survival times. In multivariate analysis, only age and Her2/neu receptor status influenced the prognosis significantly. Conclusions: In parallel to clinical, histopathological, and immunohistochemical prognostic features in breast cancer, in this study positive Her2/neu receptor status, a previously accepted poor prognostic factor, was found to have positive influence after trastuzumab treatment.
Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections. Purpose: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children. Methods: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients. Results: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2-14] years vs. 4 [2-6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more frequently in influenza patients than in COVID-19 patients (22.1% vs. 8.5%, P=0.029; 17.6% vs. 5.6%, P=0.013; and 13.2% vs. 5.6%, P=0.048, respectively). Both groups showed significantly elevated monocyte levels in the complete blood count (70.4% vs. 69.9%, P=0.511). Major chest x-ray findings in COVID-19 patients included mild diffuse ground-glass opacity and right lower lobe infiltrates. There were no statistically significant intergroup differences in hospitalization or mortality rates; however, the intensive care unit admission rate was higher among COVID-19 patients (2.4% vs. 0.5%, P=0.045). Conclusion: In this study, pediatric COVID-19 patients showed a wide range of clinical presentations ranging from asymptomatic/mild to severe illness. We found no intergroup differences in hospitalization rates, oxygen requirements, or hospital length of stay; however, the intensive care unit admission rate was higher among COVID-19 patients.
Ahn, Yong-gi;Lim, Gina;Hwang, Eun Ha;Oh, Ki Won;Cho, Min Jeng
Neonatal Medicine
/
v.28
no.1
/
pp.29-35
/
2021
Purpose: Intussusception is the most common cause of bowel obstruction in children; however, it is rarely diagnosed in newborn infants. This study aimed to describe the clinical features of intussusception in newborn infants. Methods: Medical records of eight patients diagnosed with intussusception during the newborn period at Ulsan University Hospital between March 2007 and March 2020 were retrospectively reviewed. Results: Among the eight cases, two occurred in the intrauterine period and six occurred in the postnatal period. Intrauterine intussusception presented with symptoms of bowel obstruction within 1 to 2 days after birth, and ileal atresia was diagnosed simultaneously through exploratory laparotomy. All the postnatal patients were extremely low birth weight infants (median gestational age and birth weight: 25+6 weeks and 745 g, respectively). Four cases were diagnosed preoperatively using abdominal ultrasonography. One patient was diagnosed by exploratory laparotomy because the clinical symptoms were nonspecific and difficult to differentiate from those of necrotizing enterocolitis, a more prevalent complication in preterm infants. The site of intussusception in all six patients was the small bowel. Meckel's diverticulum (one case) and meconium obstruction (two cases) were found to be the lead point. Conclusion: Neonatal intussusception tends to show different clinical features according to its period of occurrence. Intussusception, especially in preterm infants, has nonspecific clinical features; therefore, clinicians should always be cautious of this disease for its early diagnosis.
Kim, Se Jin;Kim, Ga Eun;Park, Jae Hyun;Lee, Sang Lak;Kim, Chun Soo
Clinical and Experimental Pediatrics
/
v.62
no.1
/
pp.36-41
/
2019
Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.
Purpose: Data on eosinophilic esophagitis (EoE) in South America is scarce. Moreover, no studies are available in Ecuador. We evaluated the clinical, endoscopic, and histological characteristics of Ecuadorian children with EoE. Methods: Medical records of 2,711 children who underwent upper gastrointestinal endoscopy (UGE) between 2009 and 2020 at Hospital Metropolitano de Quito, Ecuador were reviewed. Esophageal mucosal biopsies were obtained from 72 patients and the features of 35 children with EoE were described. EoE was diagnosed when there were more than 15 eosinophils in the esophagus, per high power field. Results: EoE was diagnosed in 35 children (9.4±4.5 years) with a male predominance (74%). Abdominal pain (51.4%) and vomiting (31.4%) were dominant symptoms. A history of allergic diseases was noted in 47.1% of the children, which mainly included allergic rhinitis (37.1%) and atopic dermatitis (11.4%). The most common endoscopic findings were furrowing (82.9%) and edema (74.3%). All patients were initially treated with proton-pump inhibitors (PPIs). Those who did not respond to PPIs received steroids (5.7%) and diet therapy (5.7%), and five patients were referred to an allergist. Clinical and histological resolution was observed in 65% of the patients who underwent a second UGE after 6-8 weeks of PPI. Conclusion: Our study describes the clinical features of pediatric EoE in Ecuador. This is the first retrospective study in Ecuador that describes the clinical, endoscopic, and histological manifestations of EoE in a small pediatric population. Almost half of the children who underwent a biopsy had EoE.
Adenoma malignum is an extremely well-differentiated variant of cervical adenocarcinoma in which the cells composing the tumor lack the typical cytological features of malignancy. The prognosis of this rare tumor is poor in spite of high degree of differentiation. The cytologic characteristics are extremely bland so frequently make a confusion of adenoma mailgnum with endocervical glandular hyperplasia. We report a case of adenoma malignum in a 35-year-old woman who complained of mucoid vaginal discharge and vaginal bleeding. The cervicovaginal smear showed endocervical cells exhibiting a spectrum of atypical chances. The cells were arranged in multilayered strips and monolayered sheets. Individual cells ranged from cuboidal to columnar; typically the columnar cells had abundant lacy or vacuolated cytoplasm. The smear showed the majority of only atypical cells and small numbers of frankly malignant cells.
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