Radiotherapy plays a critical role in treating esophageal cancer, but individual responses vary significantly, impacting patient outcomes. This study integrates machine learning-driven multimodal radiomics and transcriptomics to develop predictive models for radiotherapy sensitivity and prognosis in esophageal cancer. We applied the SEResNet101 deep learning model to imaging and transcriptomic data from the UCSC Xena and TCGA databases, identifying prognosis-associated genes such as STUB1, PEX12, and HEXIM2. Using Lasso regression and Cox analysis, we constructed a prognostic risk model that accurately stratifies patients based on survival probability. Notably, STUB1, an E3 ubiquitin ligase, enhances radiotherapy sensitivity by promoting the ubiquitination and degradation of SRC, a key oncogenic protein. In vitro and in vivo experiments confirmed that STUB1 overexpression or SRC silencing significantly improves radiotherapy response in esophageal cancer models. These findings highlight the predictive power of multimodal data integration for individualized radiotherapy planning and underscore STUB1 as a promising therapeutic target for enhancing radiotherapy efficacy in esophageal cancer.

Medical imaging constitutes critical information in the diagnostic and prognostic evaluation of patients, as it serves to uncover a broad spectrum of pathologies and deviances. Clinical practitioners who carry out medical image screening are primarily reliant on their knowledge and experience for disease diagnosis. Convolutional Neural Networks (CNNs) hold the potential to serve as a formidable decision-support tool in the realm of medical image analysis due to their high capacity to extract hierarchical features and effectuate direct classification and segmentation from image data. However, CNNs contain a myriad of hyperparameters and optimizing these hyperparameters poses a major obstacle to the effective implementation of CNNs. In this work, a two-phase Bayesian Optimization-derived Scheduling (BOS) approach is proposed for hyperparameter optimization for the head and cancerous tissue segmentation tasks. We proposed this two-phase BOS approach to incorporate both rapid convergences in the first training phase and slower (but without overfitting) improvements in the last training phase. Furthermore, we found that batch size and learning rate have a significant impact on the training process, but optimizing them separately can lead to sub-optimal hyperparameter combinations. Therefore, batch size and learning rate have been coupled as the batch size to learning rate (B2L) ratio and utilized in the optimization process to optimize both simultaneously. The optimized hyperparameters have been tested for a three-dimensional V-Net model with computed tomography (CT) and positron emission tomography (PET) scans to segment and classify cancerous and noncancerous tissues. The results of 10-fold cross-validation indicate that the optimal batch size to learning rate (B2L) ratio for each phase of the training method can improve the overall medical image segmentation performance.

Wrong-level spine surgery remains a significant concern in spine surgery, leading to devastating consequences for patients and healthcare systems alike. This comprehensive review aims to analyze the existing literature on wrong-level spine surgery in spine procedures, identifying key factors that contribute to these errors and exploring advanced strategies and technologies designed to prevent them. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, EMBASE, and CINAHL. The selection criteria focused on preclinical and clinical studies that specifically addressed wrong site and wrong level surgeries in the context of spine surgery. The findings reveal a range of contributing factors to wrong-level spine surgeries, including communication failures, inadequate preoperative planning, and insufficient surgical protocols. The review emphasizes the critical role of innovative technologies-such as artificial intelligence, advanced imaging techniques, and surgical navigation systems-alongside established safety protocols like digital checklists and simulation training in enhancing surgical accuracy and preventing errors. In conclusion, integrating advanced technologies and systematic safety protocols is instrumental in reducing the incidence of wrong-level spine surgeries. This review underscores the importance of continuous education and the adoption of innovative solutions to foster a culture of safety and improve surgical outcomes. By addressing the multifaceted challenges associated with these errors, the field can work towards minimizing their occurrence and enhancing patient care.

Recently, combining the strategy of consistency regularization with uncertainty estimation has shown promising performance on semi-supervised medical image segmentation tasks. However, most existing methods estimate the uncertainty solely based on the outputs of a single neural network, which results in imprecise uncertainty estimations and eventually degrades the segmentation performance. In this paper, we propose a novel Uncertainty Co-estimator (UnCo) framework to deal with this problem. Inspired by the co-training technique, UnCo establishes two different mean-teacher modules (i.e., two pairs of teacher and student models), and estimates three types of uncertainty from the multi-source predictions generated by these models. Through combining these uncertainties, their differences will help to filter out incorrect noise in each estimate, thus allowing the final fused uncertainty maps to be more accurate. These resulting maps are then used to enhance a cross-consistency regularization imposed between the two modules. In addition, UnCo also designs an internal consistency regularization within each module, so that the student models can aggregate diverse feature information from both modules, thus promoting the semi-supervised segmentation performance. Finally, an adversarial constraint is introduced to maintain the model diversity. Experimental results on four medical image datasets indicate that UnCo can achieve new state-of-the-art performance on both 2D and 3D semi-supervised segmentation tasks. The source code will be available at https://github.com/z1010x/UnCo.

The present study followed the reporting guidelines for systematic reviews and meta-analyses. We conducted this study to review the diagnostic value of artificial intelligence (AI) for various types of lumbar spinal stenosis (LSS) and the level of stenosis, offering evidence-based support for the development of smart diagnostic tools. AI is currently being utilized for image processing in clinical practice. Some studies have explored AI techniques for identifying the severity of LSS in recent years. Nevertheless, there remains a shortage of structured data proving its effectiveness. Four databases (PubMed, Cochrane, Embase, and Web of Science) were searched until March 2024, including original studies that utilized deep learning (DL) and machine learning (ML) models to diagnose LSS. The risk of bias of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies is a quality evaluation tool for diagnostic research (diagnostic tests). Computed Tomography. PROSPERO is an international database of prospectively registered systematic reviews. Summary Receiver Operating Characteristic. Magnetic Resonance. Central canal stenosis. three-dimensional magnetic resonance myelography. The accuracy in the validation set was extracted for a meta-analysis. The meta-analysis was completed in R4.4.0. A total of 48 articles were included, with an overall accuracy of 0.885 (95% CI: 0.860-0907) for dichotomous tasks. Among them, the accuracy was 0.892 (95% CI: 0.867-0915) for DL and 0.833 (95% CI: 0.760-0895) for ML. The overall accuracy for LSS was 0.895 (95% CI: 0.858-0927), with an accuracy of 0.912 (95% CI: 0.873-0.944) for DL and 0.843 (95% CI: 0.766-0.907) for ML. The overall accuracy for central canal stenosis was 0.875 (95% CI: 0.821-0920), with an accuracy of 0.881 (95% CI: 0.829-0.925) for DL and 0.733 (95% CI: 0.541-0.877) for ML. The overall accuracy for neural foramen stenosis was 0.893 (95% CI: 0.851-0.928). In polytomous tasks, the accuracy was 0.936 (95% CI: 0.895-0.967) for no LSS, 0.503 (95% CI: 0.391-0.614) for mild LSS, 0.512 (95% CI: 0.336-0.688) for moderate LSS, and 0.860 for severe LSS (95% CI: 0.733-0.954). AI is highly valuable for diagnosing LSS. However, further external validation is necessary to enhance the analysis of different stenosis categories and improve the diagnostic accuracy for mild to moderate stenosis levels.

Chronic obstructive pulmonary disease (COPD) is a common and progressive respiratory condition characterized by persistent airflow limitation and symptoms such as dyspnea, cough, and sputum production. Acute exacerbations (AE) of COPD (AE-COPD) are key determinants of disease progression; yet, existing predictive models relying mainly on spirometric measurements, such as forced expiratory volume in 1 second, reflect only a fraction of the physiological information embedded in respiratory function tests. Recent advances in artificial intelligence (AI) have enabled more sophisticated analyses of full spirometric curves, including flow-volume loops and volume-time curves, facilitating the identification of complex patterns associated with increased exacerbation risk. This study aimed to determine whether a predictive model that integrates clinical data and spirometry images with the use of AI improves accuracy in predicting moderate-to-severe and severe AE-COPD events compared to a clinical-only model. A retrospective cohort study was conducted using COPD registry data from 2 teaching hospitals from January 2004 to December 2020. The study included a total of 10,492 COPD cases, divided into a development cohort (6870 cases) and an external validation cohort (3622 cases). The AI-enhanced model (AI-PFT-Clin) used a combination of clinical variables (eg, history of AE-COPD, dyspnea, and inhaled treatments) and spirometry image data (flow-volume loop and volume-time curves). In contrast, the Clin model used only clinical variables. The primary outcomes were moderate-to-severe and severe AE-COPD events within a year of spirometry. In the external validation cohort, the AI-PFT-Clin model outperformed the Clin model, showing an area under the receiver operating characteristic curve of 0.755 versus 0.730 (P<.05) for moderate-to-severe AE-COPD and 0.713 versus 0.675 (P<.05) for severe AE-COPD. The AI-PFT-Clin model demonstrated reliable predictive capability across subgroups, including younger patients and those without previous exacerbations. Higher AI-PFT-Clin scores correlated with elevated AE-COPD risk (adjusted hazard ratio for Q4 vs Q1: 4.21, P<.001), with sustained predictive stability over a 10-year follow-up period. The AI-PFT-Clin model, by integrating clinical data with spirometry images, offers enhanced predictive accuracy for AE-COPD events compared to a clinical-only approach. This AI-based framework facilitates the early identification of high-risk individuals through the detection of physiological abnormalities not captured by conventional metrics. The model's robust performance and long-term predictive stability suggest its potential utility in proactive COPD management and personalized intervention planning. These findings highlight the promise of incorporating advanced AI techniques into routine COPD management, particularly in populations traditionally seen as lower risk, supporting improved management of COPD through tailored patient care.

Advances in medical imaging and deep learning have propelled progress in whole slide image (WSI) analysis, with multiple instance learning (MIL) showing promise for efficient and accurate diagnostics. However, conventional MIL models often lack adaptability to evolving datasets, as they rely on static training that cannot incorporate new information without extensive retraining. Applying continual learning (CL) to MIL models is a possible solution, but often sees limited improvements. In this paper, we analyze CL in the context of attention MIL models and find that the model forgetting is mainly concentrated in the attention layers of the MIL model. Using the results of this analysis we propose two components for improving CL on MIL: Attention Knowledge Distillation (AKD) and the Pseudo-Bag Memory Pool (PMP). AKD mitigates catastrophic forgetting by focusing on retaining attention layer knowledge between learning sessions, while PMP reduces the memory footprint by selectively storing only the most informative patches, or ``pseudo-bags'' from WSIs. Experimental evaluations demonstrate that our method significantly improves both accuracy and memory efficiency on diverse WSI datasets, outperforming current state-of-the-art CL methods. This work provides a foundation for CL in large-scale, weakly annotated clinical datasets, paving the way for more adaptable and resilient diagnostic models.

Information overload in electronic health records requires effective solutions to alleviate clinicians' administrative tasks. Automatically summarizing clinical text has gained significant attention with the rise of large language models. While individual studies show optimism, a structured overview of the research landscape is lacking. This study aims to present the current state of the art on clinical text summarization using large language models, evaluate the level of evidence in existing research and assess the applicability of performance findings in clinical settings. This scoping review complied with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Literature published between January 1, 2019, and June 18, 2024, was identified from 5 databases: PubMed, Embase, Web of Science, IEEE Xplore, and ACM Digital Library. Studies were excluded if they did not describe transformer-based models, did not focus on clinical text summarization, did not engage with free-text data, were not original research, were nonretrievable, were not peer-reviewed, or were not in English, French, Spanish, or German. Data related to study context and characteristics, scope of research, and evaluation methodologies were systematically collected and analyzed by 3 authors independently. A total of 30 original studies were included in the analysis. All used observational retrospective designs, mainly using real patient data (n=28, 93%). The research landscape demonstrated a narrow research focus, often centered on summarizing radiology reports (n=17, 57%), primarily involving data from the intensive care unit (n=15, 50%) of US-based institutions (n=19, 73%), in English (n=26, 87%). This focus aligned with the frequent reliance on the open-source Medical Information Mart for Intensive Care dataset (n=15, 50%). Summarization methodologies predominantly involved abstractive approaches (n=17, 57%) on single-document inputs (n=4, 13%) with unstructured data (n=13, 43%), yet reporting on methodological details remained inconsistent across studies. Model selection involved both open-source models (n=26, 87%) and proprietary models (n=7, 23%). Evaluation frameworks were highly heterogeneous. All studies conducted internal validation, but external validation (n=2, 7%), failure analysis (n=6, 20%), and patient safety risks analysis (n=1, 3%) were infrequent, and none reported bias assessment. Most studies used both automated metrics and human evaluation (n=16, 53%), while 10 (33%) used only automated metrics, and 4 (13%) only human evaluation. Key barriers hinder the translation of current research into trustworthy, clinically valid applications. Current research remains exploratory and limited in scope, with many applications yet to be explored. Performance assessments often lack reliability, and clinical impact evaluations are insufficient raising concerns about model utility, safety, fairness, and data privacy. Advancing the field requires more robust evaluation frameworks, a broader research scope, and a stronger focus on real-world applicability.

Ovarian cancer, a leading cause of cancer-related deaths among women, comprises distinct subtypes each requiring different treatment approaches. This paper presents a deep-learning framework for classifying ovarian cancer subtypes using Whole Slide Imaging (WSI). Our method contains three stages: image tiling, feature extraction, and multi-instance learning. Our approach is trained and validated on a public dataset from 80 distinct patients, achieving up to 89,8% accuracy with a notable improvement in computational efficiency. The results demonstrate the potential of our framework to augment diagnostic precision in clinical settings, offering a scalable solution for the accurate classification of ovarian cancer subtypes.