'Aariz: A Benchmark Dataset for Automatic Cephalometric Landmark Detection and CVM Stage Classification

The accurate identification and precise localization of cephalometric landmarks enable the classification and quantification of anatomical abnormalities. The traditional way of marking cephalometric landmarks on lateral cephalograms is a monotonous and time-consuming job. Endeavours to develop automated landmark detection systems have persistently been made, however, they are inadequate for orthodontic applications due to unavailability of a reliable dataset. We proposed a new state-of-the-art dataset to facilitate the development of robust AI solutions for quantitative morphometric analysis. The dataset includes 1000 lateral cephalometric radiographs (LCRs) obtained from 7 different radiographic imaging devices with varying resolutions, making it the most diverse and comprehensive cephalometric dataset to date. The clinical experts of our team meticulously annotated each radiograph with 29 cephalometric landmarks, including the most significant soft tissue landmarks ever marked in any publicly available dataset. Additionally, our experts also labelled the cervical vertebral maturation (CVM) stage of the patient in a radiograph, making this dataset the first standard resource for CVM classification. We believe that this dataset will be instrumental in the development of reliable automated landmark detection frameworks for use in orthodontics and beyond

CEPHA29: Automatic Cephalometric Landmark Detection Challenge 2023

Quantitative cephalometric analysis is the most widely used clinical and research tool in modern orthodontics. Accurate localization of cephalometric landmarks enables the quantification and classification of anatomical abnormalities, however, the traditional manual way of marking these landmarks is a very tedious job. Endeavours have constantly been made to develop automated cephalometric landmark detection systems but they are inadequate for orthodontic applications. The fundamental reason for this is that the amount of publicly available datasets as well as the images provided for training in these datasets are insufficient for an AI model to perform well. To facilitate the development of robust AI solutions for morphometric analysis, we organise the CEPHA29 Automatic Cephalometric Landmark Detection Challenge in conjunction with IEEE International Symposium on Biomedical Imaging (ISBI 2023). In this context, we provide the largest known publicly available dataset, consisting of 1000 cephalometric X-ray images. We hope that our challenge will not only derive forward research and innovation in automatic cephalometric landmark identification but will also signal the beginning of a new era in the discipline

Asymptomatic Dandy Walker malformation in an elderly male with acute haemorrhagic stroke – a case report

Dandy-Walker Malformation (DWM) is a rare congenital anomaly of the posterior cranial fossa. Features of DWM include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. MRI is the modality to confirm the diagnosis. Treatment is usually symptomatic and required when signs of hydrocephalus develop. Rare cases of asymptomatic DWM diagnosed incidentally are reported in literature. We report a case of DWM in a 60-year-old male who presented with haemorrhagic stroke and was later found to have DWM on brain imaging. Keywords: Dandy-Walker Malformation, Haemorrhagic Stroke

Cephalometric analyses of the craniofacial pattern using the Jarabak analysis

Background: For an accurate orthodontic diagnosis and management, knowledge of face development and progression is required. Objective: To evaluate the linear cranial base (LCB) and angular cranial base (ACB) measurements in various Anterior and Posterior (AP) skeletal correlations, research study used Bjork-Jarabak evaluation. Material and Methods: A total of 220 young participants presenting (120 females and 100 males; average ages of 19.34 ± 2.51 and 24.84 ± 2.81 years, correspondingly) at the Multan Medical and Dental College, Multan from March 2022 to September 2022, Pakistan, served as the basis for this retrospective cross-sectional study. Results:  In comparison to Jarabak's standards, male dimensions revealed significant differences in the articular angle, AP cranial bases, ramus height, jaw length, anterior face height while women displayed low significant differences, with the exception of mandibular body length, which is longer in Pakistani women. Conclusion: Skeletal differences between Pakistani man and women were considerable, and a contrast to the study of Bjork Jarabak's standardized linear and angular values was also noteworthy

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit