.
PURPOSE:This study addresses critical gaps in automated lymphoma segmentation from PET/CT imaging, often overlooked in prior work. While deep learning has been applied to this task, few studies evaluate generalizability on external or out-of-distribution data. Similarly, intra- and inter-observer variability analyses remain rare, limiting understanding of task difficulty. Moreover, most methods emphasize global segmentation metrics, neglecting lesion-level characteristics that are crucial for clinical decision-making. METHODS:We propose a clinically-relevant evaluation framework to assess four commonly used deep segmentation networks (ResUNet, SegResNet, DynUNet, SwinUNETR) on 611 PET/CT cases from multi-institutional datasets spanning varied lymphoma subtypes and lesion characteristics. In addition to the Dice similarity coefficient (DSC), we compute prediction errors on clinical lesion measures and analyze DSC performance as a function of these measures. Additionally, we use traditional lesion-specific detection criteria (1 and 2), providing insights into network's performance in identifying and localizing lesions respectively, and propose an additional Criterion 3 for segmenting lesions based on metabolic characteristics. Finally, we contextualize network performance by comparing it to expert human observers through intra- and inter-observer variability analyses. RESULTS:Networks perform best on large, metabolically active lesions. Their error patterns closely resemble those of expert annotators, while small and faint lesions remain challenging for both networks and physicians. CONCLUSION:Our clinically-relevant benchmarking framework enables more consistent and meaningful evaluation of lymphoma segmentation models, supporting robust decision-making in patient care. The approach is extensible to other architectures and disease types. Code is available at: https://github.com/microsoft/lymphoma-segmentation-dnn.
Never-events represent serious and preventable patient safety incidents within surgical practice, despite increasing national and international efforts to reduce them. Persistent concerns regarding wrong site surgery, retained surgical items, and incorrect implants highlight the need to understand contributory human factors and system-level weaknesses. A systematic search of PubMed/Medline, Google Scholar, and the Cochrane Library was conducted. Evidence published between 2014 and 2024 was screened according to predefined eligibility criteria to identify contemporary data relating to surgical never-events. Studies were assessed using standardised selection methods and relevant findings were extracted and synthesised. Thirty-seven studies met inclusion criteria. Across international literature, recurring contributory factors included communication breakdowns, reduced situational awareness, fatigue, inadequate staffing, inconsistent team composition, and increasing surgical caseloads. Despite advances in safety practices, these factors continued to contribute to adverse surgical outcomes. Never-events remain a persistent challenge in surgical care. Strengthening safety management systems, improving awareness of human factors, and prioritising non-technical skills training may help reduce the risk of these events. Ongoing evaluation of interventions and further UK-based research are required to support improvement in patient safety outcomes.
Background The clinical and prognostic implications of asymptomatic tuberculosis remain poorly understood. Methods We conducted a multicentre prospective cohort study to evaluate the association between asymptomatic tuberculosis (TB) and treatment outcomes. Individuals with rifampicin-susceptible pulmonary TB were enrolled from the Cohort Study of Pulmonary Tuberculosis. Asymptomatic TB was defined as the absence of any TB-related symptoms at diagnosis. The primary outcome was a favourable outcome, defined as treatment success without recurrence. Multivariable logistic regression models were used to assess associations between asymptomatic TB and favourable outcomes. The Cox proportional hazards model was applied to evaluate effect of asymptomatic TB on failure to complete treatment within 1 year. Stratified analyses by symptom status and mode of detection were performed to examine stratum-specific effects. Results Of 1071 individuals with pulmonary TB, 32.7% were asymptomatic. Compared to symptomatic patients, asymptomatic individuals were younger, less likely to be underweight and more often diagnosed through population health screening rather than clinical presentation or opportunistic testing. Asymptomatic TB was associated with higher likelihood of favourable outcome in multivariable models (adjusted odds ratio (aOR) 1.50, 95% CI 1.04-2.20) and a reduced risk of failing to complete treatment within one year in survival analyses (adjusted hazard ratio 0.66, 95% CI 0.45-0.95). Asymptomatic TB detected through health screening had the most favourable outcomes (aOR 2.41, 95% CI 1.34-4.66). Conclusion Asymptomatic TB was significantly associated with treatment success without recurrence and particularly in patients identified through health screening. Our results support symptom-agnostic screening in TB control programmes.
Background:Gait speed, a key component of exercise capacity, has been underutilised in COPD, despite its prognostic potential. We aimed to evaluate the association between gait speed and clinical outcomes in COPD using 3-year longitudinal data from the Korean COPD Subgroup Study cohort. Methods:Poor gait speed (<1.0 m·s-1) was defined by usual pace during the 6-min walk test per Asian Working Group for Sarcopenia 2019 criteria. Lung function, symptoms, acute exacerbations (AEs) and mortality were compared between gait speed groups. Analyses included propensity score-matching, quartile classification, subgroup analyses and longitudinal trajectory modelling using random coefficient models. Results:Among 2063 participants, poor gait speed (n=831, 40.3%) was associated with older age, higher symptom burden and more previous AEs despite similar lung function. This group showed higher AE risk and frequency than the normal-speed group: adjusted odds ratios 1.37-1.45 for moderate and 1.64-1.65 for severe AEs; adjusted incidence rate ratios 1.24-1.36 for moderate and 1.63-1.86 for severe AEs. The 3-year mortality was significantly higher in the poor-gait-speed group (adjusted hazard ratio 2.30, 95% CI 1.42-3.73). Longitudinally, the poor-gait-speed group demonstrated persistently worse COPD Assessment Test (CAT) and St George's Respiratory Questionnaire for COPD scores at baseline, with modest CAT worsening over time (+0.44 point/year, p=0.01), while lung function decline was similar. Conclusions:Gait speed provides a simple, integrative marker that independently predicts exacerbation risk, mortality and symptom progression in COPD.
The Hunter Outcome Survey (HOS) collected global, real-world data on the natural history of mucopolysaccharidosis II and its treatment with intravenous idursulfase. For eligible patients, home therapy offers a convenient alternative to in-clinic therapy. Using data in HOS as of January 2023, we provide an updated assessment of the safety/tolerability profile of home therapy with idursulfase. The analysis population comprised 333 patients who had received at least one home infusion and 708 patients who had never received home therapy. Median (10th percentile [P10], 90th percentile [P90]) age at home therapy start was 8.9 (2.9, 21.1) years. Median (P10, P90) ages at latest visit were 15.5 (7.7, 29.3) years in the home therapy group and 13.9 (5.2, 29.0) years in the no home therapy group. Patients received a median (P10, P90) of 6.0 (0.8, 12.0) years of home infusions after 1.8 (0.3, 8.7) years of in-clinic therapy, and these timings varied by geographic region. The infusion-related reaction (IRR) rate was 0.11/patient-year during home therapy, 0.13/patient-year for the in-clinic period for the same patients (first 6 months excluded), and 0.05/patient-year for patients who never received home therapy (first 6 months excluded). More than 60% of IRRs were categorized as mild. The adverse event (AE) rate was lower during home therapy (0.59 AEs/patient-year) than during the in-clinic period for the same patients (0.86 AEs/patient-year). Among patients who never received home therapy, the rate was 0.60 AEs/patient-year. Deaths occurred at a rate of 2.17 deaths/100 patient-years of home therapy and 3.60 deaths/100 patient-years among patients never treated with home therapy. No deaths were deemed related to treatment. The rate of missed infusions was 0.52/year during the home therapy period compared with 1.42/year during the in-clinic period for the same patients and 0.57/year for patients who never received home therapy. Our data indicate a similar safety/tolerability profile for intravenous idursulfase administered at home and in clinic in patients with mucopolysaccharidosis II.
