BACKGROUND: Neoadjuvant chemoradiotherapy followed by radical surgery has been a common practice for patients with locally advanced rectal cancer, but the response rate varies among patients. This study aimed to develop a ResNet-Vision Transformer based magnetic resonance imaging (MRI)-endoscopy fusion model to precisely predict treatment response and provide personalized treatment. METHODS: In this multicenter study, 366 eligible patients who had undergone neoadjuvant chemoradiotherapy followed by radical surgery at eight Chinese tertiary hospitals between January 2017 and June 2024 were recruited, with 2928 pretreatment colonic endoscopic images and 366 pelvic MRI images. An MRI-endoscopy fusion model was constructed based on the ResNet backbone and Transformer network using pretreatment MRI and endoscopic images. Treatment response was defined as good response or non-good response based on the tumor regression grade. The Delong test and the Hanley-McNeil test were utilized to compare prediction performance among different models and different subgroups, respectively. The predictive performance of the MRI-endoscopy fusion model was comprehensively validated in the test sets and was further compared to that of the single-modal MRI model and single-modal endoscopy model. RESULTS: The MRI-endoscopy fusion model demonstrated favorable prediction performance. In the internal validation set, the area under the curve (AUC) and accuracy were 0.852 (95% confidence interval [CI]: 0.744-0.940) and 0.737 (95% CI: 0.712-0.844), respectively. Moreover, the AUC and accuracy reached 0.769 (95% CI: 0.678-0.861) and 0.729 (95% CI: 0.628-0.821), respectively, in the external test set. In addition, the MRI-endoscopy fusion model outperformed the single-modal MRI model (AUC: 0.692 [95% CI: 0.609-0.783], accuracy: 0.659 [95% CI: 0.565-0.775]) and the single-modal endoscopy model (AUC: 0.720 [95% CI: 0.617-0.823], accuracy: 0.713 [95% CI: 0.612-0.809]) in the external test set. CONCLUSION The MRI-endoscopy fusion model based on ResNet-Vision Transformer achieved favorable performance in predicting treatment response to neoadjuvant chemoradiotherapy and holds tremendous potential for enabling personalized treatment regimens for locally advanced rectal cancer patients.
Humans ; Rectal Neoplasms/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Male ; Female ; Middle Aged ; Neoadjuvant Therapy/methods* ; Aged ; Adult ; Chemoradiotherapy/methods* ; Endoscopy/methods* ; Treatment Outcome

[Objective] To retrospectively study and discuss the indications,surgical techniques and effect of treating hallux valgus with modified Austin operation-Chevron-Gerbert osteotomy or Chevron-Youngswick osteotomy.[Method]From October 1998 to April 2006,34 patients(62 feet)with hallux valgus were treated with modified Austin operation.The X-ray films of all patients were collected preoperatively,two weeks postoperatively and during the follow-up.The hallux valgus angle(HVA),intermetataral angle(IMA),proximal articular set angle(PASA)and distal articular set angle(DASA)were measured and analyzed on radiogram.[Result]All patients were followed up for 1-8 years(mean 3.6 years).HVA before and after surgery was 33.50??1.02?and 13.6??0.826 respectively.IMA was 16.0??0.837?before and 8.6??1.078 after surgery.AOFAS score was 44.8?5.7 before,and 87.6 4.2 after surgery.Significant difference was found between the results.According to AOFAS rating system,46 feets had a excellent result and 10 feet had a good result and the other 5 feet had a fair result.The rate of excellent or good results was 90.3%.[Conclusion]The modified Austin operation is a good,simple and reliable operation means for treatment of hallux valgus,which especially applies to severe hallux valgus with big PASA.The adductor hallucis or the sesamoid is not necessarily interfered in patients with slight or moderate hallux valgus.