Abnormal Pathologies Research Articles

Terahertz in vivo imaging of human skin: Toward detection of abnormal skin pathologies.

Terahertz (THz) imaging has long held promise for skin cancer detection but has been hampered by the lack of practical technological implementation. In this article, we introduce a technique for discriminating several skin pathologies using a coherent THz confocal system based on a THz quantum cascade laser. High resolution in vivo THz images (with diffraction limited to the order of 100 μm) of several different lesion types were acquired and compared against one another using the amplitude and phase values. Our system successfully separated pathologies using a combination of phase and amplitude information and their respective surface textures. The large scan field (50 × 40 mm) of the system allows macroscopic visualization of several skin lesions in a single frame. Utilizing THz imaging for dermatological assessment of skin lesions offers substantial additional diagnostic value for clinicians. THz images contain information complementary to the information contained in the conventional digital images.

Modal adaptive super-resolution for medical images via continual learning

Details related to tiny abnormal pathologies and textures are crucial for clinical experts and computer-aided diagnosis in medical imaging. Super-resolving medical images provide significant support for disease diagnosis. However, due to differences and diversity in tissue appearance or spatial resolution of images caused by the acquisition principles or parameters in various imaging techniques, it limits their applications in multi-modal medical imaging. To this end, we propose a multi-modal adaptive super-resolution algorithm for reconstructing medical images, named MAda-SR, which improves the traditional Adam optimizer into an adaptive optimizer in terms of parameter updates and optimization strategies. Additionally, we enhance the MSE loss by adjusting its weight space, thereby increasing the transfer potential between multimodal tasks and enabling more extended continual learning. With extensive experimental validation, we demonstrate that a single super-resolution model can handle various modalities of medical datasets without compromising performance. The results indicate that our proposed MAda-SR outperforms comparative methods in terms of controlling forgetting and relearning metrics, achieving both stability and plasticity. The source code is available at https://github.com/wuzheng2022/MAda-SR.

Evaluation of the Retina and Optic Discs of Patients with Chronic and Episodic Migraine using Optical Coherence Tomography and Optical Coherence Tomography Angiography

Objective: Migraine is a very common,recurring, usually unilateral, severe, pulsating, and transient headache disorder, which causes temporary disability. Migraine has two main types: with aura and without aura. Abnormal retinal and optic disc pathologies in migraine patients were previously reported by using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In the present study, it was suggested that the changes foundin the retina and optic disc mightindicate a functional disorder in chronic (with and without aura) and episodic (with and without aura) migraine. It is also emphasized that these changes might be useful for early diagnosis and follow-up of the disease, as well as for the development of new treatments. Method: In total, 60 individuals were involved in the present study, including 28 chronic migraine patients (24 female, 4 male, 16 with aura, 12 without aura) and 32 episodic migraine patients (26 female, 6 male, 21 with aura, 11 without aura), who were diagnosed with migraine and whose migraine types were determinedby using the criteria set by the International Headache Society (IHS) in 2013. The control group consisted of 48 healthy volunteers (34 female, 14 male) aged between 18 and 45 years, who applied to the ophthalmology clinic. The retinas and optic discs of the patients were examined by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) at our ophthalmology clinic. A double-blind randomized analysis was performed for the patient data and the data were compared to control group data of similar gender and age groups. Results: Examining the demographic data, no statistically significant difference was found between the migraine patients and the healthy controls in terms of age, gender, migraine history, and migraine type. However, using Optical Coherence Tomography (OCT), it was determined that the mean vertical and horizontal cup-to-disk (c/d) ratios at the optic disc were significantly impaired in patients compared to the control group. Moreover, using Optical Coherence Tomography Angiography (OCTA), significant reductions in vessel density (VD) were detected in the foveal, parafoveal, perifoveal areas and in the superficial and deep capillary plexuses (SCP and DCP) of the patients. Conclusion: It is thought that these findings might be associated with a vasculopathy developing due to a pathology in the autonomic nervous system or impairments in the cerebral, ocular, or systemic circulation. The authors believe that the results achieved in the present study could be useful in the diagnosis, monitoring, and treatment of the disease.

Design and Implementation of a Portable Knee Actuator for the Improvement of Crouch Gait in Children with Cerebral Palsy.

Common manifestation of spastic Cerebral Palsy (CP) are abnormal gait pathologies. These conditions require greater energy expenditure to successfully ambulate and are linked with significant deterioration in joint health and childhood musculoskeletal development. Crouch gait presents with knee hyperflexion throughout stance due to extensor muscle weakness and spasticity in flexor muscles stemming from neurological damage. The goal of this study was to develop a wearable cable-driven robotic system that applies controlled perturbation to the knee joint during overground walking in children with CP. Two children with spastic CP were recruited in this pilot study. They were tested in two conditions, i.e., applying knee resistance vs. knee assistance during overground walking. Kinematic and EMG data were recorded during overground walking. Data indicated that it was feasible to apply controlled knee perturbation torque during overground walking in children with crouch and preliminary results showed an improvement in crouch gait pattern in children with CP after one session of walking with the robotic system.Clinical Relevance- This study might have a potential clinical significance modifying neuromuscular control of CP patients with Crouch Gait.

Assessment of abnormal placentation in pregnancies conceived with assisted reproductive technology.

To examine the association between assisted reproductive technology (ART) and abnormal placentation. This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The study population included 14, 970, 064 deliveries for national estimates from January 2012 to September 2015. The exposure was 48, 240 pregnancies after ART. The main outcome measure encompassed three abnormal placentation pathologies (placenta previa [PP], placenta accreta spectrum [PAS], and vasa previa [VP]). Propensity score matching was performed to assess the exposure-outcome association. Pregnancy after ART was more likely to have a diagnosis of PAS (2.8 vs 1.0 per 1000 deliveries; adjusted odds ratio [aOR], 2.06 [95% confidence interval (CI), 1.44-2.93]), PP (24.5 vs 8.6 per 1000; aOR, 2.98 [95% CI, 2.64-3.35]), and VP (2.3 vs <0.3 per 1000; aOR, 11.3 [95% CI, 5.86-21.8]) compared with pregnancy without ART. Similarly, pregnancy after ART was associated with an increased likelihood of having multiple types of abnormal placentation, including VP with PP (aOR, 15.4 [95% CI, 6.15-38.4]) and PAS with PP (aOR, 2.80 [95% CI, 1.32-5.92]) compared with non-ART pregnancy. This national-level analysis suggests that pregnancy after ART is associated with a significantly increased risk of abnormal placentation, including PAS, PP, and VP.

Rates of unanticipated premalignant and malignant lesions at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population

The rate of unanticipated premalignant or malignant pathology at the time of hysterectomy performed for pelvic organ prolapse has been previously reported to be 0.2%. It is not known whether this rate is similar in patients with limited access to regular medical care. This study aimed to describe the rates of unanticipated premalignancy and malignancy at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population and to determine the risk factors for unanticipated pathology. Hysterectomies performed for pelvic organ prolapse at a large public hospital between July 2007 and July 2019 were reviewed. Patients undergoing surgery for malignancy or premalignancy were excluded. Medical records were reviewed for demographic information, medical history, preoperative workup, and final pathology. Frequencies of abnormal pathologies were calculated. Demographic and screening factors were correlated with pathologic findings using the Fisher exact test or Mann-Whitney U test, as appropriate. This study was approved by the institutional review board. Between 2007 and 2019, 759 cases of pelvic organ prolapse were identified. Of 759 patients, 667 (87.9%) self-identified as Hispanic. The median age was 57 years old, and 505 of 759 patients (66.5%) were in the postmenopausal stage. Abnormal uterine bleeding history was present in 217 of 759 patients (28.6%). Of 759 patients, 493 (65.4%) underwent preoperative ultrasonography, and 290 (38.3%) underwent preoperative endometrial biopsy. Of the 744 uterine specimens that had available histology results, there were 2 cases of endometrial hyperplasia and 1 case of endometrial cancer. Of the 729 cervical specimens that were available for review, there was 1 case of intraepithelial neoplasia and 2 cases of cervical cancer. In the 246 patients who underwent oophorectomy, no ovarian malignancy was found. For patients undergoing hysterectomy for pelvic organ prolapse in an underscreened population, the rates of endometrial dysplasia or cancer were 0.40% (3/744), and the rates of cervical dysplasia or cancer were 0.42% (3/729). Our results underscore the importance of considering screening history when interpreting preoperative cervical and endometrial cancer screening. Consideration of higher negative predictive value tests, such as cytology with human papillomavirus cotesting and preoperative counseling on the risks and management strategies of unanticipated premalignancy or malignancy within this population may be reasonable.

Histopathologic findings in laparoscopic sleeve gastrectomy: is routine full pathologic evaluation indicated?

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric surgery. The resected gastric segment is routinely sent for pathology evaluation. No formal national recommendation exists that mandates pathology review. We proposed to study the largest histopathologic series in SG patients yet reported. The primary objective of our study was to determine whether a subgroup of patients who underwent bariatric surgery in the northeastern Unites States is more susceptible to having clinically significant pathologic findings that may benefit from routine histopathologic evaluation of the gastric sleeve specimen. University hospital. A retrospective electronic chart review of patients who underwent SG at a single large academic institution was performed. Patient demographics, body mass index, and histopathologic reports of the gastric specimens obtained during SG were analyzed. The records of 3543 patients were reviewed. A total of 1076 patients had abnormal pathologies, including gastritis (938), follicular gastritis (98), intestinal metaplasia (25), gastrointestinal stromal tumor (12), leiomyoma (1), lymphoma (1), and other malignancy (1). Black and Hispanic patients had a higher incidence of developing gastrointestinal stromal tumor and intestinal metaplasia. A higher incidence of Helicobacter pylori infection among specimens with abnormal pathologies was noted. The findings of this study call into question the routine use of pathology workup in gastric specimens after SG. Our data suggest that such analysis may be warranted in certain subtypes of patients such as older Black and Hispanic patients in the northeastern United States.

Investigating the contribution of cytoarchitecture to diffusion MRI measures in gray matter using histology.

Postmortem studies are currently considered a gold standard for investigating brain structure at the cellular level. To investigate cellular changes in the context of human development, aging, or disease treatment, non-invasive in-vivo imaging methods such as diffusion MRI (dMRI) are needed. However, dMRI measures are only indirect measures and require validation in gray matter (GM) in the context of their sensitivity to the underlying cytoarchitecture, which has been lacking. Therefore, in this study we conducted direct comparisons between in-vivo dMRI measures and histology acquired from the same four rhesus monkeys. Average and heterogeneity of fractional anisotropy and trace from diffusion tensor imaging and mean squared displacement (MSD) and return-to-origin-probability from biexponential model were calculated in nine cytoarchitectonically different GM regions using dMRI data. DMRI measures were compared with corresponding histology measures of regional average and heterogeneity in cell area density. Results show that both average and heterogeneity in trace and MSD measures are sensitive to the underlying cytoarchitecture (cell area density) and capture different aspects of cell composition and organization. Trace and MSD thus would prove valuable as non-invasive imaging biomarkers in future studies investigating GM cytoarchitectural changes related to development and aging as well as abnormal cellular pathologies in clinical studies.

Comparison of fluid dynamics changes due to physical activity in 3D printed patient specific coronary phantoms with the Windkessel equivalent model of coronary flow

Background3D printing (3DP) used to replicate the geometry of normal and abnormal vascular pathologies has been demonstrated in many publications; however, reproduction of hemodynamic changes due to physical activities, such as rest versus moderate exercise, need to be investigated. We developed a new design for patient specific coronary phantoms, which allow adjustable physiological variables such as coronary distal resistance and coronary compliance in patients with coronary artery disease. The new design was tested in precise benchtop experiments and compared with a theoretical Windkessel electrical circuit equivalent, that models coronary flow and pressure using arterial resistance and compliance.MethodsFive phantoms from patients who underwent clinically indicated elective invasive coronary angiography were built from CCTA scans using multi-material 3D printing. Each phantom was used in a controlled flow system where patient specific flow conditions were simulated by a programmable cardiac pump. To simulate the arteriole and capillary beds flow resistance and the compliance for various physical activities, we designed a three-chamber outlet system which controls the outflow dynamics of each coronary tree. Benchtop pressure measurements were recorded using sensors embedded in each of the main coronary arteries. Using the Windkessel model, patient specific flow equivalent electrical circuit models were designed for each coronary tree branch, and flow in each artery was determined for known inflow conditions. Local flow resistances were calculated through Poiseuille’s Law derived from the radii and lengths of the coronary arteries using CT angiography based multi-planar reconstructions. The coronary stenosis flow rates from the benchtop and the electrical models were compared to the localized flow rates calculated from invasive pressure measurements recorded in the angio-suites.ResultsThe average Pearson correlations of the localized flow rates at the location of the stenosis between each of the models (Benchtop/Electrical, Benchtop/Angio, Electrical/Angio) are 0.970, 0.981, and 0.958 respectively.Conclusions3D printed coronary phantoms can be used to replicate the human arterial anatomy as well as blood flow conditions. It displays high levels of correlation when compared to hemodynamics calculated in electrically-equivalent coronary Windkessel models as well as invasive angio-suite pressure measurements.

Drug Discovery of DKK1 Inhibitors.

Dickkopf-1 (DKK1) is a well-characterized Wnt inhibitor and component of the Wnt/β-catenin signaling pathway, whose dysregulation is associated with multiple abnormal pathologies including osteoporosis, Alzheimer’s disease, diabetes, and various cancers. The Wnt signaling pathway has fundamental roles in cell fate determination, cell proliferation, and survival; thus, its mis-regulation can lead to disease. Although DKK1 is involved in other signaling pathways, including the β-catenin-independent Wnt pathway and the DKK1/CKAP4 pathway, the inhibition of DKK1 to propagate Wnt/β-catenin signals has been validated as an effective way to treat related diseases. In fact, strategies for developing DKK1 inhibitors have produced encouraging clinical results in different pathological models, and many publications provide detailed information about these inhibitors, which include small molecules, antibodies, and nucleic acids, and may function at the protein or mRNA level. However, no systematic review has yet provided an overview of the various aspects of their development and prospects. Therefore, we review the DKK1 inhibitors currently available or under study and provide an outlook on future studies involving DKK1 and drug discovery.

Hysteroscopic Evaluation of Uterine Factors in Subfertile Couple Presenting to A Tertiary Care Centre: A Prospective Descriptive Study

Objectives: Evaluation of uterine factors is an essential step in the diagnostic workup of subfertile couple. Intrauterine pathologies can impair implantation and hence reduce the endometrial receptivity. The advantage of hysteroscopy is that it not only allows direct observation and accurate localization of pathology but also provides therapeutic treatment for some pathologies in a single setting. This study aims to evaluate the intra uterine condition of the subfertile couple presenting to our centre using hysteroscopy. Materials and Methods: This was a Prospective descriptive study and sixty three cases of subfertility were enrolled during the study period. Hysteroscopy was scheduled in the follicular phase of the menstrual cycle. The detailed hysteroscopic findings were noted. Data was entered in Microsoft excel format and appropriate statistical test was applied. Results: Sixty three patients underwent hysteroscopy, among them forty-eight patients (72.2%) had primary subfertility and fifteen patients (23.8%) had secondary subfertility. Thirty-nine (61.9%) patients had normal hysteroscopic findings whereas twenty-four (38.1%) patients showed abnormal hysteroscopic findings. Common abnormal pathologies were stromal oedema1(n=3,54.16%) followed by intrauterine adhesions (n=8,19%).Twenty-two (45.8%) patients with primary subfertility showed abnormal hysteroscopic findings as compared to only two (13.3%) patients of secondary subfertility which was statistically significant (p value= 0.03). Conclusion: Stromal oedema was the most common hysteroscopic finding followed by intrauterine adhesions which could have been missed during routine diagnostic investigations for subfertility workup.

Plasma phosphorylated-tau181 as a predictive biomarker for Alzheimer\u2019s amyloid, tau and FDG PET status

Plasma phosphorylated-tau181 (p-tau181) showed the potential for Alzheimer’s diagnosis and prognosis, but its role in detecting cerebral pathologies is unclear. We aimed to evaluate whether it could serve as a marker for Alzheimer’s pathology in the brain. A total of 1189 participants with plasma p-tau181 and PET data of amyloid, tau or FDG PET were included from ADNI. Cross-sectional relationships of plasma p-tau181 with PET biomarkers were tested. Longitudinally, we further investigated whether different p-tau181 levels at baseline predicted different progression of Alzheimer’s pathological changes in the brain. We found plasma p-tau181 significantly correlated with brain amyloid (Spearman ρ = 0.45, P < 0.0001), tau (0.25, P = 0.0003), and FDG PET uptakes (−0.37, P < 0.0001), and increased along the Alzheimer’s continuum. Individually, plasma p-tau181 could detect abnormal amyloid, tau pathologies and hypometabolism in the brain, similar with or even better than clinical indicators. The diagnostic accuracy of plasma p-tau181 elevated significantly when combined with clinical information (AUC = 0.814 for amyloid PET, 0.773 for tau PET, and 0.708 for FDG PET). Relationships of plasma p-tau181 with brain pathologies were partly or entirely mediated by the corresponding CSF biomarkers. Besides, individuals with abnormal plasma p-tau181 level (>18.85 pg/ml) at baseline had a higher risk of pathological progression in brain amyloid (HR: 2.32, 95%CI 1.32–4.08) and FDG PET (3.21, 95%CI 2.06–5.01) status. Plasma p-tau181 may be a sensitive screening test for detecting brain pathologies, and serve as a predictive biomarker for Alzheimer’s pathophysiology.

The Role of Diagnostic Laparoscopy in the Unexplained Infertility Cases

Purpose: The study examines how useful laparoscopy is in finalizing the diagnosis of unexplained infertility. Materials: The study included 50 women with 1 year or 2 years of infertility, who had a regular marital life with unprotected intercourse for more than a year, normal husband's semen analysis, normal ovulation by folliculometry, normal hormonal profile, and normal hysterosalpingogram at the department of Obstetrics and Gynecology at Aswan University Hospital from January to December 2019. Methods: This is a cross-sectional observational study involving 50 women who underwent diagnostic laparoscopy after investigations and imaging failed to reveal the cause of infertility. During the procedure, the pelvis was inspected for any pathology, including the uterus, fallopian tubes, round ligaments, ureterovesical pouch, uterosacral ligaments, Douglas pouch, and ovarian fossae. Results: Diagnostic laparoscopy helped uncover abnormal pathologies such as endometriosis, adhesions, and tubal pathologies in 30 women (60%) of the 50 included in the study, whereas no abnormality was detected in the remaining 20 (40%). Conclusion: Laparoscopy is not only a crucial diagnostic technique in infertility patients, but it can also help with treatment selections. Conducting laparoscopy in cases of unexplained infertility is linked to both peritubular adhesions and pelvic endometriosis. These pelvic disorders might not be appropriately detected or treated without laparoscopy, and hysterosalpingography and basic imaging such as pelvic ultrasonography are frequently ignored.

58 Rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population: An observational cohort study

To describe the rates of unanticipated pathology at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population. A secondary objective was to determine risk factors for unanticipated pathology. Hysterectomies performed for pelvic organ prolapse at a large public hospital between July 2007 and July 2019 were reviewed. Patients undergoing surgery for malignancy or atypical hyperplasia were excluded. Medical records were reviewed for demographic information, medical history, pre-operative work up, and final pathology. Frequencies of abnormal pathologies were calculated. Demographic and screening factors were correlated with pathologic findings by Fisher’s exact test or Mann-Whitney U test, as appropriate. This study was IRB approved. Between 2007 and 2019, 759 patient cases were identified. Most patients self-identified as Hispanic (87.9 %). The median age was 57 years old and 66.5 % of patients were post-menopausal. Abnormal uterine bleeding history was present in 28.6 % of patients. The majority of patients underwent preoperative ultrasonography (65.4 %) and 38.3 % underwent preoperative endometrial biopsy. Of the 744 uterine specimens that had available histology results, there were two cases of endometrial hyperplasia and one case of endometrial cancer. Of the 729 cervical specimens that were available for review, there was one case of intraepithelial neoplasia and two cases of cervical cancer. In the 246 patients who underwent oophorectomy, no ovarian malignancies were found. Those with endometrial hyperplasia or endometrial cancer were younger than those with benign findings (P=0.05) and had a thicker endometrium on ultrasound (P=0.024). Two of the three patients who had abnormal endometrial findings at the time of hysterectomy had benign pre-operative endometrial biopsies. There were no demographic or preoperative findings that were significantly different between patients with abnormal cervical pathology and benign cervical findings (all P>0.05). For patients undergoing hysterectomy for pelvic organ prolapse in a public hospital setting, the rates of endometrial dysplasia or cancer were 0.4% and the rates of cervical dysplasia or cancer were 0.4%. Given that this medically under screened population underwent appropriate perioperative evaluation, these results underscore the importance of considering screening history when interpreting perioperative diagnostic results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Incremental Cross-Domain Adaptation for Robust Retinopathy Screening via Bayesian Deep Learning

Retinopathy represents a group of retinal diseases that, if not treated timely, can cause severe visual impairments or even blindness. Many researchers have developed autonomous systems to recognize retinopathy via fundus and optical coherence tomography (OCT) imagery. However, most of these frameworks employ conventional transfer learning and fine-tuning approaches, requiring a decent amount of well-annotated training data to produce accurate diagnostic performance. This paper presents a novel incremental cross-domain adaptation instrument that allows any deep classification model to progressively learn abnormal retinal pathologies in OCT and fundus imagery via few-shot training. Furthermore, unlike its competitors, the proposed instrument is driven via a Bayesian multi-objective function that not only enforces the candidate classification network to retain its prior learned knowledge during incremental training but also ensures that the network understands the structural and semantic relationships between previously learned pathologies and newly added disease categories to effectively recognize them at the inference stage. The proposed framework, evaluated on six public datasets acquired with three different scanners to screen thirteen retinal pathologies, outperforms the state-of-the-art competitors by achieving an overall accuracy and F1 score of 0.9826 and 0.9846, respectively.

Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain.

The term ‘hip–spine syndrome’ was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics. The purpose of this narrative review is to explain the mechanism by which these three abnormal hip pathologies contribute to increased low back pain in patients without hip osteoarthritis. This paper presents a thorough rationale of the anatomical and biomechanical characteristics of the aforementioned hip pathologies, and how each contributes to premature coupling and limited hip flexion/extension. The future of hip and spine conservative and surgical management requires the implementation of a global hip–spine–pelvis-core approach to improve patient function and satisfaction.

Robotic Assisted Transvaginal Notes Hysterectomy

Study ObjectiveTo demonstrate a novel approach to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with bilateral salpingectomy using robotic assistanceDesignVideo presentation of the surgical procedure.SettingUniversity hospital.Patients or ParticipantsA 34-year-old G2P1011 with one prior cesarean section and myomectomy complained of dysmenorrhea and chronic pelvic pain and requested for the most minimally invasive form of hysterectomy.InterventionsA robotic-assisted transvaginal hysterectomy with bilateral salpingectomy was performed. The surgery began as a conventional transvaginal hysterectomy. An anterior and posterior colpotomy were performed, as which point, a camera was inserted to improve visibility. This allowed for confirmation of suspected adhesions from the patient's surgical history, most notably present in the anterior cul-de-sac between the bladder and uterus. Wristed instruments of the robot, the monopolar scissors and bipolar grasper, were also placed which enabled better navigation in the narrow surgical space. The remainder of the surgery, including the lysis of the dense adhesions, was completed smoothly with robotic assistance. The vaginal cuff was closed with a continuous running v-loc. The pelvis was inspected upon conclusion of the procedure and hemostasis was observed throughout.Measurements and Main ResultsThe surgery was completed in 90 mins without complications. The patient was discharged on the same day. On follow-up, the patient noted that her post-operative pain was significantly less than what she had experienced after her previous myomectomy.ConclusionWe showed that robotic-assisted NOTES is a novel and feasible option for transvaginal hysterectomy in indicated patients, particularly those with abnormal pathologies such as dense adhesions. In addition to image-guidance, robotic surgery allows for full articulation of instruments required for this surgery, which improves ease and access over other methods like laparoscopic surgery.

Feasibility study for use of angiographic parametric imaging and deep neural networks for intracranial aneurysm occlusion prediction

BackgroundAngiographic parametric imaging (API), based on digital subtraction angiography (DSA), is a quantitative imaging tool that may be used to extract contrast flow parameters related to hemodynamic conditions in abnormal...

Histopathological audit of appendectomy specimen in a Tertiary Care Center.

Objectives: To evaluate the histopathological findings in appendectomy specimens and observe the negative appendectomy rate (NAR). Study Design: Observational study. Setting: Department of Surgery Unit III, Peoples University of Medical &amp; Health Sciences, Nawabshah. Period: January to December 2018. Material and Methods: 117 consecutive cases of appendectomy. All the demographic data and the clinicopathological details were recorded on a proforma designed for the study. The histopathological assessment was carried out in all cases. The ultrasound examination and CT scan was carried out in selected cases. The data collected was statistically analyzed and the results were tabulated. Results: During study period 117 appendectomies were performed. The mean age of patient was 27+9.4 years, majority of patients (53.8%) were females with female to male ratio of 1.2:1. The histopathological diagnosis was made in all cases and the results indicates that 105 cases having positive appendectomy and in 12 (10.3%) cases the appendix was found histologically normal. Among 105 positive cases, 97 (83%) were diagnosed as acute appendicitis, 2 (1.7%) cases show fibrous obliteration and 6 (5.1%) cases were having unusual pathologies. The cases having histological diagnosis of acute appendicitis includs acute mucosal appendicitis, acute suppurative appendicitis with or without periappendicitis and peritonitis, acute necrotizing appendicitis and perforated gangrenous appendicitis. The 6 cases of unusual pathologies includes 3 cases of granulomatous lesions and one case each of carcinoid tumor, mucinous cystadenoma and worm infestation. The ultrasound was performed in 48 (41%) patients out of them 30 cases had positive findings on ultrasound examination were confirmed on histological examination and all 5 positive cases that were reported on CT scan were confirmed on histopathological examination. Conclusion: High rates of negative appendectomy in the female sex were observed, that can be reduced by the use of diagnostic imaging modalities specially ultrasound. The findings of abnormal pathologies on histopathological examination of the appendix suggest that histopathological analysis is necessary in all of the resected specimens.

CD34 stromal expression is inversely proportional to smooth muscle actin expression and extent of morphea.

Fibrosis is thought to be the main pathophysiology of scleroderma, and myofibroblasts play the main role in abnormal fibrotic pathologies. Altered distribution of dermal dendritic cells (DDCs) and vascular abnormalities has been reported to relate to the pathogenesis of scleroderma. To investigate fibrotic pathogenesis of morphea (localized scleroderma) by demonstrating the relative expression and distribution of DDCs and myofibroblasts, we performed immunohistochemical stains using several relevant antibodies. Skin lesions of 50 patients with morphea and age-, sex- and site-matched normal skin of 50 subjects were evaluated for the following antibodies: CD34, factor XIIIa (FXIIIa), smooth muscle actin (SMA), CD31 and vascular cell adhesion molecule-1 (VCAM-1). CD34 stromal stain was significantly lower in patients than controls (P = 0.000), while FXIIIa, SMA and VCAM-1 stains were significantly higher in patients than controls (P = 0.043, P = 0.000 and P = 0.027, respectively). In subtype analysis within patients, CD34 stromal stain showed decreasing trends with increasing disease extent and increasing fibrosis, respectively. CD34 stromal stain showed an inverse correlation and mutually exclusive spatial expression pattern with SMA stain (r = -0.286, P = 0.044). The inverse relationship was maintained in each dermal layer analysis, upper and lower dermis (r = -0.397, P = 0.004 and r = -0.281, P = 0.048, respectively). Mutually exclusive staining patterns of CD34 stromal and SMA stains suggest a phenotypic change of CD34+ DDCs into SMA+ myofibroblasts with increasing disease extent and fibrosis in morphea. Degree of loss of CD34+ DDCs can be a useful marker in predicting the extent and severity of morphea.