Irregular Contours Research Articles

MP50-05 PREDICTIVE FACTORS OF TESTICULAR CANCER IN SMALL TESTICULAR TUMORS TREATED WITH PARTIAL ORCHIECTOMY: A RETROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP50-05 PREDICTIVE FACTORS OF TESTICULAR CANCER IN SMALL TESTICULAR TUMORS TREATED WITH PARTIAL ORCHIECTOMY: A RETROSPECTIVE STUDY Jonathan Olivier, Maxence Rose, Clara Leroy, Xavier Leroy, and François Marcelli Jonathan OlivierJonathan Olivier More articles by this author , Maxence RoseMaxence Rose More articles by this author , Clara LeroyClara Leroy More articles by this author , Xavier LeroyXavier Leroy More articles by this author , and François MarcelliFrançois Marcelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical orchiectomy is the standard treatment for a testis cancer. Partial orchiectomy (PO) can be considered in the setting of a solitary functioning testis, bilateral tumors or for small testicular lesions. Objective: To evaluate possible factors predicting testicular cancer in patients undergoing PO. METHODS: We retrospectively analyzed the records of all patients who underwent PO for a solitary functioning testis, bilateral tumors or a small lesion (<2cm on preoperative ultrasound) in our center during the period 2004-2021. Testis sparing surgery consisted of tumor enucleation for FSE. Immediate radical orchiectomy was performed in all cases of malignancy at FSE but otherwise the testes were spared. RESULTS: 101 patients were included in the study. Reasons for PO included small lesion in 79 (78%); solitary functioning testis in 18 (18%) or bilateral lesions in 4 (4%). A lesion was palpable in 32 (32%) and median size was 6.6mm (IQR=5.2-10) at US. 21 patients had elevated serum tumor markers. Overall 28 of the 101 men (28%) presented with testicular cancer (20 seminomas, 6 non-seminomas, 1 germ cell neoplasia in situ and 1 burn-out tumor). Diameter of the lesion (p<0.05), presence of microlithiasis (p<0.01), irregular contour of the lesion (p<0.01) on preoperative US, elevated serum markers (p<0.05), personal history of testicular cancer (p<0.01) were predictors of malignancy (Table 1). CONCLUSIONS: Small testicular masses are often benign and do not always require radical orchiectomy. None of the predictive factors can preoperatively predict the histology of the lesion. Therefore, we suggest to perform partial orchiectomy for small testicular masses. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e686 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Olivier More articles by this author Maxence Rose More articles by this author Clara Leroy More articles by this author Xavier Leroy More articles by this author François Marcelli More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of Lunate Facet Escape after Distal Radius Fracture Volar Plating: Surgical Technique

Fractures involving the lunate facet of the distal radius (commonly called the volar ulnar corner or “critical corner”) are often difficult to recognize radiographically. “Lunate facet escape” refers to the displacement of this fragment after attempted distal radius fracture closed or open reduction methods. Lunate facet escape can have severe consequences including carpal collapse with pain, instability, and arthritis. Challenges to lunate facet fixation include irregular cortical contour that makes plate fixation difficult, as well as deforming forces by inserting structures. The goal of the management of a distal radius fracture with lunate facet involvement is first identification, then adequate stabilization until osseous healing occurs. However, subsequent lunate facet escape can pose a challenging clinical and surgical dilemma. Here we discuss our preferred approach to treat lunate facet escape after distal radius fracture volar locking plating failure.

Hepar Lobatum Carcinomatosum: A Rare Complication Discovered After an Episode of Digestive Hemorrhage

Aims: Show the importance of imaging in the diagnosis and follow up of Hepar Lobatum Carcinomatosum (HLC) in the context of a breast neoplasia. Presentation of case: We report a case of an episode of upper GI hemorrhage, in a 54 year old female patient, with chronic abdominal pain and asthenia. The CT scan showed a dysmorphic liver, with irregular contours, multiple capsular retractions, associated with abundant ascites. Discussion and Conclusion: HLC is defined as an acquired non-cirrhotic liver deformity secondary to liver metastases during a neoplasia, most often of the breast. The clinical presentations are not very specific and often late, and represented by signs of liver failure associated or not with portal hypertension in all its manifestations. Imaging in HLC, especially CT scan, shows similarities to a cirrhotic liver with hepatic dysmorphia, caudal lobe enlargement and segment IV atrophy. The presence of capsular retraction resulting in lobulated liver contours with reduced liver volume. It is therefore important to know the existence of this extensive form of secondary liver involvement and the set of complications that can arise.

Determination of arterial invasion in pancreatic ductal adenocarcinoma: what is the best diagnostic criterion on CT?

To investigate the diagnostic performance and interobserver variability in the determination of arterial invasion in pancreatic ductal adenocarcinoma (PDAC) and determine the best CT imaging criterion. We retrospectively evaluated 128 patients with PDAC (73 men and 55 women) who underwent preoperative contrast-enhanced CT. Five board-certified radiologists (expert) and four fellows (non-expert]) independently assessed the arterial invasion (celiac, superior mesenteric, splenic, and common hepatic arteries) using a 6-point score: 1, no tumor contact; 2, hazy attenuation ≤ 180°; 3, hazy attenuation > 180°; 4, solid soft tissue contact ≤ 180°; 5, solid soft tissue contact > 180°; and 6, contour irregularity. ROC analysis was performed to evaluate the diagnostic performance and determine the best diagnostic criterion for arterial invasion, with pathological or surgical findings as references. Interobserver variability was assessed using Fleiss's ĸ statistics. Among the 128 patients, 35.2% (n = 45/128) received neoadjuvant treatment (NTx). Solid soft tissue contact ≤ 180° was the best diagnostic criterion for arterial invasion as defined by the Youden Index both in patients who did and did not receive NTx (sensitivity, 100% vs. 100%; specificity, 90% vs. 93%; and AUC, 0.96 vs. 0.98, respectively). Interobserver variability among the non-expert was not inferior to that among the expert (ĸ = 0.61 vs 0.61; p = .39 and ĸ = 0.59 vs 0.51; p < .001 in patients treated with and without NTx, respectively). Solid soft tissue contact ≤ 180° was the best diagnostic criterion for the determination of arterial invasion in PDAC. Considerable interobserver variability was seen among the radiologists. • Solid soft tissue contact ≤ 180° was the best diagnostic criterion for the determination of arterial invasionin pancreatic ductal adenocarcinoma. • Interobserver agreement among non-expert radiologists was almost comparable to that among expert radiologists.

A41 FONTAN ASSOCIATED LIVER DISEASE: THE ROLE OF TRANSIENT ELASTOGRAPHY IN CHILDREN AND ADOLESCENTS

Abstract Background Non-invasive assessment of Fontan Associated Liver Disease (FALD) is of interest, but studies have yielded inconsistent results about the correlation of severity of disease with laboratory values and imaging. Transient elastography (TE) is a non-invasive imaging modality used commonly for liver stiffness measurement (LSM) and in Fontan patients it is hypothesized to reflect not only liver fibrosis but also venous congestion. Purpose To better define the potential role of TE for non-invasive assessment of the severity of FALD. Method This was a retrospective study conducted on patients’ medical records at CHU Sainte-Justine Hospital. Patients less than 18 years of age with FALD who had at undergone at least one LSM by TE between 1998-2021 were included. The relationship between LSM and liver function tests, hepatic ultrasound findings (including a cirrhosis score), cardiac catheterization results and histological fibrosis scores were analyzed. The impact of interventions during cardiac catherization on LSM were also studied. Result(s) A total of 54 patients (36 boys and 18 girls) with FALD were studied. Median age at Fontan surgery was 4.6 years (IQR 4.0 ─ 5.4 years). Higher LSM values significantly correlated with longer time from Fontan, higher total and direct bilirubin and GGT levels, higher INR, longer APTT, lower Factor V, and lower absolute lymphocyte count. Greater LSM was also significantly associated with the presence of heterogenous parenchymal echogenicity, irregular liver contours and greater ultrasonographic cirrhosis scores. Higher TE values were significantly correlated with higher wedged hepatic venous pressure and Fontan pressure. After catherization interventions that addressed stenoses, there was a statistically significant reduction in mean LSM (24.9±3.63 kPa vs 15.8±4.6 kPa, p=0.005). After closure of significant pulmonary collaterals, mean LSM tended to increase, but this difference did not reach statistical significance (19.1±1.9 kPa vs 24.6±3.5 kPa, p=0.2). At liver biopsy, significant direct correlation was found between LSM and the grade of sinusoidal fibrosis and LSM. TE with values &amp;gt;20 kPa were found to have higher grades of sinusoidal fibrosis, while values &amp;lt;20kPa had higher grades of sinusoidal dilatation. Conclusion(s) This study showed that TE allows to identify patients with higher cholestatic parameters, more severe liver fibrosis at biopsy and sonographic signs suggestive of cirrhosis. Moreover, it confirmed that liver congestion significantly contributes to LSM values. Interestingly, catheter interventions addressing pulmonary stenoses led to the improvement of TE measurements, giving hope for the reduction of hepatic venous congestion in these patients, which might have an effect on their FALD. Finally, the LSM threshold of 20 kPa could be useful clinically as a value above which fibrosis is likely to be significant, while if below could indicate a greater contribution from hepatic congestion. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

High-Grade B-Cell Lymphoma With Malignant Effusions as the Initial Presentation.

Malignant effusion is usually caused by metastatic carcinoma. Malignant lymphoma is often not included as a top differential diagnosis of malignant effusion. Here, we describe 3 cases of young female patients with no significant past medical history who presented with fluid overload and were diagnosed with high-grade B-cell lymphoma (HGBL). We conducted histopathologic examination and immunophenotypic and cytogenetic analyses on three cases using immunohistochemistry, flow cytometry, fluorescence in situ hybridization (FISH), and karyotyping. We also included patients' clinical and radiological findings in our case reports. Histologic examination of the effusion samples showed numerous intermediate to large lymphoma cells with irregular nuclear contours and fine chromatin. The lymphoma cells were positive for CD10, CD20, BCL2, BCL6, and PAX5 and negative for CD34, cyclin D1, HHV-8, and TdT. In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNAs was negative. The proliferation index by Ki-67 stain was more than 80%. Flow cytometry showed CD10-positive B cells with monotypic immunoglobulin light chain expression. Fluorescence in situ hybridization analysis demonstrated MYC, BCL2, or BCL6 rearrangements. These 3 patients were diagnosed as having HGBL with double-/triple-hit rearrangements. Despite receiving aggressive chemotherapy, all 3 patients had a dismal clinical course, with 2 patients dying less than 2 years after initial diagnosis. High-grade B-cell lymphoma should be considered in the differential diagnoses of malignant effusions. Flow cytometric and FISH analyses of the body fluid specimens are essential to reach an accurate and timely diagnosis.

Frequency of Diabetic Nephropathy, through Renal Resistive Index, among Type 2 Diabetic patients with Normal Albuminuria.

Background: The diabetes mellitus is an old known disease and closely related to the renal impairment as a cause. The exact duration for any damage to renal functions is not known but early detection of any such happening is a requirement. Many measures explain the renal damage, proteinuria is one among them. Still it appears after some damage is done. Aim: To measure the RRI for renal arteries and find frequency of diabetic nephropathy among type II diabetic patients with normal albuminuria. Methods: It was a cross-sectional study performed at Shaikh Zayed hospital Lahore, in collaboration of Diabetes Clinic and Radiology Department during January 2020 to January 2021. Here 300 diabetic patients of type 2, with normal albumin creatinine ratio were selected. Both genders with age above 18 years with albuminuria below 30 mg/g and no known diabetic nephropathy were included. Pregnant women, patients with GFR &lt;60ml/min/1.73m2 and those having any history of renal stones and known CKD patients were excluded. Results: One hundred and seventy seven (59.0%) were males, only 38(12.7%) were above 60 years age, 37(12.3%) were obese and 180(60.0%) had duration of diabetes ≤5 years. There were 60(20.0%) smokers, 106(35.3%) had hypertension and 5.0% had fatty liver of grade III. On ultrasound 75(25.0%) cases had both kidneys with irregular contour while 44(14.7%) had raised Parenchymal &amp; sinus echoes in both kidneys. On RRI, 23.3% of the cases were diagnosed to have diabetic nephropathy with max(RRI) &gt;0.70. Conclusion: Renal resistive indexcan diagnose diabetic nephropathy at early stage. Keywords: Diabetic nephropathy, Renal resistivity index, Type II diabetes mellitus, Normal albuminuria

Postoperative Antibiotics Confer No Protective Association After Fat Grafting for Breast Reconstruction.

Autologous fat grafting after breast reconstruction is a commonly used technique to address asymmetry and irregularities in breast contour. While many studies have attempted to optimize patient outcomes after fat grafting, a key postoperative protocol that lacks consensus is the optimal use of perioperative and postoperative antibiotics. Reports suggest that complication rates for fat grafting are low relative to rates after reconstruction and have been shown to not be correlated to antibiotic protocol. Studies have additionally demonstrated that the use of prolonged prophylactic antibiotics do not lower the complication rates, stressing the need for a more conservative, standardized antibiotic protocol. This study aims to identify the optimal use of perioperative and postoperative antibiotics that optimizes patient outcomes. Patients in the Optum Clinformatics Data Mart who underwent all billable forms of breast reconstruction followed by fat grafting were identified via Current Procedural Terminology codes. Patients meeting inclusion criteria had an index reconstructive procedure at least 90 days before fat grafting. Data concerning these patient's demographics, comorbidities, breast reconstructions, perioperative and postoperative antibiotics, and outcomes were collected via querying relevant reports of Current Procedural Terminology; International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; National Drug Code Directory, and Healthcare Common Procedure Coding System codes. Antibiotics were classified by type and temporal delivery: perioperatively or postoperatively. If a patient received postoperative antibiotics, the duration of antibiotic exposure was recorded. Outcomes analysis was limited to the 90-day postoperative period. Multivariable logistic regression was performed to ascertain the effects of age, coexisting conditions, reconstruction type (autologous or implant-based), perioperative antibiotic class, postoperative antibiotic class, and postoperative antibiotic duration on the likelihood of any common postoperative complication occurring. All statistical assumptions made by logistic regression were met successfully. Odds ratios and corresponding 95% confidence intervals were calculated. From more than 86 million longitudinal patient records between March 2004 and June 2019, our study population included 7456 unique records of reconstruction-fat grafting pairs, with 4661 of those pairs receiving some form of prophylactic antibiotics. Age, prior radiation, and perioperative antibiotic administration were consistent independent predictors of increased all-cause complication likelihood. However, administration of perioperative antibiotics approached a statistically significant protective association against infection likelihood. No postoperative antibiotics of any duration or class conferred a protective association against infections or all-cause complications. This study provides national, claims-level support for antibiotic stewardship during and after fat grafting procedures. Postoperative antibiotics did not confer a protective benefit association against infection or all-cause complication likelihood, while administering perioperative antibiotics conferred a statistically significant increase in the likelihood that a patient experienced postoperative complication. However, perioperative antibiotics approach a significant protective association against postoperative infection likelihood, in line with current guidelines for infection prevention. These findings may encourage the adoption of more conservative postoperative prescription practices for clinicians who perform breast reconstruction, followed by fat grafting, reducing the nonindicated use of antibiotics.

Septum-sparing minimally invasive technique for levator advancement surgery in aponeurotic ptosis.

To evaluate the outcome of small incision levator advancement with septum-sparing technique and compare it with standard levator advancement. The surgical findings and clinical data of patients with aponeurotic ptosis who underwent small incision or standard levator advancement surgery in our clinic between 2018 and 2020 were analyzed retrospectively. For both groups; age, gender, systemic and ophthalmic comorbidities, levator function, preoperative and postoperative margin-reflex distance, change in margin-reflex distance after surgery, symmetry between the eyes, follow-up time, perioperative and postoperative complications (under/overcorrection, contour irregularity, lagophthalmos) were all evaluated and recorded. The study included 82 eyes, 46 from 31 patients in Group I who had small incision surgery, and 36 from 26 patients in Group II who had standard levator surgery. There was no statistically significant difference in surgical success between the two groups (80% and 81% respectively, p = 0.692). The levator function and preoperative margin-reflex distance correlated positively with surgical success. Small incision levator advancement is a less invasive procedure than standard levator advancement because of the smaller skin incision and preservation of orbital septum integrity, but it requires good knowledge of eyelid anatomy and experience in eyelid surgery. In patients with aponeurotic ptosis, this surgery can be performed as a safe and effective surgical technique with a similar success rate as standard levator advancement.

The Management of Lumps, Bumps, and Contour Irregularities of the Lower Eyelid and Cheek After Poor Outcome Fat Transfer.

The increasing popularity of fat transfer (FT) to the lower eyelids has led to an increase in unwanted lumps, bumps, and contour irregularities (LBCs). Few studies have addressed the management of LBCs. The aim of this study was to address the management of LBCs. In this retrospective review, charts of all patients presenting for evaluation of LBCs following FT procedures to the lower eyelid were reviewed. Clinical characteristics on presentation and surgical findings were evaluated. Patient postoperative clinical course and complications were also documented. Forty-eight patients were included (45 women and 3 men), with an average follow-up of 14 months (range, 5-24 months). In 65%, LBCs manifested above the lower orbital rim (AR) and in 35% they were noted AR and below the rim (AR/BR). The type of contour deficits noted were a solitary nodule (SN) in 54%, a mixed picture (MP) in 23%, diffuse enlargement (DE) in 17%, and multiple nodules (MNs) in 6%. Combining lesion location and type of contour deficit, the most common presentation was an SN-AR in 22 patients (46%), followed by an MP-AR/BR in 8 patients (17%), and a DE-AR/BR in 5 patients (10%). Surgical findings revealed that grafted fat is consistently found separate from native eyelid/orbital fat, and within the orbicularis muscle when AR, and within the orbicularis muscle or the deep suborbicularis oculi fat when BR. LBCs tend to manifest in characteristic patterns with a predilection for an AR location. Recommendations on the diagnosis and management of these lesions are provided.

Analysis and Measurement of Large Circular Transmitting Arrays for Microwave Power Transmission

Phased arrays have been widely used in microwave power transmission. The efficiency of rectenna is closely related to the received power density. Therefore, it is necessary to accurately analyze the radiation performance of the transmitting array in order to achieve the high-efficiency power transmission. And in order to meet the long-distance and high-efficiency power transmission requirements, the transmitting array needs to have the characteristics of large electricity sizes. The direct numerical analysis method of entire array will bring huge cost in computing time and storage space. Subarray extrapolation is a method to reasonably account for the edge effects of arrays, but only for rectangular arrays. Aiming at the geometric characteristics of the array contour, this communication proposes an irregular contour recognition method. This method can expand the application of subarray extrapolation method and realizes the purpose of accurately evaluating the radiation performance of large array antennas at small calculation cost. Finally, using a large transmitting array as an example, the proposed method is verified by comparing the results of subarray extrapolation, commercial software of entire array, and the experimental measurement to validate the correctness and advancement.

A multi-institutional, single-arm, phase II trial of neoadjuvant modified-FOLFIRINOX for resectable pancreatic ductal adenocarcinoma.

715 Background: Various peri-operative treatments have been tested to increase the survival of localized PDAC. Even with superior survival among various disease extent of PDAC, resectable PDAC still shows poor outcomes with surgery followed by adjuvant chemotherapy. We report the result of a multi-institutional phase II trial of modified-FOLFIRINOX as neoadjuvant treatment for resectable PDAC. Methods: Treatment naïve pts with histologically confirmed resectable PDAC were enrolled. Resectability was confirmed by both CT and MRI according to NCCN resectability criteria (no arterial tumor contact to celiac axis, SMA or CHA; no tumor contact with SMV or PV or ≤180° contact without vein contour irregularity) in multidisciplinary team meeting. Patients received oxaliplatin 85mg/m2 D1 + leucovorin 400mg/m2 D1 + irinotecan 150mg/m2 D1 + 5-FU 2,000mg/m2 46h continuous infusion, every other week for 6 cycles (12 weeks). Response assessments were performed every 6 weeks using the RECIST criteria version 1.1. Baseline MRI, PET-CT scan, and pre-surgery MRI after 6 cycles were mandatory. The primary endpoint was R0 resection rate. Secondary endpoints included survivals, ORR, safety, resection rate, and correlative biomarker exploration. (NCT05066802). Results: Total of 27 pts were enrolled between May 2020 and Feb 2022. Among total 27 pts, 24 pts underwent curative aim surgery after neoadjuvant treatment (resection rate 88.9%), and 23 pts showed R0 resection (23/27=85.2%), meeting the primary endpoint. Among 27 pts, 19 pts (70.4%) completed the neoadjuvant treatment per protocol. The reasons for neoadjuvant treatment discontinuation included progression of the disease (n=3, 11.1%) and pts withdrawal (n=5, 18.5%). Among 19 patients who underwent surgery per protocol, only one patient was R1 resected (R0 resection rate=94.7%). As of Sep 1, 2022 (median follow-up duration = 15.2 months) 6 pts recurred after surgery (6/19=31.6%). Median recur-free survival was 18.7 months (95%CI 13.6-NR) and median OS was not reached (95%CI 17.6-NR) for the per protocol treated pts. Treatment-related AE (≥G3) occurred in 10 pts (37.0%) including 7 (25.9%) with neutropenia G3-4. Conclusions: Three months of neoadjuvant mFOLFIRINOX was feasible and tolerable for resectable PDAC. Larger randomized trial is needed to validate the impact of neoadjuvant chemotherapy for resectable pancreatic cancer and to find subgroup of pts who would get benefit most from the neoadjuvant treatment. Post hoc genomic analyses with paired pre-neoadjuvant treatment and surgical tissues are ongoing. Clinical trial information: NCT05066802 .

How Frequently Benign Uterine Myomas Appear Suspicious for Sarcoma as Assessed by Transvaginal Ultrasound?

Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019-December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as "frequently seen in uterine sarcoma", were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, "cooked" appearance, and a Doppler color score of 3-4. In addition, the examiners had to classify the lesion as suspicious based on her/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0-263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of >3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible.

Detection of sarcopenia using deep learning-based artificial intelligence body part measure system (AIBMS).

Background: Sarcopenia is an aging syndrome that increases the risks of various adverse outcomes, including falls, fractures, physical disability, and death. Sarcopenia can be diagnosed through medical images-based body part analysis, which requires laborious and time-consuming outlining of irregular contours of abdominal body parts. Therefore, it is critical to develop an efficient computational method for automatically segmenting body parts and predicting diseases. Methods: In this study, we designed an Artificial Intelligence Body Part Measure System (AIBMS) based on deep learning to automate body parts segmentation from abdominal CT scans and quantification of body part areas and volumes. The system was developed using three network models, including SEG-NET, U-NET, and Attention U-NET, and trained on abdominal CT plain scan data. Results: This segmentation model was evaluated using multi-device developmental and independent test datasets and demonstrated a high level of accuracy with over 0.9 DSC score in segment body parts. Based on the characteristics of the three network models, we gave recommendations for the appropriate model selection in various clinical scenarios. We constructed a sarcopenia classification model based on cutoff values (Auto SMI model), which demonstrated high accuracy in predicting sarcopenia with an AUC of 0.874. We used Youden index to optimize the Auto SMI model and found a better threshold of 40.69. Conclusion: We developed an AI system to segment body parts in abdominal CT images and constructed a model based on cutoff value to achieve the prediction of sarcopenia with high accuracy.

Non-crystalline light chain proximal tubulopathy associated with monoclonal gammopathy of renal significance: A case report and review of the literature.

Light chain proximal tubulopathy (LCPT) is a rare M-proteinemia-related nephropathy. Non-crystalline LCPT is even rarer. We herein report an unusual case of renal dysfunction and proteinuria due to κ-restricted and non-crystalline LCPT in a context of monoclonal gammopathy of renal significance (MGRS) without Fanconi syndrome (FS). A 67-year-old man was admitted for a 2-year history of proteinuria and renal dysfunction. Fanconi syndrome (FS) was not observed. He was noted to have IgG-κ M protein, and the previous bone marrow biopsy revealed that atypical plasma cells accounted for 1.5% of the cells, which did not meet the diagnostic criteria for multiple myeloma. A renal biopsy revealed proximal tubular injury, including increased lysosomes with irregular contours and a mottled appearance without crystalline structure and the accumulation of κ light chains. He was diagnosed with non-crystalline LCPT with MGRS. Concurrently, we reviewed the non-crystalline LCPT cases previously published in the literature. Our patient finally received chemotherapy with a bortezomib and dexamethasone regimen. The patient did not seem to achieve evident nephrological and hematological remission after chemotherapy, but he was in a stable condition. Very few similar cases are reported in the literature. It is considered crucial to enhance our knowledge about these cases to establish the definition of the non-crystalline LCPT entity and allow for early diagnosis. Chemotherapy may not be necessary for all patients to maintain good renal function. Future prospective clinical research studies are necessary.

Esthetic solutions with layered zirconia prostheses: A case series

One of the major clinical challenges in the rehabilitation of anterior teeth is achieving natural looking restorations for improper shape, size of the existing teeth, irregular gingival contour and unaesthetic shades. Increasing demand by patients for aesthetic and metal-free restorations has resulted in all-ceramic restorations such as dental zirconia that offer optimal aesthetics with desirable mechanical properties. A case series of clinical reports of layered zirconia fixed dental prostheses for anterior teeth is described. Prosthetic rehabilitation of endodontically treated and vital abutments are described and the influence of zirconia composition, design, layering technique, shade selection, occlusion and clinical challenges in each of the clinical conditions are discussed. Choice of zirconia composition, framework design and shade selection in layered zirconia prosthesis is influenced by abutments in layered zirconia prosthesis.

Piddling and Moderate-Primary Cutaneous CD4+ Small/Medium T Cell Lymphoproliferative Disorder

Initially contemplated as a provisional subtype of cutaneous T cell lymphoma (CTCL), primary cutaneous CD4+ small / medium T cell lymphoproliferative disorder manifests as an indolent, solitary cutaneous lesion in the absence of accompanying cutaneous lymphoma as mycosis fungoides. Preponderantly, infiltration of upper dermis with miniature to intermediate, pleomorphic CD4+ T cells in the absence of preceding or concurrent patches and plaques with focal epidermotropism is encountered. Primary cutaneous CD4+ small/medium T cell lymphoproliferative disorder commonly appears in adults as a solitary plaque, tumour or nodule situated upon face, neck, upper trunk or thoracic region. Upon cytology, pleomorphic, miniature, intermediate or occasionally enlarged T lymphoid cells with irregular nuclear contours are variably intermixed with miniature, reactive CD8+ T cells, B cells, plasma cells, histiocytes and monotypic plasma cells. Morphologically, an intense dermal infiltrate of atypical lymphoid cells or small / medium pleomorphic CD4+ T cells extending into subcutaneous tissue appears to configure a diffuse or nodular configuration wherein the enlarged, pleomorphic cells articulate &lt; 30% of neoplastic cellular infiltrate. Neoplastic lymphocytes appear immune reactive to T cell markers as CD3, CD4, CD5 along with T follicular helper markers as CD279 (PD-1), ICOS and CXCL13. Primary cutaneous CD4+ small/medium T cell lymphoproliferative disorder necessitates segregation from mycosis fungoides, cutaneous involvement with systemic T cell lymphoma of T follicular helper immuno-phenotype, benign inflammatory infiltrate, extra-nodal marginal zone (MALT) lymphoma or adult T cell leukaemia /lymphoma. The disorder can be therapeutically managed with intralesional steroids, radiotherapy or surgical extermination of lesion.

Stress–strain analysis of vertical shaft lining and adjacent rock mass under conditions of irregular contour

Stress–strain analysis of vertical shaft lining and adjacent rock mass under conditions of irregular contour

Paraffin gauze bolus as tissue compensator in photon irradiation for mycosis fungoides – regarding a case study

Abstract Introduction: Total skin electron beam therapy is a treatment option in patients with mycosis fungoides (MF) affecting a significant amount of the body surface. For patients with involvement of soles and interdigital folds, however, this approach is ineffective, requiring alternatives such as localised radiotherapy (RT). Although electron beams are well suited for superficial lesions, on irregular surfaces it provides inadequate tumour coverage and excess dose variance, requiring photon irradiation with tissue compensation. Methods: We present the case of a patient with extensive cutaneous MF with skin lesions spread over both lower limbs and treated on these affected areas with photon beam RT. Long sheets of paraffin gauze dressings were used to create a 0·5-cm-thick bolus. The patient received a single fraction of 8 Gy. In vivo dosimetry using Gafchromic films was performed. Results: After 3 months, a complete response was achieved. In this case, paraffin gauze bolus proved to be an inexpensive, convenient, effective and flexible method for irregular superficial cancer irradiations. Conclusion: Paraffin gauze bolus is a suitable option for irregular contours.

Novel optical coherence tomography angiography biomarkers in the diagnosis and assessment of diabetic macular edema and diabetic macular ischemia in patients with non-proliferative diabetic retinopathy.

The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non-proliferative diabetic retinopathy (NPDR). In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT-1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ-CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ-CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.