Diagnosis Of Dysplasia Research Articles

Simulation-based training improves developmental hip dysplasia examination and diagnosis skills on newborns.

Examination maneuvers used to diagnose developmental hip dysplasia (DDH) translate poorly to video and written curricula. This poses a challenge to teaching the infant hip exam to orthopedic, family medicine, and pediatric trainees. This work investigated the impact of the MiHip simulation-based training program on residents' knowledge, confidence, and exam skills in the simulated setting, and translation of these skills to the clinical setting. Fifty-four pediatric (n=39) and family medicine (n=15) residents participated in a non-randomized, stepped-wedge study during 2-4 week newborn rotations. Residents participated in simulation-based training facilitated by a pediatric orthopedic surgeon. Prior to and following training, residents completed a 10-item quiz and reported their confidence toward their DDH skills. Residents' and attendings' hip exam diagnoses were captured on 1,063 newborns. Residents' knowledge, confidence, and DDH diagnosis sensitivity were compared pre- and post-training. Chart analysis of 21 newborns that underwent a hip ultrasound compared residents' and practicing physicians' diagnoses' agreement with ultrasound findings. Following training, residents' knowledge, confidence and diagnosis skills improved modestly, P<0.001. In the clinical setting, residents' confidence (P<0.001) and skill improved for residents with (sensitivity Δ=.29) and without (Δ =.18) previous simulation-based training experience. Resident diagnoses demonstrated higher agreement with hip ultrasounds than practicing primary care physicians, (Mtrainee=88.9%, MPCP=25.0%, P = 0.003, φ=.63). The hands-on training with the MiHip simulator improved resident knowledge and DDH examination confidence, and ultimately, improved diagnostic accuracy in the clinical setting. Further work is required to assess the larger clinical impact on orthopedic referral rates.

Convolutional neural networks for accurate real-time diagnosis of oral epithelial dysplasia and oral squamous cell carcinoma using high-resolution in vivo confocal microscopy

Oral cancer detection is based on biopsy histopathology, however with digital microscopy imaging technology there is real potential for rapid multi-site imaging and simultaneous diagnostic analysis. Fifty-nine patients with oral mucosal abnormalities were imaged in vivo with a confocal laser endomicroscope using the contrast agents acriflavine and fluorescein for the detection of oral epithelial dysplasia and oral cancer. To analyse the 9168 images frames obtained, three tandem applied pre-trained Inception-V3 convolutional neural network (CNN) models were developed using transfer learning in the PyTorch framework. The first CNN was used to filter for image quality, followed by image specific diagnostic triage models for fluorescein and acriflavine, respectively. Images were categorised based on a histopathological diagnosis into 4 categories: no dysplasia, lichenoid lesions, low-grade dysplasia and high-grade dysplasia/oral squamous cell carcinoma (OSCC). The quality filtering model had an accuracy of 89.5%. The acriflavine diagnostic model performed well for identifying lichenoid (AUC = 0.94) and low-grade dysplasia (AUC = 0.91) but poorly for identifying no dysplasia (AUC = 0.44) or high-grade dysplasia/OSCC (AUC = 0.28). In contrast, the fluorescein diagnostic model had high classification performance for all diagnostic classes (AUC range = 0.90–0.96). These models had a rapid classification speed of less than 1/10th of a second per image. Our study suggests that tandem CNNs can provide highly accurate and rapid real-time diagnostic triage for in vivo assessment of high-risk oral mucosal disease.

Diffusion data augmentation for enhancing Norberg hip angle estimation.

The Norberg angle (NA) plays a crucial role in evaluating hip joint conformation, particularly in canines, by quantifying femoral head subluxation within the hip joint. Therefore, it is an important metric for evaluating hip joint quality and diagnosing canine hip dysplasia, the most prevalent hereditary orthopedic disorder in dogs. While contemporary tools offer automated quantification of the NA, their usage typically entails manual labeling and verification of radiographic images by professional veterinarians. To enhance efficiency and streamline this process, the study aims to develop a tool capable of predicting the NA directly from the image without the need for veterinary intervention. Due to the challenges in acquiring annotated, diverse, high-quality images, this study introduces diffusion models to expand the training dataset from 219 to 1493 images, encompassing original images. This augmentation enhances the dataset's diversity and scale, thereby improving the accuracy of Norberg angle estimation. The model predicts four key points: the center of left and right femoral heads and the edge of the left and right acetabulum, as well as the radii of the femoral heads and the Norberg angles. By evaluating 18 distinct pretrained ImageNet models, we investigate their performance pre- and post-incorporating augmented data from generated images. The results demonstrate a significant enhancement, with an average 35.3% improvement based on mean absolute percentage error when utilizing generated images from diffusion models. This study showcases the potential of diffusion modeling in advancing canine hip dysplasia diagnosis and underscores the value of incorporating augmented data to elevate model accuracy.

BMT: A Cross-Validated ThinPrep Pap Cervical Cytology Dataset for Machine Learning Model Training and Validation

In the past several years, a few cervical Pap smear datasets have been published for use in clinical training. However, most publicly available datasets consist of pre-segmented single cell images, contain on-image annotations that must be manually edited out, or are prepared using the conventional Pap smear method. Multicellular liquid Pap image datasets are a more accurate reflection of current cervical screening techniques. While a multicellular liquid SurePath™ dataset has been created, machine learning models struggle to classify a test image set when it is prepared differently from the training set due to visual differences. Therefore, this dataset of multicellular Pap smear images prepared with the more common ThinPrep® protocol is presented as a helpful resource for training and testing artificial intelligence models, particularly for future application in cervical dysplasia diagnosis. The “Brown Multicellular ThinPrep” (BMT) dataset is the first publicly available multicellular ThinPrep® dataset, consisting of 600 clinically vetted images collected from 180 Pap smear slides from 180 patients, classified into three key diagnostic categories.

Do children 3years at index surgery? A prospective comparative study.

Diagnosis and management of developmental dysplasia of hip (DDH) in underdeveloped regions is frequently delayed, potentially impacting final outcomes. This prospective study was conducted with the aim of answering the question, "Do children <3 years at index surgery for DDH have better outcome at 5-year follow-up in comparison to children >3 years at index surgery?" Between 2016 and 2021, all walking-age children with DDH were prospectively enrolled in the study. The study cohort was divided into 2groups: Group 1 ⩽3 years of age, and Group 2 included children >3 years old. Intraoperative decisions determined the need for addition of femoral or pelvic osteotomy to the open reduction (OR). Follow-up assessment and group comparison included acetabular-index (AI), proximal femoral growth disturbances (PFGD), and outcomes based on Severin's criteria. Subgroup analysis also compared re-dislocated hips with stable hips post-surgery. Children with follow-ups <3 years were excluded. 45 hips in 38 children analysed (31 in Group 1 and 14 in Group 2). Group 1 had higher pre-op AI (p = 0.0489). More hips in Group 2 underwent OR with femoral osteotomy (p = 0.0016). Re-dislocation occurred in 6 (19%) in Group 1 and 2 (14%) in Group 2. Subgroup analysis revealed higher index postoperative AI in re-dislocated hips (p = 0.0001). At the final follow-up, AI was similar between Groups 1 and 2 (p = 0.27). Overall, satisfactory outcomes were comparable between Groups 1 and 2 (p = 0.21). PFGD changes were significantly higher in Group 2 (p = 0.028) and in re-dislocated hips (p = 0.004). Satisfactory outcomes were found in 89% of non-re-dislocated hips and 75% of re-dislocated hips. At an average follow-up of 5 years, children above and below 3 years at index procedure for DDH show similar outcomes but older ones need femoral osteotomy more frequently. Osteonecrosis risk rises with increasing age at index surgery and after re-operations, but its impact is not clear in mid-term.

A Novel Noninvasive Approach, “DrOroscope,” for Early Detection of Dysplasia in Oral Mucosal Lesions: A Cross-sectional Study

Background Oral cancer is a significant global burden in the present scenario, and early detection has critical importance in improving the survival rate. Devices which aid in the early diagnosis of dysplastic lesions noninvasively are necessary to reduce the oral cancer burden and improve the quality of life of the patients. Purpose To evaluate the efficacy of DrOroscope in diagnosing dysplasia in oral mucosal lesions. Methods A cross-sectional study was conducted among 40 individuals clinically diagnosed with oral mucosal lesions from various demographics in Hyderabad. Participants were screened using the DrOroscope device, which detects dysplastic changes via fluorescence imaging analyzed by artificial intelligence algorithms. Based on the image analysis, lesions were categorized as variable, borderline, or severe. Confirmatory biopsies were performed on all examined lesions, with histopathological results as the gold standard. Statistical analyses, including Chi-square tests, Fisher’s exact test, Cohen’s kappa, and receiver operating characteristic (ROC) curve analysis, were conducted using SPSS version 26.0 with a confidence interval at 95% and p &lt; .05 significance. Results DrOroscope exhibited a sensitivity of 100.00% and a specificity of 69.23%. Positive predictive value was 87.10%, negative predictive value was 100.00%, and overall diagnostic accuracy was 90.00%. Cohen’s kappa value for agreement between DrOroscope and biopsy results was 0.752, indicating substantial agreement, and 0.539 for detecting dysplasia levels, indicating moderate agreement. The ROC curve analysis supported these findings, demonstrating excellent diagnostic performance. Conclusion The DrOroscope device is highly sensitive and accurate in detecting dysplastic changes in oral lesions, making it a promising adjunctive noninvasive diagnostic tool, especially in screening larger populations. This aids in the early diagnosis of dysplasia and thus reducing patients’ morbidity. However, further refinement and larger studies are needed to improve agreement with biopsy for grading of dysplasia. Clinical Significance of the Study DrOroscope plays a promising role in the early diagnosis of dysplasia. This can have a huge impact on the treatment plan, thereby improving the quality of life of the patient. Such devices play a crucial role in oral cancer screening programs, thus promoting awareness on early detection of oral cancer and also enhancing the effectiveness of oral cancer prevention.

Exploring the Clinical Signatures of Cervical Dysplasia Patients and Their Association With Vaginal Microbiota.

The vaginal microbiota plays a crucial role in women's health, and an imbalanced vaginal microbiota is linked to various diseases, including human papillomavirus (HPV) infection. However, most available data comes from Western countries and primarily focuses on HPV infection, with only a few studies considering detailed clinical factors to explore the relationship between vaginal microbiota and the development of cervical cancer, especially in China. Our study involved 266 women, including individuals at all stages of cervical dysplasia, and healthy controls with and without HPV infection. We assessed several aspects of the vaginal environment, including vaginal microbiota composition using 16S rRNA gene sequencing, HPV infection status using the standard Roche Cobas method, pH value, age, and H2O2 levels from clinical records, and partner numbers and contraceptive methods obtained through questionnaires. The association of these clinical signatures with cervical dysplasia stages and vaginal microbiota was analyzed. Our findings demonstrate a significant association between vaginal microbiota and cervical dysplasia stages. Patients with cervical dysplasia and cancer showed a substantial increase in HPV 16 infection, a higher prevalence of pH > 5, a lower H2O2 level, and older ages compared to healthy individuals. Additionally, these factors influence the beta diversity of the vaginal microbiota. These results underscore the importance of considering the vaginal microbiota within the cancer microenvironment and highlight the need to integrate all available data to aid in the current diagnosis and understanding of cervical dysplasia and the cervical cancer microenvironment.

Exploring the Efficacy of Various CNN Architectures in Diagnosing Oral Cancer from Squamous Cell Carcinoma

Oral cancer can result from mutations in cells located in the lips or mouth. Diagnosing oral cavity squamous cell carcinoma (OCSCC) is particularly challenging, often occurring at advanced stages. To address this, computer-aided diagnosis methods are increasingly being used. In this work, a deep learning-based approach utilizing models such as VGG16, ResNet50, LeNet-5, MobileNetV2, and Inception V3 is presented. NEOR and OCSCC datasets were used for feature extraction, with virtual slide images divided into tiles and classified as normal or squamous cell cancer. Performance metrics like accuracy, F1-score, AUC, precision, and recall were analyzed to determine the prerequisites for optimal CNN performance. The proposed CNN approaches were effective for classifying OCSCC and oral dysplasia, with the highest accuracy of 95.41% achieved using MobileNetV2. Key findingsDeep learning models, particularly MobileNetV2, achieved high classification accuracy (95.41%) for OCSCC.CNN-based methods show promise for early-stage OCSCC and oral dysplasia diagnosis. Performance parameters like precision, recall, and F1-score help optimize CNN model selection for this task.

Deep learning-based automated measurement of hip key angles and auxiliary diagnosis of developmental dysplasia of the hip

ObjectivesAnteroposterior pelvic radiographs remains the most widely employed method for diagnosing developmental dysplasia of the hip. This study aims to evaluate the accuracy of an artificial intelligence model in measuring angles in pelvic radiographs of the hip. The assessment seeks to demonstrate the efficacy of the artificial intelligence model in diagnosing both developmental dysplasia of the hip and borderline developmental dysplasia of the hip through the analysis of pelvic radiographs.MethodsA total of 1,029 patients, including 273 men and 757 women, were retrospectively included in this study. The anteroposterior pelvic radiographs were randomly divided into three sets: the training set (720 cases), the validation set (103 cases), and the test set (206 cases). Key anatomical points on the anteroposterior pelvic radiographs were identified. The Sharp, Tönnis, and Center Edge angles were calculated automatically based on the corresponding criteria. The hip development status was compared between measurements obtained from the artificial intelligence model and those defined manually by two radiologists. The area under the receiver operating characteristic curve was utilized to assess the diagnostic performance of the artificial intelligence model.ResultsThe results obtained from both manual measurements and the artificial intelligence model demonstrated no significant differences in the Sharp, Tönnis, and Center edge angles (all p > 0.05). The intra-class correlation coefficients and correlation coefficient r values exceeded 0.75, indicating that both the artificial intelligence model and manual measurements exhibited good repeatability and a positive correlation. Notably, the artificial intelligence model provided measurements more faster than those conducted by radiologists (p = 0.001). The artificial intelligence model also demonstrated high diagnostic accuracy, sensitivity, and specificity for developmental dysplasia of the hip. The performance of the artificial intelligence model in diagnosing developmental dysplasia of the hip was robust. Additionally, the results from the artificial intelligence model and manual measurements were largely consistent with clinical diagnosis results (p = 0.01). The artificial intelligence model can effectively evaluate hip conditions by measuring the Sharp, Tönnis, and Center edge angles, which are consistent closely with clinical diagnosis results.ConclusionsThe results of the artificial intelligence model measurements demonstrate a high degree of consistency with those obtained through manual measurements. The angles of Sharp, Tönnis, and Center edge, as evaluated by the deep learning-based convolutional neural network model, exhibit robust diagnostic performance in identifying both developmental dysplasia of the hip and borderline developmental dysplasia of the hip. Consequently, the artificial intelligence model has the potential to fully replace manual measurements of these critical hip angles, providing a more efficient and precise alternative for diagnosing both conditions of the hip.

Rigid intramedullary nailing of lower limb segments in children and adolescents with metabolic bone disease.

Children and adolescents with metabolic bone disease present to the orthopedic surgeon with pain, fractures (which may be impending), and deformity. Different modalities of orthopedic management are available. Scant literature exists on the use of rigid intramedullary nailing in this population. This study sought to evaluate the utilization of this treatment modality in the pediatric cohort, focusing on indications, techniques, and outcomes of the procedures. A retrospective review was performed over an 11-year period at a single tertiary pediatric institution in the UK. Medical records and radiographs were reviewed. Preoperative surgical and medical management, time to bony union, and complications were specifically ascertained. Twenty-seven patients (63 lower limb segments) had rigid intramedullary nailing over the specified period. The majority of patients had an underlying diagnosis of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright Syndrome). Surgical indications included acute fractures, prophylactic stabilization, previous nonunion and malunions, deformity correction, and limb lengthening. All fractures healed and deformity correction was successful. In one patient, delayed union occurred after deformity correction and was successfully treated with dynamization. Fractures healed faster than corrective osteotomies. Complications included implant prominence, cortical penetrance, and screw loosening. Nonunion occurred with limb lengthening in one patient. Rigid intramedullary nailing is a safe and effective method of treatment for lower limb fractures and deformities in children and adolescents. This technique is, therefore, recommended for patients with metabolic bone disease. However, care must be taken in preoperative surgical planning and a multidisciplinary approach should be utilized.

Changes in diagnostics and treatment pathways for developmental dysplasia of the hip after the introduction of national guidelines: An updated questionnaire amongst paediatric orthopaedic surgeons in The Netherlands.

Diagnostics and treatment pathways for developmental dysplasia of the hip are highly variable in clinical practice. Recently, two national guidelines were developed in the Netherlands, providing a uniform protocol for the diagnosis and treatment of developmental dysplasia of the hip in children under the age of 1 year. The aim of this survey study was to assess whether diagnostic and treatment strategies have changed amongst paediatric orthopaedic surgeons in the Netherlands compared to a similar survey study in 2011, after the introduction of the guidelines. A web-based online questionnaire was developed and shared amongst the members of the Dutch Paediatric Orthopaedic Society. The questions concerned the diagnosis and treatment of developmental dysplasia of the hip, ranging from mildly dysplastic to dislocated hips, in children under the age of 1 year. We used a questionnaire similar to the previous study and evaluated the results. Thirty-four participants completed the survey. Regarding diagnosis and follow-up, ultrasonography was generally applied for children younger than 6 months, while radiography was more frequently used for children aged 6-12 months. In 2011, radiography was more widely applied in all age groups. Initial treatment for dysplastic, stable hips was mostly active monitoring, while this was generally a rigid splint in 2011. For dislocated unstable hips, the first step in treatment was generally the Pavlik harness, as in 2011. The diagnostic and treatment pathways of developmental dysplasia of the hip in children under the age of 1 year seem to have partially changed amongst Dutch paediatric orthopaedic surgeons compared to 2011, after the publication of new guidelines.

Sound transmission using a tuning fork for the diagnosis of developmental dysplasia of the hip in newborns.

This study aims to estimate the validity and reliability of sound transmission tests using a tuning fork and stethoscope compared with the usual clinical procedures for the diagnosis of developmental dysplasia of the hip in newborns from the state of Guanajuato, Mexico. This is a cross-sectional study of newborns at the Guanajuato General Hospital of the Institute of Public Health from Guanajuato. The population under study comprised newborns born from April to May 2023. All parents of newborns were invited to participate. The Ortolani, Barlow, Peter-Baden, and sound transmission tests were performed with a tuning fork and stethoscope three times by two observers. Ultrasonography using the Graf technique was also applied to both hips. We evaluated the validity and repeatability of clinical procedures and sound transmission tests against ultrasonography as the gold standard. We calculated sensitivity, specificity, and predictive values for validity and Cohen's kappa for repeatability. The sample consisted of 100 newborns (56% male and 44% female); 65% born by vaginal delivery. Sound transmission test results for sensitivity, specificity, the positive predictive value, and the negative predictive value were 87.88%, 95.81%, 80%, and 97.53%, respectively. The intra-observer kappa was 0.89 (95% CI = 0.80-0.97) and the inter-observer kappa was 0.85 (95% CI = 0.73-0.97). The validity and repeatability of the Ortolani, Barlow, and Peter-Baden tests were low compared with the sound transmission test. The sound transmission test using a tuning fork and stethoscope is helpful for the diagnosis of developmental dysplasia of the hip.

Reduced cervical sampling of hysterectomy specimens with negative margins on conization: An opportunity to improve resource utilization.

The current recommendation for hysterectomy specimens performed for cervical cancer following conization is that the entire cervix be submitted for histologic examination. Given the high cost of medical procedures and concerns regarding difficulties with laboratory staffing, we sought to evaluate the potential for selective histologic examination in this setting. Post-conization hysterectomy cases were reviewed for the presence of residual disease in relation to the findings of the prior conization, with consideration of margin status. Residual disease was then assessed for clinical significance. The number of submitted blocks was recorded and the associated costs were estimated. Among 32 cases with invasive carcinoma, only cases with margins positive for invasive carcinoma on the conization specimen had residual invasion in the hysterectomy (n = 7), and there were no upgrades due to subtle microscopic disease; 1 case had a change in pathologic stage from pT1b1 to pT2b due to parametrial involvement in the setting of a grossly apparent lesion. Among 20 cases performed following a diagnosis of dysplasia, none were upgraded to invasive carcinoma. Based on protocol-based submission of the entire cervix, 16 blocks of cervix were submitted on average (range, 4-41). We estimate that representative sections from each cervical quadrant would save approximately 2 work hours for laboratory staff per case and up to 6 hours for larger cases, reducing costs for the laboratory accordingly. Selective cervical sampling in the setting of negative margins on conization provides an opportunity for improved resource utilization without compromising patient care; as this is a small study, confirmation of these findings in a larger number of cases may be warranted. Additional studies are necessary to determine what other contexts in surgical pathology could benefit from a similar reductive approach.

Rates of tracheostomy in patients with complex skeletal dysplasia: A 32-year institutional experience

ObjectiveRespiratory failure secondary to multilevel airway compromise may present complex airway challenges in patients with specific skeletal dysplasia diagnoses. This study sought to identify and characterize subgroups of skeletal dysplasia diagnoses that more frequently undergo operative airway evaluations and tracheostomy placement. MethodsRetrospective electronic medical record review of pediatric patients with an ICD-10 associated skeletal dysplasia diagnosis and CPT-specified airway intervention at a tertiary pediatric hospital from 1990 to 2022. Patients without a defined skeletal dysplasia diagnosis, subjects with craniosynostosis syndromes, and those with limited clinical data were excluded. Collected variables included demographics, age at diagnosis, comorbidities, operative procedures, and airway interventions. Descriptive statistical analysis was utilized to evaluate data distribution. ResultsFrom the initial population of 313 patients, 41 subjects were confirmed to have clinical features and/or genetic testing consistent with a skeletal dysplasia diagnosis. A tracheostomy was placed in 19/41 subjects and these patients’ records were further analyzed. Skeletal dysplasia groups with more frequent tracheostomy placement included Filamins and related disorders, Sulfation disorders, and Chondrodysplasia punctata. In the patients with a tracheostomy, skeletal dysplasia was diagnosed at a median age of 0.3 years (IQR 4.8 years), and tracheostomy was initiated at a median age of 1.8 years (IQR 2.2 years). Only four of these patients were successfully decannulated, and two subjects are deceased. ConclusionOver 32 years, nearly half of the skeletal dysplasia patients who underwent airway interventions eventually had a tracheostomy placed. Respiratory insufficiency and complex airway management challenges are common manifestations of skeletal dysplasia.

Gastric Precancerous Lesions: From Progenitor Cell and Microsatellite Instability to Clinical Interpretation of Gastric Cancer Risk

Aim: to evaluate the possibility of the MMR-system status, microsatellite instability (MSI) usage in the differential diagnosis of gastric mucosa dysplasia, determination of the gastric adenocarcinoma development risk. Material and methods. The study included gastric mucosa specimens of 75 patients: 25 with high-grade dysplasia, 25 with low-grade dysplasia, 25 were indefinite for dysplasia. Gastrobiopsy specimens were examined histologically, immunohistochemically using mouse monoclonal antibodies (Diagnostic BioSystems, USA) to the MMR system proteins: MLH-1 (clone G168-15, dilution 1:50), MSH2 (clone DBM15.82, dilution 1:100), MSH6 (clone 44, dilution 1:50), PMS2 (clone A16-4, ready to use). MSI was studied with multiplex PCR evaluation of DNA microsatellites (NR-21, NR-24, NR-27, BAT-25, BAT-26) from paraffin sections, their analysis with capillary electrophoresis. The obtained data were processed with the Statistica 10.0 (StatSoft, USA), presented using descriptive, analytical statistics. VOSviewer (1.6.20) was used to visualize the bibliometric analysis. Results. MMR-deficient cases were found in low (2.8 %) and high-grade (2.8 %) dysplasia with the immunohistochemical evaluation of MMR-system proteins in gastric mucosa specimens. In all indefinite for dysplasia cases MMR-system proteins remained unaffected. Three MSI-positive cases (6.5 %) were detected by PCR with two low-grade dysplasia, one high-grade dysplasia cases. All identified cases were also immunohistochemically MSI-positive. Conclusion. Determination of MSI can be used as an auxiliary study within a panel of biomarkers aimed to support the decision-making of a pathologist in the alternative of “indefinite for dysplasia” or “definite dysplasia — obligate precancer”.

Screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip in Brazilian population: a scoping review protocol

IntroductionDevelopmental dysplasia of the hip (DDH) includes a spectrum of clinical and imaging findings at birth or early infancy. The circumstances in which this condition is detected and managed may...

Early Diagnosis of Bronchopulmonary Dysplasia with E-Nose: A Pilot Study in Preterm Infants

Bronchopulmonary dysplasia (BPD) is the most common respiratory disease in preterm and is still associated with increased mortality and morbidity. The great interest lies in identifying early biomarkers that can predict the development of BPD. This pilot study explores the potential of e-nose for the early identification of BPD risk in premature infants by analyzing volatile organic compounds (VOCs) in the exhaled breath condensate (EBC). Fourteen mechanically ventilated very preterm infants were included in this study. The clinical parameters and EBC were collected within the first 24 h of life. The discriminative ability of breath prints between preterms who did and did not develop BPD was investigated using pattern recognition, a machine learning algorithm, and standard statistical methods. We found that e-nose probes can significantly predict the outcome of “no-BPD” vs. “BPD”. Specifically, a subset of probes (S18, S24, S14, and S6) were found to be significantly predictive, with an AUC of 0.87, 0.89, 0.82, 0.8, and p = 0.019, 0.009, 0.043, 0.047, respectively. The e-nose is an easy-to-use, handheld, non-invasive electronic device that quickly samples breath. Our preliminary study has shown that it has the potential for early prediction of BPD in preterms.

Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?

As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.

Utility of IMP3, p53, and S100P immunohistochemical stains in distinguishing reactive atypia from dysplasia in cholecystectomy specimens

BackgroundDistinguishing reactive atypia from dysplasia in cholecystectomy specimens can be histologically challenging. The aim of this study was to evaluate the utility of IMP3, p53, and S100P immunostains in differentiating reactive atypia from dysplasia in cholecystectomies.MethodsFifty-four cholecystectomies were reviewed and characterized into 5 groups: 2 normal, 29 reactive atypia, 16 low-grade dysplasia, 2 high-grade dysplasia, and 5 adenocarcinoma. IMP3, p53, and S100P immunostains were performed and evaluated. IMP3 (nuclear) and S100P (nuclear or nuclear/cytoplasmic) were categorized into negative or positive expression, and p53 was categorized into wild-type and aberrant/mutant expression. Chi-square test was used for statistical analysis.ResultsThe patients were mostly middle-aged women (mean 44, range 19–87 years, 81% female), with predominantly Hispanic White ethnicity (80%). The majority of the normal and reactive atypia cases showed negative IMP3 (100% and 75.9%, respectively) and wild-type p53 (100% and 89.7%, respectively) staining. Over half (56.3%) of the low-grade dysplasia and all the high-grade dysplasia cases showed IMP3 positivity. Aberrant p53 staining pattern was seen in half of both low and high-grade dysplasia cases. Adenocarcinoma showed IMP3 positivity in 80% and p53 aberrancy in all cases. S100P showed no statistical significance among the diagnostic categories. Significant differences in staining patterns were found between reactive atypia vs. low-grade dysplasia, and reactive atypia vs. low-grade + high-grade dysplasia using a combination of IMP3 and p53 stains (all p < 0.05).ConclusionsIn challenging cholecystectomies, IMP3 positivity or aberrant p53 expression may serve as a useful adjunct to support a diagnosis of dysplasia over reactive atypia.

Exploring the incidence of dysplasia or adenocarcinoma in early onset Barrett's esophagus.

Currently data on the risk of progression to and lifetime risk of cancer are not available for patients with young onset Barrett's esophagus (BE). Our aim was to obtain epidemiologic data on the incidence of dysplasia or adenocarcinoma in young onset BE in the Netherlands by collecting data on all histologically confirmed cases over a prolonged period of 25 years between January 1, 1991 and December 31, 2015. Data were obtained from the Dutch National Pathology Registry. Patients were included if there was a suspicion of BE visualized in the esophagus during the endoscopic examination in combination with a concordant histologic diagnosis of intestinal metaplasia. 231 patients with early onset BE were identified (median age 26 years [range 0-29 years]), with 17 progressing to dysplasia (6 prevalent and 11 incident). For the patients with incident dysplasia, the median surveillance time between the diagnosis of early onset BE and diagnosis of dysplasia was 5 years (range 0-16 years). The incidence rate of dysplasia was 7.3 per 1000 person-years. There were three patients who developed adenocarcinoma (1 prevalent and 2 incident), who were diagnosed at ages 28, 35, and 36 years. The incidence rate of adenocarcinoma was 1.3 per 1000 person-years. In this 25-year period, 231 patients were diagnosed with early onset BE in the Netherlands, with 17 patients progressing to dysplasia and three developing adenocarcinoma. This corresponded to incidence rates of 7.3 per 1000 person-years for dysplasia and 1.3 per 1000 person-years for adenocarcinoma.