Large Number Of Lesions Research Articles

Association between silent cerebral embolism and cognitive alterations following transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valve patients

Abstract Background Silent cerebral ischemic lesions (SCILs) is a common magnetic resonance imaging (MRI) finding in severe aortic stenosis patients post - transcatheter aortic valve replacement (TAVR). We evaluated the association between SCILs and cognitive alterations in patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) post-TAVR. Methods This study enrolled 100 consecutive TAVR (45 with BAV and 55 TAV). DW-MRI and neurocognitive evaluation (MoCA score) were performed at baseline, discharge, and 1- and 12-month post-discharge. Results Ninety-two out of the 100 patients (92%) exhibited cognitive dysfunction at baseline. Post-TAVR, overall cognitive function significantly improved, the average MOCA score increased from 18.69±6.74 to 22.18±6.30. During the 1-year follow-up, 54 patients demonstrated improved cognitive function, and the number of patients with moderate-to-severe cognitive dysfunction (MoCA score < 18) significantly decreased from 32 to 16. Prevalence of SCILs was 14% and 72% at baseline and discharge, respectively. New SCILs were observed in 60 patients at discharge, distributed across all vascular territories, averaging 4 lesions with a total volume of 215.4±195.4mm3. Although no significant correlation existed between total volume of new SCILs and cognitive changes post-TAVR (R=-0.133, p=0.206), patients with SCILs still displayed significant cognitive improvement (MoCA score from 18.4±6.6 to 22.0±7.1), whereas patients who developed large SCILs (lesion diameter >9) showed less improvement compared to those with small or median SCILs (number of patients who had cognitive improvement: 32 vs. 52, p<0.05). Cognitive function improvement post-TAVR did not significantly differ between BAV and TAV patients, MoCA scores were comparable (BAV group, n=45, from 18.63±6.68 to 21.88±6.80 vs. TAV group, n=55, from 18.73±6.81 to 22.42±5.80; p>0.05). DW-MRI revealed more new SCILs in BAV patients post-TAVR compare to TAV patients (235 lesions vs. 150 lesions, respectively). In BAV patients, SCILs primarily manifested in small and medium sizes (224 lesions), despite more severe calcification (valvular calcium volume 956.5±644.0 mm vs. 634.4±508.0 mm3; p=0.028). The number of large lesions was similar in the two groups (11 in BAV group and 10 in TAV group). Conclusion TAVR demonstrates positive effects on improving cognitive function in aortic stenosis patients, despite common occurrence of SCILs in both BAV and TAV patients. Cognitive function post-TAVR was comparable between BAV and TAV patients. The cognitive improvement from TAVR may be less impacted by small- and medium-sized SCILs, while severe SCILs might impede or diminish the cognitive benefits of TAVR.table

Genomic characteristics and immune landscape of super multiple primary lung cancer

In recent years, a growing number of patients with multiple primary lung cancer (MPLC) are being diagnosed, and a subset of these patients is found to have a large number of lesions at the time of diagnosis, which are referred to as 'super MPLC'. Here, we perform whole exome sequencing (WES) and immunohistochemistry (IHC) analysis of PD-L1 and CD8 on 212 tumor samples from 42 patients with super MPLC. We report the genomic alteration landscape of super MPLC. EGFR, RBM10 and TP53 mutation and TERT amplification are important molecular events in the evolution of super MPLC. We propose the conception of early intrapulmonary metastasis, which exhibits different clinical features from conventional metastasis. The IHC analyses of PD-L1 and CD8 reveal a less inflamed microenvironment of super MPLC than that of traditional non-small cell lung cancer (NSCLC). We identify the potentially susceptible germline mutations for super MPLC. Our study depicts the genomic characteristics and immune landscape, providing insights into the pathogenesis and possible therapeutic guidance of super MPLC. A full list of funding bodies that supported this study can be found in the Acknowledgements section.

Report of three patients with extensive neurocysticercosis in rural southern Tanzania: neurological, serological and neuroradiological findings

BackgroundNeurocysticercosis (NCC) is common in eastern Africa, but disease presentation varies considerably. Most patients have single or few NCC-typical lesions in their brain but some present with a large number of lesions. We present three patients with positive antibody-based serology for Taenia solium cysticercosis screened at the Vwawa district hospital, Mbozi district, southern Tanzania, in whom extensive NCC was confirmed by neuroimaging.Case presentationsPatient 1 was a 55-year-old female from the tribe Malila smallholder farmer who has had four generalized tonic–clonic epileptic seizures over a period of 11 years and one episode of transient left hemiparesis one year before seizure onset. The patient also reported monthly to weekly episodes of severe, progressive, unilateral headache. The computed tomography (CT) scan of the brain showed 25 NCC lesions of which 15 were in the vesicular stage. Patient 2 was a 30-year-old male from tribe Nyha mechanic who reported monthly episodes of moderate to severe, progressive, bilateral headache, but no epileptic seizures. The CT scan showed 63 NCC lesions of which 50 were in the vesicular stage. Patient 3 was a 54-year-old female from the tribe Malila smallholder farmer who suffered from frequent generalized tonic–clonic epileptic seizures with potential signs of focal seizure onset. She also reported weekly to daily episodes of severe, progressive, unilateral headache. The CT scan showed 29 NCC lesions of which 28 were in the vesicular stage.ConclusionsClinical presentation of NCC with multiple brain lesions varies considerably ranging from few epileptic seizures and severe headache to severe epilepsy with frequent epileptic seizures. Individuals with neurological signs/symptoms that may be due to NCC, based for example on epidemiological criteria or serological evidence of cysticercosis, are recommended to undergo neuroimaging before anthelminthic treatment is considered.

The Chrysanthemum Phenotype of Idiopathic Multifocal Choroiditis.

To describe the clinical characteristics and multimodal imaging (MMI) features of a distinctive subtype of active idiopathic multifocal choroiditis (iMFC) lesions with grey-yellow chorioretinal lesions surrounded by smaller satellite dots, a presentation referred to as "chrysanthemum lesions". Retrospective, observational, multi-center case series of eyes with active iMFC and chrysanthemum lesions. Multimodal imaging features were reviewed and presented. Twenty-five eyes from 20 patients (12 women and 8 men), with a mean age of 35.8±17.0 years (range, 7 - 78 years) were included. Chrysanthemum lesions were equally located in the macula (48.0%) or the mid/far-periphery (52.0%). The number of lesions per eye varied from 1 (16.0%) to more than 20 (56.0%). On optical coherence tomography (OCT), chrysanthemum lesions showed typical features of iMFC, including subretinal hyperreflective material splitting the retinal pigment epithelium/Bruch's membrane (RPE/BrM). Chrysanthemum lesions were hypoautofluorescent on fundus autofluorescence imaging, hyperfluorescent on fluorescein angiography, hypofluorescent on indocyanine green angiography, and associated with choriocapillaris flow signal deficit on OCT-angiography. Active iMFC may present with findings resembling chrysanthemum lesions. The distinctive lesion morphology on ophthalmoscopic examination, the high number of lesions, and the high prevalence of exclusive mid- and far-peripheral involvement may represent a distinctive phenotype of iMFC.

Risk factors associated with missed colorectal lesions in colonoscopy and impact of colonoscopy with anesthesia on miss rate

Objectives To systematically determine the miss rate and risk factors for polyps, adenomas and advanced adenomas in the same population, and to further analyze the impact of colonoscopy with anesthesia on miss rate. Methods We retrospectively analyzed the information of the patients undergoing the second colonoscopy within 1 year after their first. The patient and lesion miss rate were calculated. The patient and lesion features of missed lesion were compared with non-missed lesion. Finally, the patients were divided into anesthesia group and without anesthesia group, and the impact of colonoscopy with anesthesia on missed lesions was further analyzed. Results The patient miss rate of polyps, adenomas and advanced adenomas was 32.8, 25.6 and 10.4%, and the lesions miss rate was 19.6, 15.8 and 7.2%. In multivariable logistic regression analysis, lesion-related factors (large number of lesions, small lesion size, flat shape and location at the right colon) and patient-related factors (male, elder, abdominal symptoms, surgical history, diverticulum, colonoscopy without anesthesia and suboptimal bowel preparation) were found to be independently associated with missed polyps and adenomas (p < .05). Large number of lesions, flat shape and suboptimal bowel preparation were associated with missed advanced adenoma (p < .05). Colonoscopy with anesthesia can reduce the polyp miss rate (PMR) and male and elderly patients are more likely to be missed during colonoscopy without anesthesia. Conclusions Many factors of patients and lesions can affect the lesions miss rate. Colonoscopy with anesthesia can reduce the PMR and male and elderly patients are more likely to be missed during colonoscopy without anesthesia.

Częstość występowania i różnorodność patologicznych zmian w jamie ustnej u pacjentów leczonych w Zakładzie Chirurgii Stomatologicznej WUM w latach 2012–2017. Badanie retrospektywne

Introduction A large number of lesions of various etiopathogenesis may be found in the oral cavity. They range from benign inflammatory-hyperplastic changes to malignant tumors. The following study aims to statistically show the frequency and type of changes depending on the age and sex of patients treated in the Department of Dental Surgery of the Medical University of Warsaw. Material and methods 612 results of histopathological examinations of sections or entire lesions of the oral cavity collected from patients in the years 2012–2017 were analyzed. The results were analyzed in terms of gender, age and the site of tissue collection. Neoplasms and 8 other groups of lesions of the mucosa were distinguished. Results The most common lesion was fibroma (35%), followed by a chronic inflammatory process (15.4%), and salivary gland cysts (11.9%). Papillomas (HPV) accounted for 10.5%, epilemomas 9.64%, tumors 6.54%, cysts and ulcers 4.74% and 4.25%, respectively. Pre-neoplastic lesions were found in 70 cases. These included ulcerations, leukoplakia, changes with metaplasia, dysplasia and pseudo-neoplastic hyperplasia. The most common localization of pathological changes in the oral cavity was related to the gums. Conclusions Many lesions of various etiology may present with a similar clinical manifestation. Therefore, in order to correctly diagnose pathological changes in the oral cavity, it is necessary to conduct a thorough medical history and physical examination, and identify the factors that may have caused the lesion. A particular group of pathological changes of the oral mucosa are ulcers which, despite a conservative approach, do not respond to treatment. In such cases a neoplasm should be suspected and a section of the lesion be obtained for histopathological evaluation which is the only reliable method that allows a final diagnosis.

Combined T2 SPAIR, Dynamic Enhancement and DW Imaging Reliably Detect T Staging and Grading of Bladder Cancer With 3.0T MRI.

ObjectivesTo evaluate bladder cancer by integrating multiple imaging features acquired using multimodal 3.0T magnetic resonance imaging (MRI).MethodsWe prospectively enrolled 163 consecutive patients including 142 men (mean age, 65.2 years) and 21 women (mean age, 65.8 years). We evaluated the efficiency and reliability of the multiple imaging modalities including T2-weighted spectral attenuated inversion recovery (SPAIR) imaging, dynamic contrast-enhanced (DCE) imaging and diffusion-weighted (DW) imaging, and the imaging feature, apparent diffusion coefficient (ADC) in the identification of the T staging and grading. We compared our imaging findings with the results of histological examination using McNemar’s test. We reported the results under the significance of p < 0.05. Approval for the study was obtained from the local institutional review board.ResultsThe sensitivity and specificity using T2 SPAIR plus DW imaging (sensitivity: 85.2%; specificity: 93.2%), DCE plus DW imaging (sensitivity: 92.4%; specificity: 96.8%), and all the three imaging modalities combined, i.e., T2 SPAIR plus DCE plus DW imaging (sensitivity: 92.5%; specificity: 97.4%), were significantly greater than using T2 SPAIR imaging alone (sensitivity: 74.1%; specificity: 72.2%). One hundred six (93.0%) lesions showed a thin, pedicle arch-like shape and thus primarily demonstrated to be in Ta stage; by contrast, a large number of lesions (137 [85.6%]) were sessile and were found to be in T1 stage. The differences in the ADC were significant between low-grade (877.57 ± 24.15) and high-grade (699.54 ± 23.82) lesions (P < .01).ConclusionsT2 SPAIR and DCE plus DW imaging provided useful information for evaluating T staging and grading in bladder cancer. Those imaging features to distinguish Ta stage from T1 stage were presented.

In situ evaluation of podocytes in patients with focal segmental glomerulosclerosis and minimal change disease.

Podocyte injury in focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) results from the imbalance between adaptive responses that maintain homeostasis and cellular dysfunction that can culminate in cell death. Therefore, an in situ analysis was performed to detect morphological changes related to cell death and autophagy in renal biopsies from adult patients with podocytopathies. Forty-nine renal biopsies from patients with FSGS (n = 22) and MCD (n = 27) were selected. In situ expression of Wilms Tumor 1 protein (WT1), light chain microtubule 1-associated protein (LC3) and caspase-3 protein were evaluated by immunohistochemistry. The foot process effacement and morphological alterations related to podocyte cell death and autophagy were analyzed with transmission electronic microscopy. Reduction in the density of WT1-labeled podocytes was observed for FSGS and MCD cases as compared to controls. Foot process width (FPW) in control group was lower than in cases of podocytopathies. In FSGS group, FPW was significantly higher than in MCD group and correlated with proteinuria. A density of LC3-labeled podocytes and the number of autophagosomes in podocytes/ pedicels were higher in the MCD group than in the FSGS group. The number of autophagosomes correlated positively with the estimated glomerular filtration rate in cases of MCD. The density of caspase-3-labeled podocytes in FSGS and MCD was higher than control group, and a higher number of podocytes with an evidence of necrosis was detected in FSGS cases than in MCD and control cases. Podocytes from patients diagnosed with FSGS showed more morphological and functional alterations resulting from a larger number of lesions and reduced cell adaptation.

Human papillomavirus and Its Association with Other Sexually Transmitted Coinfection among Sexually Active Women from the Northeast of Brazil.

Objective To verify the association between HPV infection and the presence of coinfections (Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae) in women in the state of Maranhão. Methods HPV-DNA detection was performed by the nested PCR, using the primers PGMY09/11 and GP + 5/GP + 6. For the identification of sexually transmitted agents, conventional PCR was performed using the following primers: KL1/KL2 (Chlamydia trachomatis), TVA5/TVA6 (Trichomonas vaginalis), and HO1/HO3 (Neisseria gonorrhoeae). DNA-HPV positive samples were subjected to automated sequencing for genotyping. Results Among the 353 women evaluated, 204 (57.8%) had HPV-DNA, of which 140 (68.6%) exhibited HPV/STIs, while 64 (31.4%) had the only HPV. T. vaginalis infection showed a positive association with HPV (p=0.003). Women without cervical lesions were predominant (327/92.6%); however, the largest number of lesions was reported in women who had HPV/coinfections (18/8.8%). Multiple regression analysis showed that both HPV only and the concomitant presence of HPV/STI were able to indicate the occurrence of epithelial lesions (R = 0.164; R2 = 0.027). Conclusion The findings suggest that the presence of T. vaginalis can contribute to HPV infection, and HPV/IST association may influence the development of cervical intraepithelial lesions that are precursors of cervical cancer.

Clinical imaging characteristics of inpatients with coronavirus disease-2019 in Heilongjiang Province, China: a retrospective study.

Objective: To investigate the clinical, laboratory, and radiological characteristics of patients with coronavirus disease-2019 (COVID-19) in Heilongjiang Province.Results: Patients in the ICU group were older and their incidence of cardiovascular disease was higher than those in the non-ICU group. Lymphocyte levels were lower and neutrophil and D-dimer levels were higher in the ICU than that in the non-ICU group. Compared to the non-ICU group, the incidence of pulmonary consolidation and ground-glass opacity with consolidation was significantly higher in the ICU group, all lung lobes were more likely to be involved, with higher number of lung lobes and areas surrounding the bronchi. Of the 59 patients with COVID-19 in this group, 15 received mechanical ventilation. All intubated patients involved lung lobes, and a large number of lesions were observed in the area around the bronchial vessels.Conclusion: Significant differences were observed in clinical symptoms, laboratory tests, and computed tomography features between the ICU and non-ICU groups.Methods: A total of 59 patients with COVID-19, comprising 44 patients in the intensive care unit (ICU) and 15 in the non-ICU, were retrospectively analyzed. Characteristics of the two groups of patients were compared.

Hidradenitis Suppurativa: Our Experience with a Surgical Case Management Team

Background and objectivesThe complexity of hidradenitis suppurativa (HS) treatment calls for a multidisciplinary approach. We therefore created a multidisciplinary team to manage surgical care. This study aimed to describe the clinical characteristics of the patients we evaluated and the outcomes of the surgical techniques used. Material and methodsDescriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018. ResultsSurgery was used to treat 46% of the patients with HS who were evaluated. Most were men (73%) with no family history of HS (63%) and smokers or former smokers (76%). Gluteal HS comprised the largest phenotype group (41%) and the majority of cases were serious (Hurley stage II, 36%; stage III, 46%). The anatomical regions with the largest number of lesions were the axillae (51.9%) and the groin (41.3%). Surgery was most often performed in the axilla (38.3%), followed by the gluteus (23.4%). The most common drug treatment was a combination of rifampicin and clindamycin, Deroofing was the technique used most often (in 48% of the patients who underwent surgery). Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases. The HS lesion recurred in 20% and 12% developed wound dehiscence. ConclusionsOur experience leads us to recommend forming multidisciplinary teams to improve communication between specialists, provide tailored treatment for the patient with HS, and improve follow-up.

Comité quirúrgico para la hidradenitis supurativa: nuestra experiencia

Background and objectivesThe complexity of hidradenitis suppurativa (HS) treatment calls for a multidisciplinary approach. We therefore created a multidisciplinary team to manage surgical care. This study aimed to describe the clinical characteristics of the patients we evaluated and the outcomes of the surgical techniques used. Material and methodsDescriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018. ResultsSurgery was used to treat 46% of the patients with HS who were evaluated. Most were men (73%) with no family history of HS (63%) and smokers or former smokers (76%). Gluteal HS comprised the largest phenotype group (41%) and the majority of cases were serious (Hurley stage II, 36%; stage III, 46%). The anatomical regions with the largest number of lesions were the axillae (51.9%) and the groin (41.3%). Surgery was most often performed in the axilla (38.3%), followed by the gluteus (23.4%). The most common drug treatment was a combination of rifampicin and clindamycin, Deroofing was the technique used most often (in 48% of the patients who underwent surgery). Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases. The HS lesion recurred in 20% and 12% developed wound dehiscence. ConclusionsOur experience leads us to recommend forming multidisciplinary teams to improve communication between specialists, provide tailored treatment for the patient with HS, and improve follow-up.

Clinical management of very small pigmented lesions: Improved clinical outcome through dermoscopy and reflectance confocal microscopy combination.

Small-sized pigmented lesions (SSPL) <3mm in diameter are common pitfall in the daily dermatology practice. Dermoscopy alone is hampered by the lack of specific features inversely proportional to the diameter of the lesions and its performance is highly operator-dependent. Reflectance confocal microscopy (RCM) has been demonstrated to be effective in the diagnosis of several difficult lesions where dermoscopy lacks to provide conclusive information. A total of 179 lesions with uncertain or equivocal clinical and dermoscopy appearance were selected. Dermoscopist has been requested to express a diagnostic suspect when possible. Equivocal lesions underwent RCM performed by expert for second-level evaluation before surgical excision for histological diagnosis. Results have been later statistically analysed. Dermoscopy was not diagnostic in large number of lesions with low concordance histology (39.1%) instead of a much high concordance when combined with RCM (93.9%). Small-sized pigmented lesions were more likely to be located on the face area. Diagnosis of pigmented BCC was relatively easy on dermoscopy and also in the case of small lesions showing typical signs of BCC. LM and MM have been seen to be particularly difficult to be diagnosed using only dermoscopy. The combination of digital dermoscopy and RCM represents the correct approach of SSPL.

Stereotactic radiotherapy in oligometastatic (OM) gastrointestinal (GI) tumors: A single institution retrospective analysis.

825 Background: Metastatic GI cancers are mainly treated with systemic treatment (ST), in selected patients (pts), surgery is considered depending on pts characteristics and institutional preferences. Stereotactic Radiotherapy (SRT) is a growing treatment option in such landscape aiming to improve local disease control and maximize ST results for oligometastatic pts. Methods: This is a single center retrospective study. Data were collected from sequential pts with GI tumors who underwent SRT for OM-GI cancers from May 2014 to July 2019. Information was collected on pts characteristics, primary site, clinical staging at diagnosis, sites undergoing SRT, whether there was progression after the first SRT, time between the first SRT and progression and the last follow-up date. Results: 381 pts underwent SRT in our center, of these, 75 pts had OM-GI tumors and underwent 120 courses of SRT. 50,7% were women, the median age at diagnosis was 60 years and the median follow-up was 36 months. 76% had colorectal cancer (CRC) being 26% from the right, 26% from the left colon and 30% were from the rectum, in 18% of the patients we could not determine sidedness. 35% already had metastatic disease at diagnosis. The lung was the site with largest number of lesions treated with SRT (50), followed by central nervous system (CNS) (42), bones (32), liver (29) and lymph nodes (16). After a median follow up of 15.3 months, 11% of patients were progression-free and only 24% had progressed on treated lesions. The median progression free survival following SRT was 4.5 months (0.6-45.8 range) for distant metastasis and was not achieved for treated sites. Conclusions: This retrospective study adds to the previous body of evidence supporting the use of SRT to improve GI cancer management. Detailed information on pts characteristics, pathology, toxicity and previous treatments will be presented.

A novel lesion detection algorithm based on multi-scale input convolutional neural network model for diabetic retinopathy

Objective To propose a multi-scale convolutional neural network (CNN) based lesions detection method of fundus image, and evaluate its application in diabetic retinopathy (DR) assisted diagnosis. Methods A multi-scale CNN based on lesions detection method of fundus image was proposed.Compared with the existing detection methods, the problem of poor robustness based on threshold segmentation and morphological segmentation was overcome.The idea of multi-scale grids detection without relying on manual pixel-by-pixel labeling was adopted in this algorithm, and the detection performance of small lesions was significantly improved.In addition, multiple DR lesions with high accuracy could be detected by the proposed loss function under the condition of weak labels and small data sets. Results At the level of lesions, the sensitivity and specificity of hard exudation lesions detection were 92.17% and 97.17%, respectively.Compared with single-scale method, the sensitivity and accuracy of multi-scale method proposed in this paper increased by 7.41% and 5.02%, respectively, and compared with other algorithm using the same public dataset IDRiD, the specificity of this algorithm increased by 55.82%.This method could effectively detect the lesions in fundus images, and could give the basic range of the lesions.The average detection time of fundus images with a large number of lesions was 1.59 seconds. Conclusions The DR lesions in the fundus image can be quickly and reliably identified, the location information of the lesions can be marked, and the influence of subjective factors can be reduced by using this algorithm, and it can be used to assist the clinician to conduct more effectively. Key words: Artificial intelligence; Diabetic retinopathy/diagnosis; Fundus color photograph; Multi-scale convolutional neural network

ОСНОВНІ ОЗНАКИ УРАЖЕННЯ КІСТОК ПРИ МНОЖИННІЙ МІЄЛОМІ

This article is devoted to the main signs of bone damage in multiple myeloma, identified by MRI. MRI allows direct visualization of the tumor component and its relationship with the adjacent soft tissue structures. The relevance of the direction of analysis and processing of medical images is, firstly, in the rapid development of medical diagnostic technology based on the new application of physical methods of research, and secondly, the rapid development of computer technology and methods of mathematical image analysis have led to the fact that the image analysis has become not speculative, but a practical task that can be solved directly in the workplace of a doctor. Detection of pathological processes is one of the most important tasks of processing and analysis of medical images; at the same time, as is known, early diagnosis of various pathologies, including cancer, significantly increases the chances of recovery of patients.The aim of this work is to study the signs of multiple myeloma, the nuances of its influence on the human body and the features of the manifestation of modern methods of visualization.This article describes the main features of imaging MM, its reflection on the musculoskeletal system, the images showing lesions, as well as images of MRI of the lumbar spine in normal and pathological conditions.Modern imaging techniques such as magnetic resonance and x-ray computed tomography are informative methods for diagnosing bone destruction syndrome in the vertebrae. Their results allow to identify and assess the foci of destruction in the vertebrae, as well as to clarify the prevalence of the process. An integrated approach to the examination using an optimized algorithm can improve the effectiveness of early diagnosis of MM, to fully assess the prevalence of the pathological process and choose the tactics of treatment.Detection of multiple myeloma manually, that is, «on the eye» of a specialist, is a routine process, and there is a high probability that the so-called places of interest will be unnoticed, which can lead to irreversible processes associated with human life; in addition, a large number of lesions in one patient make it difficult to manually segment all lesions, so it is impossible to quantify the total volume of the tumor on the new year's day. Therefore, it is necessary to develop methods for automatic detection of lesions and segmentation.

Liver metastasis in colorectal cancer: evaluation of segmental distribution.

IntroductionIt is known that the liver is the main target for metastasis in colorectal cancer. However, we do not know enough from the literature to describe the segmental distribution of liver metastatic lesions of colorectal cancers.AimTo investigate which liver segment is affected.Material and methodsA total of 326 patients (female/male, n = 115/221; age: 53 ±8/51 ±7 years) were included in our study, classified according to their pathological diagnosis. After liver metastases of the patients were determined, they were divided according to Couinaud classification.ResultsWhile the total number of metastases detected in the right lobe was 691 (70.1%), the number of metastases detected in the left lobe was 294 (29.9%), and the difference was highly significant (p < 0.0001). Metastases in the right lobe anterior segment amounted to 279 (40.4%), and metastasis in right lobe posterior segment was 412 (59.6%), and the difference was significant. When the total number of metastatic lesions is evaluated by excluding segment I, the largest number of lesions were observed in segment VIII. The liver segments with the highest number of metastatic lesions were, respectively, VII, IV, VI, V, III, and II. In this case, the fewest metastatic lesions were observed in segment II.ConclusionsLiver metastases of colorectal cancer are more common in the right lobe than in the left lobe. The right lobe posterior segment (segment VI) is the main target of metastases.

Machine learning techniques for diabetic macular edema (DME) classification on SD-OCT images

BackgroundSpectral domain optical coherence tomography (OCT) (SD-OCT) is most widely imaging equipment used in ophthalmology to detect diabetic macular edema (DME). Indeed, it offers an accurate visualization of the morphology of the retina as well as the retina layers.MethodsThe dataset used in this study has been acquired by the Singapore Eye Research Institute (SERI), using CIRRUS TM (Carl Zeiss Meditec, Inc., Dublin, CA, USA) SD-OCT device. The dataset consists of 32 OCT volumes (16 DME and 16 normal cases). Each volume contains 128 B-scans with resolution of 1024 px × 512 px, resulting in more than 3800 images being processed. All SD-OCT volumes are read and assessed by trained graders and identified as normal or DME cases based on evaluation of retinal thickening, hard exudates, intraretinal cystoid space formation, and subretinal fluid. Within the DME sub-set, a large number of lesions has been selected to create a rather complete and diverse DME dataset. This paper presents an automatic classification framework for SD-OCT volumes in order to identify DME versus normal volumes. In this regard, a generic pipeline including pre-processing, feature detection, feature representation, and classification was investigated. More precisely, extraction of histogram of oriented gradients and local binary pattern (LBP) features within a multiresolution approach is used as well as principal component analysis (PCA) and bag of words (BoW) representations.Results and conclusionBesides comparing individual and combined features, different representation approaches and different classifiers are evaluated. The best results are obtained for LBP_{16 {text{-}} mathrm{ri}} vectors while represented and classified using PCA and a linear-support vector machine (SVM), leading to a sensitivity(SE) and specificity (SP) of 87.5 and 87.5%, respectively.

Diagnostic performance of MDCT angiography in penetrating atherosclerotic aortic ulcer and its complications compared with digital subtraction angiography

PurposeTo evaluate the role of multi-detector CT angiography in acute assessment of patients with acute aortic syndrome (AAS) and discriminating between Intramural hematoma and penetrating atherosclerotic ulcer compared with conventional angiography (CA) as a gold standard technique. Patient and methods47 patients were recruited in this prospective study, and contrast-enhanced multi-detector CT angiography examinations were performed from the thoracic inlet to the aortic bifurcation. ResultsThe mean ulcer diameter was 1.6cm. The largest number of lesions was in the part of the distal descending aorta below D8. The mean diameter of aorta at level of ulcer was 3.7cm. Opacification of false lumen was determined in 6 patients. Intramural hematoma was present in 28 patients; it was identified in unenhanced scans as hyper-attenuated mural crescent. The mean length of false lumen was also evaluated for all patients, and it was 16.4cm. There was a statistically significant correlation between MDCTA and conventional angiography in determining ulcer diameter (p=0.2359), number (p=0.5896), location (p=0.3659), as well as aortic diameter at level of ulcer (p=0.6398). ConclusionMulti-detector CT angiography is an accurate, non-invasive tool which has the ability to detect and characterize aortic PAUs correctly and comparable to conventional angiography.

Melanoma progression

Tumours progress to fully malignant neoplasms through stages of development in a stepwise process. A carcinogenic stimulus such as UV light typically results in a large number of lesions, most of which are benign. Most such lesions will remain stable or regress, while a few will develop cytological and architectural atypia, placing them in a morphologically 'intermediate' category between wholly benign and fully malignant. It is important to categorise intermediate lesions, as they may be simulants, risk markers, and potential precursors of malignancy. Although many but not all malignancies arise in an evident precursor lesion, the vast majority of 'potential precursors' will not progress, as is evidenced by their vastly greater numbers in populations. Progression continues with the onset of malignancy including in metastatic disease. In melanoma as in other tumours, progression has been clearly related to the stepwise acquisition of genetic abnormalities. The first step is the activation of a single 'driver' oncogene, which is sufficient to induce a benign neoplasm whose growth is limited by oncogene-induced senescence driven by activated suppressors. In the intermediate lesions, additional genetic alterations occur such as additional driver mutations or heterozygous loss of suppressors due to copy number variation or other mechanisms. Fully malignant lesions are characterised by complete loss of relevant suppressors and by additional abnormalities, which together account for attributes of malignancy such as invasion and metastasis. Any of the steps of progression can be 'skipped', potentially due to telescoped progression or to alternative pathways. Although stages of progression might simply be viewed as markers of an individual's risk for developing subsequent stages, genetic associations that have been demonstrated among contiguous stages of progression in complex primary tumours and in their metastases would argue against this. For example, complex primary melanomas can be associated with remnants of earlier stage lesions both clinically and histologically. These include small symmetrical benign naevi and/or morphologically atypical dysplastic naevi ('precursor naevi'), and/or radial growth phase melanomas many of which may be inexorably progressive but lack competence for metastasis. Vertical growth phase is the stage of melanoma progression in which risk for metastasis may be acquired. This risk can be characterised statistically using prognostic attributes which at present are mostly clinicopathological, although in the future molecular profiling may contribute or even supplant these attributes. In metastatic disease, tumours can continue to progress, acquiring resistance to various therapeutic strategies which presents a considerable challenge to the efficacy of current promising therapeutic strategies.