Neighboring Organs Research Articles

Building a pelvic organ prolapse diagnostic model using vision transformer on multi-sequence MRI.

Although the uterus, bladder, and rectum are distinct organs, their muscular fasciae are often interconnected. Clinical experience suggests that they may share common risk factors and associations. When one organ experiences prolapse, it can potentially affect the neighboring organs. However, the current assessment of disease severity still relies on manual measurements, which can yield varying results depending on the physician, thereby leading to diagnostic inaccuracies. This study aims to develop a multilabel grading model based on deep learning to classify the degree of prolapse of three organs in the female pelvis using stress magnetic resonance imaging (MRI) and provide interpretable result analysis. We utilized sagittal MRI sequences taken at rest and during maximum Valsalva maneuver from 662 subjects. The training set included 464 subjects, the validation set included 98 subjects, and the test set included 100 subjects (training set n=464, validation set n=98, test set n=100). We designed a feature extraction module specifically for pelvic floor MRI using the vision transformer architecture and employed label masking training strategy and pre-training methods to enhance model convergence. The grading results were evaluated using Precision, Kappa, Recall, and Area Under the Curve (AUC). To validate the effectiveness of the model, the designed model was compared with classic grading methods. Finally, we provided interpretability charts illustrating the model's operational principles on the grading task. In terms of POP grading detection, the model achieved an average Precision, Kappa coefficient, Recall, and AUC of 0.86, 0.77, 0.76, and 0.86, respectively. Compared to existing studies, our model achieved the highest performance metrics. The average time taken to diagnose a patient was 0.38s. The proposed model achieved detection accuracy that is comparable to or even exceeds that of physicians, demonstrating the effectiveness of the vision transformer architecture and label masking training strategy for assisting in the grading of POP under static and maximum Valsalva conditions. This offers a promising option for computer-aided diagnosis and treatment planning of POP.

Artificial intelligence-based motion tracking in cancer radiotherapy: A review.

Radiotherapy aims to deliver a prescribed dose to the tumor while sparing neighboring organs at risk (OARs). Increasingly complex treatment techniques such as volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), and proton therapy have been developed to deliver doses more precisely to the target. While such technologies have improved dose delivery, the implementation of intra-fraction motion management to verify tumor position at the time of treatment has become increasingly relevant. Artificial intelligence (AI) has recently demonstrated great potential for real-time tracking of tumors during treatment. However, AI-based motion management faces several challenges, including bias in training data, poor transparency, difficult data collection, complex workflows and quality assurance, and limited sample sizes. This review presents the AI algorithms used for chest, abdomen, and pelvic tumor motion management/tracking for radiotherapy and provides a literature summary on the topic. We will also discuss the limitations of these AI-based studies and propose potential improvements.

Adaptive dynamic inference for few-shot left atrium segmentation

Accurate segmentation of the left atrium (LA) from late gadolinium-enhanced cardiac magnetic resonance (LGE CMR) images is crucial for aiding the treatment of patients with atrial fibrillation. Few-shot learning holds significant potential for achieving accurate LA segmentation with low demand on high-cost labeled LGE CMR data and fast generalization across different centers. However, accurate LA segmentation with few-shot learning is a challenging task due to the low-intensity contrast between the LA and other neighboring organs in LGE CMR images. To address this issue, we propose an Adaptive Dynamic Inference Network (ADINet) that explicitly models the differences between the foreground and background. Specifically, ADINet leverages dynamic collaborative inference (DCI) and dynamic reverse inference (DRI) to adaptively allocate semantic-aware and spatial-specific convolution weights and indication information. These allocations are conditioned on the support foreground and background knowledge, utilizing pixel-wise correlations, for different spatial positions of query images. The convolution weights adapt to different visual patterns based on spatial positions, enabling effective encoding of differences between foreground and background regions. Meanwhile, the indication information adapts to the background visual pattern to reversely decode foreground LA regions, leveraging their spatial complementarity. To promote the learning of ADINet, we propose hierarchical supervision, which enforces spatial consistency and differences between the background and foreground regions through pixel-wise semantic supervision and pixel-pixel correlation supervision. We demonstrated the performance of ADINet on three LGE CMR datasets from different centers. Compared to state-of-the-art methods with ten available samples, ADINet yielded better segmentation performance in terms of four metrics.

Accidental Journeys: Intrauterine Contraceptive Device Migration to the Sigmoid Colon and Right Ovary – A Report of Two Cases

Ectopic migration of intrauterine contraceptive devices (IUCDs) to neighboring organs is infrequent, but can lead to severe consequences. This article presents two cases of IUCD migration resulting in serious outcomes, including sigmoid colon penetration in the first case (a 25-year-old) and right ovary penetration and contraceptive failure leading to pregnancy in the second case (a 19-yearold). The IUCD was inserted 6 months ago and 2 years ago in the first and second cases, respectively. Both cases underwent surgical exploration and IUCD removal. Fortunately, both patients experienced uneventful recoveries without any complications. In conclusion, although uncommon, IUCD ectopic migration may result in contraceptive failure and, in some cases, organ perforation. Thorough evaluation during care visits is necessary for proper IUCD placement, and radiological assessment should be performed in cases of a ‘missed IUCD,’ even if the patient is asymptomatic. Timely removal of an ectopic IUCD is strongly advised to minimize potential risks.

Shape prior-constrained deep learning network for medical image segmentation

We propose a shape prior representation-constrained multi-scale features fusion segmentation network for medical image segmentation, including training and testing stages. The novelty of our training framework lies in two modules comprised of the shape prior constraint and the multi-scale features fusion. The shape prior learning model is embedded into a segmentation neural network to solve the problems of low contrast and neighboring organs with intensities similar to the target organ. The latter can provide both local and global contexts to address the issues of large variations in patient postures as well as organ’s shape. In the testing stage, we propose a circular collaboration framework strategy which combines a shape generator auto-encoder network model with a segmentation network model, allowing the two models to collaborate with each other, resulting in a cooperative effect that leads to accurate segmentations. Our proposed method is evaluated and demonstrated on the ACDC MICCAI’17 Challenge Dataset, CT scans datasets, namely, in COVID-19 CT lung, and LiTS2017 liver from three different datasets, and its results are compared with the recent state of the art in these areas. Our method ranked 1st on the ACDC Dataset in terms of Dice score and achieved very competitive performance on COVID-19 CT lung and LiTS2017 liver segmentation.

The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review

New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.

A review of type III GEJ adenocarcinoma and the importance of early detection of gastric cancer

Gastric adenocarcinoma is the most common type of gastric cancer in the United States. Multiple factors can predispose a patient to develop such a malignancy, including having a history of Helicobacter pylori infection, tobacco use, alcohol use, specific genetic mutations, and being of Asian or Hispanic descent. Surgery is currently the only curative treatment for localized disease. With metastatic disease, the rate of survival decreases significantly, and most often, the only treatment option is palliative chemotherapy with or without combination radiation therapy. In the case of a 58-year-old man diagnosed with a gastroesophageal junction type III gastric adenocarcinoma that extended into the distal esophagus, what was thought to be a resectable tumor had already invaded vital neighboring organs, therefore, we were unable to eradicate the disease from this patient.

Diagnostic Challenges in Pancreatic Tumors

Background: Pancreatic tumors have a large diversity, with an increasing incidence and mortality. Although the diagnosis methods have improved in recent years, establishing a diagnosis and a histopathological type of pancreatic tumor can still pose a challenge. Aim: We propose to present a concise list of difficulties regarding the clinical, biological, and imagistic diagnosis of pancreatic tumors. Key information: The clinical manifestations of pancreatic tumors depend on their location and size, on the presence of metastatic lesions, but the difficulty of orientation towards this diagnosis is determined by the fact that most lesions are asymptomatic or present in the early stages of non-specific symptoms. The usual biological parameters are non-specific in pancreatic tumors in the early stages, but studies are underway regarding a series of biomarkers, genetic micro-sequences, or inorganic nanomaterials that could be used in the early diagnosis of pancreatic cancers. An essential stage in the diagnosis of pancreatic tumors is represented by imaging investigations, which are associated with endoscopic and tumor biopsy procedures and can outline a picture regarding the presence of the tumor at the level of the pancreas, the relationship with the neighboring organs, the nature of the tumor and the histopathological type. There are a series of indications and limitations regarding each of these investigations, trying to develop various algorithms for the diagnosis of pancreatic tumors. Conclusion: The medical research conducted to develop new diagnostic procedures has the objective of ensuring an early diagnosis of pancreatic tumors, in a stage that offers the best chances of recovery for the patient.

Objectivization study of acupuncture Deqi and brain modulation mechanisms: a review.

Deqi is an important prerequisite for acupuncture to achieve optimal efficacy. Chinese medicine has long been concerned with the relationship between Deqi and the clinical efficacy of acupuncture. However, the underlying mechanisms of Deqi are complex and there is a lack of systematic summaries of objective quantitative studies of Deqi. Acupuncture Deqi can achieve the purpose of treating diseases by regulating the interaction of local and neighboring acupoints, brain centers, and target organs. At local and neighboring acupoints, Deqi can change their tissue structure, temperature, blood perfusion, energy metabolism, and electrophysiological indicators. At the central brain level, Deqi can activate the brain regions of the thalamus, parahippocampal gyrus, postcentral gyrus, insular, middle temporal gyrus, cingulate gyrus, etc. It also has extensive effects on the limbic-paralimbic-neocortical-network and default mode network. The brain mechanisms of Deqi vary depending on the acupuncture techniques and points chosen. In addition, Deqi 's mechanism of action involves correcting abnormalities in target organs. The mechanisms of acupuncture Deqi are multi-targeted and multi-layered. The biological mechanisms of Deqi are closely related to brain centers. This study will help to explore the mechanism of Deqi from a local-central-target-organ perspective and provide information for future clinical decision-making.

Survival-Associated Cellular Response Maintained in Pancreatic Ductal Adenocarcinoma (PDAC) Switched Between Soft and Stiff 3D Microgel Culture.

Pancreatic ductal adenocarcinoma (PDAC) accounts for about 90% of all pancreatic cancer cases. Five-year survival rates have remained below 12% since the 1970s, in part due to the difficulty in detection prior to metastasis (migration and invasion into neighboring organs and glands). Mechanical memory is a concept that has emerged over the past decade that may provide a path toward understanding how invading PDAC cells "remember" the mechanical properties of their diseased ("stiff", elastic modulus, E ≈ 10 kPa) microenvironment even while invading a healthy ("soft", E ≈ 1 kPa) microenvironment. Here, we investigated the role of mechanical priming by culturing a dilute suspension of PDAC (FG) cells within a 3D, rheologically tunable microgel platform from hydrogels with tunable mechanical properties. We conducted a suite of acute (short-term) priming studies where we cultured PDAC cells in either a soft (E ≈ 1 kPa) or stiff (E ≈ 10 kPa) environment for 6 h, then removed and placed them into a new soft or stiff 3D environment for another 18 h. Following these steps, we conducted RNA-seq analyses to quantify gene expression. Initial priming in the 3D culture showed persistent gene expression for the duration of the study, regardless of the subsequent environments (stiff or soft). Stiff 3D culture was associated with the downregulation of tumor suppressors (LATS1, BCAR3, CDKN2C), as well as the upregulation of cancer-associated genes (RAC3). Immunofluorescence staining (BCAR3, RAC3) further supported the persistence of this cellular response, with BCAR3 upregulated in soft culture and RAC3 upregulated in stiff-primed culture. Stiff-primed genes were stratified against patient data found in The Cancer Genome Atlas (TCGA). Upregulated genes in stiff-primed 3D culture were associated with decreased survival in patient data, suggesting a link between patient survival and mechanical priming.

Investigating the epidemiological relevance of secretory otitis media and neighboring organ diseases through an Internet search.

This study examined the epidemiological correlations between secretory otitis media (SOM) and diseases of neighboring organs. We measured changes in disease incidences during the 2020 COVID-19 pandemic using Internet big data spanning from 2011 to 2021. This study used the Baidu Index (BI) to determine the search volume for the terms "secretory otitis media (SOM)", "tonsillitis", "pharyngolaryngitis", "adenoid hypertrophy (AH)", "nasopharyngeal carcinoma (NPC)", "nasal septum deviation (NSD)", "rhinosinusitis", "allergic rhinitis (AR)", and "gastroesophageal reflux disease (GERD)" in Mandarin from January 2011 to December 2021. The correlations between these terms were analyzed using Spearman's correlation coefficients. The results were compared search data from 2019 and 2021 to assess the effects of isolation on SOM in 2020. The seasonal variations trends of SOM and other diseases coincided well (P<0.05), except for AR. During the 11-year timeframe, the monthly searches for rhinosinusitis, NSD, tonsillitis, pharyngolaryngitis, and NPC were statistically correlated with SOM (R=0.825, 0.594, 0.650, 0.636, 0.664, respectively; P<0.05). No correlation was found between SOM and AR, SOM and AH, or SOM and GERD (R=-0.028, R=0.259, R=0.014, respectively, P>0.05). The total search volumes for SOM, rhinosinusitis, NPC, and AH decreased in 2020 compared to 2019. SOM exhibited a discernible epidemiological connection with rhinosinusitis, nasal septal deviation (NSD), tonsillitis, pharyngolaryngitis, and nasopharyngeal carcinoma (NPC). A decrease in public gatherings was observed to effectively reduce the incidences of SOM. This underscores the pivotal role of social measures in influencing the prevalence of SOM and emphasizes the intricate interplay between SOM and various associated health factors, with implications for public health strategies.

Ectopic kidney: Associated diseases and treatment

Ectopic kidney (or “renal ectopia”) describes a kidney that isn’t located in its usual position. The pelvic kidney is a rare congenital urinary malformation. However, it is the most common type of “ectopic” kidneys. It results from a lack of migration of the metanephros which remains in the pelvic position. It is often smaller than a kidney in the lumbar position, but functional. It can be associated with other malformations (urological, vascular, etc.), or present complications such as urolithiasis, hydronephrosis, urinary infection or even tumor. In that case , Urolithiasis is the most common pathology of the pelvic kidney, it can be a source of serious complications. Its discovery requires an etiological investigation in search of a hereditary, metabolic or even infectious disease. In practice, renal pelvic ectopia poses various diagnostic problems; the close relationships of ectopic kidneys with neighboring organs explain the borrowed semiology and diagnostic errors. Alongside medical care, urological care is essential. The choice of treatment in pelvic kidney pathology depends on the pathology in question, its clinical and biological repercussions, as well as the patient's condition and its comorbidities. The use of open surgery and/or laparoscopy in cases of lithiasis pelvic kidney must remain exceptional after having eliminated all possibilities of LEC and endourology surgery.

Buschke-Löwenstein Tumor: Ano-Perineal Location (About 4 Cases)

Buschke-Löwenstein tumor belongs to the group of verrucous carcinomas, a relatively rare condition and always precedes condyloma acuminata. This tumor is more common in men and immunocompromised people, it develops in the genital area, the perineum and the anus, creating a large budding lesion. The aim of our work is to analyze the epidemiological, clinical, paraclinical and therapeutic data of these tumors based on our 4 observations collected over 2 years and a review of the literature. The average age was 47.5 years with a male predominance. Sex ratio 3. The three men had spent time in a prison environment. All patients had had at least one anal coitus. Clinical signs are represented by anal swelling, rectal bleeding, moist anus and signs of anemia. Proctological examination revealed an ulcerative-budding cauliflower appearance in all patients. Immunodeficiency virus serology (HIV) was positive in 3 patients. The biopsy revealed a Buschke-Löwenstein tumor without signs of transformation in 3 patients with one case of squamous cell carcinoma. An abdominopelvic CT scan was performed in all patients revealing no signs of sphincter infiltration or other neighboring organs. The treatment consisted of a wide excision associated with analplasty in all patients. Eight months later, we noted a recurrence in one patient, but very minimal, who was treated by electrocautery. Surgical management of Buschke-Löwenstein tumor must be carried out by an experienced surgeon.

A Multiattention ResUNet and Modified U‐Net Architecture for Liver Tumor Segmentation

Liver cancer is one of the leading causes of cancer death in the world, and early diagnosis is important. However, the similarity in shape, texture, and intensity values between the liver, tumors, and other neighboring organs such as the heart, spleen, stomach, and kidneys often complicates visual differentiation. Manual identification of tumors in the liver is time‐consuming, intricate, and susceptible to errors with potential repercussions for patient care. While machine learning–based approaches have emerged for liver organ recognition and segmenting the tumor, they continue to face challenges related to recognition accuracy and the inability to distinguish tumors of varied sizes. To solve the problems, a multiattention network made up of cascaded ResUNet and U‐Net with attention mechanisms was proposed in this study. We investigated liver tumor segmentation with various configurations of U‐Net, ResUNet, U‐Net with attention mechanisms, and ResUNet with attention mechanisms on augmented and nonaugmented data. We used the 3Dircadb dataset for training and validation purposes, and the proposed method was evaluated on dice score, intersection of union (IoU), recall, and precision. The performance metrics achieved with this method on the dataset are as follows: approximately 0.89 for the dice coefficient, 0.90 for IoU, 0.93 for recall, and 0.96 for precision in the case of liver segmentation without data augmentation and 0.92, 0.90, 0.92, and 0.94, respectively, for dice score, IoU, recall, and precision with data augmentation. For tumor segmentation, the metrics include 0.70 for dice coefficient, 0.61 for IoU, 0.91 for recall, and 0.94 for precision when the data were augmented but 0.83 for dice score, 0.78 for IoU, and 0.89 and 0.90, respectively, for recall and precision.

Frontal Sinus Mucopyocele Presenting as Purulent Discharge in the Frontal Region Following a Neglected Frontal Fracture: A Case Report and Literature Review

Mucoceles are progressive growths of encapsulated mucus capable of eroding and destroying adjacent bone structures and compressing neighboring organs. They are caused by the presence of mucous cells from the sinus membrane in an undrained space. These mucoceles can become infected, leading to the formation of a mucopyocele. They may manifest many years after the initial trauma to the facial bones, especially those involving the frontal sinuses. The discovery is either fortuitous or secondary to imaging: Computed tomography (CT), magnetic resonance imaging, carried out during an etiological assessment of symptoms such as frontal pain, proptosis, diplopia, nasal obstruction, rhinorrhea. Rarely, purulent discharge through a frontal cutaneous fistula may be the initial sign of a frontal sinus mucocele or mucopyocele. We report a case of mucopyocele of the frontal sinus presenting in the form of purulent discharge at the frontal level following a neglected frontal fracture and present our therapeutic approach.

Robot-assisted transposition of aberrant lower polar renal vessels in a 14-year-old child with vasorenal hydrophnerosis

This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.

Squamous cell carcinoma of the cystic duct: A case report and literature review.

Pure squamous cell carcinoma (SCC) of the gallbladder is a rare malignant biliary tract tumor predominantly found in the body and neck of the gallbladder. However, its occurrence in the cystic duct is even rarer. Given its rarity, no established guidelines or consensus currently exist regarding the treatment of pure SCC of the gallbladder. We report an unusual case of SCC originating from the cystic duct with the intent of providing insights into the therapeutic approach for this type of malignancy. A male patient presented to our hospital with acute cholecystitis. Unexpectedly, imaging revealed gallbladder malignancy. Pathologic examination after surgery confirmed SCC of the cystic duct. Despite elevated bilirubin levels, we were able to exclude hilar involvement, enabling radical tumor resection. Intraoperatively, we discovered that the tumor was located in the cystic duct, a site associated with a high likelihood of invasion into neighboring organs. The tumor demonstrated a predominantly exophytic growth pattern, which prompted us to refrain from extending the resection range, thereby striking a balance between complete tumor removal and surgical trauma. We performed liver wedge resection only to ensure a negative resection margin while preserving the anatomical structure to the greatest extent possible. Postoperative recovery was rapid and uncomplicated. Pathological examination confirmed pure SCC, which led us to initiate a regimen of nab-paclitaxel and cisplatin, which is known to be effective in other organ SCCs. Remarkably, the patient experienced a rare and severe posttreatment cardiovascular event. Consequently, we switched the patient to a chemotherapy regimen of gemcitabine and cisplatin, which ultimately yielded positive clinical outcomes. no evidence of tumor recurrence was observed within 1 year after surgery. The diagnosis and therapeutic strategy for rare tumors such as gallbladder SCC should be meticulously tailored based on their unique characteristics to optimize postoperative patient outcomes.

Computational Assessment of Unsteady Flow Effects on Magnetic Nanoparticle Targeting Efficiency in a Magnetic Stented Carotid Bifurcation Artery.

Worldwide, cardiovascular disease is the leading cause of hospitalization and death. Recently, the use of magnetizable nanoparticles for medical drug delivery has received much attention for potential treatment of both cancer and cardiovascular disease. However, proper understanding of the interacting magnetic field forces and the hydrodynamics of blood flow is needed for effective implementation. This paper presents the computational results of simulated implant assisted medical drug targeting (IA-MDT) via induced magnetism intended for administering patient specific doses of therapeutic agents to specific sites in the cardiovascular system. The drug delivery scheme presented in this paper functions via placement of a faintly magnetizable stent at a diseased location in the carotid artery, followed by delivery of magnetically susceptible drug carriers guided by the local magnetic field. Using this method, the magnetic stent can apply high localized magnetic field gradients within the diseased artery, while only exposing the neighboring tissues, arteries, and organs to a modest magnetic field. The localized field gradients also produce the forces needed to attract and hold drug-containing magnetic nanoparticles at the implant site for delivering therapeutic agents to treat in-stent restenosis. The multi-physics computational model used in this work is from our previous work and has been slightly modified for the case scenario presented in this paper. The computational model is used to analyze pulsatile blood flow, particle motion, and particle capture efficiency in a magnetic stented region using the magnetic properties of magnetite (Fe3O4) and equations describing the magnetic forces acting on particles produced by an external cylindrical electromagnetic coil. The electromagnetic coil produces a uniform magnetic field in the computational arterial flow model domain, while both the particles and the implanted stent are paramagnetic. A Eulerian-Lagrangian technique is adopted to resolve the hemodynamic flow and the motion of particles under the influence of a range of magnetic field strengths (Br = 2T, 4T, 6T, and 8T). Particle diameter sizes of 10nm-4µm in diameter were evaluated. Two dimensionless numbers were evaluated in this work to characterize relative effects of Brownian motion (BM), magnetic force induced particle motion, and convective blood flow on particle motion. The computational simulations demonstrate that the greatest particle capture efficiency results for particle diameters within the micron range of 0.7-4µm, specifically in regions where flow separation and vortices are at a minimum. Similar to our previous work (which did not involve the use of a magnetic stent), it was also observed that the capture efficiency of particles decreases substantially with particle diameter, especially in the superparamagnetic regime. Contrary to our previous work, using a magnetic stent tripled the capture efficiency of superparamagnetic particles. The highest capture efficiency observed for superparamagnetic particles was 78% with an 8T magnetic field strength and 65% with a 2T magnetic field strength when analyzing 100nm particles. For 10nm particles and an 8T magnetic field strength, the particle capture efficiency was 55% and for a 2T magnetic field strength the particle capture efficiency was observed to be 43%. Furthermore, it was found that larger magnetic field strengths, large particle diameter sizes (1µm and above), and slower blood flow velocity improves the particle capture efficiency. The distribution of captured particles on the vessel wall along the axial and azimuthal directions is also discussed. Results for captured particles on the vessel wall along the axial flow direction showed that the particle density decreased along the axial direction, especially after the stented region. For the entrance section of the stented region, the captured particle density distribution along the axial direction is large, corresponding to the center-symmetrical distribution of the magnetic force in that section. The simulation results presented in this work have shown to yield favorable capture efficiencies for micron range particles and superparamagnetic particles using magnetized implants such as the stent discussed in this work. The results presented in this work justify further investigation of MDT as a treatment technique for cardiovascular disease.

P-375 Effect of D-Chiro-Inositol in a mouse model of endometriosis

Abstract Study question Can D-Chiro Inositol administration mitigate the phenotype of endometriosis in a mouse model? Summary answer Based on an endometriosis mouse model, we demonstrated that administration of D-Chiro Inositol can reduce development of endometriotic lesions. What is known already Endometriosis, a disease affecting 5-10% of women of reproductive age, is characterized by the spread of endometrial-like tissue outside the uterine cavity that produces ectopic endometriotic lesions causing pain and infertility. The sensitivity of endometriosis to estrogens is a characteristic that can be used for therapeutic purposes. D-Chiro Inositol (DCI), one of the nine isomers of Inositol, is known to decrease the CYP19A1 aromatase gene expression in granulosa cells. Based on these premises, it was suggested that treatment with DCI may have clinical application in conditions where decreased estrogen levels is required. Study design, size, duration To address the study question, a mouse model of endometriosis was generated. Out of 20 CD1 mice, 4 mice were randomly selected as donors of uterine fragments and the remaining 16 were recipient mice. The first day after transplantation, mice were randomly assigned to four experimental group which received for 28 days 2ml of water containing: none (CTRL); DCI 0.4mg (DCI 0.4); DCI 0.2mg and Dienogest 0.33ng (DCI 0.2+DG 0.33); DG 0.67ng (DG 0.67). Participants/materials, setting, methods Uterine horns were removed from donor mice at the diestrous stage of the reproductive cycle. The tissue cut into fragments was inoculated in recipient mice by intraperitoneal injection. Four weeks after induction, all mice were sacrificed. Their endometriotic lesions were excised, measured by number and size, and examined for the presence of blood vessels vascularization under stereomicroscope. Then, lesions were processed for histology examination by hematoxilin-eosin (H&amp;E) and Azan Mallory staining. Main results and the role of chance Endometriotic lesions developed in recipient mice met all criteria for endometriosis, including the presence of endometrial epithelial and stromal cells, and encapsulation in neighboring tissues or organs. The lesions number was reduced in all the treatment groups when compared to control (p &amp;lt; 0.05, t-test), and no differences were observed among DCI 0.4, DCI 0.2+DG 0.33 and DG 0.67. Concomitantly the rate of vascularized lesions was lower in the treated groups, with more pronounced effect in the DCI 0.4 group where no vascularized lesions were observed (p &amp;lt; 0.05, t-test). The histological analysis revealed a marked reduction of endometriotic foci in all groups. These results provide evidence that DCI can reduce development and vascularization of endometriotic lesions in a mouse model, an effect that is not observed when it is employed at lower dose in association with DG. Although molecular mechanisms underlying DCI effects requires further investigation, present findings support the hypothesis that DCI could be more effective than DG in mitigating endometriosis phenotype. Limitations, reasons for caution Results from animal studies should be extrapolated to humans with caution. Wider implications of the findings Present findings may open new avenue in testing whether DCI may have clinical application in endometriosis therapy. Trial registration number Not Applicable

Lobulated tumor contour as a predictor of preoperative tumor invasion of the lung or pericardium in thymoma patients.

Preoperative investigations to detect invasion to neighboring organs are important for deciding on the most appropriate surgical approach for thymoma. We evaluated preoperative computed tomography (CT) findings in thymoma patients to identify the CT features associated with tumor invasion. Clinicopathologic information on 193 patients who underwent surgical resection for thymoma at Chiba University Hospital between 2002 and 2016 was collected retrospectively. The surgical pathology identified invasion of thymoma in 35 patients: in the lung (n = 18), pericardium (n = 11), or both (n = 6). Contact lengths between the tumor contour and lung (CLTL) or pericardium (CLTP) were measured at the maximum section of the tumor on axial CT. Univariate and multivariate analyses were performed to analyze the relationship between pathological invasion of the lung or pericardium and the clinicopathologic features. The mean CLTL and CLTP were significantly longer in patients with invasion of the neighboring organs than in those without invasion. A lobulated tumor contour was identified in 95.6% of the patients with invasion of the neighboring organs. A multivariate analysis revealed that a lobulated tumor contour was significantly associated with both lung and pericardial invasion. A lobulated tumor contour was significantly associated with lung and/or pericardial invasion in thymoma patients.