Performance analysis of liver segmentation using nn-UNet TotalSegmentator: Focus on atypical livers, pathologies, and variants.

A 4-y-old male Labrador Retriever was submitted for autopsy following radiographic examination by the owner, a veterinarian, which had revealed 3 embedded projectiles. Autopsy revealed a single entrance wound on the left flank. Using flap-by-flap dissection, the trajectory of the projectile was traced through the skin and lumbar musculature to its location where it had perforated the abdominal aorta, causing fatal acute hemoperitoneum. Remarkably, the copper-coated pellet (Diabolo) was found in the lumen of the right femoral artery, consistent with projectile embolism. No external trauma was present at that site. Embolization can occur when a projectile enters the vasculature and travels to a distal location, typically requiring low residual kinetic energy and a vessel of sufficient caliber. Although well documented in human forensic medicine, projectile embolism is exceedingly rare in veterinary cases. To our knowledge, embolization of a projectile in the femoral artery in a dog has not been reported previously. Our case highlights the importance of comprehensive radiographic imaging before autopsy and illustrates the diagnostic value of correlating radiologic findings with meticulous gross examination in veterinary forensic pathology cases.

To evaluate the clinical utility and implementation considerations of artificial intelligence (AI)-based fetal health classification systems using the Kaggle Fetal Health Classification dataset, with a focus on obstetric physicians' perspectives. We analyzed the Kaggle Fetal Health Classification dataset (n=2,126), containing 21 cardiotocography parameters. Five machine-learning algorithms were evaluated: logistic regression, random forest, gradient boosting, support vector machine, and decision tree. Class weighting was applied to address the dataset imbalance. The model performance was assessed using standard classification metrics. An expert opinion-based clinical utility assessment framework was developed to assess interpretability, workflow integration, and safety. With class weighting applied, gradient boosting achieved the highest accuracy (89.67%), followed by random forest (88.50%) and logistic regression (82.16%). The most important predictive features were abnormal short-term variability (16.23% importance) and the percentage of time with abnormal long-term variability (13.21% importance). An analysis of all 21 features revealed that contraction-related parameters, including uterine_contractions, contributed minimally to the classification performance. The 35.3% false negative rate for pathological cases represents a significant safety concern and requires physician oversight. AI-based fetal health classification systems show potential for future applications when properly validated. However, the significant false negative rate for pathological cases indicates that these systems cannot function independently. External validation using multicenter clinical data and prospective outcome studies is essential before clinical implementation.

The paraneurium is a distinct connective tissue sheath that loosely envelopes the epineurium. The space between the para- and epineurium (the subparaneurial compartment) holds significant clinical relevance, serving as a target for deposition of regional anesthesia and a potential pathway for the pathological spread of cysts and tumors. However, visualization of the paraneurial layer, as a separate structure from the epineurium, remains challenging with conventional MRI, especially in the absence of pathology. This study evaluated the visualization of the paraneurium using ultra-high-field 7-Tesla (7 T) MRI compared to conventional field strengths. We assessed normal nerve anatomy and a spectrum of pathological cases, including intraneural ganglion cysts, schwannomas, intraneural perineuriomas, and metastatic melanoma. The results demonstrated that 7 T MRI provides superior resolution and delineation of the paraneurium compared to 1.5 and 3 T systems. In normal anatomy, T1-weighted and proton density (PD) sequences provided optimal contrast between the paraneurium and surrounding adipose tissue. In contrast, for pathological cases, T2-weighted sequences with fat suppression were superior for depicting the paraneurium and identifying subparaneurial involvement. In conclusion, 7 T MRI offers a significant advantage in identifying the thin paraneurial layer. This capability provides valuable insights into the pathogenesis of tumor spread and holds promise for improving pre-operative planning and clinical decision-making in peripheral nerve pathology.

Objective: Since specific bioelectrical reference values for Italian adults are lacking, this study aims to define specific values and test their suitability in pathological cases and athletes. Methods: A sample of 1049 Italian individuals (441 men, 608 women) aged 30-65 years was considered. Competitive athletes (bodybuilding, streetlifting and tennis) were identified within the general sample, and an independent group of individuals with obesity or anorexia nervosa was analyzed for comparison. Anthropometric (weight, kg; stature, mid-upper arm, waist and calf circumferences; cm) and bioelectrical (resistance and reactance, at 50 kHz) variables were taken. Resistivity, (Rsp, Ωcm), reactivity (Xcsp, Ωcm), impedivity (Zsp, Ωcm) and phase angle (PhA, °) were calculated. Two-way ANOVA and Hotelling's T2 test were applied to assess group differences. These data were then pooled with existing datasets to create a comprehensive reference for individuals aged 18 to 100 years. Results: The specific bioelectrical variables were: Rsp = 352.3 ± 55.5, Xcsp = 41.8 ± 9.1, PhA = 6.8 ± 1.0, r (Rsp, Xcsp) = 0.67 (men); Rsp = 384.9 ± 71.2, Xcsp = 40.7 ± 9.4, PhA = 6.1 ± 1.0, r (Rsp, Xcsp) = 0.72 (women). Men showed higher PhA values (p < 0.001), reflecting higher muscle mass and quality, and shorter vectors (p < 0.001), indicative of lower relative fat mass (FM%), than women. Advancing age was associated with lower PhA and longer vectors (p < 0.001). Bioelectrical vectors of individuals with obesity or anorexia nervosa were outside the 95% variability, indicating abnormal values of FM%, whereas those of athletes fell within the lower left quadrant. Conclusions: The specific tolerance ellipses for the Italian adult population fill a gap in the existing literature, providing essential new tools for evaluating body composition in clinical and sports settings, and for comparative analyses.

Since neuropathology departments in Germany are mainly located only at university hospitals, brain sections are frequently performed by general pathologists. This article provides practical recommendations for astructured approach and highlights situations in which neuropathological consultation is advisable. The recommendations are based on established procedures, current literature, and personal professional experience. They are intended as apractical guide rather than aformal guideline. Key steps for removal, fixation, and sectioning as well as interpretation of the findings are described. Hereby, the importance of clinical information and of asystematic assessment of macroscopic and histological changes is emphasized. Furthermore, typical situations are described in which neuropathological expertise is recommended. Astructured brain section enhances the overall quality of the autopsy. It enables avalid integration of cerebral changes into abroader context. Close collaboration between pathology and neuropathology is essential and beneficial for both sides.

Diabetic peripheral neuropathy (DPN) is a prevalent complication of type 2 diabetes that is typically diagnosed after irreversible nerve damage, largely due to the lack of molecular biomarkers that distinguish neuropathy-specific changes from general diabetic pathology. From an integrative biology perspective, the network-level molecular mechanisms underlying DPN remain incompletely defined. In this study, transcriptomic profiles from peripheral blood mononuclear cells of healthy controls, patients with type 2 diabetes, and patients with DPN were analyzed using a systems-level, network-based bioinformatics framework. Comparative analysis identified genes specifically associated with DPN, distinct from broader diabetic alterations. Protein-protein interaction and network topology analyses prioritized key hub genes enriched in immune signaling, calcium transport, lipid metabolism, and inflammatory pathways implicated in neuronal dysfunction. Among these, Toll-like receptor 9 (TLR9) emerged as a prominent biomarker candidate, demonstrating high network centrality and strong diagnostic performance (area under the curve = 1.0). TLR9 was significantly upregulated in DPN and functionally linked to mitogen-activated protein kinase and nuclear factor kappa-light-chain-enhancer of activated B-cell signaling pathways, consistent with immune-mediated mechanisms of neuropathic injury. Collectively, these findings define a DPN-specific molecular network and support TLR9 as a biomarker candidate, providing a systems-level foundation for future experimental validation and translational research in diabetic neuropathy.

Individuals who die suddenly and unexpectedly will often fall under the jurisdiction of a Medical Examiner or Coroner (MEC). Forensic pathologists may therefore be the first physicians to diagnose a genetic disease. Identifying these conditions at autopsy improves the accuracy of death certification and provides biological relatives the opportunity to seek diagnosis and intervention. Accessibility and diagnostic capabilities of postmortem genetic testing (PMGT) have rapidly expanded over the last decade since the previous National Association of Medical Examiners position paper on this topic. In this updated position paper, we review the different types of PMGT and the genetic conditions most likely to be encountered at forensic autopsy. Guidelines are also provided for the implementation of PMGT in an MEC office and for the reporting of results.

Background/Objectives: Fetal health is essential in prenatal care, influencing both maternal and fetal outcomes. Cardiotocography (CTG) monitors uterine contractions and fetal heart rate, yet manual interpretation exhibits significant inter-examiner variability. Machine learning offers automated alternatives; however, class imbalance in CTG datasets where pathological cases constitute less than 10% leads to poor detection of minority classes. This study aims to provide the first systematic benchmark comparing five resampling strategies across seven classifier families for multi-class CTG classification, evaluated using imbalance-aware metrics rather than overall accuracy alone. Methods: Seven machine learning models were employed: Naïve Bayes (NB), Random Forest (RF), Linear Discriminant Analysis (LDA), k-Nearest Neighbors (KNN), Linear Support Vector Machine (SVM), Multinomial Logistic Regression (MLR), and Multi-Layer Perceptron (MLP). To address class imbalance, we evaluated the original unbalanced dataset (base) and five resampling methods: SMOTE, BSMOTE, ADASYN, NearMiss, and SCUT. Performance was evaluated on a held-out test set using Balanced Accuracy (BACC), Macro-F1, the Macro-Matthews Correlation Coefficient (Macro-MCC), and Macro-Averaged ROC-AUC. We also report per-class ROC curves. Results: Among all models, RF proved most reliable. Training on the original distribution (base) yielded the highest BACC (0.9118), whereas RF combined with BSMOTE provided the strongest class-balanced performance (Macro-MCC = 0.8533, Macro-F1 = 0.9073) with a near-perfect ROC-AUC (approximately 0.986–0.989). Overall, resampling effects proved model dependent. While some classifiers achieved optimal performance on the natural class distribution, oversampling techniques, particularly SMOTE and BSMOTE, demonstrated significant improvements in minority class discrimination and class-balanced metrics across multiple model families. Notably, certain models benefited substantially from resampling, exhibiting enhanced Macro-F1, BACC, and minority class recall without sacrificing overall accuracy. Conclusions: These findings establish robust, model-agnostic baselines for CTG-based fetal health screening. They highlight that strategic oversampling can translate improved minority class discrimination into clinically meaningful performance gains, supporting deployment in cost-sensitive and threshold-aware clinical settings.

Comparison of bulk flow measurements in the large vessels between four-dimensional flow (4D-flow) and two-dimensional phase contrast (2D-PC) magnetic resonance imaging (MRI).

Conventional cancer statistics account only for individuals with a clinical diagnosis, overlooking potentially large numbers of undetected malignant neoplasms. Autopsy-based studies offer a unique opportunity to estimate the burden of cancer, including latent tumors. To evaluate long-term trends and characteristics of cancers using a nationwide autopsy registry in Japan. This cohort study of hospital-based autopsies over a 66-year period (1958-2023) obtained data from the Annual of the Pathological Autopsy Cases in Japan (APAC-J), a nationwide database maintained by the Japanese Society of Pathology. Latent cancers, defined as malignant neoplasms undiagnosed during life but discovered at autopsy, were analyzed based on International Statistical Classification of Diseases, Tenth Revision and International Classification of Diseases for Oncology, Third Edition. All autopsies recorded in APAC-J were included. The data were analyzed between May 7 and August 2, 2025. The main outcome was the proportion of total, multiple, and latent cancers by year, age group, and sex based on trends in latent cancer detection; metastatic status of latent cancers; and the enrichment ratio in autopsy, a novel metric comparing cancer prevalence in autopsies with national mortality statistics. From 1958 to 2023, 1 486 557 autopsies were registered in APAC-J (mean age based on available age group data, 59.1 years; 62.5% male), with 55.2% including cancer diagnoses. The proportion of multiple primary cancers increased from 1.8% (420 of 22 989) in 1974 to 14.4% (957 of 6661) in 2023. The enrichment ratio in autopsy was elevated in adolescents (aged 15-19 years), young adults (aged 20-24 years), and adults aged 80 years or older. Since 1986, 36 133 latent cancers were found in 34 174 of 811 159 autopsies (4.2%). The detection rate of latent cancers increased from 1.7% (683 of 39 839) in 1986 to 7.4% (493 of 6661) in 2023. Latent prostate cancer at age 75 to 79 years was identified in 4.5% (corresponding to a 2017-2021 prevalence of 656.2 per 100 000 population), 6.9-fold higher than the clinical incidence, whereas latent thyroid cancer at age 50 to 54 years showed substantially larger excesses (0.9% of men and 1.7% of women, representing 94.5-fold and 60.7-fold higher prevalences, respectively). Overall, metastases were present in 7.3% of latent cancers (2649 of 36 133). This cohort study of autopsies across Japan found a substantial reservoir of undiagnosed cancer, including some with metastatic potential. These findings highlight the persistent value of autopsy for assessing cancer burden and underscore the need to refine approaches for early detection while minimizing overdiagnosis.

Do technological tools improve reliability in ankle dorsiflexion assessment? A study across healthy and injured individuals.

Added value of quantitative [18F]FDG-PET analysis in MRI-negative epilepsy: A simulation-based study using realistic ground-truths.

Towards contrast- and pathology-agnostic clinical fetal brain MRI segmentation using SynthSeg.

Postmortem findings in lame cattle which underwent on farm emergency slaughter in Norway.

Introduction- Fatalities from road traffic accidents have resulted in loss of life and material resources. In India, 1374 accidents and 400 deaths take place every day, due to RTAs. Globally, RTA is the main cause of death among the 15–to 29-year-old population. Thus, all such cases must be meticulously studied to identify the mechanisms and causations to reduce such mischance. Case history- A young man, riding on a bicycle, was dashed to death by an unknown vehicle running perpendicular to its trajectory. He was declared brought dead by the EMO upon arrival in a tertiary care hospital. Accordingly, a post-mortem examination was conducted. Autopsy findings- On external examinations, rigor mortis was present. Multiple incised-looking lacerations were noted, including those in the scalp, and all over the face and neck, anterior chest wall, shoulders and upper extremities. On dissection, the base of the skull fractures and the combination of various intracranial haemorrhages were noted. The conspicuous finding was the presence of a very minimal number of abrasions over the body. Discussion and conclusion- The injuries, produced by unusual mechanics, baffled the autopsy surgeons by simulating multiple chop wounds. Reconstruction of the event with the help of information forwarded by the police and crime scene photographs solved the puzzle.

Objective: Conventional light microscopy (CLM) is the foundation for histology and pathology. Various medical organizations in different countries have begun to adapt Digital Microscopy (DM) into their general pathology program. However, there is a dearth of literature describing the viewpoint of dental students in India regarding implementation of Digital microscopy in teaching oral pathology. The study aimed to assess the ease, acceptance, benefits and disadvantages of digital V/s conventional microscopy via questionnaire and to assess the performance of students after digital microscopy intervention as compared to conventional microscopy for undergraduate oral pathology training. Methods: The study included 48 Students currently in the 3rd year B.D.S training in subject of Oral pathology. The students were trained using CLM as a routine. Further they were also trained with DM by using digital slides prepared using whole slide scanners and made available for access through a cloud-based software. A questionnaire of 26 items was given to gauge student opinions regarding use of DM in comparison to CLM. Assessment in the form of spotter examination was conducted to evaluate the performance of the students. Results: There were significantly higher ratings given to efficiency of digital microscopy as compared to CLM as per our questionnaire and the students obtained substantially higher scores with digital microscopy teaching. Conclusion: In conclusion, digital microscopy is a highly favoured replacement /adjunct for CLM for dentistry students for oral pathology practical training. Keywords: Digital Microscopy, whole slide scanners, digital slides, oral pathology training, undergraduate program

The subject of the research is a study of the diagnostic features of oral lichen planus and the application of diagnostic criteria. The aim of the research is to determine the role of pathomorphological diagnostics of oral lichen planus in making a diagnosis. Methodology. The study was conducted at the Department of Therapeutic Dentistry and Propaedeutics of Dental Diseases, the Department of Surgical Dentistry, Otolaryngology, and Maxillofacial Surgery, as well as at the clinical site of the Department of Pathological Anatomy and Forensic Medicine in the histology laboratory of the General Pathology Department of the Central Research Laboratory of the Ural State Medical University (Yekaterinburg). The study was based on an analysis of clinical examination data from 32 patients and a study of histological specimens from biopsy specimens. Results. Surgical biopsy of patients with suspected oral lichen planus revealed discrepancies between clinical and histological diagnoses. As the clinical presentation of oral lichen planus often overlaps with other diseases, and applying the new American Academy of Oral and Maxillofacial Pathology criteria showed that not all specimens contained all required pathological features, the reliability of these criteria in practice remains uncertain. Conclusion. A comprehensive approach combining clinical and histopathological analysis is crucial for diagnosing and managing lichen planus. This is mandatory not only for initial diagnosis but also for patient monitoring, particularly in cases of suspected malignancy.

Background: Burn injuries remain a major health concern nowadays and one of the leading cause of accidental death in Bangladesh. Death due to burn injuries is common in forensic practice but many a time it is very difficult to investigate the burn incident as the important evidences are destroyed. During autopsy evaluation of each victim who died due to burn injuries, the autopsy surgeon faces various challenges which include identification of the victim, determination the cause and manner of death, interpretation of temperature related arte fact like heat ruptures, heat haematoma etc. Objective: To determine the frequency and various types of burn injuries causing death of the victims along with analyzing the post-mortem findings and identify emerging trends in burn injury related tragic death. Methods: This cross-sectional descriptive study was conducted on 112 burn injured cases autopsied at Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2024 to February 2025. During autopsy, deceased bodies were meticulously examined both externally and after dissection internally. Data were collected from inquest reports, chalan, death certificates (if the victim died at hospital) which included information on victim’s demographics along with the statement of the eye witness of the scene of incident and the autopsy findings of the autopsy surgeon. A standardized protocol was followed to ensure data accuracy and consistency. Results: Results revealed a predominance of female victims 59(52.7%) compared to 53(47.3%) of male burn injured victims. The common sources of burn injuries were accidental fire from house hold gas/kerosene stove (34.8%), mosquito coil (19.6%) etc. Apart from these others factors responsible for burn injuries were accidental burst of gas cylinders (36.6%), electric short circuit (26.6%), and accident in industrial chemical factories or warehouses (16.1%). Common post-mortem findings included organ congestion in 112(100%) cases, erosions/carbon particles in respiratory tract/lungs specially in inhalation burn in 99(88.4%) cases, escharotomy present in 48(42.85%) cases and involment of the epidermis/dermis of the skin in 112(100%) cases. Conclusion: This study reveals different causes of death due to burn injuries along with the postmortem findings. Even early intervention in the clinical management of severe burn cases, still give a grave prognosis and many a times complete recovery is a great challenge. Necessary steps and precaution are needed to be taken in order to prevent these various types of accidental burn incidences. JAFMC Bangladesh, Vol 21, No 2 (December) 2025:53-58

Organizing pneumonia (OP) is often considered a benign finding, but in some cases, it may be associated with underlying malignancy. With the increasing use of minimally invasive biopsy techniques, understanding the relationship between OP and lung cancer is critical to avoid delayed or missed diagnoses. This study aims to evaluate the prevalence of OP and lung malignancy and report characteristics of these cases. A retrospective review was conducted of all lung pathology reports at Indiana University from January 1, 2010, to January 1, 2023, encompassing over 8,000 cases. Cases with histopathologic diagnoses of OP with and without lung malignancy were identified; relevant clinical, radiologic, and follow-up data were extracted. Using language extraction, we identified pathology cases showing both organizing pneumonia and carcinoma (Cohort 1) and transbronchial biopsies identified as "organizing pneumonia" (Cohort 2). Cohort 2 was selected to reflect current clinical practice. In Cohort 1 (n=57), 88% of samples demonstrating both organizing pneumonia and malignancy were obtained via surgical resection. Among these, squamous cell carcinoma accounted for 46% and adenocarcinoma for 37% of cases, with all T-stages represented (44% T1, 29% T2, 16% T3, and 11% T4). In this cohort, thirty-eight prior biopsy samples prior to surgery were reviewed; 76% revealed malignancy, but none showed definitive organizing pneumonia likely due to focal nature of OP. Cohort 2 (n=40), 7.5% of patients in whom organizing pneumonia was identified through minimally invasive bronchoscopic sampling were ultimately diagnosed with concurrent lung cancer. All required repeat tissue sampling for cancer diagnosis. Lung malignancy is known to be associated with OP. A high degree of suspicion should be maintained if OP is found on minimally invasive techniques, particularly if malignancy is strongly suspected.