Synthetic Patch Research Articles

An unsuspected extracranial internal carotid pseudoaneurysm following dog bites: a case report and review of literature

BackgroundExtracranial internal carotid artery (ICA) pseudoaneurysm is a rare condition that can be caused either by penetrating or blunt trauma, including dog bites, which is an uncommon occurrence. Together with the possibility of no symptoms or nonspecific ones such as cervical pain, hematoma, swelling, or mass, considering ICA pseudoaneurysm following a dog attack is of paramount importance to avoid life-threatening complications.Case presentationWe present a rare case of a 17-year-old male with a history of dog bites three months prior, who presented to the emergency department with left-sided neck pain, dizziness, and several episodes of blurred vision and diplopia. On physical examination, a palpable mass measuring approximately 20 × 30 millimeters was identified in the left neck region and multiple superficial lacerations were observed in this area. Laboratory tests yielded normal results. Doppler ultrasound revealed a pseudoaneurysm in the left internal carotid artery. Because the great saphenous veins were insufficient, the patient was successfully treated with synthetic graft patch arterioplasty, and no complications were seen in his one-year follow-up with computed tomography (CT) angiography.ConclusionsThis report emphasizes the significance of thorough initial evaluation and imaging in cases of dog attacks, even without apparent significant trauma, to rule out hidden arterial injuries.

Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.

Using biomaterials to treat myocardial infarction

Myocardial infarction (MI) as a risky disease, raises the awareness of the public. It results in insufficient oxygen supply due to cardiovascular blockage and ultimately leads to extensive cell necrosis. Hence, biomaterial-based therapy, angioplasty, and cardiac patches are exposed for the two stages of MI and indicate a promising direction for future MI treatment. This paper focuses on the biomaterials applicable to them one by one, including (1) The crucial function of angioplasty in treating MI; the discussion of its efficacy, mechanics, and results; analysis of clinical studies, material improvements, procedural advancements, and both the effectiveness and limitations of angioplasty. (2) The application of cardiac patches for post-MI treatment; synthetic or natural patches with different structures; review and highlight how these patches promote tissue repair and functional recovery; and the advantages and disadvantages of each patch.

Enhancing OCT patch-based segmentation with improved GAN data augmentation and semi-supervised learning

For optimum performance, deep learning methods, such as those applied for retinal and choroidal layer segmentation in optical coherence tomography (OCT) images, require sufficiently large and diverse labelled datasets for training. However, the acquisition and labelling of such data can be difficult or infeasible due to privacy reasons (particularly in the medical domain), accessing patient images such as those with specific pathologies, and the cost and time investment to annotate large volumes of data by clinical experts. Data augmentation is one solution to address this issue, either using simple variations and transformations of the images (e.g. flips, brightness) or using synthetic data from sophisticated generative methods such as generative adversarial networks (GANs). Semi-supervised learning (SSL) is another technique which aims to utilise unlabelled data to enhance the performance of deep learning methods and is beneficial where significant amounts of data may be available but are not labelled. In this study, we aim to enhance patch-based OCT retinal and choroidal layer segmentation with both GAN-based data augmentation and SSL. In particular, we employ a conditional StyleGAN2 to generate synthetic patches for data augmentation and a similar unconditional GAN for pre-training the patch classifier to perform SSL. In doing so, we propose a new patch classifier architecture based on the discriminator architecture to improve performance, in addition to the SSL benefit. Compared to previous methods, the proposed data augmentation approach provides an improved data augmentation performance for patch classification with its effectiveness widespread, particularly in the case of low data, across three different OCT datasets encompassing a range of scanning parameters, noise levels, pathology and participant variability. The method provides some subsequent improvements in boundary delineation which is of high importance from a clinical perspective. Additionally, the proposed SSL approach boosts classification performance and boundary delineation performance in some cases which provides further usefulness in the case of low data. The proposed methods can be utilised to enhance OCT segmentation methods, which may be of considerable benefit for both clinicians and researchers.

Electroconductive cardiac patch based on bioactive PEDOT:PSS hydrogels.

Engineering cardiac implants for treating myocardial infarction (MI) has advanced, but challenges persist in mimicking the structural properties and variability of cardiac tissues using traditional bioconstructs and conventional engineering methods. This study introduces a synthetic patch with a bioactive surface designed to swiftly restore functionality to the damaged myocardium. The patch combines a composite, soft, and conductive hydrogel-based on (3,4-ethylenedioxythiophene):polystyrene-sulfonate (PEDOT:PSS) and polyvinyl alcohol (PVA). This cardiac patch exhibits a reasonably high electrical conductivity (40 S/cm) and a stretchability up to 50% of its original length. Our findings reveal its resilience to 10% cyclic stretching at 1 Hz with no loss of conductivity over time. To mediate a strong cell-scaffold adhesion, we biofunctionalize the hydrogel with a N-cadherin mimic peptide, providing the cardiac patch with a bioactive surface. This modification promote increased adherence and proliferation of cardiac fibroblasts (CFbs) while effectively mitigating the formation of bacterial biofilm, particularly against Staphylococcus aureus, a common pathogen responsible for surgical site infections (SSIs). Our study demonstrates the successful development of a structurally validated cardiac patch possessing the desired mechanical, electrical, and biofunctional attributes for effective cardiac recovery. Consequently, this research holds significant promise in alleviating the burden imposed by myocardial infarctions.

Safety and performance of a synthetic sealant patch aimed to prevent postoperative pancreatic fistula after distal pancreatectomy (SHIELDS) – Prospective international multicenter phase II study

ObjectiveThe incidence for clinically relevant postoperative pancreatic fistulas (CR-POPF) in distal pancreatectomy (DP) ranges up to 25%. None of the available sealants significantly reduce CR-POPF. A new biodegradable sealant patch was able to reduce POPF and to achieve bleeding control in a preclinical porcine DP model. The aim of this first-in-human study was to assess the safety and performance of the sealant patch. MethodsIn this multicenter, single-arm study, 40 patients undergoing distal pancreatectomy were prospectively enrolled from 8 centers. Following surgical resection, the transection plane was closed according to the standard of care and manually covered with the sealant patch. As primary endpoint the incidence of CR-POPF up to 30-days postoperatively was evaluated. The secondary endpoints included the assessment of complications and device usability. ResultsAmong 40 patients after distal pancreatectomy, CR-POPF occurred in 7 (17.5%) up to postoperative day 30. No type C POPF was observed. There was no intraoperative bleeding observed after patch application. ConclusionThe results of this international phase II study demonstrate promising results of a new sealant patch regarding the rate of CR-POPF. Randomized studies are now needed to confirm the superiority of the current patch as compared to the best current practice.

Dense Out-of-Distribution Detection by Robust Learning on Synthetic Negative Data.

Standard machine learning is unable to accommodate inputs which do not belong to the training distribution. The resulting models often give rise to confident incorrect predictions which may lead to devastating consequences. This problem is especially demanding in the context of dense prediction since input images may be only partially anomalous. Previous work has addressed dense out-of-distribution detection by discriminative training with respect to off-the-shelf negative datasets. However, real negative data may lead to over-optimistic evaluation due to possible overlap with test anomalies. To this end, we extend this approach by generating synthetic negative patches along the border of the inlier manifold. We leverage a jointly trained normalizing flow due to a coverage-oriented learning objective and the capability to generate samples at different resolutions. We detect anomalies according to a principled information-theoretic criterion which can be consistently applied through training and inference. The resulting models set the new state of the art on benchmarks for out-of-distribution detection in road-driving scenes and remote sensing imagery despite minimal computational overhead.

Similar long-term outcomes for venous, bovine pericardial, and polyester patches for primary carotid endarterectomy.

Currently, the type of patch used for carotid endarterectomy closure depends on the preference of the operating surgeon. Various materials are available, including autologous venous patches, bovine pericardial patches (BPP), and synthetic patches. The purpose of this study was to compare the long-term outcomes. All patients who underwent primary carotid endarterectomy with patch angioplasty using a venous, bovine, or polyester patch between 2010 and 2020 at two high-volume medical centers were included in this retrospective analysis on largely prospectively collected data. Study endpoints included long-term ipsilateral transient ischemic attack or cerebrovascular accident, restenosis, reintervention, and all-cause mortality. Cox proportional hazard models were fitted to assess the effect of patch type to each outcome. In total, 1481 CEAs were performed with a follow-up of 32 (13-65) months. Venous patch was used in 309 patients (20.9%), BPP in 1000 patients (67.5%), and polyester patch in 172 patients (11.6%). A preoperative symptomatic carotid artery stenosis of >50% was observed in 91.9% (n=284) of the patients who received a venous patch, 92.1% (n=921) of the patients who received BPP, and 90.7% (n=156) of the patients who received a polyester patch (p=0.799). Only in selected patients with an asymptomatic stenosis of >70% surgery was considered. Multivariable analyses showed no significant differences between the three patch types regarding long-term outcomes after adjusting for confounders. In patients undergoing primary carotid endarterectomy, the use of venous, bovine pericardial, or polyester patches seems equally safe and durable in terms of comparability in long-term outcomes.

Idiopathic Ventral Spinal Cord Herniation: An Illustrative Case and Literature Review

Background and Importance: Idiopathic spinal cord herniation (ISCH), or spontaneous spinal cord herniation, is a rare but serious condition that can cause progressive myelopathy and irreversible neurological deficits if left untreated. The condition is marked by the gradual herniation of the spinal cord through a ventral defect in the dura, leading to compromised blood flow and neurological deficits. Common symptoms include Brown-Séquard syndrome or asymmetrical paraparesis. Treatment options typically focus on reducing the strangulated spinal cord and closing the dural defect with a synthetic patch. Case Presentation: We present the case of an adult woman with progressive asymmetrical weakness of the lower limbs compatible with spastic paraparesis. Thoracic magnetic resonance imaging (MRI) revealed characteristic features of ISCH at the T3-T4 level. Intraoperative neurophysiological monitoring was used during the surgical intervention, which involved a 3-level laminectomy, dura opening, excision of the dentate ligament, and reduction of the cord across the dural defect. The defect was then filled with an autogenous piece of muscle, followed by the closure of the defect with an artificial dural patch and dural closure. At the 6-month follow-up, the patient showed favorable improvement. Conclusion: Patients with slowly progressive paraparesis or Brown-Séquard syndrome should consider the possibility of ISCH as a potential cause, despite its rarity. In symptomatic cases, the preferred treatment option often involves reducing the incarcerated spinal cord followed by covering the dural defect.

Bioreactor Design for Culturing Vascularized Engineered Tissue in Flow Conditions.

Background: Current treatments for congenital heart defects often require surgery and implantation of a synthetic patch or baffle that becomes a fibrous scar and leads to a high number of reoperations. Previous studies in rats have shown that a prevascularized scaffold can integrate into the heart and result in regions of vascularized and muscularized tissue. However, increasing the thickness of this scaffold for use in human hearts requires a method to populate the thick scaffold and mature it under physiologic flow and electrical conditions. Experiment: We developed a bioreactor system that can perfuse up to six 7 mm porous scaffolds with tunable gravity-mediated flow and chronic electrical stimulation. Three polymers, which have been reported to be biocompatible, were evaluated for effects on the viability of induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM). Bioreactor flow and electrical stimulation functions were tested, and the bioreactor was operated for up to 7 days to ensure reliability and lack of leaks in a 37°C, humidified incubator. Height and flow relationships were measured for perfusion through an electrospun polycaprolactone and gelatin scaffold, previously reported by our laboratory. Culture with cells was evaluated by plating human umbilical vein endothelial cells and human dermal fibroblasts on top of the scaffolds in both static and flow conditions for 2, 5, and 7 days. As a proof-of concept, scaffolds were cryosectioned and cell infiltration was quantified using immunofluorescence staining. Results: Neither MED610 (Stratasys), Vero (Stratasys), nor FORMLAB materials affected the viability of iPSC-CM, and MED610 was chosen for manufacture due to familiarity of 3D printing from this material. The generation of electrical field stimulation from 0 to 5 V and physiological ranges of pump capacities were verified. The relationship between height and flow was calculated for scaffolds with and without cells. Finally, we demonstrated evaluation of cell depth and structure in scaffolds cultured for 2, 5, and 7 days. Conclusion: The gravity-mediated flow bioreactor system we developed can be used as a platform for 3D cell culture particularly designed for perfusing vascularized tissue constructs with electrical stimulation for cardiac maturation.

Enhancing Anomaly Detection Models for Industrial Applications through SVM-Based False Positive Classification

Unsupervised anomaly detection models are crucial for the efficiency of industrial applications. However, frequent false alarms hinder the widespread adoption of unsupervised anomaly detection, especially in fault detection tasks. To this end, our research delves into the dependence of false alarms on the baseline anomaly detector by analyzing the high-response regions in anomaly maps. We introduce an SVM-based false positive classifier as a post-processing module, which identifies false alarms from positive predictions at the object level. Moreover, we devise a sample synthesis strategy that generates synthetic false positives from the trained baseline detector while producing synthetic defect patch features from fuzzy domain knowledge. Following comprehensive evaluations, we showcase substantial performance enhancements in two advanced out-of-distribution anomaly detection models, Cflow and Fastflow, across image and pixel-level anomaly detection performance metrics. Substantive improvements are observed in two distinct industrial applications, with notable instances of elevating the image-level F1-score from 46.15% to 78.26% in optimal scenarios and boosting pixel-level AUROC from 72.36% to 94.74%.

Use of glutaraldehyde-treated autologous pericardial patch in complete atrioventricular septal defect repair.

Synthetic patch materials, such as polytetrafluoroethylene and knitted polyester, are commonly used for the repair of complete atrioventricular septal defects using the double-patch technique. In our study, we investigated the impact of glutaraldehyde-treated autologous pericardial patch on postoperative atrioventricular valve function. In this retrospective study, patients who underwent repair of complete atrioventricular septal defects using the double-patch technique between January 1, 2018, and May 15, 2023, at our pediatric cardiac center were included in the study. Patients were divided into two groups based on the type of patch used for the repair of the ventricular component of the atrioventricular septal defect: autologous pericardial patch (group 1) and polytetrafluoroethylene patch (group 2). Postoperative data of the patients were retrospectively analyzed. Thirty-four patients (57.6%) were female, and 25 (42.4%) were male, with a median age of 7 (5-18) months. The median body weight at the time of surgery was 5.5 (4.1-10) kilograms. Down syndrome was present in 45 (76.3%) patients. The autologous pericardium was used for ventricular septal defect closure in 44 (74.6%) patients (Group 1), while polytetrafluoroethylene was used in 15 (25.4%) patients (Group 2). Permanent cardiac pacemaker placement was required in 4 (6.8%) patients due to postoperative atrioventricular block. Hospital mortality was 11.9% (n=7). Among these cases, 4 (6.8%) patients died from low cardiac output syndrome, and 3 (5.1%) patients died from sepsis. Postoperative echocardiographic evaluation revealed insignificant residual ventricular septal defects in 17 (28.8%) patients. No significant differences were observed between the groups in terms of mortality and postoperative atrioventricular valve insufficiency. The median follow-up duration for discharged patients was 5 months (7 days to 3.9 years). Throughout the follow-up period, there were no reoperations due to valve insufficiency or left ventricular outflow tract obstruction. Glutaraldehyde-treated autologous pericardium is a safe material that can be confidently used for the repair of the ventricular component of complete atrioventricular septal defects. This patch material does not adversely affect atrioventricular valve function and allows for the successful closure of ventricular septal defects.

Massive Rotator Cuff Tears With Short Tendon Length Can Be Successfully Repaired Using Synthetic Patch Augmentation.

Choosing the optimal treatment for massive rotator cuff tears (MRCT) still poses a surgical problem. In MRCT with good muscle quality, but short tendon length, non-augmented repairs lead to high failure rates of up to 90%. The aim of the study was to evaluate mid-term clinical and radiological outcomes of massive rotator cuff tears with good muscle quality, but short tendon length, which were repaired with synthetic patch augmentation. A retrospective study of patients who underwent arthroscopic or open rotator cuff repairs with patch augmentation between 2016 and 2019 was performed. We included patients older than 18 years, who presented with MRCT confirmed by an MRI arthrogram showing good muscle quality (Goutallier ≤II) and short tendon length (length <15mm). Constant-Murley score (CS), subjective shoulder value (SSV) and range of motion (ROM) were compared pre- and postoperatively. We excluded patients older than 75 years or with presence of rotator cuff arthropathy Hamada ≥ 2a. Patients were followed up for two years minimum. Clinical failures were defined by re-operation, forward flexion <120 or a relative CS < 70. Structural integrity of the repair was assessed using an MRI. Comparison between different variables and outcomes was performed using Wilcoxon-Mann-Whitney and Chi square tests. Fifteen patients (mean age 57 years, 13 (86.7%) male, 9 (60%) right shoulders) were reevaluated with a mean follow-up of 43.8 months (27-55 months). There was a significant improvement in the absolute CS (from 33 to 81 points, p=0.03), the relative CS (from 41% to 88%, p=0.04), the SSV (from 31% to 93% p=0,007) and forward flexion (from 111° to 163°, p=0.004) but not in external rotation (from 37° to 38°, p=0.5). There were three clinical failures (one atraumatic, two traumatic) with re-operations (two reverse total shoulder arthroplasties and one refixation). Structurally, there were three Sugaya grade 4 and five Sugaya grade 5 re-ruptures resulting in a retear rate of 53%. The presence of a complete or partial re-rupture was not associated with inferior outcomes compared to intact cuff repairs. There were no correlations between the grade of retraction, muscle quality or rotator cuff tear configuration and re-rupture or functional outcomes. Patch augmented cuff repair leads to a significant improvement of functional and structural outcomes. Partial re-ruptures were not associated with inferior functional outcomes. Prospective randomized trials are needed to confirm the results found in our study.

Corneal endothelial image segmentation training data generation using GANs. Do experts need to annotate?

Objective.Current solutions for corneal endothelial image segmentation use convolutional neural networks. However, their potential is not exploited due to the scarcity of labeled corneal endothelial data caused by an expensive cell delineation process. Therefore, this work proposes synthesizing cell edges and corresponding images using generative adversarial neural networks. To our knowledge, such work has not yet been reported in the context of corneal endothelial image segmentation. Methods.A two-step pipeline for synthesizing training patches is proposed. First, a custom mosaic generator creates a grid that mimics a binary map of endothelial cell edges. The synthetic cell edges are then input to the generative adversarial neural network, which is trained to generate corneal endothelial image patches from the corresponding edge labels. Finally, pairs of synthetic patches are used to train the patch-based U-Net model for corneal endothelial image segmentation. Results.Experiments performed on three datasets of corneal endothelial images show that using purely synthetic data for U-Net training allows image segmentation with comparable accuracy to that obtained when using original images annotated by experts. Depending on the dataset, the segmentation quality decreases only from 1% to 4%. Conclusions:Our solution provides a cost-effective source of diverse training data for corneal endothelial image segmentation. Significance.Due to the simple graphical user interface wrapping the proposed solution, many users can easily obtain unlimited training data for corneal endothelial image segmentation and use it in various scenarios.

Application of amodal segmentation on cucumber segmentation and occlusion recovery

Computer vision tasks, such as image recognition, object detection, and semantic segmentation, have contributed tremendously to autonomous harvesting. However, these tasks are applicable to the visible parts of an object in an image. In the field of agriculture, detecting green vegetables with subtle color differences poses an additional challenge. The nature of cucumbers (Cucumis sativus) makes them difficult to detect. To address this issue, we reconstructed the occluded part of the cucumber to help autonomous robots detect and locate picking-point positions. A dataset of cucumber images from two farms located in South Korea was generated. The dataset was superimposed with synthetic leaf patches to simulate the effect of occlusion. Using this dataset, we employed amodal segmentation with an auto-encoder and an ablation study regarding shape prior post-process, shape prior refinement, and feature matching to determine a suitable method for our cucumber dataset. We then proposed amodal segmentation with a U-net reconstruction network as a novel model for cucumber occlusion recovery. In the ablation study, the model with no additional process showed the highest accuracy, average precision (AP) of 49.31 and average precision with intersection over union (IoU) 0.5 (AP50) of 82.39, and the fastest inference time of 233 ms/image. Our proposed model outperformed auto-encoder-based models with an AP of 50.06, an AP50 of 82.43, and an inference time of 220 ms/image. The proposed method has been shown to be effective in improving the accuracy of cucumber segmentation under occlusion conditions. Therefore, amodal segmentation, particularly with the U-net reconstruction network, seems promising for the vision systems of cucumber picking robots. The main contribution of the study is that with amodal segmentation, detection of occluded cucumber instances can be done in a single stage with promising accuracy and speed, thus no longer requiring additional time-consuming operations of the manipulators in harvest decision making.

Long Term Follow Up of Dacron Versus Bovine Pericardium For Carotid Endarterectomy With Patch Angioplasty: a Retrospective Cohort Study

Objective: Patch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. Various patch materials are available, including venous, Dacron, bovine pericardium, and polytetrafluoroethylene. However, the choice of which patch to use is still a matter of debate. Autologous venous material has disadvantages such as wound related problems and a prolonged intervention time. This is due to the harvesting of the vein. These limitations can be bypassed when synthetic or biological patches are used, which are immediately available. Therefore, the aim of this study was to compare the long term outcomes in patients who received a CEA with either a bovine pericardial patch (BPP) or a Dacron patch.

Arthroscopic Superior Capsule Reconstruction With Combined Fascia Lata Autograft and Synthetic Scaffold Patch Graft for the Treatment of Irreparable Rotator Cuff Tears Yields Favorable Clinical and Radiographic Outcomes at Minimum 2-Year Follow-Up

To report the results of the arthroscopic superior capsule reconstruction (ASCR) technique with a combined fascia lata autograft and synthetic scaffold patch graft for irreparable massive rotator cuff tears (RCTs). The period for this retrospective study was between December 2016 and December 2020. The criteria for inclusion were patients treated arthroscopically for an incompletely repaired massive RCT (dimension >5 cm and 2 tendons fully torn, intact or reparable subscapularis tendons and teres minor tendon with or without irreparable infraspinatus, a radiological Hamada classification between grade 0 and 4, and a minimum 24-month postoperative follow-up). Clinical outcomes were evaluated preoperatively and at a final follow-up by a visual analog scale (VAS) for pain and range of motion along with the American Shoulder and Elbow Surgeons score (ASES), the University of California Los Angeles score (UCLA), and the Constant-Murley score (CMS). Radiological outcomes were assessed, according to the rotator cuff arthropathy (RCA) and the acromiohumeral distance (AHD) stages. Graft integrity and muscle fatty infiltration were evaluated by magnetic resonance imaging (MRI). A total of 43 patients were enrolled in the study with a mean follow-up duration of 45.6 months (range: 24 to 64). All clinical scores also improved at the 2-year follow-up (mean: VAS 0.7 [SD 0.7] vs 5.4 [SD 1.1]; P < .001; mean: ASES 92.6 [SD 8.0] vs 34.8 [SD 13.4]; P < .001; mean UCLA 31.5 [SD 3.9] vs 11.0 [SD 3.2]; P < .001; and mean CMS 86.6 [SD 7.2] vs 40.0 [SD 11.6]; P < .001), and 39 of 43 fascia lata grafts were fully intact on MRI (91%). ASCR with a combined fascia lata autograft and synthetic scaffold patch graft resulted in good functional outcomes, with a high rate of graft healing at the 2-year follow-up. All patients achieved clinically relevant improvement (met minimal clinically important differences [MCID]) on ASES, UCLA, and VAS with improved abduction strength restoration. Level IV, retrospective case series.

Synthetic polytetrafluoroethylene patches for irreparable rotator cuff tears-how are they doing at 5 years?

Treating massive and irreparable rotator cuff tears are problematic. Several studies have reported that polytetrafluoroethylene (PTFE) patches demonstrated excellent construct integrity and positive clinical and patient outcomes. However, these studies either had small sample sizes or short follow-up periods. To determine the survivorship, efficacy, and medium-term (2-19 years) outcomes of PTFE patch repairs. This retrospective study used prospectively collected data to establish the medium-term outcomes of PTFE interposition patch repairs for massive rotator cuff tears that could not be repaired by the standard technique. Patients included those who met the ≥2-year follow-up criteria post repair. Standardized assessments of patient-ranked shoulder pain and function and shoulder strength and passive range of motion (ROM) were performed preoperatively and at follow-up visits. Radiographs and ultrasonography were used to evaluate repair integrity, measure proximal humeral head migration, and determine glenohumeral arthritis scores. Forty-one shoulders formed the study cohort at a mean follow-up period of 5 years (range: 2-19 years). The mean age of this group was 72 (standard deviation: 10; range: 50-88) and had 14 cm2 tears at surgery. Twenty-five of 41 (61%) PTFE interposition patch repairs remained intact at an average of 5 years postrepair. Thirteen patches failed at the patch-tendon junction, 1 was removed, and 2 patients underwent reverse total shoulder replacement. Patient-ranked shoulder stiffness (P<.05), frequency of pain during activity and sleep (P<.001), pain levels during overhead activity and rest (P<.001), and overall shoulder function significantly improved from bad preoperatively to fair at the mean 5-year postoperative visit (P<.001). No significant improvements were demonstrated in dynamometer-measured shoulder strength maneuvers and passive ROM. All patients demonstrated proximal humeral head migration on shoulder radiographs regardless of repair integrity (mean Upper Migration Index=1.2). Failed repairs were associated with higher mean preoperative glenohumeral arthritis grades compared with intact repairs (grade 2 in failed repairs compared with grade 1 in intact repairs) (P<.01). PTFE interposition patch repairs for massive and irreparable tears had good construct integrity and clinical outcomes at 2 years. These outcomes were not maintained. PTFE patch repairs often failed at the patch-tendon junction at 4 years and beyond and were ineffective in (1) preventing proximal humeral head migration, (2) stopping progression of glenohumeral arthritis, and (3) improving shoulder strength and ROM.

Abstract P6-04-10: Recurrence Prediction in Ductal Carcinoma In Situ (DCIS) Patients from Tissue Microarrays (TMAs)

Abstract Recurrence Prediction in Ductal Carcinoma In Situ (DCIS) Patients Using Generative Adversarial Network (GAN) Augmented Deep Learning Model Background: DCIS patients have an excellent overall survival rate and over-treatment is always a cause for concern due to potential side-effects. Standard clinicopathological factors (age, growth pattern, tumor size, margin status and grade) have been shown to have limited value in predicting recurrence and segregation of high and low risk patients. Early and accurate recurrence prediction would facilitate a more aggressive treatment policy for high-risk patients (mastectomy or adjuvant radiation therapy), and simultaneously reduce over-treatment of low-risk patients. In this work, we have developed a deep learning (DL) classification framework that predicts recurrence in DCIS patients from Tissue microarrays (TMAs) hematoxylin and eosin (H&amp;E) images using a generative adversarial network (GAN) augmented deep learning (DL) classification model. A GAN is a class of DL models, in which two adversarial neural networks, generator and discriminator contest among each other to generate high quality images. During the adversarial training process, the generator learns to synthesize realistic images similar to those in the training set while the discriminator learns to distinguish between real and generated images. In recent years, high quality medical images have been generated by GAN models. To the best of our knowledge, this is the first time a GAN model has been used to generate H&amp;E images to train a DL classification model to predict recurrence in DCIS patients. Materials and methods: The cohort was comprised of 68 DCIS patients, aged between 35-89 years, lesion size of 5-90 mm, with a mix of low (15%), intermediate (35%) and 50% high grade cases. Patients were treated with mastectomy and/or a combination of lumpectomy, radiation and hormone therapy. TMAs were constructed from 2mm cores (1-3 cores per patient) in consultation with a breast pathologist to create hematoxylin and eosin (H&amp;E) images for further analysis. The cohort was split into independent training (n=50 patients, 10 with recurrences at 5years) and validation groups (n=18 patients, 6 with recurrences at 5years). TMA (H&amp;E) images were divided into smaller image patches of size 256x256 to train a GAN to generate image patches. A DL classification network (Resnet-Inception v2) was trained using TMA image patches and aggressive image patches generated by GAN to predict recurrence. The ability to generate synthetic image patches of aggressive lesions permitted training of a large DL classification network and predict recurrence in DCIS patients. Importantly, manual annotation was not necessary for the process. Results: The DL classification model trained with both TMA and GAN generated image patches predicted recurrence with an AUC of 0.87, sensitivity of 0.83 and specificity of 0.91 in the validation dataset. The DL classification model trained with image patches from TMAs only predicted recurrence with an AUC of 0.81. Conclusions: The use of a GAN model to generate H&amp;E images circumvents the needs for a large cohort and accurate labor-intensive manual annotation of histopathological images, which is often required for training a large DL classification model. The use of GAN generated aggressive image patches during training significantly improves recurrence prediction accuracy of the DL classification model. Validation in independent larger cohorts is ongoing, and if successful, could provide a novel assay for risk prediction that does not waste precious tissue samples. Citation Format: Ghose Soumya, Yesim Gokmen-Polar, Sanghee Cho, Elizabeth McDonough, Cynthia Davis, Jhimli Mitra, Zhanpan Zhang, Fiona Ginty, Sunil Badve. Recurrence Prediction in Ductal Carcinoma In Situ (DCIS) Patients from Tissue Microarrays (TMAs) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-04-10.

Synthetic patch infection after congenital diaphragmatic hernia repair: A case series

Synthetic patch infection after congenital diaphragmatic hernia repair: A case series