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Current Pediatric Reviews 2021Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. (Review)
Review
BACKGROUND
Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life.
OBJECTIVE
To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas.
METHODS
A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS
The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement.
CONCLUSION
Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
Topics: Adrenergic beta-Antagonists; Child; Child, Preschool; Conservative Treatment; Dermatologic Surgical Procedures; Hemangioma; Humans; Infant; Prognosis; Remission, Spontaneous; Skin Neoplasms; Watchful Waiting
PubMed: 32384034
DOI: 10.2174/1573396316666200508100038 -
BMC Bioinformatics 2015Dermoscopy is a highly effective and noninvasive imaging technique used in diagnosis of melanoma and other pigmented skin lesions. Many aspects of the lesion under...
BACKGROUND
Dermoscopy is a highly effective and noninvasive imaging technique used in diagnosis of melanoma and other pigmented skin lesions. Many aspects of the lesion under consideration are defined in relation to the lesion border. This makes border detection one of the most important steps in dermoscopic image analysis. In current practice, dermatologists often delineate borders through a hand drawn representation based upon visual inspection. Due to the subjective nature of this technique, intra- and inter-observer variations are common. Because of this, the automated assessment of lesion borders in dermoscopic images has become an important area of study.
METHODS
Fast density based skin lesion border detection method has been implemented in parallel with a new parallel technology called WebCL. WebCL utilizes client side computing capabilities to use available hardware resources such as multi cores and GPUs. Developed WebCL-parallel density based skin lesion border detection method runs efficiently from internet browsers.
RESULTS
Previous research indicates that one of the highest accuracy rates can be achieved using density based clustering techniques for skin lesion border detection. While these algorithms do have unfavorable time complexities, this effect could be mitigated when implemented in parallel. In this study, density based clustering technique for skin lesion border detection is parallelized and redesigned to run very efficiently on the heterogeneous platforms (e.g. tablets, SmartPhones, multi-core CPUs, GPUs, and fully-integrated Accelerated Processing Units) by transforming the technique into a series of independent concurrent operations. Heterogeneous computing is adopted to support accessibility, portability and multi-device use in the clinical settings. For this, we used WebCL, an emerging technology that enables a HTML5 Web browser to execute code in parallel for heterogeneous platforms. We depicted WebCL and our parallel algorithm design. In addition, we tested parallel code on 100 dermoscopy images and showed the execution speedups with respect to the serial version. Results indicate that parallel (WebCL) version and serial version of density based lesion border detection methods generate the same accuracy rates for 100 dermoscopy images, in which mean of border error is 6.94%, mean of recall is 76.66%, and mean of precision is 99.29% respectively. Moreover, WebCL version's speedup factor for 100 dermoscopy images' lesion border detection averages around ~491.2.
CONCLUSIONS
When large amount of high resolution dermoscopy images considered in a usual clinical setting along with the critical importance of early detection and diagnosis of melanoma before metastasis, the importance of fast processing dermoscopy images become obvious. In this paper, we introduce WebCL and the use of it for biomedical image processing applications. WebCL is a javascript binding of OpenCL, which takes advantage of GPU computing from a web browser. Therefore, WebCL parallel version of density based skin lesion border detection introduced in this study can supplement expert dermatologist, and aid them in early diagnosis of skin lesions. While WebCL is currently an emerging technology, a full adoption of WebCL into the HTML5 standard would allow for this implementation to run on a very large set of hardware and software systems. WebCL takes full advantage of parallel computational resources including multi-cores and GPUs on a local machine, and allows for compiled code to run directly from the Web Browser.
Topics: Dermoscopy; Humans; Image Interpretation, Computer-Assisted; Melanoma; Pattern Recognition, Automated; Skin; Skin Neoplasms
PubMed: 26423836
DOI: 10.1186/1471-2105-16-S13-S5 -
Italian Journal of Dermatology and... Jun 2021The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma...
The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma subtypes have come to light. The dermatoscopic morphology of superficial spreading melanoma (SSM) has been extensively investigated in the literature. Atypical network, irregular dots, irregular globules, irregular streaks and irregular blotch correspond to histopathologic alterations at the level of the junction, blue-white veil and atypical vessels suggest intradermal growth, whereas regression structures, negative network and white shiny streaks might reflect junctional or dermal alterations. The list of melanoma specific criteria has been recently updated to include features that typify early melanoma, such as irregular hyperpigmented areas and prominent skin markings and features seen in melanoma on sun damaged skin such as angulated lines. Nodular melanoma lacks most of the aforementioned criteria and is typified by the coexistence of blue and black color, atypical vessels and pink color. Lentigo maligna dermatoscopic criteria mainly develop at the outline of the follicular openings. However, at an early stage these features might be very subtle and the diagnosis should be based on the exclusion of benign tumors (inverse approach). Acral lentiginous melanoma is typified by a parallel ridge pattern, but also SSM criteria should be taken into consideration. The diagnosis of subungual melanoma is based on the assessment of the color and characteristics of the pigmented nail band. For the diagnosis of mucosal melanoma, the assessment of colors is more informative than the assessment of structures and the detection of blue, white or gray should raise the suspicion of melanoma. White shiny streaks and regression structures are the most common features of desmoplastic melanoma. The diagnosis of nevoid melanoma might be highly challenging and require information on the lesion's history. Melanoma on small- and medium-sized congenital nevi is typified by an eccentric location of the suspicious area, negative network and gray angulated lines. Recent advances in knowledge on the dermatoscopic characteristics of peculiar subtypes of the tumor significantly enrich the diagnostic armamentarium of clinicians. The challenge of the forthcoming years is to better characterize biologically aggressive melanomas and to optimize the screening strategies so as to identify them.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Hyperpigmentation; Melanoma; Skin Neoplasms
PubMed: 33314891
DOI: 10.23736/S2784-8671.20.06784-X -
Computers in Biology and Medicine Jul 2022Accurate skin lesion segmentation plays a fundamental role in computer-aided melanoma analysis. Recently, some FCN-based methods have been proposed and achieved...
Accurate skin lesion segmentation plays a fundamental role in computer-aided melanoma analysis. Recently, some FCN-based methods have been proposed and achieved promising results in lesion segmentation tasks. However, due to the variable shapes, different scales, noise interference, and ambiguous boundaries of skin lesions, the capabilities of lesion location and boundary delineation of these works are still insufficient. To overcome the above challenges, in this paper, we propose a novel Neighborhood Context Refinement Network (NCRNet) by using the coarse-to-fine strategy to achieve accurate skin lesion segmentation. The proposed NCRNet contains a shared encoder and two different but closely related decoders for locating the skin lesions and refining the lesion boundaries. Specifically, we first design the Parallel Attention Decoder (PAD), which can effectively extract and fuse the local detail information and global semantic information on multiple levels to locate skin lesions of different sizes and shapes. Then, based on the initial lesion location, we further design the Neighborhood Context Refinement Decoder (NCRD), aiming at leveraging the fine-grained multi-stage neighborhood context cues to refine the lesion boundaries continuously. Furthermore, the neighborhood-based deep supervision used in the NCRD can make the shared encoder pay more attention to the lesion boundary areas and promote convergence of the segmentation network. The public skin lesion segmentation dataset ISIC2017 is adopted to validate the effectiveness of the proposed NCRNet. Comprehensive experiments prove that the proposed NCRNet reaches the state-of-the-art performance than the other nine competitive methods and gets 78.62%, 86.55%, and 94.01% on Jaccard, Dice, and Accuracy, respectively.
Topics: Humans; Image Processing, Computer-Assisted; Melanoma; Neural Networks, Computer; Skin Diseases; Skin Neoplasms
PubMed: 35477048
DOI: 10.1016/j.compbiomed.2022.105545 -
Clinical & Translational Immunology 2023The leading cause of mortality in patients with rheumatoid arthritis is atherosclerotic cardiovascular disease (CVD). We have shown that murine arthritis impairs...
OBJECTIVES
The leading cause of mortality in patients with rheumatoid arthritis is atherosclerotic cardiovascular disease (CVD). We have shown that murine arthritis impairs atherosclerotic lesion regression, because of cellular cholesterol efflux defects in haematopoietic stem and progenitor cells (HSPCs), causing monocytosis and impaired atherosclerotic regression. Therefore, we hypothesised that improving cholesterol efflux using a Liver X Receptor (LXR) agonist would improve cholesterol efflux and improve atherosclerotic lesion regression in arthritis.
METHODS
mice were fed a western-type diet for 14 weeks to initiate atherogenesis, then switched to a chow diet to induce lesion regression and divided into three groups; (1) control, (2) K/BxN serum transfer inflammatory arthritis (K/BxN) or (3) K/BxN arthritis and LXR agonist T0901317 daily for 2 weeks.
RESULTS
LXR activation during murine inflammatory arthritis completely restored atherosclerotic lesion regression in arthritic mice, evidenced by reduced lesion size, macrophage abundance and lipid content. Mechanistically, serum from arthritic mice promoted foam cell formation, demonstrated by increased cellular lipid accumulation in macrophages and paralleled by a reduction in mRNA of the cholesterol efflux transporters , and . T0901317 reduced lipid loading and increased and expression in macrophages exposed to arthritic serum and increased ABCA1 levels in atherosclerotic lesions of arthritic mice. Moreover, arthritic clinical score was also attenuated with T0901317.
CONCLUSION
Taken together, we show that the LXR agonist T0901317 rescues impaired atherosclerotic lesion regression in murine arthritis because of enhanced cholesterol efflux transporter expression and reduced foam cell development in atherosclerotic lesions.
PubMed: 37091327
DOI: 10.1002/cti2.1446 -
Journal of Interventional Cardiac... Mar 2019Despite the wide use of cryoenergy, there is a paucity of data regarding the impact of certain ablation parameters on lesion size. Specifically, this study sought to... (Comparative Study)
Comparative Study
PURPOSE
Despite the wide use of cryoenergy, there is a paucity of data regarding the impact of certain ablation parameters on lesion size. Specifically, this study sought to evaluate the impact of catheter type, ablation time, heat load, and tip orientation on lesion dimensions using a porcine thigh model with focal cryoablation catheters.
METHODS
In 6 pigs, 251 lesions were created on thigh muscle with parameter permutations to compare the acute impact of catheter type (electrode tip sizes 4, 6, and 8 mm), ablation time (2, 2 × 2, 3, 4, and 2 × 4 min), heat load (1 and 2 L/min), and tip orientation (perpendicular or parallel) on lesion dimensions (length, depth, and cross-sectional area) immediately post-ablation. As a sub-study to evaluate the importance of tissue contact during the cryoablation procedure, a 1-min freeze was performed without tissue contact until an ice ball formed, followed by an additional 2-3 min freeze.
RESULTS
The linear regression model revealed that catheter type (p < 0.0001) and the interaction between catheter orientation and catheter type (p = 0.027) were significantly associated with lesion cross-sectional area. Lesion length and depth, but not cross-sectional area, are significantly impacted by the catheter type (p < 0.0001; p = 0.003) and orientation (p < 0.0001; p < 0.0001), respectively. Compared to parallel catheter placement, lesions created with the perpendicular orientation were deeper using 4-mm (p = 0.136), 6-mm (p = 0.005), and 8-mm tip catheter (p = 0.004). Lesion creation with an ice ball significantly reduced lesion depth compared to lesions made without an ice ball (p < 0.05). In contrast, ablation time (p = 0.097) and heat load (p = 0.467) were not significantly associated with lesion size. Additionally, there was no statistical significant difference in lesion size between 2 × 2 and 4 min ablation times.
CONCLUSIONS
The present study demonstrated that lesion size was significantly impacted by catheter type and catheter tip orientation and that maintaining tissue contact prior to applying cryoenergy is essential.
Topics: Animals; Cardiac Catheters; Cryosurgery; Equipment Design; Female; Linear Models; Models, Animal; Myocardium; Operative Time; Random Allocation; Risk Factors; Sus scrofa
PubMed: 30251226
DOI: 10.1007/s10840-018-0452-x -
Restorative Neurology and Neuroscience 2004A stroke may modulate motor cortex excitability. We examined if distinct ischemic brain lesions are associated with a specific pattern of excitability changes. We also... (Review)
Review
INTRODUCTION
A stroke may modulate motor cortex excitability. We examined if distinct ischemic brain lesions are associated with a specific pattern of excitability changes. We also investigated the effects of a rehabilitative therapy on motor excitability.
METHODS
In stroke patients, the consequences of a) a lesion in the central somatosensory system, b) a cerebellar lesion and c) a two week period of Constraint-induced movement therapy (CIMT), on motor cortex excitability were studied. Transcranial magnetic stimulation techniques and functional magnetic resonance imaging (fMRI) were employed.
RESULTS
Patients with a lesion in the primary somatosensory cortex or in the ventroposterolateral nucleus of the thalamus had a decreased intracortical inhibition on the affected side. Patients with lesions in the territory of the superior cerebellar artery had a loss of intracortical facilitation and an increase of intracortical inhibition. Patients with cortical lesions undergoing CIMT had a loss of intracortical inhibition prior to therapy. After CIMT, changes of ICI were stronger in the lesioned than in the non-lesioned hemisphere but could result either in an increase of ICI or a reduction of ICI. In three patients fMRI results showed that cortical activation was less post CIMT as compared to pre-treatment activation. In parallel, ICI was reduced after treatment.
CONCLUSIONS
Our results suggest that, physiologically, central somatosensory influence on the motor cortex is inhibitory. In contrast, the cerebellum normally exerts a facilitatory influence on the motor cortex. CIMT induces changes of intracortical excitability mainly in the affected hemisphere.
Topics: Brain; Humans; Neuronal Plasticity; Recovery of Function; Stroke; Stroke Rehabilitation
PubMed: 15502271
DOI: No ID Found -
Pain Medicine (Malden, Mass.) Dec 2014This study aims to compare radiofrequency (RF) heat lesion size across electrodes and generator settings available for interventional pain management.
OBJECTIVE
This study aims to compare radiofrequency (RF) heat lesion size across electrodes and generator settings available for interventional pain management.
METHODS
Monopolar lesions are generated ex vivo in animal tissue using sharp cannulae with tip diameters 23, 22, 20, 18, 16 gauge; tip lengths 5, 6, 10, 15 mm; set temperatures 60, 70, 80, 90°C; set times 1, 1.5, 2, 3, 5, 10 minutes. Lesions are generated using the RRE electrode, cooled RF, and parallel-tip bipolar RF for comparison. Lesion sizes are assessed by automated photographic temperature inference from over 400 lesions, using multiple lesions per configuration.
RESULTS
Monopolar lesion width and length increase with each factor (P < 0.001). Increasing cannula diameter from 22 to 16 gauge increases average lesion width 58-65% (3-4 mm) at 80°C and 2 minutes. Increasing temperature from 60°C to 90°C increases lesion width 108-152% at 2 minutes. Although dimensions grow most rapidly over the first minute, average lesion width is 11-20% larger at 2 minutes, and 23-32% larger at 3 minutes, compared with 1 minute. Lesion length extends distal and proximal to the tip, and exceeds tip length by 1-5 mm at 80°C and 2 minutes. Conventional 16 gauge cannulae at 80-90°C for 2-3 minutes generate lesions of average width similar to that produced by the cooled RF configuration proposed for sacroiliac joint denervation. Bipolar RF between parallel cannulae produces a rounded brick-shaped lesion of comparable shape to three sequential monopolar lesions generated using the same cannulae and generator settings.
CONCLUSIONS
Tip gauge, tip length, temperature, and time substantially affect RF lesion size.
Topics: Animals; Axotomy; Catheter Ablation; Cattle; Electrodes; Hot Temperature; Models, Animal
PubMed: 25312825
DOI: 10.1111/pme.12566 -
Neurobiology of Language (Cambridge,... 2023Sentence structure, or syntax, is potentially a uniquely creative aspect of the human mind. Neuropsychological experiments in the 1970s suggested parallel syntactic...
Sentence structure, or syntax, is potentially a uniquely creative aspect of the human mind. Neuropsychological experiments in the 1970s suggested parallel syntactic production and comprehension deficits in agrammatic Broca's aphasia, thought to result from damage to syntactic mechanisms in Broca's area in the left frontal lobe. This hypothesis was sometimes termed , converging with developments in linguistic theory concerning central syntactic mechanisms supporting language production and comprehension. However, the evidence supporting an association among receptive syntactic deficits, expressive agrammatism, and damage to frontal cortex is equivocal. In addition, the relationship among a distinct grammatical production deficit in aphasia, paragrammatism, and receptive syntax has not been assessed. We used lesion-symptom mapping in three partially overlapping groups of left-hemisphere stroke patients to investigate these issues: grammatical production deficits in a primary group of 53 subjects and syntactic comprehension in larger sample sizes ( = 130, 218) that overlapped with the primary group. Paragrammatic production deficits were significantly associated with multiple analyses of syntactic comprehension, particularly when incorporating lesion volume as a covariate, but agrammatic production deficits were not. The lesion correlates of impaired performance of syntactic comprehension were significantly associated with damage to temporal lobe regions, which were also implicated in paragrammatism, but not with the inferior and middle frontal regions implicated in expressive agrammatism. Our results provide strong evidence against the overarching agrammatism hypothesis. By contrast, our results suggest the possibility of an alternative grammatical parallelism hypothesis rooted in paragrammatism and a central syntactic system in the posterior temporal lobe.
PubMed: 37946730
DOI: 10.1162/nol_a_00117