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Heliyon May 2024Accurate segmentation is crucial in diagnosing and analyzing skin lesions. However, automatic segmentation of skin lesions is extremely challenging because of their...
Accurate segmentation is crucial in diagnosing and analyzing skin lesions. However, automatic segmentation of skin lesions is extremely challenging because of their variable sizes, uneven color distributions, irregular shapes, hair occlusions, and blurred boundaries. Owing to the limited range of convolutional networks receptive fields, shallow convolution cannot extract the global features of images and thus has limited segmentation performance. Because medical image datasets are small in scale, the use of excessively deep networks could cause overfitting and increase computational complexity. Although transformer networks can focus on extracting global information, they cannot extract sufficient local information and accurately segment detailed lesion features. In this study, we designed a dual-branch encoder that combines a convolution neural network (CNN) and a transformer. The CNN branch of the encoder comprises four layers, which learn the local features of images through layer-wise downsampling. The transformer branch also comprises four layers, enabling the learning of global image information through attention mechanisms. The feature fusion module in the network integrates local features and global information, emphasizes important channel features through the channel attention mechanism, and filters irrelevant feature expressions. The information exchange between the decoder and encoder is finally achieved through skip connections to supplement the information lost during the sampling process, thereby enhancing segmentation accuracy. The data used in this paper are from four public datasets, including images of melanoma, basal cell tumor, fibroma, and benign nevus. Because of the limited size of the image data, we enhanced them using methods such as random horizontal flipping, random vertical flipping, random brightness enhancement, random contrast enhancement, and rotation. The segmentation accuracy is evaluated through intersection over union and duration, integrity, commitment, and effort indicators, reaching 87.7 % and 93.21 %, 82.05 % and 89.19 %, 86.81 % and 92.72 %, and 92.79 % and 96.21 %, respectively, on the ISIC 2016, ISIC 2017, ISIC 2018, and PH2 datasets, respectively (code: https://github.com/hyjane/CCT-Net).
PubMed: 38807881
DOI: 10.1016/j.heliyon.2024.e31395 -
The Journal of Thoracic and... May 2024This study aims to provide an update on the clinical presentation, diagnostic work-up, operative strategies, and mid-term outcomes in children undergoing ventricular...
OBJECTIVE
This study aims to provide an update on the clinical presentation, diagnostic work-up, operative strategies, and mid-term outcomes in children undergoing ventricular fibroma resection.
METHODS
Single-center, retrospective cohort study of patients undergoing ventricular fibroma resection between 2000 and 2023.
RESULTS
Among 52 patients, median age at surgery was 2.0 years (IQR 0.8-4.6) and median tumor volume index was 69 milliliters/m (IQR 49-169). Tumor distorted the atrioventricular (AV) valve/subvalvar apparatus in 30 (58%) patients and abutted major epicardial coronary arteries in 41 (79%) patients. Surgery was indicated for arrythmia (n=45, 86%), symptoms (n=14, 27%), and/or hemodynamic compromise (n=11, 21%). Tumor was debulked in 34 (65%) patients, including the last 21 patients. Concomitant AV valvuloplasty was performed in 18 patients and ventricular cavity closure in 15 (29%) patients. During a median follow-up of 2.4 years (IQR 0.8-6.2), there was no mortality, cardiac arrests, heart transplants, or single ventricle palliation. The 15-year risk of reoperation and clinical ventricular tachycardia/fibrillation was 6.7% (95% CI 0-14.3%) and 2.4% (95% CI 0-7.2%), respectively. On latest imaging, pre- and post-debulking LV ejection fraction did not significantly differ (P=.069), while no patients had signs of outflow tract obstruction, inflow tract obstruction, or > moderate AV valve regurgitation.
CONCLUSIONS
Large ventricular fibromas can be resected safely with appropriate surgical planning and an emphasis on debulking. Most children maintain left ventricular function and remain free of recurrent ventricular arrhythmias at follow-up. Extended follow-up is warranted to understand whether patients remain at risk for scar-based ventricular arrhythmias in the future.
PubMed: 38802044
DOI: 10.1016/j.jtcvs.2024.05.013 -
Journal of Oral and Maxillofacial... 2024Sclerosing odontogenic carcinoma (SOC) was first described by Koutlas . in 2008. Despite its inclusion in the World Health Organization (WHO) as a distinct entity, it is...
Sclerosing odontogenic carcinoma (SOC) was first described by Koutlas . in 2008. Despite its inclusion in the World Health Organization (WHO) as a distinct entity, it is a tumour that remains poorly defined in the literature, with only 10 reported cases to date. The mandibular premolar and molar region is more commonly affected compared to the maxilla. In the maxilla, the anterior and the molar regions are most commonly affected. This article describes a case report of a Sclerosing Odontogenic Carcinoma in a 50 year old male patient in the mandibular region. The radiograph showed a well-defined radiolucency extending from the left ramus of the mandible to the right lower molar region. SOC is low grade with mild atypia and frequent mitosis and diffused infiltrative and perineural spread.
PubMed: 38800446
DOI: 10.4103/jomfp.jomfp_128_21 -
Expert Review of Anticancer Therapy Jun 2024APC-associated polyposis is a rare hereditary disorder characterized by the development of multiple adenomas in the digestive tract. Individuals with APC-associated... (Review)
Review
INTRODUCTION
APC-associated polyposis is a rare hereditary disorder characterized by the development of multiple adenomas in the digestive tract. Individuals with APC-associated polyposis need to be managed by specialized multidisciplinary teams in dedicated centers.
AREAS COVERED
The study aimed to review the literature on Familial adenomatous polyposis (FAP) to provide an update on diagnostic and surgical management while focusing on strategies to minimize the risk of desmoid-type fibromatosis, cancer in anorectal remnant, and postoperative complications. FAP individuals require a comprehensive approach that includes diagnosis, surveillance, preventive surgery, and addressing specific extracolonic concerns such as duodenal and desmoid tumors. Management should be personalized considering all factors: genotype, phenotype, and personal needs. Total colectomy and ileo-rectal anastomosis have been shown to yield superior QoL results when compared to Restorative Procto colectomy and ileopouch-anal anastomosis with acceptable oncological risk of developing cancer in the rectal stump if patients rigorously adhere to lifelong endoscopic surveillance. Additionally, a low-inflammatory diet may prevent adenomas and cancer by modulating systemic and tissue inflammatory indices.
EXPERT OPINION
FAP management requires a multidisciplinary and personalized approach. Integrating genetic advances, innovative surveillance techniques, and emerging therapeutic modalities will contribute to improving outcomes and quality of life for FAP individuals.
Topics: Humans; Adenomatous Polyposis Coli; Quality of Life; Colectomy; Postoperative Complications; Patient Care Team; Precision Medicine; Phenotype; Genotype; Fibromatosis, Aggressive
PubMed: 38785081
DOI: 10.1080/14737140.2024.2344649 -
Hand Surgery & Rehabilitation Jun 2024ChatGPT and its application in producing patient education materials for orthopedic hand disorders has not been extensively studied. This study evaluated the quality and... (Comparative Study)
Comparative Study
INTRODUCTION
ChatGPT and its application in producing patient education materials for orthopedic hand disorders has not been extensively studied. This study evaluated the quality and readability of educational information pertaining to common hand surgeries from patient education websites and information produced by ChatGPT.
METHODS
Patient education information for four hand surgeries (carpal tunnel release, trigger finger release, Dupuytren's contracture, and ganglion cyst surgery) was extracted from ChatGPT (at a scientific and fourth-grade reading level), WebMD, and Mayo Clinic. In a blinded and randomized fashion, five fellowship-trained orthopaedic hand surgeons evaluated the quality of information using a modified DISCERN criteria. Readability and reading grade level were assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) equations.
RESULTS
The Mayo Clinic website scored higher in terms of quality for carpal tunnel release information (p = 0.004). WebMD scored higher for Dupuytren's contracture release (p < 0.001), ganglion cyst surgery (p = 0.003), and overall quality (p < 0.001). ChatGPT - 4th Grade Reading Level, ChatGPT - Scientific Reading Level, WebMD, and Mayo Clinic written materials on average exceeded recommended reading grade levels (4th-6th grade) by at least four grade levels (10th, 14th, 13th, and 11th grade, respectively).
CONCLUSIONS
ChatGPT provides inferior education materials compared to patient-friendly websites. When prompted to provide more easily read materials, ChatGPT generates less robust information compared to patient-friendly websites and does not adequately simplify the educational information. ChatGPT has potential to improve the quality and readability of patient education materials but currently, patient-friendly websites provide superior quality at similar reading comprehension levels.
Topics: Humans; Comprehension; Internet; Patient Education as Topic; Artificial Intelligence; Hand; Dupuytren Contracture; Ganglion Cysts; Trigger Finger Disorder; Health Literacy; Carpal Tunnel Syndrome
PubMed: 38782361
DOI: 10.1016/j.hansur.2024.101723 -
Journal of Plastic, Reconstructive &... Jul 2024The non-genetic factors predisposing to trigger finger (TF) have mostly been characterised in small studies from individual institutions. Here, we aimed to provide a...
BACKGROUND
The non-genetic factors predisposing to trigger finger (TF) have mostly been characterised in small studies from individual institutions. Here, we aimed to provide a more complete picture of TF and its associations.
METHODOLOGY
This case-control study used cross-sectional data from the UK Biobank population-based cohort to identify and determine the strength of associations of phenotypic variables with TF. We performed multivariable logistic regression of a multitude of phenotypic factors associated with TF.
RESULTS
We identified 2250 individuals with medical and surgical diagnostic codes for TF, and 398,495 controls. TF was found to be significantly associated with age (OR 1.04, 95% CI 1.03-1.04, P < 2.23×10), female sex (OR 1.22, 95% CI 1.08-1.39, P = 2.35×10), body mass index (OR 1.10, 95% CI 1.04-1.16, P = 5.52×10), carpal tunnel syndrome (OR 9.59, 95% CI 8.68-10.59, P < 2.23×10), Dupuytren's disease (OR 4.89, 95% CI 4.06-5.89, P < 2.23×10), diabetes mellitus without complications (OR 1.35, 95% CI 1.15-1.58, P = 2.03×10) and with complications (OR 2.46, 95% CI 1.90-3.17, P = 4.98×10), HbA1c (OR 1.01, 95% CI 1.01-1.02, P = 8.99×10), hypothyroidism (OR 1.24, 95% CI 1.07-1.43, P = 4.75×10) and rheumatoid arthritis (OR 1.33, 95% CI 1.06-1.68, P = 0.014).
CONCLUSION
Our results provide evidence supporting the well-known risk factors such as diabetes mellitus, carpal tunnel syndrome, age and female sex. Furthermore, we can confirm putative associations such as hypothyroidism, obesity and rheumatoid arthritis, while providing evidence against others such as hypertension and hyperlipidaemia. A novel finding arising from this study is the strong association with Dupuytren's disease. Our study design allowed us to identify these associations as being independent from carpal tunnel syndrome, thereby indicating a shared pathophysiology between this disease and TF.
Topics: Humans; Trigger Finger Disorder; Female; Male; Case-Control Studies; Middle Aged; Cross-Sectional Studies; Risk Factors; United Kingdom; Aged; Sex Factors; Adult; Age Factors; Body Mass Index; Carpal Tunnel Syndrome; Dupuytren Contracture
PubMed: 38776627
DOI: 10.1016/j.bjps.2024.04.066 -
Heliyon May 2024This study aimed to assess the surgical outcomes and identify the conversion risk factors of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in...
OBJECTIVE
This study aimed to assess the surgical outcomes and identify the conversion risk factors of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in treating ovarian cyst.
METHODS
This was a retrospective study of 505 patients who underwent vNO TES for treating ovarian cyst from March 2019 to February 2022 wherein the patients were classified into "converted" or "nonconverted" groups. T-tests, χ tests, and logistic regression were used for statistical analyses.
RESULTS
There were 16 (3.17 %) surgical conversions and 12 (2.38 %) other surgical complications in our study cohort. Teratomas accounted for 56.8 % of complications in nonconverted cases and 18.8 % in converted cases. Adenocystomas were found in 12.3 % of nonconverted cases and 18.8 % of converted cases. Other types included paraovarian cysts (3.3 % and 0 %), fibroma, granulosa cell tumor, Brenner tumor (1.2 % and 0 %), corpus luteum cysts, follicular cysts (7.6 % and 6.3 %), old abscess (0.2 % and 0 %), and simple cysts (17.6 % and 12.5 %) in the nonconverted and converted groups, respectively. The converted group included more cases of endometriotic cysts (43.8 % vs 12.3 %, p = 0.023), bilateral cysts (37.5 % vs 8.2 %, p < 0.001), severe pelvic adhesion (68.8 % vs 3.3 %, p < 0.001), deep endometriosis (12.5 % vs 0.4 %, p < 0.001), and at least two cysts (37.5 % vs 8.81 %; p < 0.001). Severe pelvic adhesion (adjusted odds ratio [OR], 86.96; range, 18.33-431.77; p < 0.001), bilateral cysts (adjusted OR, 4.75; range, 1.05-21.57, p = 0.043) and endometriotic cysts (adjusted OR, 7.69; range, 3.11-17.08; p < 0.001) were also predictors of surgical conversion.
CONCLUSION
vNOTES demonstrates low complication and conversion rates in treating ovarian cyst compared with TU-LESS. Surgical conversion is associated with severe pelvic adhesions, bilateral cysts, and endometriotic cysts.
PubMed: 38774314
DOI: 10.1016/j.heliyon.2024.e31014 -
Oral Surgery, Oral Medicine, Oral... Jul 2024Tenosynovial giant cell tumor is a benign neoplasm arising from the synovium of joints, including the temporomandibular joint (TMJ). Despite its benign nature, these...
Tenosynovial giant cell tumor is a benign neoplasm arising from the synovium of joints, including the temporomandibular joint (TMJ). Despite its benign nature, these tumors may exhibit aggressive behavior. A 57-year-old woman with a swollen, hardened area in the left TMJ was referred to the university´s clinic. The diagnosis of tenosynovial giant cell tumor was made based on the presence of hyperplastic synovial lining containing mononuclear and giant cells, hemorrhagic areas, hemosiderin deposits, and calcification foci in the biopsy. A low condylectomy was performed, and histopathologic analysis of the surgical piece upheld the diagnosis. Due to histopathologic resemblance with other giant cell-rich lesions (giant cell granuloma of the jaws, brown tumor of hyperparathyroidism, and non-ossifying fibroma) for which signature mutations are known, mutational analysis of KRAS, FGFR1, and TRPV4 genes was conducted. The results revealed wild-type sequences for all the mutations tested, thereby supporting the diagnosis of tenosynovial giant cell tumor.
Topics: Humans; Female; Middle Aged; Giant Cell Tumor of Tendon Sheath; Diagnosis, Differential; Biopsy; Temporomandibular Joint Disorders; Receptor, Fibroblast Growth Factor, Type 1; DNA Mutational Analysis; Proto-Oncogene Proteins p21(ras)
PubMed: 38760286
DOI: 10.1016/j.oooo.2024.01.014 -
European Journal of Cancer (Oxford,... Jul 2024Sorafenib and pazopanib, two tyrosine kinase inhibitors (TKI), are widely used in patients with progressive symptomatic desmoid tumors (DT). Limited real-word data is...
BACKGROUND
Sorafenib and pazopanib, two tyrosine kinase inhibitors (TKI), are widely used in patients with progressive symptomatic desmoid tumors (DT). Limited real-word data is available on long-term outcomes of patients who progressed on, stopped, or continued TKIs.
METHODS
Patients diagnosed with DTs and treated with sorafenib or pazopanib between 2011 and 2022 at 11 institutions were reviewed. Patient history, response to therapy and toxicity were recorded. Statistical analyses utilized Kaplan-Meier and log-rank tests.
RESULTS
142 patients with DT treated with sorafenib (n = 126, 88.7 %) or pazopanib (n = 16, 11.3 %) were analyzed. The median treatment duration was 10.8 months (range: 0.07- 73.9). The overall response rate and the disease control rate were 26.0 % and 95.1 %, respectively. The median tumor shrinkage was - 8.5 % (range -100.0 %- +72.5 %). Among responders, the median time to an objective response was 15.2 months (range: 1.1 to 33.1). The 1-year and 2-year progression-free survival rates were 82 % and 80 %. Dose reductions were necessary in 34 (23.9 %) patients. Grade 3 or higher adverse events were reported in 36 (25.4 %) patients. On the last follow-up, 55 (38.7 %) patients continued treatment. Treatment discontinuation (n = 85, 59.9 %) was mainly for toxicity (n = 35, 45.9 %) or radiological or clinical progression (n = 30, 35.3 %). For the entire cohort, 36 (25.4 %) patients required subsequent treatment. In the 32 responders, only 1 (3.1 %) patient required a subsequent treatment. In patients who discontinued TKI, 25 (44.6 %) with stable disease received subsequent treatment compared to 0 (0.0 %) of responders.
CONCLUSION
This retrospective study represents the largest cohort of DT patients treated with sorafenib or pazopanib to date. Discontinuation of treatment in responders is safe. The optimal treatment duration in patients with stable disease remains to be defined.
Topics: Humans; Indazoles; Sorafenib; Sulfonamides; Male; Female; Pyrimidines; Middle Aged; Adult; Aged; Young Adult; Fibromatosis, Aggressive; Adolescent; Retrospective Studies; Aged, 80 and over; Progression-Free Survival; Protein Kinase Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Treatment Outcome
PubMed: 38759389
DOI: 10.1016/j.ejca.2024.114119 -
Genes, Chromosomes & Cancer May 2024Superficial fibromas are a group of mesenchymal spindle cell lesions with pathomorphological heterogeneity and diverse molecular backgrounds. In part, they may be...
Superficial fibromas are a group of mesenchymal spindle cell lesions with pathomorphological heterogeneity and diverse molecular backgrounds. In part, they may be indicators of an underlying syndrome. Among the best-known entities of superficial fibromas is Gardner fibroma, a plaque-like benign tumor, which is associated with APC germline mutations and occurs in patients with familial adenomatosis polyposis (Gardner syndrome). Affected patients also have an increased risk to develop desmoid fibromatosis (DTF), a locally aggressive neoplasm of the deep soft tissue highly prone to local recurrences. Although a minority of DTFs occur in the syndromic context and harbor APC germline mutations, most frequently their underlying molecular aberration is a sporadic mutation in Exon 3 of the CTNNB1 gene. Up to date, a non-syndromic equivalent to Gardner fibroma carrying a CTNNB1 mutation has not been defined. Here, we present two cases of (sub-)cutaneous tumors with a hypocellular and collagen-rich Gardner fibroma-like appearance and pathogenic, somatic CTNNB1 mutations. We aim to differentiate these tumors from other fibromas according to their histological appearance, immunohistochemical staining profile and underlying somatic CTNNB1 mutations. Furthermore, we distinguish them from locally aggressive desmoid fibromatosis regarding their biological behavior, prognosis and indicated therapeutic strategies. Consequently, we call them CTNNB1-mutated superficial fibromas as a sporadic counterpart lesion to syndromic Gardner fibromas.
Topics: Humans; beta Catenin; Fibroma; Male; Female; Mutation; Middle Aged; Fibromatosis, Aggressive; Adult; Gardner Syndrome; Germ-Line Mutation
PubMed: 38757718
DOI: 10.1002/gcc.23247