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American Journal of Perinatology Jul 2024Studies have shown that 2019 novel coronavirus disease (COVID-19) may be associated with an increased risk of adverse pregnancy outcomes including preeclampsia, preterm...
OBJECTIVE
Studies have shown that 2019 novel coronavirus disease (COVID-19) may be associated with an increased risk of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth. However, the relationship between COVID-19 and abnormal fetal growth (i.e., low neonatal birthweight) has not been elucidated. Because other viruses affect fetal growth, obstetrical providers began to recommend ultrasound studies during the third trimester to assess fetal growth in patients with COVID-19 during pregnancy.The aim of this study was to determine if neonatal birthweight was different between low-risk patients diagnosed with COVID-19 during pregnancy and low-risk patients without COVID-19 in pregnancy, to ascertain if third trimester growth ultrasound is warranted in this patient population.
STUDY DESIGN
We performed a retrospective cohort study of low-risk pregnant patients (who had no other indications for sonographic fetal surveillance during the third trimester) with and without COVID-19 during pregnancy. Patient demographics, gestational dating, neonatal birthweights, and corresponding Alexander growth curve birthweight percentiles were collected. The primary outcome was small-for-gestational age (SGA) neonates, defined as birthweight <10th percentile for gestational age at delivery (SGA10).
RESULTS
Our cohort (N=513) included 248 COVID-19-exposed patients and 265 patients who did not have COVID-19 during pregnancy. Gestational age at delivery and average neonatal birthweights were similar in COVID-19 exposed (38 weeks 5 days, 3,266 grams) and unexposed patients (38 weeks 4 days, 3,224 grams P=0.434, P=0.358). Rates of SGA10 neonates were similar in the COVID-19 exposed (22/248, 8.9%) and unexposed (23/265, 8.7%, P=0.939). Timing and severity of COVID-19 during pregnancy also were not associated with rates of SGA neonates.
CONCLUSION
In a cohort of low-risk patients, rates of SGA neonates were similar in patients with and without COVID-19 during pregnancy. These findings suggest that ultrasound surveillance to detect fetal growth restriction in low-risk patients with COVID-19 during pregnancy is not warranted.
PubMed: 38955216
DOI: 10.1055/a-2358-9710 -
American Journal of Veterinary Research Jul 2024To develop an innovative process for stereotactic brain biopsies in dogs and cats that would provide a definitive diagnosis and optimize the management of patients with...
Using a three-dimensional-printed device with the patient's maxillary dental impression allows to perform minimally invasive brain biopsies in dogs and cats: a preliminary study.
OBJECTIVE
To develop an innovative process for stereotactic brain biopsies in dogs and cats that would provide a definitive diagnosis and optimize the management of patients with brain lesions.
ANIMALS
4 dogs and 1 cat diagnosed with 1 or more brain lesion(s) underwent brain biopsies between March 24, 2023, and October 25, 2023.
METHODS
Based on trajectories selected on images of MRI and CT scan performed on each patient, a computerized software program was used to design a 3-D-printed patient-specific device with maxillary dental impression located on a baseplate to secure the patient's head and with insertion ports for the biopsy instrumentations located on a C-arm. As proof of concept, the device was successfully used in 2 cadavers before being used on clinical patients. All biopsy samples were submitted for histopathological examination.
RESULTS
Histological diagnosis was obtained in 80% (4/5) of the cases (choroid plexus tumor, astrocytoma, meningioma, and chronic meningoencephalitis of unknown origin). In 1 patient, the results of biopsy were nondiagnostic; postmortem diagnosis was consistent with a low-grade oligodendroglioma. All the patients were discharged within 24 hours after the procedure without complications. This novel stereotactic system allows the surgeon to perform safe, easy-to-use, inexpensive, and minimally invasive precise brain biopsies in dogs and cats, without complications.
CLINICAL RELEVANCE
This unique technique could be applied to any size and type of skull and for any type of brain lesions and would provide diagnostic information that would be valuable for future treatment planning and prognosis.
PubMed: 38955214
DOI: 10.2460/ajvr.24.04.0122 -
Arquivos de Neuro-psiquiatria Jul 2024Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder with a wide clinical, cognitive, and behavioral expressivity.
BACKGROUND
Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder with a wide clinical, cognitive, and behavioral expressivity.
OBJECTIVE
To assess the neuropsychological profile of individuals clinically diagnosed with TSC and the factors that could significantly impact their cognitive development.
METHODS
A total of 62 individuals with ages ranging from 3 to 38 years were followed up in a tertiary attention hospital in Southern Brazil, and they were assessed using a standard battery and the Vineland Adaptive Behavior Scales, when intellectual disability was observed.
RESULTS
History of epilepsy was found in 56 participants (90.3%), and 31 (50%) presented an intellectual disability. Among the other half of TSC individuals without intellectual disability, 8 (12.9%) presented borderline classification, 20 (32.2%) presented average scores, and 3 (4.8%) were above average. In total, 17 participants (27.4%) fulfilled the diagnostic criteria for autism spectrum disorder. The results of the multiple linear regression analysis suggested that seizures, age at diagnosis, visual perception, and general attention significantly impact cognitive performance indexes.
CONCLUSION
The present study suggests that the occurrence of epileptic seizures and older age at diagnosis contribute to higher impairment in the domains of cognitive development, underlining the importance of early diagnosis and the prevention of epileptic seizures or their rapid control. The development of attentional skills, visual perception, and executive functions must be followed up.
Topics: Humans; Tuberous Sclerosis; Male; Female; Child; Neuropsychological Tests; Adolescent; Adult; Young Adult; Brazil; Child, Preschool; Intellectual Disability; Cognition; Epilepsy; Autism Spectrum Disorder; Cohort Studies; Cognition Disorders
PubMed: 38955213
DOI: 10.1055/s-0044-1787797 -
Laryngo- Rhino- Otologie Jul 2024Allergies play a pivotal role in the daily practice of ENT specialists. Allergic symptoms induced by inhalant allergens are widespread in the population and can manifest... (Review)
Review
Allergies play a pivotal role in the daily practice of ENT specialists. Allergic symptoms induced by inhalant allergens are widespread in the population and can manifest through a wide range of symptoms, including rhinorrhea, sneezing, conjunctival redness, cough and dyspnea. Inconsistent diagnosis and treatment of allergic conditions can lead to reduced quality of life, decreased work performance, and socioeconomically significant secondary diseases. In addition to the medical history, the skin prick test and serological IgE diagnostics are the most important diagnostic procedure for detecting type-I allergies. To clarify clinical relevance, molecular diagnostics and nasal provocation testing may be employed. The key to effective treatment lies in a comprehensive allergological diagnosis coupled with a detailed patient history. General treatment recommendations such as allergen avoidance and nasal irrigation should complement pharmacological therapy. In the treatment of allergic rhinitis topical steroids are first line treatment options. The primary goal of treatment is symptom control, and if control is insufficient, causal therapy through specific allergen immunotherapy is recommended. Challenges in the ENT clinic involve selecting the necessary diagnostics and appropriate, effective treatments. Hence, using diagnostic and treatment algorithms, as well as standardized patient history questionnaires, can serve as invaluable tools in daily patient interactions, especially considering limited time availability.
Topics: Humans; Immunoglobulin E; Skin Tests; Desensitization, Immunologic; Referral and Consultation; Hypersensitivity
PubMed: 38955155
DOI: 10.1055/a-2073-9474 -
Computers in Biology and Medicine Jul 2024Intervertebral disc disease, a prevalent ailment, frequently leads to intermittent or persistent low back pain, and diagnosing and assessing of this disease rely on...
Intervertebral disc disease, a prevalent ailment, frequently leads to intermittent or persistent low back pain, and diagnosing and assessing of this disease rely on accurate measurement of vertebral bone and intervertebral disc geometries from lumbar MR images. Deep neural network (DNN) models may assist clinicians with more efficient image segmentation of individual instances (discs and vertebrae) of the lumbar spine in an automated way, which is termed as instance image segmentation. In this work, we proposed SymTC, an innovative lumbar spine MR image segmentation model that combines the strengths of Transformer and Convolutional Neural Network (CNN). Specifically, we designed a parallel dual-path architecture to merge CNN layers and Transformer layers, and we integrated a novel position embedding into the self-attention module of Transformer, enhancing the utilization of positional information for more accurate segmentation. To further improve model performance, we introduced a new data synthesis technique to create synthetic yet realistic MR image dataset, named SSMSpine, which is made publicly available. We evaluated our SymTC and the other 16 representative image segmentation models on our private in-house dataset and public SSMSpine dataset, using two metrics, Dice Similarity Coefficient and the 95th percentile Hausdorff Distance. The results indicate that SymTC surpasses the other 16 methods, achieving the highest dice score of 96.169 % for segmenting vertebral bones and intervertebral discs on the SSMSpine dataset. The SymTC code and SSMSpine dataset are publicly available at https://github.com/jiasongchen/SymTC.
PubMed: 38955128
DOI: 10.1016/j.compbiomed.2024.108795 -
Pathology, Research and Practice Jun 2024Cancer is a serious disease that can affect various parts of the body such as breast, colon, lung or stomach. Each of these cancers has their own treatment dependent...
Cancer is a serious disease that can affect various parts of the body such as breast, colon, lung or stomach. Each of these cancers has their own treatment dependent historical subgroups. Hence, the correct identification of cancer subgroup has almost same importance as the timely diagnosis of cancer. This is still a challenging task and a system with highest accuracy is essential. Current researches are moving towards analyzing the gene expression data of cancer patients for various purposes including biomarker identification and studying differently expressed genes, using gene expression data measured in a single level (selected from different gene levels including genome, transcriptome or translation). However, previous studies showed that information carried by one level of gene expression is not similar to another level. This shows the importance of integrating multi-level omics data in these studies. Hence, this study uses tumor gene expression data measured from various levels of gene along with the integration of those data in the subgroup classification of nine different cancers. This is a comprehensive analysis where four different gene expression data such as transcriptome, miRNA, methylation and proteome are used in this subgrouping and the performances between models are compared to reveal the best model.
PubMed: 38955118
DOI: 10.1016/j.prp.2024.155419 -
Talanta Jun 2024Accurate and sensitive determination of human immunoglobulin G (HIgG) level is critical for diagnosis and treatment of various diseases, including rheumatoid arthritis,...
Accurate and sensitive determination of human immunoglobulin G (HIgG) level is critical for diagnosis and treatment of various diseases, including rheumatoid arthritis, humoral immunodeficiencies, and infectious disease. In this study, versatile tri-signal probes were developed by preparing CdS@SiO nanorods that integrate photoluminescence (PL), multi-phonon resonant Raman scattering (MRRS) and infrared absorption (IRA) properties. Through the coating of multiple CdS nanoparticles as cores within SiO shells, the PL and MRRS properties of CdS were improved, resulting in a significantly lowered limit of detection (LOD), with the lowest LOD of 12.37 ag mL. Integration with the distinctive IRA property of SiO shells widened the detection range towards higher concentrations, establishing a final linear range of 50 ag mL to 10 μg mL. The remarkable consistency among the three signals highlighted the robust internal verification capability for accurate detection. This approach enhances flexibility in selecting detection methodologies to suit diverse scenarios, facilitating HIgG detection. The tri-signal nanoprobes also exhibited excellent detection selectivity, specificity and repeatability. This study presents a fresh idea for developing high-performance detection strategies.
PubMed: 38955105
DOI: 10.1016/j.talanta.2024.126495 -
International Journal of Surgery Case... Jun 2024Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare...
INTRODUCTION AND IMPORTANCE
Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky.
CASE PRESENTATION
We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days.
CASE DISCUSSION
Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ.
CONCLUSION
Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.
PubMed: 38954968
DOI: 10.1016/j.ijscr.2024.109976 -
International Journal of Surgery Case... Jun 2024Chondrosarcomas are the third most frequent malignant bone tumors. With pelvic bones being their most common primary location, diagnosis and treatment of these tumors is...
INTRODUCTION AND IMPORTANCE
Chondrosarcomas are the third most frequent malignant bone tumors. With pelvic bones being their most common primary location, diagnosis and treatment of these tumors is especially challenging due to the diverse clinical manifestations and involvement of critical anatomic structures. We present the case of a grade III pelvic chondrosarcoma of the left iliopubic branch managed through a multidisciplinary approach.
CASE PRESENTATION
A 26-year-old male patient presented with a 1-year history of a mass in the left iliopubic branch. The imaging findings suggested chondrosarcoma and showed extrinsic compression of pelvic structures causing right hydronephrosis, marked elongation and tortuosity of the sigmoid colon, and anterior and superior displacement of the bladder. Following multidisciplinary meeting it was decided to perform a left hemicolectomy, colostomy, and internal hemipelvectomy in the 1-2-3 left zones, with resection of the intrapelvic and intra-abdominal tumor, and preservation of the left lower extremity. The patient presented two episodes of intestinal obstruction, which resolved with medical management. Was discharged without presenting further complications.
CLINICAL DISCUSSION
Chondrosarcomas management demands a methodical approach. Appropriate surgical strategy requires individualization according to the characteristics of the lesion and the degree of involvement of surrounding structures. Complete resection of the tumor and preservation of the lower extremity function are critical achievements.
CONCLUSION
This case underscores the effective management of a challenging tumor such as pelvic chondrosarcoma. The multidisciplinary approach and collaboration of several specialties was crucial to reach an appropriate surgical strategy.
PubMed: 38954964
DOI: 10.1016/j.ijscr.2024.109860 -
Medical Image Analysis Jun 2024Accurate histopathological subtype prediction is clinically significant for cancer diagnosis and tumor microenvironment analysis. However, achieving accurate...
Accurate histopathological subtype prediction is clinically significant for cancer diagnosis and tumor microenvironment analysis. However, achieving accurate histopathological subtype prediction is a challenging task due to (1) instance-level discrimination of histopathological images, (2) low inter-class and large intra-class variances among histopathological images in their shape and chromatin texture, and (3) heterogeneous feature distribution over different images. In this paper, we formulate subtype prediction as fine-grained representation learning and propose a novel multi-instance selective transformer (MIST) framework, effectively achieving accurate histopathological subtype prediction. The proposed MIST designs an effective selective self-attention mechanism with multi-instance learning (MIL) and vision transformer (ViT) to adaptive identify informative instances for fine-grained representation. Innovatively, the MIST entrusts each instance with different contributions to the bag representation based on its interactions with instances and bags. Specifically, a SiT module with selective multi-head self-attention (S-MSA) is well-designed to identify the representative instances by modeling the instance-to-instance interactions. On the contrary, a MIFD module with the information bottleneck is proposed to learn the discriminative fine-grained representation for histopathological images by modeling instance-to-bag interactions with the selected instances. Substantial experiments on five clinical benchmarks demonstrate that the MIST achieves accurate histopathological subtype prediction and obtains state-of-the-art performance with an accuracy of 0.936. The MIST shows great potential to handle fine-grained medical image analysis, such as histopathological subtype prediction in clinical applications.
PubMed: 38954942
DOI: 10.1016/j.media.2024.103251