Fast Medical Image Auto-segmentation for Bleeding Gastric Tissue Detection based on Deep DuS-KFCM Clustering

Detection and classification of gastric bleeding tissues are one of the challenging tasks in endoscopy image analysis. Lesion detection plays an important role in gastric cancer (GC) diagnosis and follow-up. Manual segmentation of endoscopy images is a very time-consuming task and subject to intra- and inter-rater variability. Accurate GB segmentation in abdominal sequences is an essential and crucial task for surgical planning and navigation in gastric lesion ablation. However, GB segmentation in endoscope is a substantially challenging work because the intensity values of gastric blood are similar to those of adjacent structures. Objective: In this paper the idea is to combine two parts: Neural Network and Fuzzy Logic--Hybrid Neuro-Fuzzy system. The objective of this manuscript is to provide an efficient way to segment the gastric bleeding lesion area. This work focuses on design and development of an automated diagnostic system using gastric bleeding cancer endoscopy images. Methods: In this paper, a coarse-to-fine method was applied to segment gastric bleeding lesion from endoscopy images, which consists of two stages including rough segmentation and refined segmentation. The rough segmentation is based on a kernel fuzzy C-means algorithm with spatial information (SKFCM) algorithm combined with spatial gray level co-occurrence matrix (GLCM) and the refined segmentation is implemented with deeplabv3+ (backbone with resnet50) algorithm to improve the overall accuracy. Results: Experimental results for gastric bleeding segmentation show that the method provides an accuracy of 87.9476% with specificity of 96.3343% and performs better than other related methods. Conclusions: The performance of the method was evaluated using two benchmark datasets: The GB Segmentation and the healthy datasets. Then use the gastric red spots (GRS) dataset to do the final test to verify weak bleeding symptoms. Our method achieves high accuracy in gastric bleeding lesion segmentation. The work describes an innovative way of using GLCM based textural features to extract underlying information in gastric bleeding cancer imagery. Modified deep DuS-KFCM endoscopy image segmentation method based on GLCM feature, The experimental results shown to be effective in image segmentation and has good performance of resisting noise, segmentation effect more ideal.

Efficacy of vonoprazan against bleeding from endoscopic submucosal dissection-induced gastric ulcers under antithrombotic medication: A cross-design synthesis of randomized and observational studies

Vonoprazan, a potassium-competitive acid blocker, is expected to be superior to proton pump inhibitors (PPIs) in preventing post-endoscopic submucosal dissection (ESD)-induced gastric bleeding. However, the results of randomized controlled trials (RCTs) and observational studies on the efficacy of vonoprazan have been inconsistent. This study aimed to evaluate the effectiveness of vonoprazan in antithrombotic drug users, a population that has been excluded from RCTs. Treatment effects were assessed using cross-design synthesis, which can be adjusted for differences in study design and patient characteristics. We used data from an RCT in Japan (70 patients in the vonoprazan group and 69 in the PPI group) and an observational study (408 patients in the vonoprazan group and 870 in the PPI group). After matching, among the antithrombotic drug users in the observational study, post-ESD bleeding was noted in 8 out of 86 patients in the vonoprazan group and 18 out of 86 patients in the PPI group. After pooling the data from the RCT and observational study, the risk difference for antithrombotic drug users was -14.6% (95% CI: -22.0 to -7.2). CDS analysis suggested that vonoprazan is more effective than PPIs in preventing post-ESD bleeding among patients administered antithrombotic medications.

First Clinical Experience of Venous Reconstruction With Autologous Vascular Prosthesis From the Sickle Ligament of the Liver With Partial Portosystemic Bypass Surgery

Aim of study. Presentation of our own first clinical experience of venous reconstruction in portosystemic bypass surgery with the use of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of liver cirrhosis of viral etiology.Material and methods. Clinical observation of a patient born in 1978 with a diagnosis of cirrhosis of the liver of viral etiology (HCV) Child-Pugh A (6). MELD 10 points. Inactive phase. Intrahepatic portal hypertension syndrome. Esophageal varices grade III according to A. G. Scherzinger, gastric varices type I (GOV1) according to Sarin. Condition after repeated recurrent esophageal-gastric bleeding. Due to the high risk of another bleeding, as a secondary prevention of esophageal-gastric bleeding, partial splenorenal anastomosis of “H” - type was performed with the use of an autologous vascular prosthesis of the falciform ligament of the liver in the splenorenal position.Results. A flap measuring 60.0x20.0 mm was cut from the falciform ligament of the patient’s liver. From the latter, after adjusting the size of the graft to the individual needs of the patient, an autologous conduit was formed. It was used as an insert in the formation of an “H” - type splenorenal anastomosis with the imposition of two end-to-side anastomoses between the splenic vein and one end of the conduit and between the left renal vein and the other end of the conduit. The patency of the anastomosis was checked using intraoperative sonography. In a satisfactory condition, the patient was discharged for outpatient follow-up treatment at the place of residence. At the moment of writing the article, the follow-up period was 8 months. The bleeding did not recur. No varicose veins were found in the esophagus and stomach during control endoscopic examinations. The patency of the splenorenal shunt was confirmed by ultrasound dopplerography.Conclusion. The first clinical experience of venous reconstruction with portosystemic bypass surgery using as a possible replacement of autologous vascular prostheses of the falciform ligament of the liver in the splenorenal position in a patient with portal hypertension syndrome in the outcome of cirrhosis of the liver of viral etiology gives hope for the possibility of further successful testing of this method of splenorenal bypass surgery to reduce the risk of bleeding from varicose veins.

Efficacy of radiotherapy for gastric bleeding associated with advanced gastric cancer

Background Gastric bleeding negatively impacts the quality of life of patients with unresectable advanced gastric cancer and is frequently lethal. We investigated the efficacy of RT for palliation of gastric bleeding from gastric cancer and identified an optimal radiotherapy (RT) strategy. Methods The study analyzed 57 patients submitted to palliative RT for gastric bleeding associated with gastric cancer between January 2009 and February 2019. Changes in hemoglobin (Hb) levels were analyzed based on measurements taken before and immediately, 1 month, and 2 months after RT. Re-bleeding after RT was identified as either Hb level dropping to < 7.0 g/dL or the administration of a blood transfusion after RT. Results The median biologically effective dose (α/β = 10) was 37.5 Gy (range 23.6–58.5). The most common regimen was 25 Gy in five fractions. The mean Hb levels before, immediately after, 1 month, and 2 months after RT (6.6, 9.7, 10.3, and 9.7 g/dL, respectively) were significantly higher than that before RT (all p < 0.001). No significant differences in re-bleeding rates were observed according to total dose, fractional dose, and fraction number. Gastric tumor response evaluated by computed tomography within 2 months after RT showed partial responses were more frequent in patients achieving bleeding control (25.0% vs. 10.8%, p = 0.023) and overall survival was significantly improved for bleeding control within 3 months after RT (median, 15.4 vs. 10.0 weeks, p = 0.048). Conclusions RT was an effective modality for gastric bleeding control in gastric cancer, which can be achieved with a short course scheme with five fractions.

SURGICAL STRATEGY OF PATIENTS WITH STOMACH CANCER COMPLICATED WITH ACUTE GASTRIC BLEEDING

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with acute gastric bleeding. Materials and methods. It was shown the analysis of results of surgical treatment of 252 patients with stomach cancer complicated with acute gastric bleeding, which got the hospital treatment at GI “V. T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine“ from 2010 till 2019, aged 29 till 76. All patients randomly divided on 2 groups: the group of control — 129 patients (got the hospital treatment from 2010 till 2014), and the basic group — 123 patients (from 2015 till 2019). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic was used at the basic group. Radical surgery was performed in 120 (47.6%) cases; in 132 (52,4%) cases – palliative and symptomatic(the 121(48,0%) cases of it was major abdominal surgery). Postoperative complications occurred in 79 patients (31.1%) and postoperative mortality in 7.9% (20 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic with wide using of minimally invasive procedure for the treatment of patients with stomach cancer complicated with acute gastric bleeding. Using of this tactic leads to increasing of quantity of radical operations from 38(29,2%) at the group of control till 82(72,8%) at the basic group and leads to decreasing post-operative deaths from 8,5 % till 7,2 % respectively.

An extremely rare case of a gastric accessory spleen: case report and review of the literature

Background The accessory spleen has no anatomical or vascular relationship with the normal spleen, The tissue structure and physiological function of the accessory spleen are the same as those of the normal spleen, which usually locate in the splenic hilum and the tail of the pancreas. The aims of this manuscript are to present a rare case of the gastric accessory spleen and a review of the literature. Case presentation A 19-year-old male patient was sent to the emergency department with stomach bleeding after drinking alcohol. The computed tomographic scan showed a 1.2 cm × 1.7 cm mass at the lesser curvature of the gastric fundus. Gastrointestinal endoscopy displayed a submucosal elevated lesion on the gastric fundus, and gastrectomy was performed. Postoperative pathological examination proved an accessory spleen in the stomach. The postoperative course was uneventful, and the patient was discharged on the 6th day after the surgery. Conclusions The accessory spleen at the fundus of stomach is extremely rare, especially in this case, which is accompanied by acute gastric bleeding, and it is difficult to diagnosis before operation. Many literatures reported that it was misdiagnosis as tumor, so it is necessary to diagnose accessory spleen correctly.

Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

Indomethacin has been widely used in preterm infants with hemodynamically significant patent ductus arteriosus (PDA). Gastrointestinal complications of indomethacin have been reported in 5% of treated neonates. However, massive gastric mucosa hemorrhage is a rarely reported complication. To the best of our knowledge, the infant in this report is the smallest reported in the literature to have undergone successful surgery for such a complication. A male preterm infant weighing 566 g was born at 252/7 weeks of gestational age without a complicated maternal history. Soon after birth, he received nasal noninvasive respiratory support and minimal feeding. PDA was observed since the first day of life (DOL), treatments were initiated on the second DOL for the hemodynamical significance, and PDA was closed after two courses of indomethacin therapy (0.2 mg/kg). At midnight on the seventh DOL, generalized pallor, bloody gastric drainage, and a distended stomach were observed. Massive gastric bleeding was suspected. He suffered from intermittent hypotension, which was corrected with blood products and fluid resuscitation under monitoring with a radial arterial line. Gastric lavage with cooling saline was performed twice but in vain. Prior to surgical consultation, intravascular volume transfusion was given twice. An exploratory laparotomy was arranged after obtaining the parents’ consent. Blood oozing from the gastric mucosa was observed through gastrostomy and was successfully stopped via epinephrine-soaked gauze compression. After the operation, his clinical course remained uneventful, and he was discharged without neurological anomaly at two-year follow-up. Physicians need to be cautious of indomethacin’s effect on platelet dysfunction in preterm infants with multiple predisposing factors. The tendency for mucosal bleeding should be continuously monitored after indomethacin therapy.

Successful treatment of gastric bleeding due to left-sided portal hypertension by transcatheter arterial embolization (clinical case report)

Objective: to evaluate the results of transcatheter arterial embolization in patients with acute and chronic pancreatitis complicated by left-sided portal hypertension and bleeding from varicose veins of the stomach fundus and body. Materials and methods: 5 patients with left-sided portal hypertension were treated. Patients were admitted with a clinical picture of gastrointestinal bleeding, which was confirmed by laboratory and instrumental methods of research. Fibrogastroduodenoscopy revealed bleeding from varicose veins of the fundus and body of the stomach in all patients. The average age was 55.4±3.1 years. Results. All patients showed varicose veins of the fundus and body of the stomach, with signs of bleeding. Due to the high risk of recurrent bleeding, subtractive digital angiography with no signs of contrast agent extravasation was performed, followed by spiral embolization of the splenic artery in the proximal third until the blood flow was stopped. The technical and clinical success rate was 100%. Conclusion. Endovascular methods of treatment for left-sided portal hypertension syndrome are minimally invasive but highly effective methods of hemostasis. The indication for their use is unsuccessful endoscopic hemostasis or high risk of recurrence of bleeding from varicose veins of the fundus and body of the stomach.

Idarucizumab for the Reversal of Dabigatran-induced Anticoagulation in the Treatment of Gastric Bleeding: a Case Report

BACKGROUND:The drug instruction for dabigatran recommends the does adjustment 110 mg twice-a-day for the patient with bleeding risk, and at least 1 time of renal function test per year for moderate renal impairment. However, dabigatran still can be abnormal accumulation due to the chronic insidiously progressive renal insufficiency, which requiring idarucizumab to reverse the anticoagulation on account of acute erosive gastritis with extensive gastric mucosal bleeding.CASE SUMMARY: A 76-year-old female, with a history of Atrial Fibrillation (AF), took dabigatran 110 mg twice-a-day as recommended does adjustment to reduce the risk of stroke, and admitted to the hospital for the main complaints of hematemesis and melena. The laboratory findings showed severe life-threatening blood-loss anemia with hemoglobin (Hb) 41.0g/L, and significant coagulation abnormalities with thrombin time (TT) > 180s, most likely caused by dabigatran metabolic disorder. Aggressive acid suppressive, hemostatic and blood transfusion therapy brought out a short-time bleed-controlled misconception, which situation was exactly confirmed by re-bleeding. Idarucizumab was given timely to reverse the anticoagulation effect of dabigatran. 12 hours later, TT was tested as 17.4s which belonged to the normal range. Finally, she had no active bleeding signs, with labs showing Hb 104g/L and TT 17.7s.CONCLUSION:It is recommended to monitor renal function regularly, even coagulation function and dabigatran concentration, for the elder. There is at present no general agreement on the use of Proton Pump Inhibitor (PPI)–dabigatran coadministration to prevent upper gastrointestinal bleeding.

Cytotoxicity and Anti-Inflammatory Activity of Tamarillo (Solanum betaceum Cav.) Peel Extract in Lipopolysaccharide Stimulated RAW 264.7 Cells

Abstrak: Obat anti inflamasi sering diresepkan dalam bidang kedokteran gigi. Umumnya obat-obat ini memiliki efek samping beragam, dari yang ringan hingga parah seperti perdarahan lambung. Oleh karena itu, bahan anti inflamasi yang alami dan lebih aman diperlukan sebagai alternatif. Solanum betaceum Cav., dikenal sebagai terong Belanda, merupakan buah eksotik yang dapat juga dipergunakan sebagai bahan obat. Limbah buah seperti kulit dan biji biasanya tidak dikonsumsi. Beberapa penelitian menunjukkan bahwa limbah dari berbagai jenis buah mengandung senyawa bioaktif yang bermanfaat. Penelitian ini bertujuan untuk mengetahui sitotoksistas dan kemampuan anti-inflamasi dari ekstrak kulit terong Belanda terhadap makrofag lini RAW 264.7 yang diinduksi oleh lipopolisakarida (LPS). Sitotoksistas diuji untuk menentukan konsentrasi yang aman dengan menggunakan metode MTS. Aktivitas anti-inflamasi dinilai dengan membandingkan kadar PGE-2, TNF-α, dan IL-1β pada sel RAW 264.7 yang distimulasi LPS antara kelompok yang diberikan ekstrak dan yang tidak diberikan ekstrak menggunakan metode ELISA. Hasil penelitian mendapatkan bahwa ekstrak kulit terong Belanda dapat menekan produksi PGE-2, TNF-α, dan IL-1β pada sel RAW 264.7 yang diinduksi dengan LPS. Simpulan penelitian ini ialah ekstrak kulit Solanum betaceum Cav memiliki kemampuan antiinflamasi melalui penekanan produksi PGE-2, TNF-α, dan IL-1β pada sel RAW 264.7 yang diinduksi LPS.Kata kunci: ekstrak kulit Solanum betaceum Cav. (terong Belanda), sitotoksistas, antiinflamasi Abstract: Anti-inflammatory agents are commonly prescribed in dentistry. Most of them have side effects varying from mild to severe such as gastric bleeding. Therefore, a safer and natural anti-inflammatory agent is needed as an alternative. Solanum betaceum Cav., known as tamarillo, is one of exotic fruits used in traditional medicines. The fruit wastes such as peels and seeds, are usually unconsumed. However, many investigators have reported that wastes from numerous fruits had potent bioactive compounds. This study was aimed to assess the cytotoxicity and anti-inflammatory activities of tamarillo peel extract (TPE) in lipopolysaccharide (LPS) stimulated RAW 264.7 macrophage cell line. The cytotoxicity of TPE was performed to determine the non-toxic concentration by using MTS method. The inflammatory markers measured in this study were PGE-2, TNF-α, and IL-1β. Their concentrations were measured by using ELISA based assay. The anti-inflammatory activity was determined by comparing the reduction of the inflammatory mediators between the LPS stimulated RAW 264.7 cells treated with TPE and the non-treated group. This study revealed that TPE could reduce the production of PGE-2, TNF-α, and IL-1β in LPS stimulated RAW 264.7 cells. In conclusion, tamarillo peel extract possess an anti-inflammatory effect by reducing the production of PGE-2, TNF-α, and IL-1β in LPS stimulated RAW 264.7 cells.Keywords: Solanum betaceum Cav. (tamarillo) peel extract, cytotoxicity, anti-inflammatory