3D AGSE-VNet: an automatic brain tumor MRI data segmentation framework

Background Glioma is the most common brain malignant tumor, with a high morbidity rate and a mortality rate of more than three percent, which seriously endangers human health. The main method of acquiring brain tumors in the clinic is MRI. Segmentation of brain tumor regions from multi-modal MRI scan images is helpful for treatment inspection, post-diagnosis monitoring, and effect evaluation of patients. However, the common operation in clinical brain tumor segmentation is still manual segmentation, lead to its time-consuming and large performance difference between different operators, a consistent and accurate automatic segmentation method is urgently needed. With the continuous development of deep learning, researchers have designed many automatic segmentation algorithms; however, there are still some problems: (1) The research of segmentation algorithm mostly stays on the 2D plane, this will reduce the accuracy of 3D image feature extraction to a certain extent. (2) MRI images have gray-scale offset fields that make it difficult to divide the contours accurately. Methods To meet the above challenges, we propose an automatic brain tumor MRI data segmentation framework which is called AGSE-VNet. In our study, the Squeeze and Excite (SE) module is added to each encoder, the Attention Guide Filter (AG) module is added to each decoder, using the channel relationship to automatically enhance the useful information in the channel to suppress the useless information, and use the attention mechanism to guide the edge information and remove the influence of irrelevant information such as noise. Results We used the BraTS2020 challenge online verification tool to evaluate our approach. The focus of verification is that the Dice scores of the whole tumor, tumor core and enhanced tumor are 0.68, 0.85 and 0.70, respectively. Conclusion Although MRI images have different intensities, AGSE-VNet is not affected by the size of the tumor, and can more accurately extract the features of the three regions, it has achieved impressive results and made outstanding contributions to the clinical diagnosis and treatment of brain tumor patients.

Evaluation of Procalcitonin and Interleukin-6 as a Marker of Bacterial Urinary Tract Infection

Urinary tract infection (UTI) is a major clinical problem in a wide age range that is associated with a high morbidity rate. Due to issues such as low specificity and the inability to differentiate between different types of infection in current diagnostic methods, there is a need to introduce novel UTI markers. The present study was conducted to evaluate the utility of Procalcitonin (PCT) and interleukin-6 (IL-6) as a marker of bacterial urinary tract infection. For this purpose, a cross-sectional study was conducted between November 2020 and February 2021 among 125 patients and 60 healthy volunteers (control) in Erbil Teaching Hospital. The concentration of PCT and IL-6 was quantified using the ELISA cloud immunoassay test. Between-group comparisons were assessed for the variables with analysis of variance. The results revealed that there was a significant difference between PCT levels in UTI patients (104.6±6.07) and control groups (54±2.24) (p <0.0001). The differences in IL-6 concentration in UTI patients (55.74±4.2) and control groups (24.56±2.4) were also significant (p <0.0001), implying that the level of both PCT and IL-6 increased due to bacterial infection in the urinary tract. As a whole, the findings of this study provide

Opportunities and Limitations of Pelvic Exenteration Surgery

Purpose: The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. Methods: This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993–2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. Results: A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2–5%), the still relatively high morbidity rate (32–84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79–82% of patients report satisfying results according to PROs (patient-reported outcomes). Conclusion: Due to multimodality treatment strategies combined with extended surgical expertise and patients’ preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.

P-BN54 The outcomes after a Laparoscopic subtotal cholecystectomy

Background Laparoscopic subtotal cholecystectomy (LSC) is a recognised option when the “critical view” cannot be safely delineated. It carries a high morbidity rate as there are increased frequencies of a bile leak occurring however reducing the risk of bile duct injury. LSC can be further divided into fenestrating or reconstituting cholecystectomy, the later entails closing the remnant. The literature state reconstituting cholecystectomy reduced rate of bile leak. We reviewed our cases to analyse the complication rates of LSC and there outcomes. Methods A retrospective review of patients who underwent a laparoscopic subtotal cholecystectomy (LSC) using electronic records between January 2015 to March 2021. A total of 160 patients, with a mean age of 65, 51% male and 49% female. Results 76% of LSC were performed as an emergency. Mean operation length was 96min and the mean blood loss 92ml. Complications occurred in 50% of patients. Post operatively 22% underwent an ERCP and the re-operation rate was 9%. The mean length of stay was 8 days. Conclusions Based on our results LSC carry a high rate of bile leak with the majority requiring intervention in the form of ERCP or laparoscopy and wash out. A reconstituting cholecystectomy, closing with an endoloop of suture seems to slightly reduce the rate of bile leak. LSC are only performed when managing a difficult gallbladder with a dense/ inflamed Calot's triangle. There were no mortalities associated with a LSC.

The efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method

Background: The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers. Although breast abscess is a serious common complication of mastitis with high morbidity rate, there is a lack of high-quality randomized trial to demonstrate the best treatments.Methods: The Study was conducted in the Department of Surgery of Universal medical college and hospital, Dhaka, Bangladesh and MH Samorita hospital and medical college. It was a randomized controlled trial to see the efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method. Total 120 population were randomly selected in group A (60 patients) and group B (60 patients) and data was collected with their signed ethical consent. The study was conducted from January 2014 to December 2019. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using Statistical package for social sciences (SPSS) version 22.Results: In patients of group A, most breast abscesses healed successfully with a nicer circumareolar scar, earlier healing, lesser number of hospital visits and lower total cost as compared to patients in group B. There was early resumption of breastfeeding and better patient satisfaction seen in group A.Conclusions: Primary closure of lactational breast abscess following incision and drainage is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for larger and multilocular breast abscesses while traditional incision and drainage should be reserved for abscesses with gangrenous skin changes, where primary closure is not justified.

Retrospective Analysis of Complications and Causes of Mortality in Patients Undergoing Esophagectomy for Esophageal Cancer

Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity. Objective: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer. Material and Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Çukurova University Medical School Hospital were collected and analyzed retrospectively between January 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD grade , respectively. Results: The mean±SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56.38±11.00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0.034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups; however, a higher rate of respiratory complications was observed in Group 2 (P=0.038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2. Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of life in patients.

Pathology and Molecular Characterization of Porcine Sapelovirus in Indian Pigs

Background: The porcine sapelovirus (PSV) is a small, non-enveloped, single-stranded, positive-sense, RNA virus of the family Picornaviridae. The PSV infections in pigs have been found associated with diarrhoea, polioencephalomyelitis, pneumonia and reproductive disorders with a high morbidity rate. Despite of its economical importance very few studies are available on the pathology of PSV. The present study was conducted with the aim to investigate the PSV infection and associated pathology in Indian pigs. Methods: Tissue samples along with intestinal content were collected from a total of 78 necropsied cases for histopathological examination and molecular investigation during April 2019 to August 2020. The amplification of 5' UTR region of PSV was carried out via RT-PCR and confirmed by sequencing. The Genetic characterization of Indian isolate of the PSV was done on the basis of viral 5' UTR gene. Result: A total of eight out of 78 cases were found positive for the PSV. Catarrhal and haemorrhagic enteritis, thickening and clouding of brain meninges along with congestion of brain and pneumonia was observed as common gross lesions. Microscopic lesions included perivascular cuffing, focal gliosis, neuronophagia, congestion of meningeal and cerebral vessels, interstitial pneumonia, inflammatory changes in the intestinal mucosa and sloughing of villi. The genetic characterization revealed maximum identity of 96.89% with PSV-1 strain PSV-46-V (LC508233) and PSV-1 strain PSV-26-B (LC508232) of Zambia. This study reported the pathological and molecular investigation of PSV from Indian pigs. Further explorative surveillance along with experimental studies in suitable animal model and cell lines are highly warranted for better understanding of PSV pathology in Indian pigs.

Parents’ Perception on Childhood Obesity and its Prevention; a Population-Based Observational Study in Jazan, Saudi Arabia with Intention to Develop Self Instructional Module

Globally, Childhood obesity is one of the most serious public health challenges in the 21st century. In 2017, the Commission on Ending Childhood Obesity (ECHO) reported that worldwide obesity increased 10-fold among children and adolescents during the last 40 years. According to World Health Organization (WHO) & Childhood Obesity Surveillance Initiative (COSI) data, childhood obesity rates are highest in the Southern European Countries in the World. Childhood obesity is one of the most important public concerns due to increased incidence with a high morbidity rate. This study was intended to identify the parent's attitude on causes and its prevention of childhood obesity in Jazan province. With the Stratified Random sampling method, 100 obese children's parents were selected. Initially, personal information was obtained about a child and mother, and then "Google Form" 5-point Likert's scale was administered to assess parents' attitude on obesity and its prevention. It has four domains (General information on obesity - 2 questions, causes of obesity - 14, consequences of obesity - 4, and prevention of obesity - 10) with 30 questions. The results of the study are expressed as mean and standard deviation (mean percentage). The parent’s attitude score was expressed in terms of obesity 5.86 ± 1.27 (58.6%), causes 38.75 ± 6.52 (55.36%), consequences 11.65 ± 2.36 (58.25%) and prevention 29 ± 5.15 (58%). The overall mean score and standard deviation were 86.67 ± 13.81 (54.84%). The parents had an average attitude score (64.57%) on the causes and prevention of childhood obesity. There was no association between attitude scores with the demographic variables, except the variable age associated with attitude scores. Obesity prevention requires effective intervention measures. The research study proposed that family education and impulse are essential for treating childhood obesity. Schools play a significant role in promoting healthy eating habits and physical activity.

The past, present, prospects and problems of improving the specifi c prevention of brucellosis

Brucellosis remains the most widespread zoonotic infection in the world. Th e spread of the infection is controlled by animals vaccination because the high morbidity rate of the population is associated with the spread of infection among livestock. Th e research is ongoing on a commercial preparation of an eff ective and safe vaccine for immunization of humans and animals against brucellosis. Th e review is devoted to the prospects and problems of improving the specifi c prevention of brucellosis. Th e authors analyzed scientifi c publications from various databases of electronic libraries, such as PubMed, e-library, CyberLeninka, etc.

​Pathological and Molecular Investigation of Porcine Kobuvirus (PKV) from Indian Pigs

Background: The porcine kobuvirus (PKV) is a single-stranded, positive-sense, RNA virus of the family Picornaviridae which composed of small, non-enveloped viruses. The PKV is suspected to cause large outbreaks of diarrhoea and dehydration along with vomition in suckling piglets with a high morbidity rate. Despite of its economical importance very few studies are available on the pathology of PKV. The present study was conducted with the aim to investigate PKV in naturally infected Indian pigs. Methods: A total of 41 intestinal content and tissue samples from dead pigs were collected from post-mortem facility of, ICAR-IVRI during April, 2019 to July 2020. All the carcasses were subjected to detailed necropsy examination and appropriate tissue samples were collected for histopathological examination and molecular investigation. The amplification of 3D region of PKV was carried out via RT-PCR using the specific primers. The Genetic characterization of Indian isolate of the PKV was done on the basis of viral 3D gene of PKV. Result: A total of six out of 41 necropsied piglets were found positive for the PKV. The diarrhoea and dehydration were observed as the main clinical signs. The thickening and clouding of brain meninges, congestion of brain, pneumonia along with catarrhal and haemorrhagic enteritis was observed as common gross lesions. Microscopic lesions observed in brain were mild to moderate perivascular cuffing, congestion of meningeal and cerebral vessels, focal gliosis and neuronophagia. Mild to severe interstitial pneumonia and emphysema was noticed in lungs. Intestinal mucosa revealed severe inflammatory changes along with sloughing of villi. The genetic characterization revealed maximum identity of 91-93% with Indian isolate of PKV MH394282 and Chinese strain of PKV FJ459905. This study reported the first pathological investigation of PKV from Indian pigs and described the molecular findings in detail. Further explorative surveillance along with epidemiological studies are highly warranted to find out the real impact of the PKV on Indian pigs.