Adherence to the Porto Criteria Based on the Hungarian Nationwide Pediatric Inflammatory Bowel Registry (HUPIR)

Objectives: According to the Porto criteria, upper endoscopy and ileocolonoscopy with histology for patients with pediatric inflammatory bowel disease (pIBD) are recommended with small bowel imaging (SBI). We aimed to evaluate the adherence to the Porto criteria and biopsy sampling practice and to evaluate the diagnostic yield of magnetic resonance enterography (MRE) first time in a nationwide pIBD inception cohort.Methods: Newly diagnosed pIBD cases (ages 0–18 years) are registered in the prospective, nationwide Hungarian Paediatric IBD Registry (HUPIR). We analyzed the diagnostic workup of patients recorded between the 1st of January 2007 and the 31st of December 2016.Results: Data for diagnostic workup was available in 1,523 cases. Forty percent of the cases had complied with the Porto criteria. Adherence to the Porto criteria increased significantly from 20 to 57% (p < 0.0001) between 2007 and 2016. The most frequent reason for the incomplete diagnostic work-up was the lack of small bowel imaging (59%). In 2007, 8% of cases had a biopsy from all segments, and this rate reached 51% by 2016 (p < 0.0001). We analyzed the diagnostic yield of MRE in 113 patients (10.1%), who did not have any characteristic lesion for Crohn's disease. The MRE was positive for the small bowel in 44 cases (39%).Conclusions: Adherence to the Porto criteria increased significantly during the 10-year period. This is the first study that reports multiple biopsy sampling as the less accepted recommendation. The diagnostic yield of MRE in patients without characteristic lesion for Crohn's disease is 39%.

Achieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic review

Background: Chronic Rhinosinusitis is currently classified into eosinophilic and non-eosinophilic, according to the histologic quantification of the number of eosinophils in nasal mucosa biopsy. There is a lack of unanimous histopathologic criteria and methodology for this classification and no consensus regarding a cut-off point for Eosinophils per High power field. Methodology: A systematic electronic search was performed on BVS, PUBMED, PUBMED PMC, SCOPUS, WEB OF SCIENCE, EMBASE, COCHRANE and PROQUEST databases looking for studies that reported a cut point for classification of Eosinophilic Chronic Rhinosinusitis (eCRS), and data concerning methodology of classification was extracted. Results: We identified 142 studies that reported 29 different cut-off values for classification of eCRS, and different methods of histologic analysis. Out of these studies 13 reported their own methodology to establish the cut-off point, and used different reference standards as polyp recurrence, asthma and allergy, immunocytochemistry, quality of life index, standard deviation of the control population and cluster analysis. Conclusions: Further studies are needed to determine a precise cut-off point, especially international multicentered cluster analysis. Moreover, methodologic standardization of biopsy and analysis is needed to certify comparable results. Multiple biopsy sites, densest cellular infiltration area examination and oral steroids restriction at least four weeks before sampling are advisable.

The histopathological synovitis score is influenced by biopsy location in patients with knee osteoarthritis

Introduction Osteoarthritis (OA) and rheumatoid arthritis (RA) represent the most common forms of arthritis, which are mainly caused by mechanical and inflammatory components, respectively. Determination of synovial inflammation in synovial biopsies via the histopathological Krenn score may be crucial for correct diagnosis and treatment. Specifically, it remains unclear whether synovitis scores differ among multiple biopsy locations within a single joint. Materials and methods Eighty synovial samples were taken from four standardized regions of the knee in 20 patients (ten primary OA, ten secondary OA) undergoing total knee arthroplasty (TKA) or total synovectomy. The Krenn synovitis score (grade 0–9) was determined in a blinded manner by two expert pathologists in all biopsies. Next to the inter-rater reliability, we evaluated the agreement of the determined scores among the four biopsy locations within each knee. Results The inter-rater reliability between the two pathologists was very high (Cohen’s kappa = 0.712; r = 0.946; ICC = 0.972). The mean synovitis score was significantly higher in knees with secondary than in primary OA (p = 0.026). Importantly, we found clear differences between the scores of the four different biopsy locations within the individual knee joints, with an average deviation of 10.6%. These deviations were comparable in knees with primary and secondary OA (p = 0.64). Conclusions While we confirmed the synovitis score as a reliable and reproducible parameter to assess the histopathological synovitis grade in the knee, the considerable variability within the joint indicates that multiple synovial biopsies from different regions should be obtained to enable reliable results of the synovitis score.

Systemic sarcoidosis revealed by venepunctures: a very rare but rewarding cutaneous manifestation

A 67-year-old man was referred to our department for the onset of cutaneous lesions following venepunctures. His recent medical history included brief flu-like syndrome, persistent cough, dyspnoea, dry mouth, blurred vision and weight loss. The extensive clinical, biological and radiological check-up showed signs consistent with systemic sarcoidosis: right uveitis, hypercalcemia, renal failure, inflammatory syndrome, elevated levels of ACE, alveolitis with elevated CD4+/CD8+ T cell ratio, hilar and mediastinal lymphadenopathy, bilateral pulmonary infiltrates, mild bronchial obstruction and lowered diffusing capacity of the lungs for carbon monoxide. Multiple biopsy samples (bronchus, accessory salivary glands and one of the skin lesions) eventually confirmed the diagnosis. Corticosteroids resulted in skin lesions resolution in a few days and overall clinical, biological and lung function improvement. The infiltration of scars by granulomatous tissue is well recognised in sarcoidosis but its onset in venepuncture sites is a very rare but easily recognisable condition, which can be helpful for quick diagnosis purpose.

Detection of prostate cancer and determination of its significance using explainable artificial intelligence.

5555 Background: The variation of the human perception has limited the potential of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in determining prostate cancer and identifying significant prostate cancer. The current study aims to overcome this limitation and utilizes an explainable artificial intelligence to leverage the diagnostic potential of mpMRI in detecting prostate cancer (PCa) and determining its significance. Methods: A total of 6,020 MR images from 1,498 cases were considered (1,785 T2 images, 2,719 DWI images, and 1,516 ADC maps). The treatment determined the significance of PCa. Cases who received radical prostatectomy were considered significant, whereas cases with active surveillance and followed for at least two years were considered insignificant. The negative biopsy cases have either a single biopsy setting or multiple biopsy settings with the PCa exclusion. The images were randomly divided into development (80%) and test sets (20%) after stratifying according to the case in each image type. The development set was then divided into a training set (90%) and a validation set (10%). We developed deep learning models for PCa detection and the determination of significant PCa based on the PlexusNet architecture that supports explainable deep learning and volumetric input data. The input data for PCa detection was T2-weighted images, whereas the input data for determining significant PCa include all images types. The performance of PCa detection and determination of significant PCa was measured using the area under receiving characteristic operating curve (AUROC) and compared to the maximum PiRAD score (version 2) at the case level. The 10,000 times bootstrapping resampling was applied to measure the 95% confidence interval (CI) of AUROC. Results: The AUROC for the PCa detection was 0.833 (95% CI: 0.788-0.879) compared to the PiRAD score with 0.75 (0.718-0.764). The DL models to detect significant PCa using the ADC map or DWI images achieved the highest AUROC [ADC: 0.945 (95% CI: 0.913-0.982; DWI: 0.912 (95% CI: 0.871-0.954)] compared to a DL model using T2 weighted (0.850; 95% CI: 0.791-0.908) or PiRAD scores (0.604; 95% CI: 0.544-0.663). Finally, the attention map of PlexusNet from mpMRI with PCa correctly showed areas that contain PCa after matching with corresponding prostatectomy slice. Conclusions: We found that explainable deep learning is feasible on mpMRI and achieves high accuracy in determining cases with PCa and identifying cases with significant PCa.

Biopsy darting of common bottlenose dolphins (Tursiops truncatus) in southern Brazil: evaluating effectiveness, short-term responses and wound healing

Cetacean biopsy sampling is a widely used technique with undisputable scientific value. Although it is generally considered as a harmless technique with no apparent long-lasting effects, studies have recommended examining behavioral responses to evaluate potential impacts on individuals, groups and sampled populations. In this study, we evaluated individual behavioral reactions and wound-healing in common bottlenose dolphins (Tursiops truncatus) during a biopsy sampling program carried out in southern Brazil from 2003 to 2012, and compared sampling effectiveness between dedicated and opportunistic sampling surveys. Two hundred and fiftytwo biopsy attempts were made, resulting in 118 hits (48% of attempts) and 134 samples (52% of attempts) collected successfully. Responses to biopsy sampling were low-level, of short-term duration, and elicited similar reactions on the dolphins, irrespective of shot distance, sex of individuals, dolphins’ group size and pre-behavioral state. Dolphins subjected to multiple biopsy attempts reacted in a similar manner as in previous attempt(s), with no evidence of increasing the intensity of the reaction. Wounds could be monitored in 18 animals and healed over 18 to 35 days. Generally, wounds appeared to be covered by epidermis in about three weeks with no observed signs of skin infection. Our results agree with previous studies suggesting that biopsy sampling does not cause significant disturbance to the behavior of dolphins. At a local level, this study demonstrates that biopsy sampling of bottlenose dolphins in the Patos Lagoon Estuary is more effective, less costly and less intrusive when conducted opportunistically, but that long-term sampling is required to achieve a relatively good sample size from photoidentified individuals in the population.