Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding

ABSTRACT Objectives: to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. Methods: this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied. Results: Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity. Conclusions: the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.

Automatic detection of vessel structure by deep learning using intravascular ultrasound images of the coronary arteries

Intravascular ultrasound (IVUS) is a diagnostic modality used during percutaneous coronary intervention. However, specialist skills are required to interpret IVUS images. To address this issue, we developed a new artificial intelligence (AI) program that categorizes vessel components, including calcification and stents, seen in IVUS images of complex lesions. When developing our AI using U-Net, IVUS images were taken from patients with angina pectoris and were manually segmented into the following categories: lumen area, medial plus plaque area, calcification, and stent. To evaluate our AI’s performance, we calculated the classification accuracy of vessel components in IVUS images of vessels with clinically significantly narrowed lumina (< 4 mm2) and those with severe calcification. Additionally, we assessed the correlation between lumen areas in manually-labeled ground truth images and those in AI-predicted images, the mean intersection over union (IoU) of a test set, and the recall score for detecting stent struts in each IVUS image in which a stent was present in the test set. Among 3738 labeled images, 323 were randomly selected for use as a test set. The remaining 3415 images were used for training. The classification accuracies for vessels with significantly narrowed lumina and those with severe calcification were 0.97 and 0.98, respectively. Additionally, there was a significant correlation in the lumen area between the ground truth images and the predicted images (ρ = 0.97, R2 = 0.97, p < 0.001). However, the mean IoU of the test set was 0.66 and the recall score for detecting stent struts was 0.64. Our AI program accurately classified vessels requiring treatment and vessel components, except for stents in IVUS images of complex lesions. AI may be a powerful tool for assisting in the interpretation of IVUS imaging and could promote the popularization of IVUS-guided percutaneous coronary intervention in a clinical setting.

Intraspinal Sparganosis Diagnosed by Metagenomics Next Generation Sequencing：An Uncommon Infection

In this paper, we report a case of lumbago with lower limb fatigue. After a series of biochemical, immunological, imaging, and pathological examinations, the patient was diagnosed with intraspinal sparganosis based on metagenomics next generation sequencing. Due to the length of infection, the presence of multiple complex lesions, and the high risk of surgical treatment with poor prognosis, we did not advocate surgical treatment, but chose to administer a high dose and long course of praziquantel treatment for this case.

Liver Trauma Management

Liver trauma is responsible for the majority of penetrating abdominal trauma and is the third most common injury caused by firearms. Presenting a 20% mortality rate, it is an organ with wide and complex vascularization, receiving blood from the hepatic veins and portal vein, as well as from the hepatic arteries. The diagnosis is not always simple in polytrauma patients and contains a wide range of exams such as computerized tomography and diagnostic peritoneal lavage. Treatment depends mostly on a few factors such as the patient’s hemodynamic stability, the degree of injury according to the AAST classification, the resources available, and the surgeon’s expertise. Considering these factors, minor lesions can be treated mostly with a conservative approach in hemodynamically stable patients. Embolization by arteriography has shown good results in major lesions in clinically stable patients as well. On the other hand, more complex lesions associated with hemodynamically unstable patients may indicate damage control surgery applying techniques such as temporary liver packing and clamping the pedicle to restore the hemodynamic status. This chapter aims to describe those techniques and their indications in liver trauma.

Resection of a recurrent pineal region teratoma via a posterior interhemispheric transcallosal approach

The authors describe the unusual case of a 6-year-old boy presenting with decorticate posturing, diminished hearing, and an inability to open his eyes, despite being verbally responsive. He underwent a posterior interhemispheric transcallosal intervenous approach for resection of a pineal region mature teratoma, which recurred 2 years postoperatively. This video demonstrates his initial surgery and reresection, illustrating the value of this approach for more complex lesions that involve the internal cerebral veins (ICVs). At the time of recurrence, microsurgical dissection of the scarred interhemispheric fissure was required to facilitate removal of the multifocal recurrent teratoma, resulting in gross-total resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2134.

Uncommon involvement of multiple lesions in the oral cavity: A case report

In maxillomandibular complex lesions of various etiolopathogenesis may occur. Commonly, lesions are solitary, however, in in rare cases, multiple lesions with distinct natures affect the maxillo-mandibular complex. Until now, the recent literature, there are no reports of simultaneous impairment of periapical cysts, dentigerous and cementoblastoma in the same patient. We report the case of a 38-year-old with syndromic appearance, short stature, brachyfacial, showing hypertelorism, but no definitive diagnosis with multiple oral lesions in the jaws. In the reported case, a residual periapical cyst associated with the swelling in the anterior region of the maxilla occurring simultaneously to a dentigerous cyst and associated with tooth 35 cementoblastoma included. Despite the simultaneous involvement of multiple lesions with different etiopathogenesis is uncommon in the literature, this report seeks to emphasize the importance of thorough and systematic clinical examination, promoting proper conduct of maxillary lesions and perform the correct treatment.

Overcoming very late severe calcific stenosis due to two layers of under-expanded stents with intravascular lithotripsy treatment: a case report

Under-expanded stents in calcific coronary stenoses are a common challenge for interventional cardiologists as we undertake more complex coronary interventions for older population cohorts. It results in short-term and long-term stent failure and adverse patient outcomes. These complex lesions can be treated after many years with intravascular lithotripsy (IVL-Shockwave).

Non-invasive characterization of complex coronary lesions

Conventional invasive diagnostic imaging techniques do not adequately resolve complex Type B and C coronary lesions, which present unique challenges, require personalized treatment and result in worsened patient outcomes. These lesions are often excluded from large-scale non-invasive clinical trials and there does not exist a validated approach to characterize hemodynamic quantities and guide percutaneous intervention for such lesions. This work identifies key biomarkers that differentiate complex Type B and C lesions from simple Type A lesions by introducing and validating a coronary angiography-based computational fluid dynamic (CFD-CA) framework for intracoronary assessment in complex lesions at ultrahigh resolution. Among 14 patients selected in this study, 7 patients with Type B and C lesions were included in the complex lesion group including ostial, bifurcation, serial lesions and lesion where flow was supplied by collateral bed. Simple lesion group included 7 patients with lesions that were discrete, $$<10\hbox {mm}$$ < 10 mm long and readily accessible. Intracoronary assessment was performed using CFD-CA framework and validated by comparing to clinically measured pressure-based index, such as FFR. Local pressure, endothelial shear stress (ESS) and velocity profiles were derived for all patients. We validates the accuracy of our CFD-CA framework and report excellent agreement with invasive measurements ($$n=14, R^2 = 0.6, p = 0.0013$$ n = 14 , R 2 = 0.6 , p = 0.0013 ). Ultra-high resolution achieved by the model enable physiological assessment in complex lesions and quantify hemodynamic metrics in all vessels up to 1mm in diameter. Importantly, we demonstrate that in contrast to traditional pressure-based metrics, there is a significant difference in the intracoronary hemodynamic forces, such as ESS, in complex lesions compared to simple lesions at both resting and hyperemic physiological states [n = 14, $$p=0.03$$ p = 0.03 ]. Higher ESS was observed in the complex lesion group ($$7.0\pm 4.7$$ 7.0 ± 4.7 Pa) than in simple lesion group ($$4.8\pm 3.6$$ 4.8 ± 3.6 Pa). Complex coronary lesions have higher ESS compared to simple lesions, such differential hemodynamic evaluation can provide much the needed insight into the increase in adverse outcomes for such patients and has incremental prognostic value over traditional pressure-based indices, such as FFR.