Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review.

Background: Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. Methods: A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Results: Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Conclusions: Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.

Gynaecological Artificial Intelligence Diagnostics (GAID) GAID and Its Performance as a Tool for the Specialist Doctor.

BACKGROUND: Human-centric artificial intelligence (HCAI) aims to provide support systems that can act as peer companions to an expert in a specific domain, by simulating their way of thinking and decision-making in solving real-life problems. The gynaecological artificial intelligence diagnostics (GAID) assistant is such a system. Based on artificial intelligence (AI) argumentation technology, it was developed to incorporate, as much as possible, a complete representation of the medical knowledge in gynaecology and to become a real-life tool that will practically enhance the quality of healthcare services and reduce stress for the clinician. Our study aimed to evaluate GAIDS' efficacy and accuracy in assisting the working expert gynaecologist during day-to-day clinical practice. METHODS: Knowledge-based systems utilize a knowledge base (theory) which holds evidence-based rules ("IF-THEN" statements) that are used to prove whether a conclusion (such as a disease, medication or treatment) is possible or not, given a set of input data. This approach uses argumentation frameworks, where rules act as claims that support a specific decision (arguments) and argue for its dominance over others. The result is a set of admissible arguments which support the final decision and explain its cause. RESULTS: Based on seven different subcategories of gynaecological presentations-bleeding, endocrinology, cancer, pelvic pain, urogynaecology, sexually transmitted infections and vulva pathology in fifty patients-GAID demonstrates an average overall closeness accuracy of zero point eighty-seven. Since the system provides explanations for supporting a diagnosis against other possible diseases, this evaluation process further allowed for a learning process of modular improvement in the system of the diagnostic discrepancies between the system and the specialist. CONCLUSIONS: GAID successfully demonstrates an average accuracy of zero point eighty-seven when measuring the closeness of the system's diagnosis to that of the senior consultant. The system further provides meaningful and helpful explanations for its diagnoses that can help clinicians to develop an increasing level of trust towards the system. It also provides a practical database, which can be used as a structured history-taking assistant and a friendly, patient record-keeper, while improving precision by providing a full list of differential diagnoses. Importantly, the design and implementation of the system facilitates its continuous development with a set methodology that allows minimal revision of the system in the face of new information. Further large-scale studies are required to evaluate GAID more thoroughly and to identify its limiting boundaries.

The Use of Synthetic Graft for MPFL Reconstruction Surgery: A Systematic Review of the Clinical Outcomes.

(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft.

SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study.

PURPOSE: Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes. METHODS: We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed. RESULTS: The cohort consisted of 419 adult patients between the ages of 16-94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay. CONCLUSIONS: SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.

Computer-Aided Diagnosis by Tissue Image Analysis as an Optical Biopsy in Hysteroscopy.

This review of our experience in computer-assisted tissue image analysis (CATIA) research shows that significant information can be extracted and used to diagnose and distinguish normal from abnormal endometrium. CATIA enabled the evaluation and differentiation between the benign and malignant endometrium during diagnostic hysteroscopy. The efficacy of texture analysis in the endometrium image during hysteroscopy was examined in 40 women, where 209 normal and 209 abnormal regions of interest (ROIs) were extracted. There was a significant difference between normal and abnormal endometrium for the statistical features (SF) features mean, variance, median, energy and entropy; for the spatial grey-level difference matrix (SGLDM) features contrast, correlation, variance, homogeneity and entropy; and for the gray-level difference statistics (GLDS) features homogeneity, contrast, energy, entropy and mean. We further evaluated 52 hysteroscopic images of 258 normal and 258 abnormal endometrium ROIs, and tissue diagnosis was verified by histopathology after biopsy. The YCrCb color system with SF, SGLDM and GLDS color texture features based on support vector machine (SVM) modeling correctly classified 81% of the cases with a sensitivity and a specificity of 78% and 81%, respectively, for normal and hyperplastic endometrium. New technical and computational advances may improve optical biopsy accuracy and assist in the precision of lesion excision during hysteroscopy. The exchange of knowledge, collaboration, identification of tasks and CATIA method selection strategy will further improve computer-aided diagnosis implementation in the daily practice of hysteroscopy.

The effectiveness of internal fixation in the management of acute chondral fractures. A systematic review.

INTRODUCTION: Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical treatments designed specifically for cartilage repair and restoration have been introduced. Internal fixation has demonstrated good benefits in case reports and small qualitative studies. Our systematic review aimed to evaluate the effectiveness of internal fixation in the management of acute chondral fractures. METHODS: A comprehensive search strategy was carried out using the NICE Healthcare Databases Advanced Search. The systematic review was prospectively registered with PROSPERO (CRD42022302976) and was performed in accordance with the PRISMA guidelines. RESULTS: Eleven studies consisting of fifty patients were included in this systematic review. Seventy-eight percent of patients showed good results and twenty-two percent of the cases had excellent results. Ninety-two percent of patients returned to preoperative level of sport activities at the end of the follow-up period. All of them returned to the original activity level without pain, stiffness, or restriction of movement after 1 year latest. The majority of patients had no complications at all, good recovery time and satisfactory outcomes for pain and activity level. The only complications presented were patella instability and quadriceps weakness. CONCLUSION: Internal fixation for acute chondral fractures is an effective method to treat acute chondral fractures in both adolescents and young adults that want to get back to an active lifestyle. However, more data examining the long-term functional status, quality of life (QoL), recovery post-injury and pain free sports activity involvement are needed.

New insights into the neural network of the nongravid uterus.

The human uterus is exposed to epigenetic factors during maturation, which might influence its neural network. The mesh muscle is formed from the circular muscle during development and maturation, and it coordinates the longitudinal and circular muscle function. The uterus has an autonomous neural network with contractility and propagation patterns that determine its reproductive potential and health during pregnancy and delivery. Emerging knowledge on the uterine neural network and mesh muscle ultrastructure contributes to new ideas and solutions on the role of intrauterine pressure and distending fluid intravasation during hysteroscopy, and even allows for improving the operative techniques of myomectomy, adenoma cytoreductive surgery and metroplasty. Good health and well-being start from the in utero stage of life. Prenatal and antenatal care are of paramount importance to minimize the risks of malnutrition and pollutants, and foster a healthy uterus. Research regarding the neural network, function and contractility of the nongravid uterus is a new chapter in gynecology that provides significant information for a better understanding and early diagnosis and treatment of uterine pathologies and early pregnancy support.

Biomolecular and Genetic Prognostic Factors That Can Facilitate Fertility-Sparing Treatment (FST) Decision Making in Early Stage Endometrial Cancer (ES-EC): A Systematic Review.

Endometrial cancer occurs in up to 29% of women before 40 years of age. Seventy percent of these patients are nulliparous at the time. Decision making regarding fertility preservation in early stage endometrial cancer (ES-EC) is, therefore, a big challenge since the decision between the risk of cancer progression and a chance to parenthood needs to be made. Sixty-two percent of women with complete remission of ES-EC after fertility-sparing treatment (FST) report to have a pregnancy wish which, if not for FST, they would not be able to fulfil. The aim of this review was to identify and summarise the currently established biomolecular and genetic prognostic factors that can facilitate decision making for FST in ES-EC. A comprehensive search strategy was carried out across four databases; Cochrane, Embase, MEDLINE, and PubMed; they were searched between March 1946 and 22nd December 2022. Thirty-four studies were included in this study which was conducted in line with the PRISMA criteria checklist. The final 34 articles encompassed 9165 patients. The studies were assessed using the Critical Appraisal Skills Program (CASP). PTEN and POLE alterations we found to be good prognostic factors of ES-EC, favouring FST. MSI, CTNNB1, and K-RAS alterations were found to be fair prognostic factors of ES-EC, favouring FST but carrying a risk of recurrence. PIK3CA, HER2, ARID1A, P53, L1CAM, and FGFR2 were found to be poor prognostic factors of ES-EC and therefore do not favour FST. Clinical trials with bigger cohorts are needed to further validate the fair genetic prognostic factors. Using the aforementioned good and poor genetic prognostic factors, we can make more confident decisions on FST in ES-EC.

Arthroscopically reduced, irreducible patella dislocation.

Acute patella dislocations account for approximately 2%-3% of knee injuries and are therefore a relatively common presentation in the accident and emergency department. The majority of patella dislocations can be reduced with simple manoeuvres or even spontaneously and can be managed conservatively by bracing and rehabilitation. The aim of this study is to identify and review the main causes of the unique and unexpected event of irreducible patella dislocation and their characteristic presentations. Irreducible patella dislocations can happen but are very rare. Currently, a limited number of case reports are available, prompting for a need for research on this topic. This case study can shed light on the possible pathogenesis and pathognomonic features of irreducible patella dislocations and provide insight on the available therapeutic approaches.

Is Computer-Assisted Tissue Image Analysis the Future in Minimally Invasive Surgery? A Review on the Current Status of Its Applications.

PURPOSE: Computer-assisted tissue image analysis (CATIA) enables an optical biopsy of human tissue during minimally invasive surgery and endoscopy. Thus far, it has been implemented in gastrointestinal, endometrial, and dermatologic examinations that use computational analysis and image texture feature systems. We review and evaluate the impact of in vivo optical biopsies performed by tissue image analysis on the surgeon's diagnostic ability and sampling precision and investigate how operation complications could be minimized. METHODS: We performed a literature search in PubMed, IEEE, Xplore, Elsevier, and Google Scholar, which yielded 28 relevant articles. Our literature review summarizes the available data on CATIA of human tissues and explores the possibilities of computer-assisted early disease diagnoses, including cancer. RESULTS: Hysteroscopic image texture analysis of the endometrium successfully distinguished benign from malignant conditions up to 91% of the time. In dermatologic studies, the accuracy of distinguishing nevi melanoma from benign disease fluctuated from 73% to 81%. Skin biopsies of basal cell carcinoma and melanoma exhibited an accuracy of 92.4%, sensitivity of 99.1%, and specificity of 93.3% and distinguished nonmelanoma and normal lesions from benign precancerous lesions with 91.9% and 82.8% accuracy, respectively. Gastrointestinal and endometrial examinations are still at the experimental phase. CONCLUSIONS: CATIA is a promising application for distinguishing normal from abnormal tissues during endoscopic procedures and minimally invasive surgeries. However, the efficacy of computer-assisted diagnostics in distinguishing benign from malignant states is still not well documented. Prospective and randomized studies are needed before CATIA is implemented in clinical practice.