Histology segmentation using active learning on regions of interest in oral cavity squamous cell carcinoma.

In digital pathology, deep learning has been shown to have a wide range of applications, from cancer grading to segmenting structures like glomeruli. One of the main hurdles for digital pathology to be truly effective is the size of the dataset needed for generalization to address the spectrum of possible morphologies. Small datasets limit classifiers' ability to generalize. Yet, when we move to larger datasets of whole slide images (WSIs) of tissue, these datasets may cause network bottlenecks as each WSI at its original magnification can be upwards of 100 000 by 100 000 pixels, and over a gigabyte in file size. Compounding this problem, high quality pathologist annotations are difficult to obtain, as the volume of necessary annotations to create a classifier that can generalize would be extremely costly in terms of pathologist-hours. In this work, we use Active Learning (AL), a process for iterative interactive training, to create a modified U-net classifier on the region of interest (ROI) scale. We then compare this to Random Learning (RL), where images for addition to the dataset for retraining are randomly selected. Our hypothesis is that AL shows benefits for generating segmentation results versus randomly selecting images to annotate. We show that after 3 iterations, that AL, with an average Dice coefficient of 0.461, outperforms RL, with an average Dice Coefficient of 0.375, by 0.086.

Feminine famishment: Graphic medicine and anorexia nervosa.

Socio-cultural rigidities regarding the shape and size of a woman's body have not only created an urgency to refashion themselves according to a range of set standards but also generated an infiltrating sense of body dissatisfaction and poor self-esteem leading to eating disorders. Interestingly, through an adept utilisation of the formal strengths of the medium of comics, many graphic medical anorexia narratives offer insightful elucidations on the question of how the female body is not merely a biological construction, but a biocultural construction too. In this context, by drawing theoretical postulates from Susan Bordo, David Morris and other theoreticians of varying importance, and by close reading Lesley Fairfield's Tyranny and Katie Green's Lighter than My Shadow, this article considers anorexia as the bodily manifestation of a cultural malady by analysing how cultural attitudes regarding body can be potential triggers of eating disorders in girls. Furthermore, this article also investigates why comics is the appropriate medium to provide a nuanced representation of the corporeal complications and socio-cultural intricacies of anorexia.

Need and Feasibility of a Transition Clinic for Adolescents with Chronic Illness: A Qualitative Study.

OBJECTIVE: To assess the need and feasibility of a Transition Clinic in the care of adolescents with chronic illness. METHODS: A qualitative study, piloted by a questionnaire-based survey, followed by Focus Group Discussions was conducted in the Department of Pediatrics in a government teaching hospital in Kerala. The participants were adolescents with chronic disease, viz., renal disease, diabetes, HIV/AIDS, cancer survivors with Hepatitis B, parents of renal patients, pediatricians and adult specialists. Twenty patients were administered a structured, rated, 18-item questionnaire regarding their attitude and preparedness for transfer to adult departments. The need and feasibility of a Transition Clinic was discussed by 7 focus groups viz., pediatricians, adult physicians, 4 patient groups and 1 parent group. Thematic analysis of data was done. RESULTS: Except among pediatricians, awareness of the concept of Transition Clinic was low. All participants agreed that abrupt transfer of care hinders treatment and that there is a definite need for a Transition Clinic. Pediatricians discussed the complex needs of adolescents and limitations of their care. Adult specialist physicians described their inadequacy to handle adolescent problems and difficulties posed by large volumes of patients. The adolescents and young adults with chronic illness discussed their reluctance to shift to the adult departments. Parents voiced their concerns about the future of their children. All groups gave constructive suggestions for conduct of the clinic and smooth transition. CONCLUSIONS: There is a definite need for a Transition Clinic in the management of adolescents with chronic illness to ensure smooth transfer of care. Introducing such clinics in the existing health framework is feasible using a multidisciplinary approach.

Seeded Biopsy Tract Recurrence After Extirpative Surgery for Renal Cell Carcinoma.

Background: Renal mass biopsy (RMB) is an increasingly utilized modality in the work-up of patients with suspicious renal masses. Recurrence of renal cell carcinoma (RCC) from biopsy tract seeding is exceedingly rare in the literature. We report a case of such a phenomenon. Case Presentation: Our patient is a 75-year-old Caucasian man and former smoker with a functionally solitary left kidney, initially worked up for gross hematuria and left flank pain. Imaging revealed hydronephrosis and a left renal mass, which was biopsied. Pathology analysis demonstrated clear cell RCC, and a left robotic radical nephrectomy was performed with negative surgical margins. Sixteen months postoperatively, imaging revealed multiple small masses along the biopsy tract, suspicious for recurrence. These were biopsied and pathology analysis confirmed recurrent clear cell RCC. Conclusion: Despite its rarity, biopsy tract seeding is a serious complication of RMB. This warrants thorough counseling and shared decision making between providers and all patients with renal masses planning to undergo a RMB.