Deep learning-aided 3D proxy-bridged region-growing framework for multi-organ segmentation.

Accurate multi-organ segmentation in 3D CT images is imperative for enhancing computer-aided diagnosis and radiotherapy planning. However, current deep learning-based methods for 3D multi-organ segmentation face challenges such as the need for labor-intensive manual pixel-level annotations and high hardware resource demands, especially regarding GPU resources. To address these issues, we propose a 3D proxy-bridged region-growing framework specifically designed for the segmentation of the liver and spleen. Specifically, a key slice is selected from each 3D volume according to the corresponding intensity histogram. Subsequently, a deep learning model is employed to pinpoint the semantic central patch on this key slice, to calculate the growing seed. To counteract the impact of noise, segmentation of the liver and spleen is conducted on superpixel images created through proxy-bridging strategy. The segmentation process is then extended to adjacent slices by applying the same methodology iteratively, culminating in the comprehensive segmentation results. Experimental results demonstrate that the proposed framework accomplishes segmentation of the liver and spleen with an average Dice Similarity Coefficient of approximately 0.93 and a Jaccard Similarity Coefficient of around 0.88. These outcomes substantiate the framework's capability to achieve performance on par with that of deep learning methods, albeit requiring less guidance information and lower GPU resources.

Anatomía Comparada del Bazo de la Rata Blanca (Rattus norvegicus albinus), Una Revisión de la Literatura / Comparative Anatomy of the Spleen of the White Rat, (Rattus norvegicus albinus) a Literature Review

El bazo es el órgano linfático intraperitoneal más grande del organismo, presentando dos funciones principales: defensiva, mediante respuesta inmunitaria y filtración sanguínea. El objetivo de la presente revisión, fue obtener información actualizada sobre la anatomía del bazo de la rata albina (Rattus norvegicus albinus) y comparativa con la anatomía del bazo humano, perro, gato y cerdo, al representar las principales especies de importancia en la medicina, medicina veterinaria y en las ciencias biomédicas. Se realizó una búsqueda de material bibliográfico actualizado en diferentes sitios web científicos. Es así como, se revisaron 71 fuentes bibliográficas, en su gran mayoría artículos científicos (31), libros de anatomía humana y veterinaria (17), artículos especializados (17) y tesis (6). En general existe consenso, sobre la descripción anatómica del bazo, el cual se sitúa en la región hipocondriaca izquierda del abdomen, entre el fondo del estómago y el diafragma, irrigado por la arteria y vena esplénica. Se evidenció que existen similitudes en aspectos macroscópicos, al comparar el bazo de la rata blanca, con el bazo de otras especies (funcionalidad, peso relativo, ubicación topográfica). En aspectos microscópicos, el bazo en humanos y otros mamíferos se compone de estroma, además de parénquima, constituido a su vez por pulpa blanca y roja. En particular, existen diferencias entre el bazo de rata, humano, gato, perro y cerdo, en formas, tamaños y aspectos microscópicos, relacionados con la microcirculación e inmunidad. Mientras que existen semejanzas en procesos patológicos y respuestas a tratamientos farmacológicos y clínicos. Por lo anteriormente expuesto, se concluye que la rata albina constituye un buen modelo biológico, específicamente en aspectos anatómicos microscópicos del bazo de tipo inmunológico. Mientras que el bazo de cerdo es mejor comparativamente, en estudios anatómicos macroscópicos de tipo quirúrgicos, resultando ambos extrapolables, especialmente a la medicina humana.

SUMMARY: The spleen is the largest intraperitoneal lymphatic organ of the body, presenting two main functions: defensive, through immune response and blood filtration. The objective of the present review was to obtain updated information on the anatomy of the spleen of the albino rat (Rattus norvegicus albinus) and to compare it with the anatomy of the human, dog, cat and pig spleen, representing the main species of importance in medicine, veterinary medicine and biomedical sciences. A search for updated bibliographic material was carried out in different scientific websites. Thus, 71 bibliographic sources were reviewed, mostly scientific articles (31), human and veterinary anatomy books (17), specialized articles (17) and theses (6). In general, there is consensus on the anatomical description of the spleen, which is located in the left hypochondriac region of the abdomen between the fundus of the stomach and the diaphragm, irrigated by the splenic artery and vein. It was evidenced that there are similarities in macroscopic aspects when comparing the spleen of the white rat with the spleen of other species (functionality, relative weight, topographic location). In microscopic aspects, the spleen in humans and other mammals is composed of stroma, in addition to parenchyma, constituted in turn by white and red pulp. In particular, there are differences between rat, human, cat, dog and pig spleens in shapes, sizes and microscopic aspects related to microcirculation and immunity. While there are similarities in pathological processes and responses to pharmacological and clinical treatments. For the above mentioned, it is concluded that the albino rat constitutes a good biological model, specifically in microscopic anatomical aspects of the spleen of immunological type. While the pig spleen is comparatively better in macroscopic anatomical studies of surgical type, both are extrapolable especially to human medicine.

Validation of 2d ultrasound and volume estimation formulae for volume assessment of kidneys and spleens: an in-vitro study / alidación de la fórmula de estimación de volumen y ultrasonido 2D para la evaluación del volumen de los riñones y el bazo: un estudio in vitro

The accuracy of internal organ volume estimation done with ultrasound (US) was found to be multifactorial. Hence, we aimed to describe and validate the volume assessment of ultrasound and standard volume estimation formulae for different shaped intra-abdominal organs using spleens and kidneys.Dissected cadaveric kidneys (n=25) and spleens (n=29) were scanned to obtain linear measurements and ultrasound auto-generated volumes (USV). Linear measurements were used to calculate the volumes manually with ellipsoid, prolate, and Lambert volume estimating formulae. The actual volumes (AV) of organs were obtained by the water displacement method. Volume assessment accuracy of USV and different formulae were compared by comparing bias, precision and Bland-Altman plot analysis. The US linear and volume measurement procedure was reliable with high inter and intra-observer agreements (linear: Chronbach's α=0.983 to 0.934; volumes: Chronbach's α=0.989). USV estimates were accurate with a high correlation to AV and low estimation bias (-5.9%). Also, prolate (bias=-0.75%) and ellipsoid formulae (bias=-3.75%) were reliable with a negligible bias in estimated volumes. Contrary, the Lambert formula was unreliable due to a high bias (41.6%). For all evaluated methods, the estimation error found to be related to the organ size (T=3.483; p=0.001), mainly when the assessed organ is larger than 50 ml. Also, the shape related estimation error found to be related to the volume estimation formula used.This study has validated the USV for kidney and splenic volume assessments while describing volume-calculating formula employed, organ size and shape as significant contributors for volume estimation accuracy.

Se encontró que la precisión de la estimación del volumen de órganos internos realizada con ultrasonido (US) es multifactorial. El objetivo fue describir y validar la evaluación de volumen mediante ecografía y las fórmulas estándar de estimación de volumen para órganos intraabdominales de diferentes formas utilizando bazos y riñones.Se evaluaron riñones cadavéricos disecados (n = 25) y bazos (n = 29) para obtener medidas lineales y volúmenes autogenerados por ultrasonido (USV). Se utilizaron medidas lineales para calcular los volúmenes manualmente con fórmulas de estimación de volumen elipsoide, prolate y Lambert. Los volúmenes reales (AV) de los órganos se obtuvieron mediante el método de desplazamiento de agua. Se comparó la precisión de la evaluación del volumen de USV y diferentes fórmulas comparando el sesgo, la precisión y el análisis de la gráfica de Bland-Altman. El procedimiento de medición lineal y de volumen mediante US fue confiable con alta concordancia inter e intraobservadores (lineal: α de Chronbach = 0,983 a 0,934; volúmenes: α de Chronbach = 0,989). Las estimaciones de USV fueron precisas con una alta correlación con AV y un bajo sesgo de estimación (-5,9%). Además, las fórmulas prolate (sesgo= -0,75%) y elipsoide (sesgo = -3,75%) fueron confiables con un sesgo insignificante en los volúmenes estimados. Por el contrario, la fórmula de Lambert no fue confiable debido a un alto sesgo (41,6%). Para todos los métodos evaluados, se encontró que el error de estimación estaba relacionado con el tamaño del órgano (T = 3.483; p = 0.001), principalmente cuando el órgano evaluado es mayor de 50 ml. Además, se encontró que el error de estimación de forma está relacionado con la fórmula de estimación de volumen utilizada.Este estudio ha validado el USV para evaluaciones de volumen renal y esplénico al mismo tiempo que describe la fórmula de cálculo de volumen empleada, el tamaño y la forma de los órganos como contribuyentes significativos de la precisión de la estimación de volumen.

Ginkgo biloba leaf extract improves growth, intestinal histomorphometry, immunity, antioxidant status and modulates transcription of cytokine genes in hapa-reared Oreochromis niloticus.

This study was designed to evaluate the impacts of dietary supplementation with Ginkgo biloba leaf extract (GBL) on the growth, intestinal histomorphometry, immunity, antioxidant status, and expression of cytokine genes in Nile tilapia reared in the hapas. A control diet was enriched with different GBL levels (0.0, 5.0, 7.0, and 9.0 g/kg) to form 4 experimental diets and were fed to Nile tilapia for 8 weeks. The findings illustrated that dietary GBL significantly enhanced the growth and feed utilization indices compared to those reared in the control group. A dose-dependent increase of hepatic catalase, superoxide dismutase, and glutathione peroxidase activities alongside a decline of hepatic malondialdehyde levels were recorded in GBL groups compared with the control. Serum lysozyme activity, complement C3, and immunoglobulin M levels were significantly increased in GBL groups compared with the control group. Moreover, dietary GBL maintained the normal intestinal and hepatopancreatic histological structures with a significant increase of some histomorphometric measurements of proximal, middle, and distal intestinal parts of the treated fish. Interestingly, dietary GBL supplementation significantly increased the mRNA expression of interleukin-1 beta (IL-1ß), IL-6, IL-10, tumor necrosis factor alpha (TNF-α) and interferon gamma (INF-γ) genes in the splenic tissues of treated fish over the control group. To conclude, it could be recommended to use GBL as a functional phytogenic feed additive to improve the growth, hepatic and intestinal health status, hepatic antioxidant status, and immunity of treated Nile tilapia. Besides, the second order polynomial regression revealed that 7.50 g GBL/kg diet is the optimal inclusion level to improve growth with no negative impacts on the overall health condition of treated Nile tilapia.

Safety of natural anthraquinone emodin: an assessment in mice.

BACKGROUND: Emodin, a natural anthraquinone, has shown potential as an effective therapeutic agent in the treatment of many diseases including cancer. However, its clinical development is hindered by uncertainties surrounding its potential toxicity. The primary purpose of this study was to uncover any potential toxic properties of emodin in mice at doses that have been shown to have efficacy in our cancer studies. In addition, we sought to assess the time course of emodin clearance when administered both intraperitoneally (I.P.) and orally (P.O.) in order to begin to establish effective dosing intervals. METHODS: We performed a subchronic (12 week) toxicity study using 3 different doses of emodin (~ 20 mg/kg, 40 mg/kg, and 80 mg/kg) infused into the AIN-76A diet of male and female C57BL/6 mice (n = 5/group/sex). Body weight and composition were assessed following the 12-week feeding regime. Tissues were harvested and assessed for gross pathological changes and blood was collected for a complete blood count and evaluation of alanine transaminase (ALT), aspartate transaminase (AST) and creatinine. For the pharmacokinetic study, emodin was delivered intraperitoneally I.P. or P.O. at 20 mg/kg or 40 mg/kg doses to male and female mice (n = 4/group/sex/time-point) and circulating levels of emodin were determined at 1, 4 and 12 h following administration via liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis. RESULTS: We found that 12 weeks of low (20 mg/kg), medium (40 mg/kg), or high (80 mg/kg) emodin feeding did not cause pathophysiological perturbations in major organs. We also found that glucuronidated emodin peaks at 1 h for both I.P. and P.O. administered emodin and is eliminated by 12 h. Interestingly, female mice appear to metabolize emodin at a faster rate than male mice as evidenced by greater levels of glucuronidated emodin at the 1 h time-point (40 mg/kg for both I.P. and P.O. and 20 mg/kg I.P.) and the 4-h time-point (20 mg/kg I.P.). CONCLUSIONS: In summary, our studies establish that 1) emodin is safe for use in both male and female mice when given at 20, 40, and 80 mg/kg doses for 12 weeks and 2) sex differences should be considered when establishing dosing intervals for emodin treatment.

[Intraoperative anatomical observation of mesentery morphology of colonic splenic flexure].

Objective: At present, surgeons do not know enough about the mesenteric morphology of the colonic splenic flexure, resulting in many problems in the complete mesenteric resection of cancer around the splenic flexure. In this study, the morphology of the mesentery during the mobilization of the colonic splenic flexure was continuously observed in vivo, and from the embryological point of view, the unique mesenteric morphology of the colonic splenic flexure was reconstructed in three dimensions to help surgeons further understand the mesangial structure of the region. Methods: A total of 9 patients with left colon cancer who underwent laparoscopic radical resection with splenic flexure mobilization by the same group of surgeons in Union Hospital of Fujian Medical University from January 2018 to June 2019 were enrolled. The splenic flexure was mobilized using a "three-way approach" strategy based on a middle-lateral approach. During the process of splenic flexure mobilization, the morphology of the transverse mesocolon and descending mesocolon were observed and reconstructed from the embryological point of view. The lower margin of the pancreas was set as the axis, and 4 pictures for each patient (section 1-section 4) were taken during middle-lateral mobilization. Results: The median operation time of the splenic flexure mobilization procedure was 31 (12-55) minutes, and the median bleeding volume was 5 (2-30) ml. One patient suffered from lower splenic vessel injury during the operation and the bleeding was stopped successfully after hemostasis with an ultrasound scalpel. The transverse mesocolon root was observed in all 9 (100%) patients, locating under pancreas, whose inner side was more obvious and tough, and the structure gradually disappeared in the tail of the pancreatic body, replaced by smooth inter-transitional mesocolon and dorsal lobes of the descending colon. The mesenteric morphology of the splenic flexure was reconstructed by intraoperative observation. The transverse mesocolon was continuous with a fan-shaped descending mesocolon. During the embryonic stage, the medial part (section 1-section 2) of the transverse mesocolon and the descending mesocolon were pulled and folded by the superior mesenteric artery (SMA). Then, the transverse mesocolon root was formed by compression of the pancreas on the folding area of the transverse mesocolon and the descending mesocolon. The lateral side of the transverse mesocolon root (section 3-section 4) was distant from the mechanical traction of the SMA, and the corresponding folding area was not compressed by the tail of the pancreas. The posterior mesangial lobe of the transverse mesocolon and the descending mesocolon were continuous with each other, forming a smooth lobe. This smooth lobe laid flat on the corresponding membrane bed composed of the tail of pancreas, Gerota's fascia and inferior pole of the spleen. Conclusions: From an embryological point of view, this study reconstructs the mesenteric morphology of the splenic flexure and proposes a transverse mesocolon root structure that can be observed consistently intraopertively. Cutting the transverse mesocolon root at the level of Gerota's fascia can ensure the complete resection of the mesentery of the transverse colon.

Presencia y biometría de bazo accesorio en individuos chilenos: estudio por tomografía computarizada / Presence and biometry of accessory spleen in Chilean individuals: study by computerized tomography

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.

Architecture and Cellular Composition of the Spleen in the Japanese Quail (Coturnix japonica).

The spleen is considered a key player in birds' immunity. The stroma and the parenchyma of the spleen of the adult quail were demonstrated histologically, histochemically, and ultrastructurally. A thin capsule and the absence of trabeculae were the most characteristics of spleen stroma. The demarcation between white pulp and red pulp was not observed in the quail. White pulp formed from the periarterial lymphatic sheath and the periellipsoidal lymphatic sheath, both of which were surrounded by arteriole and ellipsoid, respectively. Ellipsoids appeared more numerous and were characterized by cuboidal lining of the epithelium and supporting cells. Red pulp consisted of sinuses and cords. White pulp and red pulp of the quail spleen contained various cells, such as red blood cells, macrophages, heterophils with characteristic granules, lymphocytes of different sizes, dendritic cells, plasma cells, and telocytes. In addition, closed circulation and open circulation established the blood flow on the spleen.

Behavioral and physiological responses to intraperitoneal injection of zymosan in chicks.

Zymosan is a cell wall component of the yeast Saccharomyces cerevisiae and produces severe inflammatory responses in mammals. When zymosan is peripherally injected in mammals, it induces several behavioral and physiological changes including anorexia and hyperthermia. However, to our knowledge, behavioral and physiological responses to zymosan have not yet been clarified in birds. Therefore, the purpose of the present study was to determine if intraperitoneal injection of zymosan affects food intake, voluntary activity, cloacal temperature, plasma corticosterone (CORT) and glucose concentrations, and splenic gene expression of cytokines in chicks (Gallus gallus). Intraperitoneal injection of zymosan (2.5 mg) significantly decreased food intake, voluntary activity, and plasma glucose concentration, and increased plasma CORT concentration. The injection of 0.5 mg zymosan significantly increased cloacal temperature, while 2.5 mg zymosan had a tendency to increase it. Finally, 2.5 mg zymosan significantly increased the splenic gene expression of interleukin-1ß (IL-1ß), IL-6, IL-8, interferon-γ, and tumor necrosis factor-like cytokine 1A. The present results suggest that zymosan would be one of components which induces nonspecific symptoms including anorexia, hypoactivity, hyperthermia, and stress responses, under fungus infection in chicks.

Does the Spleen Have a Function in Digestion? Medical History, Phylogenetic and Embryological Development of the Splenogastric System.

BACKGROUND: Before the spleen was discovered to be a lymphatic blood organ, it had for centuries been considered to be a digestive organ. Concepts of a regulative, secretory and resorptive function in the digestive system were based mainly on a postulated connection between the stomach and the spleen. Splenogastric vascular connections have recently been rediscovered by modern surgery. SUMMARY: To test the hypothesis that the spleen has a digestive function, this article reviews the literature focusing on the interaction between the spleen and the stomach. We examine the historical medical view of the spleen and stomach system and the reasons why a digestive function was abandoned in the 17th and 18th centuries. We then review the rediscovery of the splenogastric system and the present-day state of knowledge (anatomical origin, variability, haemodynamics) and present it in terms of the phylogenetic and embryological development of the spleen and stomach system. Key Message: Splenogastric arteries and gastrosplenic veins form a portal system which directly connects the spleen and stomach parenchyma. Despite its mesodermal anlage, phylogenetically and embryologically the spleen is intimately interconnected with the entodermal stomach parenchyma but detaches from this in the course of development. Further study is required to establish whether the splenogastric system is merely an evolutive remnant or actually a part of a functioning spleen-stomach system as postulated in complementary and integrative medicine.

Optimization of Organotypic Cultures of Mouse Spleen for Staining and Functional Assays.

By preserving cell viability and three-dimensional localization, organotypic culture stands out among the newest frontiers of cell culture. It has been successfully employed for the study of diseases among which neoplasias, where tumoral cells take advantage of the surrounding stroma to promote their own proliferation and survival. Organotypic culture acquires major importance in the context of the immune system, whose cells cross-talk in a complex and dynamic fashion to elicit productive responses. However, organotypic culture has been as yet poorly developed for and applied to primary and secondary lymphoid organs. Here we describe in detail the development of a protocol suitable for the efficient cutting of mouse spleen, which overcomes technical difficulties related to the peculiar organ texture, and for optimized organotypic culture of spleen slices. Moreover, we used microscopy, immunofluorescence, flow cytometry, and qRT-PCR to demonstrate that the majority of cells residing in spleen slices remain alive and maintain their original location in the organ architecture for several days after cutting. The development of this protocol represents a significant technical improvement in the study of the lymphoid microenvironment in both physiological and pathological conditions involving the immune system.

Development and reactivity of the immune system of Japanese quail lines divergently selected for the shape of the growth curve.

1. Selection strategies for broilers must balance rapid growth with the welfare and health of animals, strategies must deal with the trade-off with other vital functions.2. Divergent selection of Japanese quail for high (HG) and low (LG) relative body weight gain between 11 and 28 days of age has been conducted to accelerate linear phase growth without influencing the final adult body weight. Higher body growth rate is often connected with a weakened immune system. Therefore, the present study explored the immunological characterisation of quail from HG and LG lines, which differ substantially in their growth rate.3. The trial evaluated the maternal investment to immunologically active substances, cell-mediated immunity stimulated by phytohaemagglutinin (PHA) injection and the acute phase of the immune response to lipopolysaccharide (LPS) administration in three different phases of early postnatal growth.4. Except for higher lysozyme activity in the LG group when compared to the HG line, the maternal investment did not differ between the two lines. Plasma antibody concentrations responded quickly to any change in growth rate in both lines. Overall, it seems that initial rapid growth of the LG line had long-lasting effects on immune responsiveness, even after the growth rate of the HG line escalated during the linear phase of growth.5. The study indicated that changes in the growth rate caused by the selection for growth in meat-type Japanese quail can influence the acute phase of the immune response and development of the immune system.

How do patient characteristics and anatomical features correlate to accuracy of organ dose reconstruction for Wilms' tumor radiation treatment plans when using a surrogate patient's CT scan?

In retrospective radiation treatment (RT) dosimetry, a surrogate anatomy is often used for patients without 3D CT. To gain insight in what the crucial aspects in a surrogate anatomy are to enable accurate dose reconstruction, we investigated the relation of patient characteristics and internal anatomical features with deviations in reconstructed organ dose using surrogate patient's CT scans. Abdominal CT scans of 35 childhood cancer patients (age: 2.1-5.6 yr; 17 boys, 18 girls) undergoing RT during 2004-2016 were included. Based on whether an intact right or left kidney is present in the CT scan, two groups were formed each containing 24 patients. From each group, four CTs associated with Wilms' tumor RT plans with an anterior-posterior-posterior-anterior field setup were selected as references. For each reference, a 2D digitally reconstructed radiograph was computed from the reference CT to simulate a 2D radiographic image and dose reconstruction was performed on the other CTs in the respective group. Deviations in organ mean dose (DEmean) of the reconstructions versus the references were calculated, as were deviations in patient characteristics (i.e. age, height, weight) and in anatomical features including organ volume, location (in 3D), and spatial overlaps. Per reference, the Pearson's correlation coefficient between deviations in DEmean and patient characteristics/features were studied. Deviation in organ locations and DEmean for the liver, spleen, and right kidney were moderately correlated (R2 > 0.5) for 8/8, 5/8, and 3/4 reference plans, respectively. Deviations in organ volume or spatial overlap and DEmean for the right and left kidney were weakly correlated (0.3 < R2 < 0.5) in 4/4 and 1/4 reference plans. No correlations (R2 < 0.3) were found between deviations in age or height and DEmean. Therefore, the performance of organ dose reconstruction using surrogate patients' CT scans is primarily related to deviation in organ location, followed by volume and spatial overlap. Further, results were plan dependent.

Abdominopelvic trauma: from anatomical to anatomo-physiological classification.

Abdominopelvic trauma has been for decades classified with the AAST-OIS (American Association for the Surgery of Trauma-Organ Injury Scale) classification. It has represented a milestone. At present, the medical evolutions in trauma management allowed an incredible progress in trauma decision-making and treatment. Non-operative trauma management has been widely applied. The interventional radiological procedures and the modern conception of Hybrid and Endovascular Trauma and Bleeding Management (EVTM) led to good results in increasing the rate of patients managed non-operatively, opening new scenarios and options. Even severe anatomical lesions in hemodynamically stable patients can be safely managed non-operatively. The driving issue in deciding for the best treatment is anatomy, as well as physiology, for the patient physiological derangement grade is even more important. The emergency general surgeon must be prepared in those pathophysiological issues that play the pivotal role in the team management of trauma patients. Moreover, the classification of trauma patients cannot only remain anchored to anatomical lesions. The necessity to follow the modern possibilities of treatment imposes addressing trauma using a classification based on anatomical lesions and on the physiological status of the patient.

Sonographic Evaluation of Normal Liver, Spleen, and Renal Parameters in Adult Population: A Multicenter Study.

OBJECTIVE: To determine the normal liver, spleen, and renal parameters in adult patients with no comorbidities. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dow Institute of Radiology, Ojha Campus, LEJ Campus, and Al-Mustafa Hospital Karachi, from October 2016 to March 2017. METHODOLOGY: A total of 3,136 study participants with more than 16 years of age of either gender underwent ultrasound examination. All individuals with morbid conditions like hypertension (HTN), diabetes mellitus (DM), liver cirrhosis, hydronephrosis, renal cyst, and liver mass were excluded. Ultrasound scan was performed and longitudinal and transverse sections were obtained of both kidneys (in full inspiration), spleen and liver. RESULTS: A significant positive correlation was observed between age and spleen size of the individuals (r=0.053, p=0.012). The correlation of BMI and liver size was also found significantly positive (r=0.237, p <0.001). The correlation of age and kidney size was found significantly negative in between age and right kidney (r=-0.074, p <0.001) and left kidney (r=-0.087, p <0.001). Similarly, the correlation of BMI and renal size was found significantly weak positive between BMI and right kidney (r=0.206, p <0.001) and BMI and left kidney (r=0.227, p <0.001). CONCLUSION: BMI was found significantly positively correlated with liver size and both kidneys in study participants. Moreover, spleen was found directly and renal size inversely correlated with age of the individuals.

Spleen size evaluation in children: Time to define splenomegaly for pediatric surgeons and pediatricians.

BACKGROUND: We determined the range of normal spleen dimensions evaluated by ultrasonography (US) in children according to sex and age and the relationship between splenic measurements, auxological data and body proportions, in order to define splenomegaly parameters in support of the surgical mini-invasive approaches in pediatrics. METHODS: We prospectively examined 317 caucasian children of both sexes. The patients were divided into three groups: 0-3 years; 4-10 years; 11-18 years. Sex, weight, height/length, body mass index (BMI), waist circumference and xipho-pubic distance were determined for each child. US spleen evaluation included longitudinal/antero-posterior/transverse diameters, transverse area and volume. Spleen volume/abdominal volume, longitudinal spleen diameter/longitudinal left kidney diameter and longitudinal spleen diameter/xipho-pubic distance ratios were also calculated. RESULTS: For caucasian subjects, in different age groups spleen volume, transverse area and diameter increased while the spleen/abdominal volume ratio decreased significantly (p<0.001). A significant (p<0.001) decrease in longitudinal spleen diameter/xipho-pubic distance ratio was noted between the 0-3 years group and both 4-10 and 11-18 years group. Age and auxological data, except BMI, showed a high correlation with spleen dimension (r≥0.8). CONCLUSIONS: The current concept of splenomegaly is not applicable in pediatric surgery. A dedicated classification of splenomegaly is needed for children and would improve the safety and feasibility of treatment.

CD154 Costimulation Shifts the Local T-Cell Receptor Repertoire Not Only During Thymic Selection but Also During Peripheral T-Dependent Humoral Immune Responses.

CD154 is a transmembrane cytokine expressed transiently on activated CD4 T cells upon T-cell receptor (TCR) stimulation that interacts with CD40 on antigen-presenting cells. The signaling via CD154:CD40 is essential for B-cell maturation and germinal center formation and also for the final differentiation of CD4 T cells during T-dependent humoral immune responses. Recent data demonstrate that CD154 is critically involved in the selection of T-cell clones during the negative selection process in the thymus. Whether CD154 signaling influences the TCR repertoire during peripheral T-dependent humoral immune responses has not yet been elucidated. To find out, we used CD154-deficient mice and assessed the global TCRß repertoire in T-cell zones (TCZ) of spleens by high-throughput sequencing after induction of a Th2 response to the multiepitopic antigen sheep red blood cells. Qualitative and quantitative comparison of the splenic TCZ-specific TCRß repertoires revealed that CD154 deficiency shifts the distribution of Vß-Jß genes after antigen exposure. This data led to the conclusion that costimulation via CD154:CD40 during the interaction of T cells with CD40-matured B cells contributes to the recruitment of T-cell clones into the immune response and thereby shapes the peripheral TCR repertoire.