A CNN-based model to count the leaves of rosette plants (LC-Net).

Plant image analysis is a significant tool for plant phenotyping. Image analysis has been used to assess plant trails, forecast plant growth, and offer geographical information about images. The area segmentation and counting of the leaf is a major component of plant phenotyping, which can be used to measure the growth of the plant. Therefore, this paper developed a convolutional neural network-based leaf counting model called LC-Net. The original plant image and segmented leaf parts are fed as input because the segmented leaf part provides additional information to the proposed LC-Net. The well-known SegNet model has been utilised to obtain segmented leaf parts because it outperforms four other popular Convolutional Neural Network (CNN) models, namely DeepLab V3+, Fast FCN with Pyramid Scene Parsing (PSP), U-Net, and Refine Net. The proposed LC-Net is compared to the other recent CNN-based leaf counting models over the combined Computer Vision Problems in Plant Phenotyping (CVPPP) and KOMATSUNA datasets. The subjective and numerical evaluations of the experimental results demonstrate the superiority of the LC-Net to other tested models.

Prognostic Role of Human Epididymis Protein4 (HE4) in Endometrial Lesions: Study in a Tertiary Care Centre.

Endometrial cancer accounts for 20% of malignant tumours in the female reproductive system. A novel biological marker human epididymis protein4 (HE4) represents an important alternative indicator which may benefit patient mortality. To correlate the immunohistochemical expression of HE4 in different non-neoplastic and neoplastic endometrial lesions and with the WHO grade of the tumours. Our study was a cross-sectional, observational study done in a tertiary care hospital from December 2019 to June 2021 on the hysterectomy sample of 50 patients with a clinical history of abnormal uterine bleeding and pelvic pain. The study showed strong positivity of HE4 in cases of endometrial carcinoma, weak positivity in cases of atypical endometrial hyperplasia, and negativity in cases of endometrial hyperplasia without atypia group. WHO grade 3(50%) and grade 2 (29%) endometrioid adenocarcinoma NOS in our study showed strong positivity for HE4 which was statistically significant (P value = 0.001). In recent studies using overexpression of HE4-related genes, the malignant biological behaviour such as cell adhesion, invasion, and proliferation was enhanced. It was seen in our study that strong positivity of HE4 was seen in all endometrial carcinoma groups and with higher WHO grade. So, HE4 may become a potential therapeutic target for advanced-stage endometrial carcinoma which requires further research. Thus, human epididymis-specific protein 4 (HE4) has been shown to be a promising marker for the detection of endometrial carcinoma patients who could be benefitted from targeted therapy.

A survey on recent trends in deep learning for nucleus segmentation from histopathology images.

Nucleus segmentation is an imperative step in the qualitative study of imaging datasets, considered as an intricate task in histopathology image analysis. Segmenting a nucleus is an important part of diagnosing, staging, and grading cancer, but overlapping regions make it hard to separate and tell apart independent nuclei. Deep Learning is swiftly paving its way in the arena of nucleus segmentation, attracting quite a few researchers with its numerous published research articles indicating its efficacy in the field. This paper presents a systematic survey on nucleus segmentation using deep learning in the last five years (2017-2021), highlighting various segmentation models (U-Net, SCPP-Net, Sharp U-Net, and LiverNet) and exploring their similarities, strengths, datasets utilized, and unfolding research areas.

Unusual Presentation of Postoperative Intussusception in Two Infants.

We present two infants with postoperative intussusception following stoma formation for stricture bowel due to necrotizing enterocolitis. They had unusual clinical features which need a high index of suspicion to diagnose.

46 XY disorder of sex development (DSD) due to 5 alpha (SRD5A2) deficiency - Experience from a multidisciplinary Pediatric Gender Clinic.

BACKGROUND: SRD5A2 deficiency leads to incomplete masculinization of individuals with a 46 XY karyotype. A definitive diagnosis in early infancy facilitates decisions concerning choice of sex of rearing and management. AIM: To review the clinical presentation, diagnosis, treatment and outcome of children with 46 XY DSD due to SRD5A2 deficiency at a Paediatric Gender Clinic. STUDY DESIGN AND METHODS: Retrospective review of cases of SRD5A2 deficiency (2000-15) managed with a standard protocol at a multidisciplinary clinic. Demographic data, clinical presentation, physical findings, investigations (hormonal profile, imaging, genitoscopy), psychological evaluation (child, family), medical and surgical management, outcome and follow up were collated and analyzed. RESULTS: There were 12 cases aged 3 days-14 years at presentation, 3 had parental consanguinity. Eight were reared as males and 4 as females. Specialist referral was sought for hypospadias (5), atypical genitalia (5) or incongruent pubertal masculinization (2). All had chordee, symmetrical inguinoscrotal gonads, rugose labioscrotum and proximal hypospadias (perineoscrotal -9, perineal -3). Both pubertal cases had significant masculinization and no gynecomastia. The median testosterone/dihydrotestosterone ratio was 22.1(IQR-8.6-55.7). Despite a classical phenotype, four (2 prepubertal, 2 pubertal) had a ratio <10. Genitoscopy showed urogenital sinus remnant (4) and hypoplastic verumontanum (5). Sex reassignment was done in 4. Surgical management was staged and completed by 4 years in those with infantile presentation. Besides correction of chordee and urethroplasty in 11, other procedures included orchidopexy (5), excision of a urogenital sinus remnant (4) and correction of penoscrotal transposition (4). The urethroplasty was single staged in 3. All operated cases were followed up (mean age at last follow up - 10.63 years, mean follow up period - 7.25 years). The overall cosmetic result was satisfactory, but the phallic structure remained relatively small across prepubertal period. Uroflowmetry curves were normal in 9. All showed penile tumescence/erection and two peripubertal cases had typical secondary sexual characters. All cases, including those with sex reassignment, have a well-adjusted male psyche. DISCUSSION AND CONCLUSION: The diagnosis, management and longitudinal follow up of cases of SRD5A2 deficiency at a multidisciplinary gender clinic is presented. Diagnostic dilemmas with low T/DHT ratios remained in a third of cases. Most were diagnosed in infancy and assigned a male sex of rearing, all underwent staged masculinizing genitoplasty. Those with sex reassignment also fared well with comprehensive management after family counseling.

Superior Mesenteric Artery Injury during Radical Nephrectomy in an Infant: Delayed Diagnosis and Successful Management.

Superior mesenteric artery (SMA) injury during a left radical nephrectomy is an uncommon complication in children with a potentially devastating outcome. Successful management depends on early diagnosis and re-establishing SMA perfusion. We report the successful management of an iatrogenic SMA injury during radical nephrectomy in a 10-month-old boy with left upper polar Wilms' tumor.

Bedside laparotomy in newborns -A single institute experience.

BACKGROUND/PURPOSE: Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here. MATERIALS AND METHODS: Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres. RESULTS: The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation. CONCLUSION: Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.

Congenital Midline Cervical Cleft with Respiratory Epithelium: A Rare Association.

Congenital midline cervical cleft is a rare anomaly and is clinically apparent at birth. Histology of this defect is consistent with the presence of stratified squamous epithelium. However, we present a case of 1-year-old boy with chronic mucocutaneous candidiasis associated with two cysts and presence of focal respiratory epithelium. We attempt to discuss the presentation, the histological differences, and the optimal surgical treatment for the same.

Appendicular Biopsy in Total Colonic Aganglionosis: A Histologically Challenging and Inadvisable Practice.

Background The reliability of intraoperative evaluation of ganglion cells in the appendix as a guide to a diagnosis of total colonic aganglionosis is unclear. Objective To evaluate the diagnostic utility of appendicular innervation in colonic Hirschsprung disease (HD) and TCA. Methods Prospective, systematic study of ganglion cells and the neural plexii in appendices from cases (HD and TCA) and age matched controls with frozen and paraffin sections, rapid acetylcholinesterase (AChE) and immunohistochemistry. Results A total of 48 appendices (28 controls, 20 cases; 19 frozen) were evaluated. Of these 48, 30 were neonates. Ganglion cell clusters were smaller in controls (28) and HD (6) than those in the rectum, distorted at places and mimicked lymphocytes and endothelial cells, especially in neonates. Complete study of 13 appendices in TCA showed absence of ganglion cells, hypertrophic nerves, AChE activity, and calretinin staining. In 2/13 TCA, an erroneous frozen section identification of ganglia was later corrected based on AChE histochemistry and a panel of IHC stains. Ileal biopsies guided the placement of a ganglionic ileostomy in all. One case each of skip segment aganglionosis in a TCA and variable hypoganglionosis in long segment colonic HD is reported. Conclusion Intraoperative characterization of appendicular innervation as a guide to the diagnosis of TCA is unreliable, in part because of the possibility of skip segment disease/variable hypoganglionosis. We propose terminal ileal biopsies for diagnosis and leveling of aganglionosis. AChE on frozen/calretinin on paraffin tissue is the best approach to avoid diagnostic errors.

Atypical extragonadal germ cell tumors.

AIM: To review the experience with the diagnosis and management of extragonadal germ cell tumors (GCT) with a subset analysis of those with atypical features. MATERIALS AND METHODS: A retrospective chart review of patients of extragonadal germ cell tumors between 2000 and 2010 was carried out. RESULTS: Fifteen children aged 7 days to 15 years (median, 1.5 years) were included. Three had an antenatal diagnosis (one sacrococcygeal, one retrobulbar, one retroperitoneal tumor) and were operated in the neonatal period. The locations were distributed between the retrobulbar area (1), anterior neck-thyroid gland (1), mediastinum (4), abdominothoracic extending through the esophageal hiatus (1), retroperitoneal (4) and sacrococcygeal (4). On histological examination, five harbored immature elements while two were malignant; the latter children received postexcision adjuvant chemotherapy. There was no mortality. At a median follow-up of 4.5 years (6 months to 8 years), 14/15 have had an event-free survival. One immature mediastinal teratoma that recurred locally 7.5 years after the initial operation was excised and adjuvant chemotherapy instituted. CONCLUSIONS: Extragonadal GCTs in children are uncommon and occasionally present with atypical clinical, radiological and histological features resulting in diagnostic and therapeutic dilemmas.

Embryonal carcinoma in a cryptorchid testis of a 3-year old.

The undescended testis is at an increased risk of malignant transformation. Almost all such tumours occur in the second to fourth decades of life and are usually seminomas. A case of a mixed germ-cell tumour with yolk sac and embryonal carcinoma components arising in one of the hitherto uncorrected bilateral cryptorchid testes of a3-year old child is presented.

Preputial adhesions--a misunderstood entity.

OBJECTIVE: To assess the trends and outcomes in referrals of 'phimosis for circumcision' to a tertiary care pediatric surgical department. METHODS: This is a prospective study of 100 consecutive children of presumed phimosis referred for circumcision. They were assessed and classified by the senior author as having either preputial adhesions or phimosis. The patients in the former group underwent outpatient preputial adhesiolysis while those in the latter group were offered circumcision primarily. All were followed up till resolution. RESULTS: All 100 were referred with a non-retractile prepuce and an additional reason - preputial ballooning at voiding, dysuria or suspect UTI. Eight (mean age -58 months, referred for preputial ballooning at voiding -6/8 and dysuria -2/8) had phimosis and were primarily offered circumcision. The remaining 92 (mean age - 22 months, referred for preputial ballooning at voiding -52/92, dysuria -28/92 and suspect UTI -12/92) had preputial adhesions. In the latter group, none has a documented urinary infection on specific investigations. These 92 underwent outpatient preputial adhesiolysis. Seventy three (79 %) required a single sitting, 11 (12%) required 2 -4 sittings and 4(4.5%) required 5-8 sittings over a follow up period of 1 -24 months (median -3 weeks). 4/92(4.5%) were deemed non-responders to adhesiolysis and were circumcised later. CONCLUSION: The majority of children referred with 'phimosis for circumcision' to this tertiary pediatric surgical centre were actually physiologic preputial adhesions that were managed with outpatient preputial adhesiolysis. This study underscores a lack of awareness amongst referring primary care physicians regarding preputial adhesions and the potential for an erroneous diagnosis of phimosis translating into unnecessary circumcisions in many young boys.