Artificial-Intelligence-Based Imaging Analysis of Stem Cells: A Systematic Scoping Review.

This systematic scoping review aims to map and identify the available artificial-intelligence-based techniques for imaging analysis, the characterization of stem cell differentiation, and trans-differentiation pathways. On the ninth of March 2022, data were collected from five electronic databases (PubMed, Medline, Web of Science, Cochrane, and Scopus) and manual citation searching; all data were gathered in Zotero 5.0. A total of 4422 articles were collected after deduplication; only twenty-seven studies were included in this systematic scoping review after a two-phase screening against inclusion criteria by two independent reviewers. The amount of research in this field is significantly increasing over the years. While the current state of artificial intelligence (AI) can tackle a multitude of medical problems, the consensus amongst researchers remains that AI still falls short in multiple ways that investigators should examine, ranging from the quality of images used in training sets and appropriate sample size, as well as the unexpected events that may occur which the algorithm cannot predict.

Does needle-type increase the diagnostic yield of malignancies in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)?-a prospective comparative study.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed minimally invasive technique for diagnosing mediastinal pathologies. Currently, many needle types are being developed to improve the accuracy of the final diagnosis. Our study aimed to assess the possible advantages and disadvantages between the 22-gauge ProCore® needle and the standard 22-gauge needles. Methods: In this prospective study, we enrolled a group of 363 EBUS-TBNA patients. For each patient, we used either the ProCore® needle or the standard one. We used the ProCore® needle in 51 patients and the standard needle in 312 patients. When a diagnosis could not be made, it was subsequently established with a surgical biopsy. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the biopsy for both needle types. Results: By using EBUS-TBNA, a diagnosis was established in 306 patients (84.3%). The rates of the final diagnoses in ProCore® and standard needle groups were 92.2% and 83.0% (P=0.14), respectively. The sensitivity, specificity, PPV, and NPV for ProCore® vs. standard needles did not differ and were 89.2% vs. 79.3%, 100.0% vs. 95.7%, 100.0% vs. 98.5%, and 77.8% vs. 57.3%, respectively. A total of 57 patients required mediastinoscopy or surgical biopsy to obtain a final pathology. However, this number was not significantly different between the needles [ProCore® (7.8%) vs. standard (17%), P=0.26]. Conclusions: Both types of needles demonstrated very high diagnostic efficiency for malignancy, and there was no significant advantage of the ProCore® over the standard needle.

Brain structure and stroke risk score in subjects without a history of atrial fibrillation.

CHA2DS2-VASc score system aids in clinical decision-making in subjects with atrial fibrillation (AF). Little is known on the association between CHA2DS2-VASc scores and brain structure in patients without cardiac arrhythmia. Detailed brain architecture analysis was performed. Assessment of bivariate correlation between the volume of segmented brain structures and Z-scores of CHA2DS2-VASc showed that higher risk scores correlated negatively and significantly with various brain framework. Our study confirms that a cluster of risk factors incorporated in a well-established risk score correlated with brain tissue volume independently of the presence of an arrhythmia.

COVID-19 pandemic in flu season. Chest computed tomography - what we know so far.

Chest computed tomography (CT) is proven to have high sensitivity in COVID-19 diagnosis. It is available in most emergency wards, and in contrast to polymerase chain reaction (PCR) it can be obtained in several minutes. However, its imaging features change during the course of the disease and overlap with other viral pneumonias, including influenza pneumonia. In this brief analysis we review the recent literature about chest CT features, useful radiological scales, and COVID-19 differentiation with other viral infections.

Impact of smoking history on postoperative complications after lung cancer surgery - a study based on 286 cases.

AIM: The aim of the study was to evaluate the impact of smoking cessation and its timing in the preoperative period on postoperative morbidity in patients undergoing surgery for non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Two hundred and eighty-six patients surgically treated for NSCLC were prospectively analyzed in terms of duration and intensity of smoking, time period from smoking cessation to surgery, and postoperative morbidity. The patients were divided into five groups: I - current smokers and past smokers who quit smoking less than 2 weeks before surgery (n = 67), II - past smokers who quit 2 weeks to 3 months (n = 106), III - past smokers who quit 3 months to 1 year (n = 30), IV - past smokers who quit more than 1 year (n = 71), V - never smokers (n = 12). RESULTS: In the analyzed group 95.8% were smokers or past smokers. Postoperative complications occurred in 40.2% of patients including pulmonary (21.3%) and cardiac morbidity (17.8%). The pulmonary and circulatory morbidity rates were the lowest in group V but the differences were not significant. Similarly, there were no significant differences between groups with and without pulmonary or circulatory complications regarding: number of daily smoked cigarettes, smoking duration and the moment of cessation. The analysis of segmental regression showed the smallest percentage of complications in patients who quit smoking between the 8th and the 10th week before the operation. CONCLUSIONS: Among patients surgically treated for NSCLC, duration of smoking and number of smoked cigarettes has no significant influence on frequency and type of postoperative complications. The best moment to quit smoking is the period between the 8th and the 10th week preceding surgery.

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

INTRODUCTION: Additional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications. AIM: To evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications. MATERIAL AND METHODS: From 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43). RESULTS: The early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed. CONCLUSIONS: The use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

Analyzing Effectiveness of Routine Pleural Drainage After Nuss Procedure: A Randomized Study.

BACKGROUND: The routine use of postoperative pleural cavity drainage after the Nuss procedure is not widely accepted, and its limited use depends on experience. This study analyzed the influence of pleural drainage in the surgical treatment of patients with pectus excavatum on the prevention of pneumothorax and the efficacy of using drainage after a corrective operation. METHODS: From November 2013 to May 2015, 103 consecutive patients with pectus excavatum, aged 11 to 39 years, underwent surgical treatment by the Nuss procedure. Patients were prospectively randomized into two groups. In 58 patients, a 28F chest tube was routinely introduced into the right pleural cavity during procedure for 2 consecutive days (group I). In the remaining 45 patients, the drain was not inserted (group II). RESULTS: No statistically significant differences were found between the study groups, including sex, age, body mass index, or clinical subjective and objective factors in the preoperative evaluation. Group II manifested more complications in the early postoperative period; however, this was not statistically significant (group I vs group II; p = 0.0725). Pneumothorax requiring additional chest tube placement was statistically significant (group I vs group II; p = 0.0230). Other complications were also more frequent among patients from group II, although this did not reach statistical significance. Follow up was 22.9 ± 6.4 months. CONCLUSIONS: Routine drainage of the pleural cavity during the Nuss procedure significantly reduces the incidence of postoperative pneumothorax and should be considered as a routine procedure.

The role of simulation to support donation after circulatory death with extracorporeal membrane oxygenation (DCD-ECMO).

Maintaining the viability of organs from donors after circulatory death (DCD) for transplantation is a complicated procedure, from a time perspective in the absence of appropriate organizational capabilities, that makes such transplantation cases difficult and not yet widespread in Poland. We present the procedural preparation for Poland's first case of organ (kidney) transplantation from a DCD donor in which perfusion was supported by extracorporeal membrane oxygenation (ECMO). Because this organizational model is complex and expensive, we used advanced high-fidelity medical simulation to prepare for the real-life implementation. The real time scenario included all crucial steps: prehospital identification, cardiopulmonary resuscitation (CPR), advanced life support (ALS); perfusion therapy (CPR-ECMO or DCD-ECMO); inclusion and exclusion criteria matching, suitability for automated chest compression; DCD confirmation and donor authorization, ECMO organs recovery; kidney harvesting. The success of our first simulated DCD-ECMO procedure in Poland is reassuring. Soon after this simulation, Maastricht category II DCD procedures were performed, involving real patients and resulting in two successful double kidney transplantations. During debriefing, it was found that the previous simulation-based training provided the experience to build a successful procedural chain, to eliminate errors at the stage of identification, notification, transportation, donor qualifications and ECMO organ perfusion to create DCD-ECMO algorithm architecture.

The role of extracorporeal membrane oxygenation in patients after irreversible cardiac arrest as potential organ donors.

The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition. Various systems, including extracorporeal membrane oxygenation (ECMO), supporting perfusion of organs for transplantation play a key role. In 2016 the "ECMO for Greater Poland" program was established. Although its main goal is to improve the survival rate of patients suffering from life-threatening cardiopulmonary conditions, one of its branches aims to increase the donation rate in patients with irreversible cardiac arrest. In this review, the role of ECMO in the latter group as the potential organ donors is presented.

Early and Late Results of the Nuss Procedure in Surgical Treatment of Pectus Excavatum in Different Age Groups.

BACKGROUND: The aim of this study was a comparison of early and late results in surgical treatment of funnel chest using the Nuss method in patients in various age groups to find the optimal age to perform the corrective procedure. METHODS: Six hundred eighty patients operated on from June 2002 to October 2012 were included in the retrospective analysis. Patients were divided into 3 different age groups: group A = 156 patients from 7 to 14 years, group B = 328 patients aged 15 to 20 years, and group C = 196 patients older than 20 years of age. The mean follow-up was 33 months. RESULTS: Early non-life-threatening complications developed in 238 (35.0%) patients and frequency increased with age (group A, 24.3%; group B, 37.8%; group C, 38.8%; p = 0.0063). Good and very good corrective effects were achieved in 97.7 % of the entire patient population. Recurrence of the deformity was observed more often in younger patients (group A, 3.2 %) than in the other patients (group B, 1.2%; group C, 1.5%), although the difference between the studied groups was not significant (p = 0.3251). CONCLUSIONS: Good cosmetic results obtained with the use of the Nuss operation were not related to the age of the patients. The high incidence of minor complications in older patients seems to be an acceptable cost of a good cosmetic outcome and stable correction. Surgical morbidity is lowest in younger patients; however, the frequency of the recurrence of deformation is higher than in other groups.

[Medical simulation as a professional tool which affect the safety of the patient used in the learning process]. / Symulacja medyczna jako profesjonalne narzedzie wplywajace na bezpieczenstwo pacjenta wykorzystywane w procesie nauczania.

Simulation is the methodology of teaching, learning process using educational equipment from simple simulators, designed to study individual tasks, through advanced mannequins called human patient stimulators faithfully mimic the human and its parameters. The medical simulation's main task is education and improvement patients' safety. Advanced human simulators can realistically cough, vomit with artificial chyme and bleed with artificial blood causing a real stress of medical personnel and the need for immediate action. Medical simulation gives the opportunity to prepare medical personnel to the profession more effectively, in less time than traditional education and also clearly affects the patients' safety.

A novel method for the in vivo isolation of circulating tumor cells from peripheral blood of cancer patients using a functionalized and structured medical wire.

The isolation of circulating tumor cells (CTCs) from the blood of patients afflicted with solid malignant tumors becomes increasingly important as it may serve as a 'liquid biopsy' with the potential of monitoring the course of the cancer disease and its response to cancer therapy, with subsequent molecular characterization. For this purpose, we functionalized a structured medical Seldinger guidewire (FSMW), normally used to obtain safe access to blood vessels and other organ cavities, with a chimeric monoclonal antibody directed to the cell surface expressed epithelial cell surface adhesion molecule (EpCAM). This medical device was optimized in vitro and its biocompatibility was tested according to the regulations for medical devices and found to be safe with no noteworthy side effects. Suitability, specificity and sensitivity of the FSMW to catch and enrich CTCs in vivo from circulating peripheral blood were tested in 24 breast cancer or non-small cell lung cancer (NSCLC) patients and in 29 healthy volunteers. For this, the FSMW was inserted through a standard venous cannula into the cubital veins of healthy volunteers or cancer patients for the duration of 30 min. After removal, CTCs were identified by immuno-cytochemical staining of EpCAM and/or cytokeratins and staining of their nuclei and counted. The FSMW successfully enriched EpCAM-positive CTCs from 22 of the 24 patients, with a median of 5.5 (0-50) CTCs in breast cancer (n=12) and 16 (2-515) CTCs in NSCLC (n=12). CTCs could be isolated across all tumor stages, including early stage cancer, in which distant metastases were not yet diagnosed, while no CTCs could be detected in healthy volunteers. In this observatory study, no adverse effects were noted. Evidently, the FSMW has the potential to become an important device to enrich CTCs in vivo for monitoring the course of the cancer disease and the efficacy of anticancer treatment.

Can the condition of the cell microenvironment of mediastinal lymph nodes help predict the risk of metastases in non-small cell lung cancer?

BACKGROUND: The aim of this study was to analyze the properties of the immune cell microenvironment of regional lymph nodes (LNs) positive for lung cancer. METHODS: Twenty-four patients operated on for stages T1 and T2 of the NSCLC, were enrolled in the study. Peripheral blood and LN tissue were obtained from different lymph node sites and levels. As a control, LN tissue was taken from patients diagnosed with emphysema or pneumothorax. The cells from randomly chosen LN were tested by multi-color flow cytometry. Separate portions of LN were snap-frozen and examined for the presence of cytokeratin positive cells (CK). Propensity for apoptosis, level of TCR zeta chain expression of T cells and the number and maturation status of dendritic cells were confronted with the presence of CK-positive cells. RESULTS: The presence of metastases correlated with the downregulation of TCR zeta, especially CD8(+) T cells. The most striking feature was the reduction in the number of myeloid CD11c(+) dendritic cells in the LN of patients with LN metastases. This could be a reflection of the immunodeficient state observed in lung cancer patients. Even in the absence of metastases in the regional LN, the same type of changes in the LN microenvironment were observed in those LN located nearer the primary tumor. CONCLUSIONS: The preliminary results of this study suggest that this approach may be helpful as an independent tumor staging factor. It is also worth noting that part of the staging process could also be based on features describing the immune cells in the peripheral blood.

The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease.

OBJECTIVE: The aim of this study was to analyze the early and long-term results of simultaneous surgical treatment of both coronary heart disease (CHD) and lung cancer. METHODS: Twenty-five patients with the diagnoses of both non-small cell lung cancer (NSCLC) and unstable angina were operated on between 2001 and 2006 in the Department of Cardiothoracic Surgery at the University of Medical Sciences in Poznan, Poland. Myocardial revascularization was performed simultaneously with the lung resection. The mean patient age was 63 years. The majority (18 patients) were male and the stage of lung cancer was predominantly AJCC II. Most of the patients were classified as stage II or III CCS and the predominant pathology was a two-vessel disease. Fifteen lobectomies, six pneumonectomies and four wedge resections were performed together with the aortocoronary graft implantation (mean: 1.9 graft per patient). RESULTS: There were no postoperative deaths or perioperative myocardial infarctions (MI). The most frequent complications were as follows: atrial fibrillation (24%), atelectasis (12%) and residual pneumothorax (12%). All the patients were followed up for 8-60 months. Within this period, eight patients (32%) died, mostly due to the cancer relapse. The local recurrence of lung cancer and distant metastases were the only factors statistically influencing the late survival. No patient in the entire follow-up period had a MI. In three patients, the symptoms of recurrent angina occurred and one of them underwent a coronary stent implantation. CONCLUSIONS: Simultaneous off-pump myocardial revascularization and lung resection is a safe and effective treatment when unstable CHD and lung cancer coexist. In selected patients, this combined procedure may be an alternative to the two-stage approach, surgical or non-surgical (cardiologic) interventions preceding the pulmonary resection. The only statistically significant factor having an impact on long-term survival is the recurrence of the cancer.

[Pulmonary embolism in the course of antiphospholipid syndrome]. / Zatorowosc plucna w przebiegu zespolu antyfosfolipidowego.

A short overview of the literature on pulmonary thromboembolism in the course of antiphospholipid syndrome (APS) is presented. The mechanism of pulmonary thrombosis and related arterial emboli as well as non-thrombotic changes in pulmonary vessels are discussed. The antithrombotic prophylaxis, conservative and surgical treatment of pulmonary thrombosis associated with APS are reviewed.

Prognostic value of DNA ploidy: 5-year follow-up of patients with resectable squamous cell carcinoma (SCC) of the lung.

This study was designed to show the relation between DNA-ploidy in patients with resectable lung cancers and their 5-year survival rate. The results are compared with those from our 2-year follow-up study of the same group of patients published in 2000. The group of 80 patients with SCC who underwent lung resection between 1995 and 96 were re-analyzed. For the statistical analysis the hazard Cox model and an exponential multiple regression model were used. The survival curves were drawn using the Kaplan-Meier method. DNA-aneuploidy was found in 45% of cancer tumors. There was no statistically significant correlation between aneuploidy and gender, age, cancer staging or grading. In the 3-year follow-up the survival rate in patients with aneuploid type tumors was significantly lower than in those with the diploid type. However, this difference was not found after 5 years of follow-up. Tumor ploidy was an independent prognostic factor only in patients between 55 and 60 years of age. The mortality rate in patients with aneuploid tumors was mainly the result of distant metastases while, in patients with diploid tumors, local recurrence was the main reason for death. In the first three years after surgical resection patients with aneuploid tumors are at higher risk of distant metastases than patients with the diploid type. Tumor ploidy can be recognized as an independent prognostic factor in younger (55-60) patients. Aneuploidy promoted the occurrence of early distant metastases while the diploid type was associated with late (after 3 years) local tumor recurrence.