Segmentation and Volumetric Analysis of Heart from Cardiac CT Images.

PURPOSE: Cardiac CT is a valuable diagnostic tool in evaluating cardiovascular diseases. Accurate segmentation of the heart and its structures from cardiac CT and MRI images is essential for diagnosing functional abnormalities, treatment plans and cardiovascular diseases management. Accurate segmentation and quantitative assessments are still a challenge. Manual delineation of the heart from the scan images is labour-intensive, time-consuming, and error prone as it depends on the radiologist's experience. Thus, automated techniques are highly desirable as they can significantly improve the efficiency and accuracy of image analysis. METHOD: This work addresses the above problems. A new, image-driven, fast, and fully automatic segmentation method was developed to segment the heart from CT images using a processing pipeline of adaptive median filter, multi-level thresholding, active contours, mathematical morphology, and the knowledge of human anatomy to delineate the regions of interest. RESULTS: The algorithm proposed is simple to implement and validate and requires no human intervention. The method is tested on the 'Image CHD' DICOM images (multi-centre, clinically approved single-phase de-identified images), and the results obtained were validated against the ground truths provided with the dataset. The results show an average Dice score, Jaccard score, and Hausdorff distance of 0.866, 0.776, and 33.29 mm, respectively, for the segmentation of the heart's chambers, aorta, and blood vessels. The results and the ground truths were compared using Bland-Altmon plots. CONCLUSION: The heart was correctly segmented from the CT images using the proposed method. Further this segmentation technique can be used to develop AI based solutions for segmentation.

Risk of diabetes and expected years in life without diabetes among adults from an urban community in India: findings from a retrospective cohort.

BACKGROUND: Diabetes prevalence has increased over the past few decades, and the shift of the burden of diabetes from the older population to the younger population has increased the exposure of longer durations in a morbid state. The study aimed at ascertaining the likelihood of progression to diabetes and to estimate the onset of diabetes within the urban community of Mumbai. METHODS: This study utilized an observational retrospective non-diabetic cohort comprising 1629 individuals enrolled in a health security scheme. Ten years of data were extracted from electronic medical records, and the life table approach was employed to assess the probability of advancing to diabetes and estimate the expected number of years lived without a diabetes diagnosis. RESULTS: The study revealed a 42% overall probability of diabetes progression, with age and gender variations. Males (44%) show higher probabilities than females (40%) of developing diabetes. Diabetes likelihood rises with age, peaking in males aged 55-59 and females aged 65-69. Males aged 30-34 exhibit a faster progression (10.6 years to diagnosis) compared to females (12.3 years). CONCLUSION: The study's outcomes have significant implications for the importance of early diabetes detection. Progression patterns suggest that younger cohorts exhibit a comparatively slower rate of progression compared to older cohorts.

Treatment of Recurrent Low-grade Serous Ovarian Cancer With MEK Inhibitors: A Systematic Review.

OBJECTIVE: Low-grade serous ovarian cancer (LGSC) represents 5% of all epithelial ovarian cancers. They are characterized by indolent growth and KRAS and BRAF mutations, differing from high-grade serous ovarian cancer both clinically and molecularly. LGSC has low response rates to traditional systemic therapies, including chemotherapy and hormonal therapy. The objective of this systematic review was to appraise the literature describing the efficacy of MEK inhibitors in the treatment of LGSC. METHODS: A comprehensive search was conducted of the following databases: Medline ALL, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Sciences, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICFRP), and International Standard Randomized Controlled Trials Number (ISRCTN) Registry. All studies investigating MEKi in the treatment of LGSC in the adjuvant or recurrent setting for patients 18 years of age or older were included. All titles/abstracts were then screened by 2 independent reviewers (A.K. and C.C.). The full-text articles were then screened. All disagreements were resolved by a third independent reviewer (T.Z.). Two independent reviewers (A.K. and C.C.) extracted data from the studies deemed eligible for final review. RESULTS: A total of 2108 studies were identified in the initial search. Of these, a total of 4 studies met the eligibility criteria for systematic review. In these studies, 416 patients were treated with an MEKi alone. All patients included in the studies were being treated for LGSC in the recurrent setting. Varied results and efficacy of the MEKi were reported in each study. CONCLUSIONS: The results highlighted in this systematic review demonstrate varied responses to MEKi for recurrent LGSC. Further research is needed in this field comparing the efficacy to current therapies, as well as to further evaluate the safety and toxicity profile with long-term use of MEKi.

The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study.

BACKGROUND: Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai. METHODS: The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011-2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group. RESULTS: A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40-44 years old to 4.2% among those age 70 years and above. CONCLUSION: The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.

A study of beliefs towards mental illness among teachers in Sikar city, Rajasthan.

Background: Understanding the significance of adolescents' mental health, school-based mental health interventions are being implemented with the help of teachers globally. Aim: Owing to the dearth of literature concerning the beliefs, and stigma among the teachers, the present study was conducted with an aim to study the mental health beliefs among teachers. Methods: This is a cross-sectional study conducted among randomly selected teachers teaching in government and private schools of Sikar city of Rajasthan. A general sociodemographic questionnaire, Beliefs Towards Mental Illness Scale, and a questionnaire about prior exposure to mental health issues was administered. Stata 15.0 was used for statistical analysis, and independent t-test and one-way analysis of variance test were applied to find out associations. Results: Majority of the participants were in age group of 31-40 years, married, and postgraduate. The mean Beliefs Towards Mental Illness Scale score of 147 teachers was 49.95 ± 17.34 of 105. Only 2% of the study participants have ever received training related to mental health issues. Teachers who had prior exposure to mental health issues, residing in semi-urban and urban areas showed more positive beliefs. Conclusion: Study participants have displayed negative beliefs toward mental health. This brings to light the important interventions like creating knowledge and awareness among the study population by conducting trainings. More research is needed to explore the mental health beliefs among the teachers.

Role of HPV in the Prediction of Persistence/Recurrence After Treatment for Cervical Precancer.

OBJECTIVES: (1) To determine the role of human papillomavirus (HPV) testing after excisional treatment of cervical precancer. (2) To determine clinical factors associated with persistence of cervical precancer post-treatment. METHODS: A retrospective chart review was conducted including patients who had a loop electrosurgical excision procedure (LEEP) for cervical precancer (cervical intraepithelial neoplasia 3/adenocarcinoma in situ/high-grade squamous intraepithelial lesions [HSIL]). All patients treated between 2016 and 2018 at a tertiary centre colposcopy unit were included. Persistence/recurrence of disease was defined as high-grade cytology or histology identified during the time of follow-up. Univariate and multivariate regression models were performed to identify factors associated with persistence/recurrence and HPV positivity at exit testing. RESULTS: A total of 284 patients were included. The median follow-up time was 19 months. Of the LEEP specimens, 90.8% (n = 258) demonstrated HSIL and 3.9% (n = 11) had adenocarcinoma in situ. 28.5% (n = 81) of the LEEP specimens had positive margins. In follow-up, 72.9% had negative cytology, 17.6% had atypical squamous cells of undetermined significance/low-grade SIL, 1.8% had atypical squamous cells, HSIL cannot be excluded/low-grade SIL-H, and 6.7% had HSIL. At the final follow-up, 27.8% (n = 79) were HPV+. Overall rate of persistence/recurrence was 11.3% (n = 32); median time to persistence/recurrence was 6.5 months. Multivariate regression models demonstrated that follow-up HPV positivity (OR = 22.0) and positive margins (OR = 3.7) were significantly associated with persistence/recurrence. Similarly, in univariate regression models, positive margins were significant (OR = 2.2) for predicting HPV positivity in exit testing. CONCLUSIONS: Persistence/recurrence of precancer can occur due to incomplete treatment of lesions by local excision and by the persistence of HPV infection. Surveillance strategies for women treated for cervical precancer require a risk-based approach and should rely on HPV testing.

Phytochemical Characterization, Antioxidant and Anti-Proliferative Properties of Rubia cordifolia L. Extracts Prepared with Improved Extraction Conditions.

Rubia cordifolia L. (Rubiaceae) is an important plant in Indian and Chinese medical systems. Extracts prepared from the root, stem and leaf have been used traditionally for the management of various diseases. Some of the known effects are anti-inflammation, neuroprotection, anti-proliferation, immunomodulation and anti-tumor. A comparative account of the extracts derived from different organs that lead to the identification of the most suitable solvent is lacking. We explored the presence of phytochemicals, antioxidant activity and anti-proliferative properties of a variety of solvent-based extracts of root, and methanol extracts of stem and leaf of R. cordifolia L. The antioxidant potential was determined by DPPH, hydrogen peroxide, nitric oxide and total antioxidant assays. The anti-proliferative nature was evaluated by MTT assay on HeLa, ME-180 and HepG2 cells. The composition of the extracts was determined by UPLC-UV-MS. We found that the root extracts had the presence of higher amounts of antioxidants over the stem and leaf extracts. The root extracts prepared in methanol exhibited the highest cytotoxicity in HepG2 cells. The main compounds identified through UPLC-UV-MS of the methanol extract give credibility to the previous results. Our comprehensive study corroborates the preference given to the root over the stem and leaf for extract preparation. In conclusion, we identified the methanol extract of the root to be the most suited to have bioactivity with anti-cancer potential.

Innovations in the Management of Vaginal Cancer.

Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed.

What Do Nurses Prefer? A Cross-sectional Study of Catheter Preference After Pelvic Organ Prolapse Surgery.

PURPOSE: The purpose of this study was to determine nursing preferences regarding catheter type (transurethral indwelling catheters vs intermittent catheterization vs suprapubic tube drainage) when caring for patients in hospital after pelvic organ prolapse surgery. DESIGN: Cross-sectional survey study. SUBJECTS AND SETTING: Registered nurses practicing in academic and community hospitals across North America (the United States and Canada). METHODS: Three hundred fifty-four RNs who routinely care for patients after pelvic organ prolapse surgery from centers across North America were sent an electronic survey between February 2018 and March 2019. The survey comprised 24 questions that collected information on the participants' demographics and their experience with using different catheters in a hospital setting, along with knowledge of and preference for the different catheter types. Descriptive statistics were used to determine catheter preferences of respondents in addition to their catheter rankings according to catheter-related outcomes. RESULTS: One hundred sixty nurses completed the survey, representing a 45% response rate. More than half (63.1%, n = 101) of respondents stated a preference for transurethral indwelling catheters, 23.1% (n = 37) preferred suprapubic tubes, and 10.6% (n = 17) preferred intermittent catheterization. Transurethral indwelling catheters were ranked by nurses as the best catheter type for ease of use and pain/discomfort for patients. Intermittent catheterization was ranked by nurses as the best for lowest malfunction rates and return of bladder function. Suprapubic tubes were ranked by nurses as best for lowest infection rates. CONCLUSIONS: This study has demonstrated that nurses practicing in inpatient care units have a strong preference for transurethral indwelling catheters over intermittent catheterization and suprapubic tubes when caring for patients after pelvic organ prolapse surgery.

A Systematic Approach of Data Collection and Analysis in Medical Imaging Research.

BACKGROUND: Obtaining the right image dataset for the medical image research systematically is a tedious task. Anatomy segmentation is the key step before extracting the radiomic features from these images. OBJECTIVE: The purpose of the study was to segment the 3D colon from CT images and to measure the smaller polyps using image processing techniques. This require huge number of samples for statistical analysis. Our objective was to systematically classify and arrange the dataset based on the parameters of interest so that the empirical testing becomes easier in medical image research. MATERIALS AND METHODS: This paper discusses a systematic approach of data collection and analysis before using it for empirical testing. In this research the image were considered from National Cancer Institute (NCI). TCIA from NCI has a vast collection of diagnostic quality images for the research community. These datasets were classified before empirical testing of the research objectives. The images in the TCIA collection were acquired as per the standard protocol defined by the American College of Radiology. Patients in the age group of 50-80 years were involved in various clinical trials (multicenter). The dataset collection has more than 10 billion of DICOM images of various anatomies. In this study, the number of samples considered for empirical testing was 300 (n) acquired from both supine and prone positions. The datasets were classified based on the parameters of interest. The classified dataset makes the dataset selection easier during empirical testing. The images were validated for the data completeness as per the DICOM standard of the 2020b version. A case study of CT Colonography dataset is discussed. CONCLUSION: With this systematic approach of data collection and classification, analysis will be become more easier during empirical testing.
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Data Integrity of Radiology Images Over an Insecure Network Using AES Technique.

BACKGROUND: While transmitting the medical images in radiology information systems the adversary effect can break the CIA (Confidentiality, Integrity, and Availability) triads of information security. The objective of the study was to transmit the complete set of image objects in a dataset without data integrity violation. METHODS: In this paper a hybrid cryptographic technique which combines the prime details from the patient dataset (stack of axial 2D images) and the Advanced Encryption Standard (AES) method has been proposed. The steps include a) Creating an artificial X-ray image (DRR) from the 3D volume, b) dividing the DRR image in x and y directions equally into four regions, c) applying the zig-zag pattern to each quadrant, and d) encryption of each quadrant with block cipher mode using the AES algorithm. After dataset transmission the DRR image was regenerated at the receiver and compared each of the deciphered blocks (transmitted ones) using the histogram technique. RESULTS: The technique was tested on CT and MRI scans of sixty datasets. The image injection techniques, such as adding and deleting an image from the dataset and modifying the image pixels, were tested. The results were validated statistically using mean square error and histogram matching techniques. CONCLUSION: The combination of the DRR and the AES technique has ensured the secured transmission of the entire dataset and not an individual image.

The Preferred Catheter Type After Prolapse Surgery: A Survey Study of Surgeons.

OBJECTIVE: The aim of this study was to determine surgeon preference for catheter type in the management of postoperative urinary retention after prolapse surgery, specifically comparing transurethral indwelling catheters (TIC), clean intermittent self-catheterization (CISC), and suprapubic tubes (SPT). METHODS: Electronic surveys were sent to 1182 urogynecologists and urologists through the American Urogynecologic Society and the Canadian Society of Pelvic Medicine. RESULTS: A total of 247 (21%) surveys were completed, where 53% of the respondents ranked TIC as the best catheter option, compared with 42% for CISC and 4% for SPT (P < 0.0001). Most (75%) of the respondents stated they do not offer their patients a choice in catheter selection. Most (43%) of the respondents ranked ease of use for the patient as the most important catheter characteristic. For ease of use for the patient, 71% of the respondents ranked TIC as the best, compared with CISC and SPT. For all other characteristics (pain/discomfort, infection, catheter malfunction, and return of bladder function), CISC was ranked as the best by the majority. CONCLUSIONS: This study showed that surgeons have a significant preference for TIC over CISC and SPT for the management of postoperative urinary retention, and the majority of surgeons do not offer their patients a choice with regard to catheter type.

Performance Indicators for Colposcopy in Ontario.

OBJECTIVE: This study sought to evaluate the delivery of colposcopy assessments and treatments in Ontario from 2009 to 2017 according to specific performance measures, derived from guidelines on colposcopy use. METHODS: This population-based descriptive analysis included screen-eligible women ages 21 to 69 in Ontario who underwent cervical screening between 2009 and 2017. Performance measures that describe the quality of colposcopy services in the province were calculated. RESULTS: Five performance measures were used to assess the use of colposcopy in Ontario from 2009 to 2017. From 2013 to 2017, the percentage of women seen for colposcopy after a first diagnosis of atypical squamous cells of undetermined significance (ASCUS), without evidence of repeat cytology, remained stable, ranging from 5.9% to 6.3%. The median wait time to colposcopy for atypical glandular cells (AGC), atypical squamous cells (ASC-H), cannot rule out high-grade squamous intraepithelial lesions, and high-grade squamous intraepithelial lesions (HSIL), remained relatively stable from 2013 to 2017. In addition, the percentage of women with high-grade Pap test results who were seen in colposcopy within 6 months increased from 74.7% to 83.5%. The percentage of women who were not seen in follow-up within 12 months after treatment for cervical dysplasia remained stable, as did the percentage of women who discontinued colposcopy after three normal Pap test results following treatment for cervical dysplasia. CONCLUSION: This study developed five performance indicators and used them to assess the delivery of colposcopic services in Ontario from 2009 to 2017. Performance indicators have previously been used effectively in the field of colorectal cancer screening to identify strengths and weaknesses in the delivery of healthcare services. This had never previously been done in colposcopy.

Elucidation of hypoglycemic action and toxicity studies of insulin-like protein from Costus igneus.

We have reported earlier, an orally active insulin-like protein (ILP) from Costus igneus having potent hypoglycemic property in STZ-induced diabetic Swiss mice. The blood glucose level was reduced significantly within two hours after feeding ILP orally in an oral glucose tolerance test. The present study elucidates the mechanism underlying the hypoglycemic action of ILP. Mechanism of action of ILP was studied in differentiated L6 myotubes. 2-NBDG uptake stimulated by ILP was studied in differentiated L6 myotubes under normoglycemic, hyperglycemic and induced insulin resistant conditions. ILP treatment significantly increased 2-NBDG uptake in differentiated L6 myotubes. The levels of insulin signaling molecules IRS-1 and GLUT-4 were assessed in ILP treated L6 myotubes by immunoblot analysis of cytoplasmic and plasma membrane fractions respectively. Immunoblot analysis revealed an increase in cytoplasmic IRS-1 with a concomitant increase in GLUT-4 translocation to the plasma membrane in a time dependent manner. Toxicity studies of ILP were performed on normal as well as diabetic Swiss albino mice. ILP did not show any toxicity in the acute and sub-chronic toxicity studies in normal as well as diabetic Swiss albino mice. Mass spectrometry was carried out to identify ILP. MALDI TOF/TOF MS analysis of ILP revealed sequence homology with the predicted protein from Physcomitrella patens. Our study reveals that ILP acts via insulin signaling pathway and can be used as oral insulin mimetic.

Robotic-assisted thermal ablation of liver tumours.

OBJECTIVE: This study aimed to assess the technical success, radiation dose, safety and performance level of liver thermal ablation using a computed tomography (CT)-guided robotic positioning system. METHODS: Radiofrequency and microwave ablation of liver tumours were performed on 20 patients (40 lesions) with the assistance of a CT-guided robotic positioning system. The accuracy of probe placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated on a five-point scale (5-1: excellent-poor). The radiation doses were compared against 30 patients with 48 lesions (control) treated without robotic assistance. RESULTS: Thermal ablation was successfully completed in 20 patients with 40 lesions and confirmed on multiphasic contrast-enhanced CT. No procedure related complications were noted in this study. The average number of needle readjustment was 0.8 ± 0.8. The total CT dose (DLP) for the entire robotic assisted thermal ablation was 1382 ± 536 mGy.cm, while the CT fluoroscopic dose (DLP) per lesion was 352 ± 228 mGy.cm. There was no statistically significant (p > 0.05) dose reduction found between the robotic-assisted versus the conventional method. CONCLUSION: This study revealed that robotic-assisted planning and needle placement appears to be safe, with high accuracy and a comparable radiation dose to patients. KEY POINTS: • Clinical experience on liver thermal ablation using CT-guided robotic system is reported. • The technical success, radiation dose, safety and performance level were assessed. • Thermal ablations were successfully performed, with an average performance score of 4.4/5.0. • Robotic-assisted ablation can potentially increase capabilities of less skilled interventional radiologists. • Cost-effectiveness needs to be proven in further studies.

Web-based education and attitude to delivery by caesarean section in nulliparous women.

OBJECTIVE: To measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women. METHODS: We constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pre-test survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants' knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views. RESULTS: Seventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P < 0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a "little fearful" or "not fearful at all" of vaginal deliveries. In the second survey, significantly more responded that they were "very fearful" or "fearful" of CS (P < 0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have "very favourable" or "somewhat favourable" views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery. CONCLUSIONS: We demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.

Objectif : Mesurer l'effet d'un outil pédagogique Web traitant des connaissances de base sur les risques et les avantages de la césarienne chez les nullipares en santé. Méthodes : Nous avons créé un outil pédagogique Web visant à fournir des renseignements factuels sur les risques et les avantages possibles de la césarienne chez les nullipares en santé pendant le deuxième trimestre. Nous avons inclus des femmes présentant une grossesse monofœtale sans complications qui recevaient des soins prénatals au Mount Sinai Hospital. Les femmes admissibles ont ouvert une session sur le site Web afin de remplir un sondage prétest. Une fois le sondage rempli, elles ont obtenu accès à l'outil pédagogique et ont reçu un lien menant à un deuxième sondage. Ces sondages ont permis de recueillir des données démographiques de référence et d'évaluer les connaissances des participantes quant à l'innocuité et aux risques perçus de l'accouchement vaginal et de la césarienne, leurs sources d'information et l'influence qu'avaient ces sources sur leurs opinions. Résultats : Soixante-treize participantes ont rempli les deux sondages. Elles présentaient, au départ, une préférence élevée (84 %) pour l'accouchement vaginal. Le score moyen quant aux connaissances sur l'accouchement vaginal et la césarienne a augmenté considérablement entre les sondages, passant de 47 % à 76 % (P < 0,001). Aucun changement appréciable n'a été constaté entre les sondages en ce qui concerne la préférence en matière de mode d'accouchement. Dans les deux sondages, plus de participantes ont dit ne ressentir « aucune crainte ¼ ou ressentir « une légère crainte ¼ relativement à l'accouchement vaginal. Dans le deuxième sondage, par contre, un nombre considérablement plus élevé de participantes ont dit ressentir « de la crainte ¼ ou « beaucoup de crainte ¼ en ce qui concerne la césarienne (P < 0,05). L'amélioration des connaissances à propos des risques propres à l'accouchement vaginal n'a pas empêché les participantes de continuer de privilégier l'accouchement vaginal. Toutefois, le fait d'en connaître plus au sujet des risques associés à la césarienne les rendait plus susceptibles d'avoir une opinion « relativement favorable ¼ ou « très favorable ¼ à l'égard de l'accouchement vaginal. L'ethnicité et le pays d'origine n'ont eu aucun effet appréciable sur la préférence en matière de méthode d'accouchement. Conclusions : Nous avons démontré que l'utilisation d'un outil pédagogique Web améliorait considérablement les connaissances sur les risques et les avantages de l'accouchement vaginal et de la césarienne. Toutefois, l'intervention pédagogique n'a pas modifié les préférences de façon marquée.

Ancient schwannoma of the orbit.

The ancient schwannoma is a rare variant of a neurilemoma with a course typical of a slow-growing benign neoplasm. Histologically, it can be confused with a malignant mesenchymal tumor because of increased cellularity, nuclear pleomorphism, and hyperchromatism. Despite the degree of nuclear atypia, mitotic figures are absent. We describe the clinical and histopathologic features of an ancient schwannoma of the orbit. A need for early removal of such tumors is recommended to prevent complications.