An integrative web-based software tool for multi-dimensional pathology whole-slide image analytics.

Objective.In the era of precision medicine, human tumor atlas-oriented studies have been significantly facilitated by high-resolution, multi-modal tissue based microscopic pathology image analytics. To better support such tissue-based investigations, we have developed Digital Pathology Laboratory (DPLab), a publicly available web-based platform, to assist biomedical research groups, non-technical end users, and clinicians for pathology whole-slide image visualization, annotation, analysis, and sharing via web browsers.Approach.A major advancement of this work is the easy-to-follow methods to reconstruct three-dimension (3D) tissue image volumes by registering two-dimension (2D) whole-slide pathology images of serial tissue sections stained by hematoxylin and eosin (H&E), and immunohistochemistry (IHC). The integration of these serial slides stained by different methods provides cellular phenotype and pathophysiologic states in the context of a 3D tissue micro-environment. DPLab is hosted on a publicly accessible server and connected to a backend computational cluster for intensive image analysis computations, with results visualized, downloaded, and shared via a web interface.Main results.Equipped with an analysis toolbox of numerous image processing algorithms, DPLab supports continued integration of community-contributed algorithms and presents an effective solution to improve the accessibility and dissemination of image analysis algorithms by research communities.Significance.DPLab represents the first step in making next generation tissue investigation tools widely available to the research community, enabling and facilitating discovery of clinically relevant disease mechanisms in a digital 3D tissue space.

Proposition of quantitative parameters for pre- and early post-operative assessment in pulmonary thromboendarterectomy - An Indian prospective study.

INTRODUCTION: Chronic thromboembolic pulmonary hypertension results from the incomplete resolution of the vascular obstruction associated with pulmonary embolism. Symptoms are exertional dyspnoea and fatigue, and over a period of time, right ventricular dysfunction sets in. Pulmonary thromboendarterectomy is an effective surgical remedy for this condition. Our study is an initial post-operative experience of pulmonary thromboendarterectomy and we have also tried to formulate quantitative parameters for the prediction of the post-operative course in patients who are undergoing surgery. METHODS: Twenty patients with chronic thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy between July 2017 and January 2020. Pre-operatively, each patient was subjected to the (i) 6-min walk test, (ii) pre-operative brain natriuretic peptide values and (iii) pulmonary artery systolic pressure. Following the surgery and subsequent discharge, the patients were followed up at intervals of 15 days, 1, 3, 6, 9 months and at 1 year. At one year post-operatively, the same three quantitative tests were performed on each subject. RESULTS: Post-operatively, the mean 6-min walk distance was 499.75 m as against 341.35 m pre-operatively (p < 0.0001). Mean brain natriuretic peptide was 8.69 pm/l as against 47.58 pm/l pre-operatively (p < 0.0001). Mean pulmonary artery systolic pressure was 22.25 as against 67.1 pre-operatively (p < 0.0001). CONCLUSION: 6-Min walk test, brain natriuretic peptide and pulmonary artery systolic pressure could be considered as useful predictors of the haemodynamic severity of disease and predict the post-operative outcome.

Individual Versus Sequential Saphenous Vein Grafts for on-Pump Coronary Artery Bypass Grafting - Does Smaller Coronaries in Indians Affect Graft Choice? - A Mid-Term Patency Comparison Study.

PURPOSE: Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG's. METHODS: In the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms. RESULTS: Results were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively. CONCLUSIONS: Sequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.

The dilemma faced by a budding cardiothoracic surgeon in India-a first hand account.

Cardiothoracic surgery is undoubtedly one of the most glamorous and exciting surgical fields on earth. The field requires passionate and hardworking youngsters who are always willing to learn. Bright young surgeons should know what is going to be on their platter once they have decided to take the plunge into cardiac surgery. This article is a fruit of my 3 years of residency experience and my ongoing stint as an assistant professor. In this article, I have tried to make young surgeons aware of what they will face during their residency tenure and also to attend to some of their worries prior to selecting cardiac surgery as a career option.

Characterization of entanglements in glassy polymeric ensembles using the Gaussian linking number.

We propose a method for enumerating entanglements between long chained, linear polymers that is based on the Gaussian linking number. The linking number is calculated between closely approaching segments of the macromolecular chains. Topological features of an entanglement, i.e., the extent to which one open segment winds around another, are reflected by the linking number. We show that using this measure, we can track disentanglement events through a deformation history and gain insights into how large scale disentanglements lead to failure. Incorporating an additional step where the topological entanglements identified along each chain are optimally clustered using standard clustering algorithms, we can also obtain a measure of the average number of rheological constraints that exist along each chain in an ensemble. Comparisons with other methods of enumerating entanglements, especially the primitive path analysis, are also made. Our results indicate that the linking number between two entangled segments in the undeformed state is a good indicator of the strength of the entanglement. Also, disentanglements occurring overwhelmingly around chain ends are an important cause of failure when a triaxial stress state exists in the polymer.

Collateral miracle-reformation of iliac and femoral arteries by collaterals from bilateral subclavian arteries following contained rupture of abdominal aortic aneurysm in a hypertensive female.

Rupture of an abdominal aortic aneurysm is readily diagnosed when the triad of abdominal or back pain, shock and a pulsatile abdominal mass are present. However in a few cases, a chronic contained ruptured abdominal aortic aneurysm can present in a multitude of manners rather than as life threatening haemorrhage. In our case we are reporting a 41 year old hypertensive female who developed claudication pain in both her lower limbs. Imaging later revealed that she had a contained ruptured abdominal aortic aneurysm, a thing she was previously unaware of, with collaterals from the bilateral subclavian arteries supplying her femorals.

Mini percutaneous nephrolithotomy for renal calculi in paediatric patients: A review of twenty cases.

OBJECTIVE: The objective was to report our initial experience of mini percutaneous nephrolithotomy (mPCNL) performed on patients in the pediatric age group (<18 years) using a miniature nephroscope (12F). SUBJECTS AND METHODS: A total of 20 children underwent mPCNL for renal stone extraction in the Department of Urology, Yenepoya Medical College, Mangalore, India, from February 2013 to January 2014. The patients were evaluated on the basis of parameters viz. age at the time of surgery, size and number of stones, duration of surgery, stone clearance, and postoperative complications. RESULTS: A total of 20 mPCNLs were performed on children, with age ranging from 8 to 16 years. Three children had three stones each, six children had two stones each, eight children had one stone each, and three had multiple. The median stone burden was 1.36 cm. The procedure was via single puncture in 15 cases, and two punctures in five cases. Punctures were upper calyceal in seven cases, lower calyceal in seven cases, and combined upper and lower calyceal in six cases. The calculi were accessed by a 12F mini nephroscope, laser lithotripsy was used in 12 cases and pneumatic lithotripsy used for the rest. Total clearance was achieved in 18 out of 20 cases (90%). Postoperative complications developed in one child, in the form of sepsis. CONCLUSION: Our initial experience concludes that mPCNL is a safe and efficacious tool for the management of renal calculi in the pediatric population.