Triangular pulley traction facilitates endoscopic full-thickness resection of exogenous gastric tumor in the fornix of the stomach.

A 65-year-old woman was diagnosed with an exogenous submucosal tumor located in the fornix of the stomach, on the basis of the endoscopic ultrasound and enhanced CT findings. She refused surgery and referred for EFTR. It is difficult to perform EFTR at the gastric fornix and suture the large surgical defect. Therefore, we created technique of triangular pulley traction combined with pre-closure.

Design, Synthesis, and Biological Evaluation of Pyrido [1,2-α] Pyrimidinone Mesoionic Derivatives Bearing Propenylbenzene as the Vector Control Insecticide.

A series of novel pyrido [1,2-α] pyrimidinone mesoionic derivatives bearing a propenylbenzene group at the 1-position were synthesized on the basis of the structure of mesoionic insecticides triflumezopyrim and dicloromezotiaz via a rationally conceived pharmacophore model and evaluated for their insecticidal activities against three insect vectors. The bioassay results showed that some compounds exerted remarkable insecticidal activities against M. domestica, Ae. albopictus, and B. germanica. Particularly, compound 26l displayed outstanding insecticidal activity against Ae. Albopictus, with an LC50 value of 0.45 µg/mL, far superior to that of imidacloprid (LC50 = 1.82 µg/mL) and equivalent to that of triflumezopyrim (0.35 µg/mL). Meanwhile, compound 34l presented a broad insecticidal spectrum, with LC50 values of 1.51 µg/g sugar, 0.52 µg/mL and 0.14 µg/adult, which were about 2.88, 3.50, and 1.50 times better than that of imidacloprid (LC50 = 4.35 µg/g sugar, 1.82 µg/mL and 0.21 µg/adult against M. domestica, Ae. albopictus, and B. germanica, respectively) and equivalent to that of triflumezopyrim against M. domestica (1.13 µg/g sugar) and Ae. albopictus (0.35 µg/mL) but lower than the potency against B. germanica (0.06 µg/g sugar). The molecular docking study by energy minimizations revealed that introducing propenylbenzene at the 1-position of compounds 26l and 34l could embed into the binding pocket of nicotinic acetylcholine receptors and form pi-alkyl interaction with LEU306. These results demonstrated that compounds 26l and 34l could be promising candidates for vector control insecticides, which deserved further investigation.

Entire traction using clip-and-nylon ring to facilitate endoscopic submucosal dissection of a laterally spreading tumor with fibrosis in the rectum.

A 78-year-old woman with hematochezia underwent a colonoscopy and found a 2 × 2-cm laterally spreading tumor (LST) in the rectum, 3 cm from the anus. Because of the risk related to anus preservation and the potential operative trauma, the patient refused surgery and was referred for ESD treatment. Here, we applied a novel entire traction method to deal with this subset of tumors.

Tooth recognition of 32 tooth types by branched single shot multibox detector and integration processing in panoramic radiographs.

Purpose: The purpose of our study was to analyze dental panoramic radiographs and contribute to dentists' diagnosis by automatically extracting the information necessary for reading them. As the initial step, we detected teeth and classified their tooth types in this study. Approach: We propose single-shot multibox detector (SSD) networks with a side branch for 1-class detection without distinguishing the tooth type and for 16-class detection (i.e., the central incisor, lateral incisor, canine, first premolar, second premolar, first molar, second molar, and third molar, distinguished by the upper and lower jaws). In addition, post-processing was conducted to integrate the results of the two networks and categorize them into 32 classes, differentiating between the left and right teeth. The proposed method was applied to 950 dental panoramic radiographs obtained at multiple facilities, including a university hospital and dental clinics. Results: The recognition performance of the SSD with a side branch was better than that of the original SSD. In addition, the detection rate was improved by the integration process. As a result, the detection rate was 99.03%, the number of false detections was 0.29 per image, and the classification rate was 96.79% for 32 tooth types. Conclusions: We propose a method for tooth recognition using object detection and post-processing. The results show the effectiveness of network branching on the recognition performance and the usefulness of post-processing for neural network output.

Endoscopic retrograde appendicitis therapy for management of acute appendicitis.

BACKGROUND: This study investigated the feasibility of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute appendicitis. METHODS: There were 210 patients included who were admitted to our hospital from January 2017 to October 2019 with a diagnosis of acute appendicitis. According to the method of treatment, patients were stratified into the ERAT group, laparoscopic appendectomy (LA) group, or open appendectomy (OA) group for comparison of perioperative information extracted from the medical records of the patients. RESULTS: The operations were successfully completed in all patients. The length of operation in the ERAT group (median: 48 min, range: 34-78 min) was significantly shorter compared to the LA group (median: 67 min, range: 47-90 min) or OA group (median: 85 min, range: 58-120 min). Postoperatively, the length of the hospital stay, the amount of time spent bedridden following surgery, surgery-related complications, and in-patient expenses were all significantly less than those in both the LA and OA groups (all p < 0.05). Moreover, the recurrence rate of appendicitis after ERAT was 2.86% during the first six months of postoperative follow-up. Thirteen patients in the ERAT group were diagnosed with appendicular abscesses, all of which successfully proceeded by colonoscopically incising the most protruding or fluctuating place around the appendix opening without procedure-related complications during the follow-up period. CONCLUSION: ERAT is a safe and effective endoscopic treatment method for acute appendicitis and abscesses of the appendix. The advantages include reduced trauma, faster recovery times, and lower costs in comparison with either OA or LA procedures. ERAT with internal incision and drainage can be safely performed with immediate effect, especially in patients with acute uncomplicated appendicitis accompanied by either fecal stones or stenosis of the appendix cavity, or an abscess within the appendix cavity.

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports.

BACKGROUND: Appendectomy is the procedure of choice for the treatment of acute appendicitis. However, surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis (AP). Endoscopic retrograde appendicitis treatment (ERAT) may be a novel alternative to surgery for treating such patients where existing medical therapies have failed. CASE SUMMARY: We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy. One patient had moderately severe AP due to hyperlipidemia, while the other patient had a gallstone induced by moderately severe AP. Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP. Therefore, the alternative and minimally invasive ERAT was considered. After written informed consent was collected from the patients, the ERAT procedure was performed. Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma. CONCLUSION: ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.

Tooth detection and classification on panoramic radiographs for automatic dental chart filing: improved classification by multi-sized input data.

OBJECTIVES: Dental state plays an important role in forensic radiology in case of large scale disasters. However, dental information stored in dental clinics are not standardized or electronically filed in general. The purpose of this study is to develop a computerized system to detect and classify teeth in dental panoramic radiographs for automatic structured filing of the dental charts. It can also be used as a preprocessing step for computerized image analysis of dental diseases. METHODS: One hundred dental panoramic radiographs were employed for training and testing an object detection network using fourfold cross-validation method. The detected bounding boxes were then classified into four tooth types, including incisors, canines, premolars, and molars, and three tooth conditions, including nonmetal restored, partially restored, and completely restored, using classification network. Based on the visualization result, multisized image data were used for the double input layers of a convolutional neural network. The result was evaluated by the detection sensitivity, the number of false-positive detection, and classification accuracies. RESULTS: The tooth detection sensitivity was 96.4% with 0.5 false positives per case. The classification accuracies for tooth types and tooth conditions were 93.2% and 98.0%. Using the double input layer network, 6 point increase in classification accuracy was achieved for the tooth types. CONCLUSIONS: The proposed method can be useful in automatic filing of dental charts for forensic identification and preprocessing of dental disease prescreening purposes.

[Semantic Segmentation of Eight Regions of Upper and Lower Limb Bones Using 3D U-Net in Whole-body CT Images].

PURPOSE: Automated analysis of skeletal muscle in whole-body computed tomography (CT) images uses bone information, but bone segmentation including the epiphysis is not achieved. The purpose of this research was the semantic segmentation of eight regions of upper and lower limb bones including the epiphysis in whole-body CT images. Our targets were left and right upper arms, forearms, thighs, and lower legs. METHOD: We connected two 3D U-Nets in cascade for segmentation of eight upper and lower limb bones in whole-body CT images. The first 3D U-Net was used for skeleton segmentation in whole-body CT images, and the second 3D U-Net was used for eight upper and lower limb bones' segmentation in skeleton segmentation results. Thirty cases of whole-body CT images were used in the experiment, and the segmentation results were evaluated using Dice coefficient with 3-fold cross-validation. RESULT: The mean Dice coefficient was 93% in the left and right upper arms, 89% in the left and right forearms, 95% in the left and right thighs, and 94% in the left and right lower legs. CONCLUSION: Although the accuracy of the segmentation results of relatively small bones remains a challenge, the semantic segmentation of eight regions of upper and lower limb bones including the epiphysis in whole-body CT images has been achieved.

Misdiagnosis of peripheral abscess caused by duodenal foreign body: a case report and literature review.

BACKGROUND: The induction of chronic inflammation, perforation, and abscess by foreign bodies (FBs) in adults is uncommon. We present a delayed diagnosis case for a patient who had a fishbone stuck in the duodenal bulb, resulting in chronic abdominal pain for nearly 3 months. We present the diagnosis and treatment procedures for chronic patients, which differ from those for acute and emergency FB ingestion, and also summarize the characteristics of such patients through a systematic literature review. CASE PRESENTATION: A 68-year-old woman was brought to our hospital with repeated right upper abdominal pain lasting for 3 months and aggravation for 9 h. Computed tomography (CT) showed a streaky high-density shadow (approximately 3 cm in length) on the posterior wall of the gastric antrum extending outside the wall. Endoscopic ultrasonography showed hyperechoic space with a cross-section of approximately 0.1 × 0.1 cm in the deep submucosal layer of the local stomach, accompanied by an acoustic shadow in the rear. The possibility of a fishbone as well as perforation was considered and the object was removed using FB forceps. Fasting as well as acid inhibition and anti-infection medication were prescribed for the patient. She eventually recovered and was discharged from the hospital. CONCLUSION: Endoscopic intervention can be recommended as the first option for patients with gastrointestinal FBs.

Automatic Segmentation of Multiple Organs on 3D CT Images by Using Deep Learning Approaches.

This chapter focuses on modern deep learning techniques that are proposed for automatically recognizing and segmenting multiple organ regions on three-dimensional (3D) computed tomography (CT) images. CT images are widely used to visualize 3D anatomical structures composed of multiple organ regions inside the human body in clinical medicine. Automatic recognition and segmentation of multiple organs on CT images is a fundamental processing step of computer-aided diagnosis, surgery, and radiation therapy systems, which aim to achieve precision and personalized medicines. In this chapter, we introduce our recent works on addressing the issue of multiple organ segmentation on 3D CT images by using deep learning, a completely novel approach, instead of conventional segmentation methods originated from traditional digital image processing techniques. We evaluated and compared the segmentation performances of two different deep learning approaches based on 2D- and 3D deep convolutional neural networks (CNNs) without and with a pre-processing step. A conventional method based on a probabilistic atlas algorithm, which presented the best performance within the conventional approaches, was also adopted as a baseline for performance comparison. A dataset containing 240 CT scans of different portions of human bodies was used for training the CNNs and validating the segmentation performance of the learning results. A maximum number of 17 types of organ regions in each CT scan were segmented automatically and validated with the human annotations by using ratio of intersection over union (IoU) as the criterion. Our experimental results showed that the IoUs of the segmentation results had a mean value of 79% and 67% by averaging 17 types of organs that were segmented by the proposed 3D and 2D deep CNNs, respectively. All results using the deep learning approaches showed better accuracy and robustness than the conventional segmentation method that used the probabilistic atlas algorithm. The effectiveness and usefulness of deep learning approaches were demonstrated for multiple organ segmentation on 3D CT images.

Bouveret syndrome: A case report.

BACKGROUND: Bouveret syndrome is a rare complication of cholelithiasis, with only 315 cases reported in the literature between 1967 and 2016. Delay in diagnosis is associated with a high mortality rate. Diagnosis is based upon clinical manifestations, gastroscopy, and imaging studies such as abdominal computed tomography and magnetic resonance cholan-giopancreatography. Endoscopic stone extraction or lithotripsy is the preferred choice for treatment as it is safe and minimally invasive with few complications. However, if endoscopy fails, surgery is required. CASE SUMMARY: A 61-year-old female patient presented with recurrent epigastric pain for more than 6 mo. On endoscopy, a large amount of food residue was present in the stomach with multiple stones and ulcers in the antro-pyloric region. Based on these findings, a diagnosis of gastrolithiasis was made. However, computed tomography of the abdomen revealed the correct diagnosis of Bouveret syndrome. Initially, endoscopic treatment was attempted but it failed. Later, she was successfully managed by cholecystectomy with duodenal stone extraction and fistula repair (one-step method). At the last follow-up 6 mo after surgery, the patient was symptom-free. CONCLUSION: Bouveret syndrome is a rare complication of gallstones that requires prompt endoscopic or surgical treatment to prevent mortality.