Computerized Ultrasonic Imaging Inspection: From Shallow to Deep Learning.

For many decades, ultrasonic imaging inspection has been adopted as a principal method to detect multiple defects, e.g., void and corrosion. However, the data interpretation relies on an inspector's subjective judgment, thus making the results vulnerable to human error. Nowadays, advanced computer vision techniques reveal new perspectives on the high-level visual understanding of universal tasks. This research aims to develop an efficient automatic ultrasonic image analysis system for nondestructive testing (NDT) using the latest visual information processing technique. To this end, we first established an ultrasonic inspection image dataset containing 6849 ultrasonic scan images with full defect/no-defect annotations. Using the dataset, we performed a comprehensive experimental comparison of various computer vision techniques, including both conventional methods using hand-crafted visual features and the most recent convolutional neural networks (CNN) which generate multiple-layer stacking for representation learning. In the computer vision community, the two groups are referred to as shallow and deep learning, respectively. Experimental results make it clear that the deep learning-enabled system outperformed conventional (shallow) learning schemes by a large margin. We believe this benchmarking could be used as a reference for similar research dealing with automatic defect detection in ultrasonic imaging inspection.

[Systemic chemotherapy and surgery for recurrent metachronous liver metastases with peritoneal dissemination from triple colon cancers-a case report].

Although the first-line treatment for liver metastases arising from colorectal cancer is surgery, it is unknown whether this treatment is equally effective for liver metastases with peritoneal dissemination. We report a case of long-term survival after oxaliplatin-based chemotherapy and surgery for metachronous liver metastases with peritoneal dissemination from triple colon cancer. A 76-year-old man with a history of stage III descending colon cancer developed recurrent localized peritoneal dissemination and multiple liver metastases 30 months after surgery. He underwent partial liver resection, partial peritoneal resection, and 8 courses of capecitabine plus oxalitlatin (XELOX). There has been no disease recurrence 75 months after the initial surgery. While though there is no consensus for treatment of liver metastasis with peritoneal dissemination, surgery combined with systemic chemotherapy may be beneficial.

Drone-based displacement measurement of infrastructures utilizing phase information.

Drone-based inspections provide an efficient and flexible approach to assessing aging infrastructures while prioritizing safety. Here, we present a pioneering framework that employs drone cameras for high-precision displacement measurement and achieves sub-millimeter accuracy, meeting the requirements for on-site inspections. Inspired by the principles of human auditory equilibrium, we have developed an effective scheme using a group of strategical reference markers on the bridge girders to measure structural displacements in the bridge. Our approach integrates the phase-based sampling moiré technique with four degrees-of-freedom geometric modeling to accurately delineate the desired bridge displacements from camera motion-induced displacements. The proposed scheme demonstrates favorable precision with accuracy reaching up to 1/100th of a pixel. Real-world validations further confirmed the reliability and efficiency of this technique, making it a practical tool for bridge displacement measurement. Beyond its current applications, this methodology holds promise as a foundational element in shaping the landscape of future autonomous infrastructure inspection systems.

Risk factors for intra-abdominal infection after pancreaticoduodenectomy - a retrospective analysis to evaluate the significance of preoperative biliary drainage and postoperative pancreatic fistula.

BACKGROUND/AIMS: Intra-abdominal infection (IAI) after pancreaticoduodenectomy (PD) is a common cause of prolongation of postoperative hospital stay and readmission to the hospital following discharge. METHODOLOGY: Two hundred and six patients undergoing PD were reviewed to investigate the risk factors for IAI after PD. Patients were separated into two groups: those who developed IAI after PD (Group A; n=44), and those who had not developed IAI after PD (Group B; n=162), the two groups were then compared to identify the risk factors for IAI after PD. A hundred and six patients (51.5%) underwent preoperative biliary drainage (PBD). RESULTS: Multivariate analysis revealed that pancreatic fistula (PF) was an independent risk factor for IAI after PD (p<0.001; odds ratio=9.58; 95% confidence interval=4.37-21.0), but PBD was not a significant risk factor. CONCLUSIONS: We demonstrated that the adequate PBD might not affect IAI after PD. On the other hand, PF was an independent risk factor for IAI after PD. A large randomized controlled trial, which would prove the effect of early removal of a prophylactic placed drain to prevent IAI, should be planned.

Risk factor for pancreatic fistula after pancreaticoduodenectomy performed by a surgeon during a learning curve: analysis of a single surgeon's experiences of 100 consecutive patients.

BACKGROUND/AIMS: Among several kinds of morbidities, pancreatic fistula (PF) is the most common complication of pancreaticoduodenectomy (PD). However, it has not been clarified what kind of perioperative factors are risk factors of PF after PD is performed by a training surgeon. METHODOLOGY: We evaluated the risk factors of PF after PD in which all procedures for 100 consecutive patients were performed by a single training surgeon, retrospectively. The 100 cases were divided into two groups and the first 50 cases were named Group A and the latter 50 cases were named Group B. RESULTS: Multivariate analysis demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF (p=0.0080; OR=5.311; 95% CI=1.116-7.025). There was no significant difference of the frequencies of grade B and grade C PF between Group A and Group B (p=0.13361). CONCLUSIONS: We demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF after PD was performed by a training surgeon; for those without pancreatic duct dilatation, PD can be performed by a surgeon in the earlier training period with an acceptable rate of PF.

Factors influencing improved patient outcomes after pancreaticoduodenectomy--a single institute experience of 209 consecutive patients in a decade.

BACKGROUND/AIMS: Postoperative mortality and morbidity after pancreaticoduodenectomy (PD) remain major issues today and we discuss the factors influencing improved patient outcome after PD. METHODOLOGY: Two hundred and nine patients underwent PD between 2001 and 2010 In our hospital. The first 58 cases between 2001 and 2004 were named Group A and the latter 151 cases between 2005 and 2010 were named Group B. Then, we compared the intraoperative outcomes and postoperative mortality and major morbidities between two groups. RESULTS: Between 2005 and 2010, the annual volume of PD has been over 20 continuously. In Group A, 58 PDs were performed by five surgeons but in Group B, the main surgeon performed 131 of 151 (86.8%) PDs. The mortality rate in Group A (1.7%) was not different from that in Group B (1.3%). The frequency of patients with all postoperative morbidities in Group B (43.7%) was significantly lower than that in Group A (70.7%) (p=0.00048). The frequencies of DGE and SSI in Group B (8.6%, 23.8%) were significantly lower than those in Group A (25.8%, 37.9%) (p=0.010, p=0.042). CONCLUSIONS: The increases of surgeon and hospital volume and the change of the mode of PD were factors influencing improved patient outcomes after PD.

Modified keyhole plus technique with partial release of posterior rectus sheath for parastomal hernia repair after ileal conduit.

Parastomal hernia (PH) is a common complication of ileal conduit diversions. The Sugarbaker technique has a lower recurrence rate than the keyhole (KH) technique and is typically preferred. However, it may not be feasible in some cases because of anatomical features including the length of the conduit and torsion of the ureter. An 80-year-old woman with complaints of abdominal distention was diagnosed with PH 5 years after radical cystectomy. Computed tomography revealed a 90 × 20-mm muscular layer defect on the cranial side of the ileal conduit. Therefore, we performed the KH technique with intracorporeal closure of the defect using a relief incision of the posterior rectus sheath, avoiding the possibility of torsion of the ureteral ileal anastomosis. No hernia recurrence was observed at postoperative 10 months. The proposed KH plus technique may be an effective method for PH after ileal conduit diversion, thus preventing urinary complications.

Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique.

INTRODUCTION: Herein, we describe a novel technique for suprapubic incisional hernia repair using a modified transabdominal partial extraperitoneal technique in four patients. MATERIALS AND SURGICAL TECHNIQUE: We implemented four-trocar placement to achieve a coaxial setting for the pubic bone. The pubic bone and Cooper's ligament were exposed by an incision dorsal to the hernial orifice, and the bladder was mobilized as an inferior peritoneal flap. The retropubic space was dissected approximately 5 cm from the hernial defect and this was closed with an intracorporeal non-absorbable barbed suture. A mesh was introduced into the intra-abdominal cavity, positioned to cover the closed defect, and tied to Cooper's ligament, the pubic bone, and rectus muscles. The dissected peritoneal flap was reattached to the abdominal wall by tacking and suturing. DISCUSSION: The modified transabdominal partial extraperitoneal technique for suprapubic incisional hernia repair may contribute to decreased recurrence and seroma formation.

Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair.

Introduction Surgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases. Methods Patients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period. Results Twenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months. Conclusion hLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.

Point defect detection and strain mapping in Si single crystal by two-dimensional multiplication moiré method.

Although defect detection is critical for evaluating the manufacturing processes of semiconductor materials and metals, the detection of crystal defects, especially point defects, over a large field of view still faces considerable challenges. Herein, we report on the development of a two-dimensional (2D) multiplication moiré method using digital image processing to simultaneously detect point and line defects in a wide field of view. Defect locations were automatically detected by employing the concept of a hybrid strain, that is, the absolute value of the product of the strain distributions in different principal directions. To demonstrate a typical application of the proposed method, the hybrid strain distribution in a Si single crystal was measured, and point defects were successfully detected by transmission electron microscopy. The effectiveness of the proposed method was experimentally verified based on the enlarged views of atomic structures at several detected defect locations. This method is capable of visualizing defects by magnifying the lattice distortion in situ, which is a good solution to the problem faced by traditional methods in detecting point defects. This study paves the way for the detection of vacancies, interstitial atoms, substitutional atoms, dislocations, slips, and interfaces in various crystal structures and 2D materials.

Mucin-producing carcinoma of the gallbladder associated with primary sclerosing cholangitis and ulcerative colitis.

Mucin-producing carcinoma of the gallbladder is very rare. We report here a case of mucin-producing carcinoma of the gallbladder associated with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). A 74-year-old female had been treated with salazosulfapyridine and ursodesoxycholic acid becase of UC and PSC. After 7 years of treatment, laboratory data showed that the liver function took a turn for the worse, and the patient was admitted to our hospital for further examination. Enhanced computed tomography and ultrasonography showed an enlarged gallbladder associated with wall thickening and diffuse papillary protrusion. Endoscopic retrograde cholangiography showed stenosis and dilatation of the bile duct, which were compatible with PSC. Under the diagnosis of an early carcinoma of the gallbladder, we performed simple cholecystectomy. The tumor showed a papillary growth pattern located diffusely in the gallbladder with a massive amount of mucin filling the gallbladder. Histologically, it was diagnosed as a papillary adenocarcinoma localized in the mucosal layer. To the best of our knowledge, this is the first case of mucin-producing carcinoma of the gallbladder associated with PSC and UC. PSC and UC patients should be regarded as a high-risk group not only for cholangiocarcinoma but also carcinoma of the gallbladder.

Topology Optimization-Based Damage Identification Using Visualized Ultrasonic Wave Propagation.

This study proposes a new damage identification method based on topology optimization, combined with visualized ultrasonic wave propagation. Although a moving diagram of traveling waves aids in damage detection, it is difficult to acquire quantitative information about the damage, for which topology optimization is suitable. In this approach, a damage parameter, varying Young's modulus, represents the state of the damage in a finite element model. The feature of ultrasonic wave propagation (e.g., the maximum amplitude map in this study) is inversely reproduced in the model by optimizing the distribution of the damage parameters. The actual state of the damage was successfully estimated with high accuracy in numerical examples. The sensitivity of the objective function, as well as the appropriate penalization exponent for Young's modulus, was discussed. Moreover, the proposed method was applied to experimentally measured wave propagation in an aluminum plate with an artificial crack, and the estimated damage state and the sensitivity of the objective function had the same tendency as the numerical example. These results demonstrate the feasibility of the proposed method.

Complete intracorporeal defect closure using unidirectional barbed suture in laparoscopic incisional hernia repair: Preliminary experience with short-term follow-up.

INTRODUCTION: Surgical techniques to close defects in laparoscopic incisional hernia repair vary across the literature. We herein demonstrate our original and standardized surgical technique for laparoscopic incisional hernia repair with complete intracorporeal defect closure using barbed suture. MATERIALS AND SURGICAL TECHNIQUE: Complete intracorporeal defect closures were indicated for defects less than or equal to 6 cm in transverse diameter. We performed a defect closure with a running suture using barbed suture in a caudal to cranial direction, with tissue bites and inter-suture spacing of 1 cm each. The hernial sac was incorporated into the suturing to reduce possible dead space. After the procedure, intraperitoneal onlay mesh was placed. Seven patients underwent this procedure. The median total operative time was 188 min, and the median time specifically for defect closure was 25 min. There was no seroma, mesh bulge, persisting pain, or hernia recurrence at follow-up. DISCUSSION: Our proposed technique is simple and can be safely performed with good short-term outcomes.

The use of self-gripping mesh with anterior component separation technique in incisional hernia repair: A case series.

INTRODUCTION: Incisional hernia (IH) is a common postoperative complication that affects 10% of the patients who undergo abdominal surgery. The component separation (CS) technique is suitable for large and/or complex hernias; however, CS alone may not eliminate recurrence and is associated with an increased incidence of wound complications. Self-gripping mesh enhances tissue adhesion and contributes to a reduced risk of migration, chronic pain, and other complications. Here, we present three cases of IH that were successfully repaired by anterior CS (ACS) using onlay self-gripping meshes. CASE PRESENTATION: All three patients underwent surgery using the following technique: Briefly, a skin flap was created with release of the external oblique muscle and preservation of the perforating vessels. The linea alba was closed with absorbable interrupted sutures. A self-gripping mesh was trimmed and placed with a 4-5 cm overlap bilaterally from the closed linea alba using an onlay technique. For all patients, the postoperative courses were uneventful and there were no complications at the 3-month follow-up. DISCUSSION: The advantages of our technique include more sufficient abdominal reinforcement, technical simplicity, and minimal time required for mesh placement. The disadvantages are the potential risk of decreased blood flow of the skin flaps, wound infection, intestinal fistula, persisting or chronic pain, and difficulty with subsequent abdominal surgery. CONCLUSION: The use of self-gripping mesh with ACS can be performed without increasing the operative time or causing short-term surgical complications. This technique may be recommended for large IH because of its simplicity and secure abdominal reinforcement provided.

Successful mesh plug repair using a hybrid method for recurrent inguinal hernia after laparoscopic transabdominal preperitoneal approach: A case report.

INTRODUCTION: The HerniaSurge Group and the European Hernia Society guidelines recommend an anterior approach to treat recurrent inguinal hernias after a failed posterior approach. The hybrid method combining explorative laparoscopy and anterior open approach can provide the benefits of both approaches. PRESENTATION OF CASE: A 79-year-old man presented with a recurrent inguinal hernia after primary repair for an indirect hernia using the laparoscopic transabdominal preperitoneal approach (TAPP) 5 years ago. The indirect hernia formed inferior to the lower edge of the previous mesh was diagnosed under laparoscopy. The hernia defect (2 cm) was fixed using a mesh plug via the anterior approach. Appropriate mesh overlap was confirmed using laparoscopy. DISCUSSION: This minimally invasive method enabled us to choose the best treatment for recurrent hernia and prevent chronic pain due to possible nerve damage caused by extended dissection of the scar tissue. Furthermore, the final confirmation step using laparoscopy assures complete coverage of all defects within the myopectineal orifice. CONCLUSION: This hybrid method facilitates the choice of an optimal approach for the treatment of recurrent hernia and may reduce surgical complications and re-recurrence rate.

Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report.

INTRODUCTION: Optimal surgery for a midline incisional hernia extending to the subcostal region remains unclear. We report successful hybrid laparoscopic and percutaneous repair for such a complex incisional hernia. PRESENTATION OF CASE: An 85-year-old woman developed a symptomatic incisional hernia after open cholecystectomy. Computed tomography revealed a 14 × 10 cm fascial defect. Four trocars were placed under general anesthesia. Percutaneous defect closure was performed using multiple non-absorbable monofilament threads, i.e., a "square stitch." Each thread was inserted into the abdominal cavity from the right side of the defect and pulled out to the left side. The right side of the thread was subcutaneously introduced anterior to the hernia sac. The threads were sequentially tied in a cranial to caudal direction. A multifilament polyester mesh with resorbable collagen barrier was selected and fixed using absorbable tacks with additional full-thickness sutures. The cranial-most limit of mesh fixation was at the level of the subcostal margin, and the remaining part was draped over the liver surface. The postoperative course was uneventful, with no seroma, mesh bulge, or hernia recurrence at 1, 3, 6, and 12 months of follow-up. DISCUSSION: The advantages of our technique are the minimal effect on the scar in the midline during defect closure, the minimal damage to the ribs and obtaining more overlap during mesh fixation. The disadvantage is the postoperative pain. CONCLUSION: Our proposed hybrid surgical approach may be considered as the treatment of choice for a large midline incisional hernia extending to the bilateral costal region.

Pancreas head carcinoma with total fat replacement of the dorsal exocrine pancreas.

We report a case of pancreas head carcinoma associated with fat replacement of the body and tail. A 68-year-old man presented with obstructive jaundice and was admitted to our hospital. Ultrasonography and computed tomography showed pancreas head tumor with a neighboring cystic lesion and fatty replacement of parenchyma of the pancreas body and tail. By endoscopic retrograde pancreatography, abruption of the main pancreatic duct and the presence of an accessory duct were detected. After percutaneous transhepatic biliary drainage, pancreatoduodenectomy was successfully performed. At laparotomy, the pancreas head was easily dissected from the replaced fatty tissue of the body and tail without continuity of the ductal system or parenchyma. Microscopic examination revealed the existence of an infiltrating ductal adenocarcinoma and a neighboring. cyst in the pancreas head. The dorsal exocrine pancreas was completely replaced by the fat tissues, in which viable Langerhans' islets were scattered. The patient's postoperative course was uneventful, and exogenous insulin administration was unnecessary for the maintenance of normal blood sugar level. Acquired fat replacement of the body and tail of the pancreas is an uncommon disorder, mimicking congenital agenesis of the dorsal pancreas. Though the mechanism is controversial, obstruction of the main pancreatic duct by a cystic lesion or carcinoma in the pancreas head is a possible cause of fatty degeneration of the pancreatic parenchyma.

Detecting effective classes of medical incident reports based on linguistic analysis for common reporting system in Japan.

The analysis of medical incident reports is indispensable for patient safety. Most incident reports are composed from freely written descriptions, but an analysis of such free descriptions is not sufficient in the medical field. In this study, we aim to conduct new findings using incident information, to clarify improvements that should be made to solve the root cause of an accident, and to ensure safe medical treatment through such improvements. We employed natural language processing (NLP) and network analysis to identify effective classes of medical incident reports. Network analysis can find various relationships that are not only direct but also indirect. After that, we compared the clustering results between Jichi Medical University and Osaka City University Hospital. By finding the common and different parts in medical incident report' s classes, we could show new perspectives on proposing a common reporting systems in Japan for improving patient safety.

Acute pancreatitis secondary to duodenoduodenal intussusception in duodenal adenoma.

Duodenoduodenal intussusception is a rare condition that is in general caused by a tumor. We describe duodenoduodenal intussusception secondary to a tubulovillous adenoma that caused acute pancreatitis in a 31-year-old female. We resected a duodenal tumor from the submucosal layer and then simply closed the duodenal wall. To the best of our knowledge, this is the first description of acute pancreatitis secondary to duodenoduodenal intussusception by tubulovillous adenoma in the second part of the duodenum in an adult.