CW-NET for multitype cell detection and classification in bone marrow examination and mitotic figure examination.

MOTIVATION: Bone marrow (BM) examination is one of the most important indicators in diagnosing hematologic disorders and is typically performed under the microscope via oil-immersion objective lens with a total 100× objective magnification. On the other hand, mitotic detection and identification is critical not only for accurate cancer diagnosis and grading but also for predicting therapy success and survival. Fully automated BM examination and mitotic figure examination from whole-slide images is highly demanded but challenging and poorly explored. First, the complexity and poor reproducibility of microscopic image examination are due to the cell type diversity, delicate intralineage discrepancy within the multitype cell maturation process, cells overlapping, lipid interference and stain variation. Second, manual annotation on whole-slide images is tedious, laborious and subject to intraobserver variability, which causes the supervised information restricted to limited, easily identifiable and scattered cells annotated by humans. Third, when the training data are sparsely labeled, many unlabeled objects of interest are wrongly defined as background, which severely confuses AI learners. RESULTS: This article presents an efficient and fully automatic CW-Net approach to address the three issues mentioned above and demonstrates its superior performance on both BM examination and mitotic figure examination. The experimental results demonstrate the robustness and generalizability of the proposed CW-Net on a large BM WSI dataset with 16 456 annotated cells of 19 BM cell types and a large-scale WSI dataset for mitotic figure assessment with 262 481 annotated cells of five cell types. AVAILABILITY AND IMPLEMENTATION: An online web-based system of the proposed method has been created for demonstration (see https://youtu.be/MRMR25Mls1A).

Environmentally responsive changes in mucus indicators and microbiota of Chinese sturgeon Acipensersinensis.

The impact of environmental factors on the health of the endangered Chinese sturgeon (Acipenser sinensis) and the potential hazards associated with sample collection for health monitoring pose urgent need to its conservation. In this study, Chinese sturgeons were selected from indoor and outdoor environments to evaluate metabolic and tissue damage indicators, along with a non-specific immune enzyme in fish mucus. Additionally, the microbiota of both water bodies and fish mucus were determined using 16S rRNA high-throughput sequencing. The correlation between the indicators and the microbiota was investigated, along with the measurement of multiple environmental factors. The results revealed significantly higher levels of two metabolic indicators, total protein (TP) and cortisol (COR) in indoor fish mucus compared to outdoor fish mucus (p < 0.05). The activities of acid phosphatase (ACP), alkaline phosphatase (ALP), creatine kinase (CK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were significantly higher in indoor fish, serving as indicators of tissue damage (p < 0.05). The activity of lysozyme (LZM) was significantly lower in indoor fish (p < 0.01). Biomarker analysis at the phylum and genus levels in outdoor samples revealed that microorganisms were primarily related to the catabolism of organic nutrients. In indoor environments, microorganisms displayed a broader spectrum of functions, including ecological niche establishment, host colonization, potential pathogenicity, and antagonism of pathogens. KEGG functional enrichment corroborated these findings. Dissolved oxygen (DO), electrical conductivity (EC), ammonia nitrogen (NH3-N), turbidity (TU), and chemical oxygen demand (COD) exerted effects on outdoor microbiota. Temperature (TEMP), nitrate (NO3-), total phosphorus (TP), and total nitrogen (TN) influenced indoor microbiota. Changes in mucus indicators, microbial structure, and function in both environments were highly correlated with these factors. Our study provides novel insights into the health impacts of different environments on Chinese sturgeon using a non-invasive method.

Rehabilitation Perspectives in Long COVID-19.

Long COVID is a term used to describe the persistence of symptoms in people who have had COVID-19 for an extended period. It affects multiple systems including neurological (fatigue, brain fog, attention issues, memory issues), neuromuscular (sarcopenia, myositis, arthritis and myopathy), cardiovascular (myopericarditis, right ventricular dysfunction, vasculitis and aortic, arterial and venous thrombosis) and respiratory (pulmonary fibrosis, pleurisy, pulmonary embolism and pneumonitis). This results in functional impairments which adversely affect the quality of life of patients. The rehabilitation of persons who have experienced long COVID-19, also known as "long haulers," is a relatively new field of study. We have described potential rehabilitation interventions to improve functional capacity and quality of life in patients with long COVID. These rehabilitation interventions include but are not limited to, endurance, flexibility and strength training, pulmonary rehabilitation, task specific exercises to improve Activities of Daily Living (ADL), psychological rehabilitation, medical rehabilitation, pain management and management of dysphagia.

Solifenacin-induced acute urticaria and angioedema: a rare adverse effect.

Antimuscarinics are first-line medication for management of overactive bladder with solifenacin being commonly prescribed. Angioedema is the swelling of mucosa and submucosal tissue. There are no published case reports of drug-induced angioedema involving solifenacin. We report a case of a 41-year-old man with spinal cord injury who presented with oedema of face, lips, tongue and associated pruritic urticaria after taking 5 mg of solifenacin. All other possible causes including food allergy, insect bite, hereditary angioedema, use of NSAIDs, ACE inhibitors and antibiotics were ruled out. The temporal association between solifenacin and angioedema and complete resolution of symptoms after discontinuing the drug suggest that solifenacin was the most probable cause of angioedema in our patient.

Fully Automatic Registration Methods for Chest X-Ray Images.

PURPOSE: Image registration is important in medical applications accomplished by improving healthcare technology in recent years. Various studies have been proposed in medical applications, including clinical track of events and updating the treatment plan for radiotherapy and surgery. This study presents a fully automatic registration system for chest X-ray images to generate fusion results for difference analysis. Using the accurate alignment of the proposed system, the fusion result indicates the differences in the thoracic area during the treatment process. METHODS: The proposed method consists of a data normalization method, a hybrid L-SVM model to detect lungs, ribs and clavicles for object recognition, a landmark matching algorithm, two-stage transformation approaches and a fusion method for difference analysis to highlight the differences in the thoracic area. In evaluation, a preliminary test was performed to compare three transformation models, with a full evaluation process to compare the proposed method with two existing elastic registration methods. RESULTS: The results show that the proposed method produces significantly better results than two benchmark methods (P-value ≤ 0.001). The proposed system achieves the lowest mean registration error distance (MRED) (8.99 mm, 23.55 pixel) and the lowest mean registration error ratio (MRER) w.r.t. the length of image diagonal (1.61%) compared to the two benchmark approaches with MRED (15.64 mm, 40.97 pixel) and (180.5 mm, 472.69 pixel) and MRER (2.81%) and (32.51%), respectively. CONCLUSIONS: The experimental results show that the proposed method is capable of accurately aligning the chest X-ray images acquired at different times, assisting doctors to trace individual health status, evaluate treatment effectiveness and monitor patient recovery progress for thoracic diseases.

Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury.

BACKGROUND: Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. OBJECTIVE: This study was done to know more about factors associated with inpatient mortality in EP with AKI. METHODS: We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. RESULTS: 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P = 0.04, 95% CI: 1.05-9.72), presence of oliguria (OR: 3.42, P = 0.006, 95% CI: 1.42-8.22), and need for vasopressors (OR: 6.90, P < 0.001, 95% CI: 2.42-19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P = 0.02, 95% CI: 0.89-0.99). History of hypertension (OR: 0.49, P = 0.03, 95% CI: 0.25-0.95) and high admission creatinine (OR: 0.68, P = 0.01, 95% CI: 0.50-0.91) were also associated with less mortality. CONCLUSION: Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population.

Effect of intravitreal bevacizumab on macular thickness: exploring serum and vitreous proangiogenic biomarkers in patients with diabetic macular edema

Background/aim: This study evaluates diabetic macular-edema (DME) patients for the effect of intravitreal bevacizumab (IVB) injection on macular thickness and proangiogenic biomarkers in serum and vitreous. Materials and methods: Forty DME patients were analyzed for macular thickness (MT). Twelve proangiogenic biomarkers in serum and vitreous were analyzed before and after IVB. Results: Significant decrease in MT with vitreal vascular endothelial growth factor-A (VEGF-A) was observed as expected after IVB, while serum VEGF-A did not follow a decreasing trend in contrast to VEGF-C, which decreased both in serum and vitreous. Other vitreal factors like bone morphogenetic protein-9 (BMP9) and fibroblast growth factor (FGF) were also significantly decreased, while endothelial growth factor (EGF) increased following IVB. Before IVB, significant negative correlations were vitreous BMP9 with serum FGF, vitreous human growth factor (HGF) and interleukin-8 (IL-8) with serum endothelin, and vitreous and serum FGF and serum placental growth factor (PLGF) with EGF. After IVB, negative correlations in serum vs. vitreous were found for both HGF and PLGF with BMP9, and angiopoietin with FGF. Cube average thickness was negatively correlated with serum FGF and positively correlated with vitreous PLGF and endothelin. Conclusion: Vascular endothelial growth factors are not the only factors that cause macular edema in diabetic patients. The effect of IVB on different proangiogenic biomarkers indicated a complex interplay of other factors in DME.

Recurrent Brachiocephalic Vein Stenosis as a Cause for Persistent Left-sided Transudative Pleural Effusion in a Hemodialysis Patient.

BACKGROUND: Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis. METHODS: A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem. Her dialysis duration was optimized from 2 times a week to 3 times a week for 4 hr and her dry weight was adjusted. Despite adequate dialysis for 1 month, effusion on the left side persisted. She had a previous venoplasty for a stenosis in brachiocephalic vein but restenosis occurred again. RESULTS: Brachiocephalic vein stenting was performed which successfully lead to resolution of left arm swelling and left effusion. She was later on successfully transplanted. CONCLUSIONS: Brachiocephalic stenosis can cause ipsilateral transudative effusion. Venoplasty and stenting of the brachiocephalic vein lead to complete resolution of effusion.

Late thrombosis of Gore Cardioform septal occluder device in a patient with history of patent foramen ovale closure.

Patent foramen ovale (PFO) is a flaplike opening in the fossa ovalis; between the septum primum and secundum. It is highly prevalent with approximately 25% of the population having a PFO. It is usually asymptomatic but can rarely cause paradoxical embolism leading to stroke and/or significant right to left shunting causing hypoxia. The complications of PFO closure with a percutaneous device include embolization, cardiac perforation, and thrombosis. These are all early complications. We describe the case of a patient with a history of PFO closure who had device thrombosis 3 years after implantation. Management includes anticoagulation with warfarin. Repeat cardiac imaging to document the resolution of thrombosis is recommended.

Evaluating Transperineal Prostate Biopsies Performed by a New Operator: A Prospective Clinical Audit at Dorset County Hospital.

Introduction The transperineal (TP) approach for prostate biopsy offers advantages such as a low risk of infection, the ability to target lesions in difficult locations, and a rapid acquisition of proficiency. This prospective clinical audit aims to evaluate the outcomes and patient experiences of TP prostate biopsies performed by a new operator to determine the feasibility of adopting the TP biopsy as the primary method for prostate evaluations. Methods The study included all patients who underwent a TP prostate biopsy from August 1 to September 30, 2022, at Dorset County Hospital National Health Service Foundation Trust. The operator, a member of the urology team, had recently begun performing these biopsies independently after completing a four-month supervised training program and receiving approval from two consulting trainers. The biopsy technique was evaluated based on diagnostic yield and patient experience, comparing pre-procedure imaging results with histology reports and analyzing patient-completed questionnaires. Results Among the 42 patients, the cancer detection rate was 79%. The highest core positivity rate was 100% in two patients (5%), with 90% in 11 patients (26%). Of the patients, 57% showed complete agreement between magnetic resonance imaging findings and histology. A questionnaire assessing patient experience received a 64% response rate. The most common pain score reported was 2 (on a scale of 0-10), noted in 25% of patients. Most reported mild lower urinary tract symptoms (88%) and mild hematuria (85%). Of the patients, 44% rated their overall satisfaction as 10 (on a scale of 0-10), and no urinary tract infections were reported. Conclusion The findings support the adoption of TP biopsy as the primary method for prostate biopsies due to its short learning curve, high diagnostic yield, and favorable patient satisfaction. Training for new operators should be encouraged to achieve this goal.

Predictive Ability of LRINEC Score for Lower Extremity Amputation in Moderate to Severe Diabetic Foot Infection.

OBJECTIVE: To assess the predictive ability of the laboratory risk indicator for necrotising fasciitis (LRINEC) score for lower extremity amputation in patients with moderate to severe diabetic foot infection (DFI). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from June to September 2023. METHODOLOGY: Patients admitted to the surgical ward with moderate to severe DFI were included by convenience sampling. Patients with severe sepsis, unstable haemodynamics, pressure injuries, and terminal illnesses were excluded. Demographic and clinical data of patients were noted down. LRINEC score was calculated on the day of admission. Final outcome (amputation or otherwise) was recorded on the 30th day the since the day of admission. RESULTS: Two hundred patients with moderate to severe DFI were included. The median age of patients was 56 years (IQR 49-66 years). The median duration of diabetes was 11 years (IQR 4 - 18.75 years). The median LRINEC score at admission was 6 (IQR 3-9). The majority of the patients (65.5%) had some other medical comorbid besides diabetes. Patients who had amputation due to DFI at 30 days post-admission had higher LRINEC scores on admission as compared to those patients who did not have amputation (Median 8 vs. 2, p <0.001). The cut-off point of LRINEC score ≥6.5 at admission had sensitivity of 74% and specificity of 94% in predicting amputation. CONCLUSION: The LRINEC score may be used as an objective scoring system to predict the risk of amputation in patients with moderate to severe DFI in indoor clinical settings. KEY WORDS: Diabetic foot, LRINEC score, Limb loss, Necrotising fasciitis.

Independent predictors of mortality and 5-year trends in mortality and resource utilization in hospitalized patients with diffuse large B cell lymphoma.

Background: This retrospective study analyzed factors influencing all-cause inpatient mortality in 80,930 adult patients (2016-2020) with diffuse large B cell lymphoma using the National Inpatient Sample database. Methods: Utilizing ICD-10 codes, patients were identified, and statistical analysis was conducted using STATA. Fisher's exact and Student's t tests compared proportions and variables, multivariate logistic regression examined mortality predictors, and a 5-year longitudinal analysis identified mortality and resource utilization trends. Results: The inpatient mortality rate was found to be 6.56% with a mean age of 67.99 years. Several hospital- and patient-level factors including specific comorbidities such as congestive heart failure, atrial fibrillation, acute kidney injury, chronic obstructive pulmonary disease, liver failure, pancytopenia, tumor lysis syndrome, and severe protein-calorie malnutrition were independently associated with inpatient mortality. Hospitalization costs showed an increasing trend, impacting the overall population and survivors. Conclusion: These insights may refine risk assessment, treatment selection, and interventions.

Bio-based microplastic polylactic acid exerts the similar toxic effects to traditional petroleum-based microplastic polystyrene in mussels.

Microplastics (MPs) have accumulated in the oceans, causing adverse effects on marine organisms and the environment. Biodegradable polylactic acid (PLA) is considered as an excellent substitute for traditional petroleum-based plastics, but it is difficult to degrade completely and easily become MPs in the marine environment. To test the ecological risk of bio-based PLA, we exposed thick-shelled mussels (Mytilus coruscus) to bio-based PLA and petroleum-based polystyrene (PS) (at 102, 104, and 106 particles/L) for 14 days. The significant increase in enzyme activities related to oxidative stress and immune response showed that mussels were under physiological stress after MP ingestion. While enzyme activities of nerve conduction and energy metabolism were significantly disturbed after exposure. Meanwhile, normal physiological activities in respiration, ingestion and assimilation were also suppressed in association with enzyme changes. The negative effects of PS and PLA in mussels were not differentiated, and further integration analysis of integrated biomarker response (IBR) and principal component analysis (PCA) also showed that PLA would induce adverse effects in mussels and ecological risks as PS, especially at environmental concentrations. Therefore, it is necessary to pay more attention to the environmental and ecological risk of bio-based MP PLA accumulating in the marine environment.

Pros and cons of live kidney donation in prediabetics: A critical review and way forward.

There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.

A multi-objective optimisation approach with improved pareto-optimal solutions to enhance economic and environmental dispatch in power systems.

This work implements the recently developed nth state Markovian jumping particle swarm optimisation (PSO) algorithm with local search (NS-MJPSOloc) awareness method to address the economic/environmental dispatch (EED) problem. The proposed approach, known as the Non-dominated Sorting Multi-objective PSO with Local Best (NS-MJPSOloc), aims to enhance the performance of the PSO algorithm in multi-objective optimisation problems. This is achieved by redefining the concept of best local candidates within the search space of multi-objective optimisation. The NS-MJPSOloc algorithm uses an evolutionary factor-based mechanism to identify the optimum compromise solution, a Markov chain state jumping technique to control the Pareto-optimal set size, and a neighbourhood's topology (such as a ring or a star) to determine its size. Economic dispatch refers to the systematic allocation of available power resources in order to fulfill all relevant limitations and effectively meet the demand for electricity at the lowest possible operating cost. As a result of heightened public consciousness regarding environmental pollution and the implementation of clean air amendments, nations worldwide have compelled utilities to adapt their operational practises in order to comply with environmental regulations. The (NS-MJPSOloc) approach has been utilised for resolving the EED problem, including cost and emission objectives that are not commensurable. The findings illustrate the efficacy of the suggested (NS-MJPSOloc) approach in producing a collection of Pareto-optimal solutions that are evenly dispersed within a single iteration. The comparison of several approaches reveals the higher performance of the suggested (NS-MJPSOloc) in terms of the diversity of the Pareto-optimal solutions achieved. In addition, a measure of solution quality based on Pareto optimality has been incorporated. The findings validate the effectiveness of the proposed (NS-MJPSOloc) approach in addressing the multi-objective EED issue and generating a trade-off solution that is both optimal and of high quality. We observed that our approach can reduce ∼ 6.4% of fuel costs and ∼ 9.1% of computational time in comparison to the classical PSO technique. Furthermore, our method can reduce ∼ 9.4% of the emissions measured in tons per hour as compared to the PSO approach.