Convolutional neural network deep learning model accurately detects rectal cancer in endoanal ultrasounds

BACKGROUND

Imaging is vital for assessing rectal cancer, with endoanal ultrasound (EAUS) being highly accurate in large tertiary medical centers. However, EAUS accuracy drops outside such settings, possibly due to varied examiner experience and fewer examinations. This underscores the need for an AI-based system to enhance accuracy in non-specialized centers. This study aimed to develop and validate deep learning (DL) models to differentiate rectal cancer in standard EAUS images.

METHODS

A transfer learning approach with fine-tuned DL architectures was employed, utilizing a dataset of 294 images. The performance of DL models was assessed through a tenfold cross-validation.

RESULTS

The DL diagnostics model exhibited a sensitivity and accuracy of 0.78 each. In the identification phase, the automatic diagnostic platform achieved an area under the curve performance of 0.85 for diagnosing rectal cancer.

CONCLUSIONS

This research demonstrates the potential of DL models in enhancing rectal cancer detection during EAUS, especially in settings with lower examiner experience. The achieved sensitivity and accuracy suggest the viability of incorporating AI support for improved diagnostic outcomes in non-specialized medical centers.

Surgical outcomes of minimally invasive trephine surgery for pilonidal sinus disease with and without laser therapy: a comparative study

BACKGROUND

Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in patients with PSD.

METHODS

A retrospective cohort study was conducted at a large tertiary medical center, including all adult patients with PNS who underwent trephine surgery with/without laser therapy between 2016 and 2021[AUTHORS TO INSERT MONTH]. Propensity score matching was used to address confounding factors, and the primary outcome was the 1-year recurrence rate.

RESULTS

The study included 221 patients with PSD, with a mean age of 23.73 years (87.7% male). In the unmatched cohort (130 trephine surgery alone, 91 trephine surgery + laser therapy), significant differences were observed in mean age (23 vs. 25 years; p < 0.01)[AUTHROS TO USE MEDIAN PLUS RANGE OR ADD SD] and surgeons' experience (p = 0.014). Propensity score matching was applied to overcome confounding factors, resulting in a matched cohort including 73 patients in each group. The addition of laser therapy demonstrated a significantly lower recurrence rate (8.2% vs. 32.9%; p < 0.001) compared to pit excision without laser therapy. Logistic regression analysis showed that the addition of laser was significantly associated with a lower risk for recurrence (OR 0.23; 95% CI 0.089-0.633; p < 0.01).

CONCLUSION

The incorporation of laser therapy along with trephine/pit excision surgery significantly reduces the recurrence rate in patients with PNS. Further prospective studies are needed to confirm our findings.

A unique proteomic signature of extracellular vesicles derived from mesenchymal stromal cells of epicardial fat from patients with and without ischemic heart disease

Background

Mesenchymal stromal cells (MSCs) have been implicated in the development and progression of myocardial diseases. However, the role of extracellular vesicles (EVs) secreted from human MSCs (hMSCs) of epicardial fat (eFat) in the pathogenesis of ischemic heart disease (IHD) has never been studied.

Purpose

We sought to characterize EVs from eFat-hMSCs of patients with and without IHD.

Methods

We collected eFat specimens from 12 patients with (n=7) and without (n=5) IHD who underwent open heart surgery. We isolated and cultured hMSCs by enzymatic digestion and adherence to plastic. EVs were separated from the culture media by differential ultra-centrifugation. We assessed EV size and structure by electron microscopy and nanoparticle tracking analysis. Finally, we evaluated the proteomic profile of EVs from ischemic and non-ischemic patients by mass spectrometry.

Results

eFat-hMSCs from ischemic patients, secreted higher amounts of small EVs (size range of 70–200 nm) compared with non-ischemic controls (Figure 1A+B). Proteomic analysis revealed over 1,000 proteins inside isolated EVs. We identified 13 proteins that were significantly differentially expressed between patients with and without IHD, including apolipoprotein E, transforming growth factor-β and collagen α-1 (Figure 1C). We performed an enrichment analysis which showed that EVs from eFat-hMSCs from ischemic patients encapsulated functional protein networks associated with immune activation. Unlike IHD patients, EVs from non-ischemic patients carried functional protein networks that regulate angiogenesis.

Conclusions

eFat-hMSCs of patients with IHD secrete higher amounts of small EVs with a unique proteomic signature related to immune activation. EVs derived from eFat-hMSCs should be further studied for their potential role in the initiation and progression of cardiovascular diseases, such as coronary artery disease, heart failure and arrhythmias.

Figure 1

Funding Acknowledgement

Type of funding source: None

Small extracellular vesicles from epicardial fat of patients with atrial fibrillation induce inflammation, fibrosis and re-entrant arrhythmias

Background and aim

Epicardial fat (eFat) has been linked to atrial remodeling and fibrillation (AF). Small extracellular vesicles (sEVs) are heterogeneous membrane vesicles released by all cell types. They can both protect and damage tissues by the delivery of multiple different messengers. Surprisingly, the role of sEVs in the pathogenesis of AF has not been studied. Thus, we aimed to determine whether sEVs derived from eFat play a role in the pathogenesis of AF.

Methods and results

We collected eFat specimens from patients with and without chronic or paroxysmal AF undergoing open-heart surgery. Isolated eFat specimens were cut into small pieces and incubated as organ cultures. We isolated sEVs from the medium of the explant by differential ultra-centrifugation, high-density gradient or size exclusion chromatography (SEC), and characterized vesicle size distribution, morphology, specific markers, histology and molecular cargo. Immunostaining for macrophage accumulation, fibrosis and apoptosis confirmed the pro-inflammatory and pro-fibrotic properties of eFat sEVs from patients with AF (Fig. 1). eFat sEVs labeled with PKH26 were massively up taken by endothelial cells (Fig. 2). Real-time PCR showed an increased level of oxidative stress genes in endothelial cells. eFat sEVs from patients with AF caused more fibrosis after injection into rat hearts than those without AF. (Fig. 3). Finally, while eFat sEVs from patients with and without AF induced shorter action potential duration, only eFat sEVs from patients with AF induced sustained re-entry (rotor) in human induced pluripotent stem cell (iPS)-derived cardiomyocytes (Fig. 4)

Conclusion

We show, for the first time, that sEVs from eFat of patients with AF demonstrate unique pro-inflammatory, pro-fibrotic and pro-arrhythmic properties. Our findings suggest that eFat sEVs can induce cellular, molecular and electrophysiological remodeling that can subsequently lead to the development of AF.

Funding Acknowledgement

Type of funding source: None

The efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome: a systematic review and meta-analysis

BACKGROUND

Sacral neuromodulation (SNM) has become one of the main treatment options in patients with fecal incontinence. The aim of this study was to determine the efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome (LARS).

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was conducted using the Pubmed, Embase, Ovid, and Cochrane databases, restricted to the English language and to articles published from 2000 to November 2018.

RESULTS

A total of 434 articles on the efficacy of SNM in the treatment of LARS were retrieved, and 13 studies were included in the final analysis, with a total of 114 patients treated with SNM for LARS The overall success rate excluding study heterogeneity was 83.30% [95% CI (71.33-95.25%)]. Improvement in anal continence was seen in several clinical and functional parameters, including the Wexner Score [10.78 points, 95% CI (8.55-13.02), p < 0.0001], manometric maximum resting pressure [mean improvement of 6.37 mm/Hg, 95% CI (2.67-10.07), p = 0.0007], maximum squeeze pressure [mean improvement of 17.99 mm/Hg, 95% CI (17.42-18.56), p < 0.0001] and maximum tolerated volume [mean improvement of 22.74 ml, 95% CI (10.65-34.83), p = 0.0002]. Quality of life questionnaires also demonstrated significant improvement in patients' quality of life, but were reported only in a small group of included patients.

CONCLUSIONS

SNM significantly improves symptoms and quality of life in patients suffering from fecal incontinence following low anterior resection.

P2581Unique molecular profile of exosomes from epicardial fat of patients with atrial fibrillation

Background and aim

Exosome, the smallest vesicles that originate from intracellular compartments, contains and delivers specific bioactive proteins, lipids, mRNA, and miRNA to facilitate intercellular signaling. However, the role and mechanism of exosomes in atrial remodeling and fibrillation (AF) has not been determined. While epicardial fat (eFat) and inflammation have been linked to atrial remodeling and fibrillation (AF), the role of eFat exosomes in the pathogenesis of AF remains unknown. Thus, we aimed to determine whether eFat exosomes play a role in the initiation and progression of AF.

Methods and results

We collected eFat specimens from patients with and without chronic or paroxysmal AF undergoing heart surgery. Isolated fat specimens were cut into small pieces and incubated as organ cultures. We isolated exosomes from the medium of the explant by differential ultra-centrifugation and characterized the vesicle size distributions, morphology, specific markers, and molecular cargo. Immunoblotting of CD63, CD81 and TSG101 confirmed the presence of exosomes (Fig.1 B). Significantly, eFat from patients with AF secreted higher amounts of exosomes compared with controls (p<0.001), which confirmed by Nanoparticle Tracking Analysis (NTA) (Fig.1 A). The levels of exosomal pro-inflammatory and pro-fibrotic cytokines were higher in exosomes from patients with, compared with those without, AF (Fig.1 C, D). Measurements of micro RNA (miRNA) by real-time PCR showed lower levels of anti-fibrotic miRNA-133a (p=0.2), and higher levels of pro-fibrotic miRNA-146b (p=0.2) in exosomes from patients with, compared with those without, AF (Fig.1 E, F)

Conclusion

We show, for the first time, that exosomes from eFat of patients with AF have a unique pro-inflammatory and pro-fibrotic profile. We suggest a novel mechanism that links eFat to AF and eFat exosomes as novel biomarkers and potential therapeutic targets for AF.

Is there an association between mesenteric panniculitis and lymphoma? A case control analysis

AIM

To determine the prevalence and association of mesenteric panniculitis (MP) in a group of patients with non-Hodgkin's lymphoma (NHL) compared to control group.

MATERIALS AND METHODS

We retrospectively evaluated computed tomography (CT) and combined positron-emission tomography (PET) with CT examinations of a total of 166 patients who were diagnosed with NHL over a period of 5 years (2008-2013). The control group consisted of 332 subjects who were matched for gender and age at the time period the examinations were performed on the study group. A combination of radiological signs and absence of 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG)-uptake was used to establish the diagnosis of MP and distinguish it from the involvement of mesentery by lymphoma.

RESULTS

MP was identified in three patients (prevalence 1.8%) from the study group as compared to seven subjects out of 332 (2.1%) in the control group (p=0.556). During the course of follow-up no changes in the imaging features of MP were seen in either group. Additionally, 27 (16.2%) patients from the study group were found to have changes in the mesentery, which were attributed to the involvement of the mesentery in the primary disease.

CONCLUSION

The prevalence of MP among patients with NHL was found to be 1.8%, which corresponds to the range of its prevalence in the general population. This is contrary to the proposition that MP is associated with NHL.

Why not the best? Social anxiety symptoms and perfectionism among Israeli Jews and Arabs: a comparative Study

BACKGROUND

Social Anxiety Disorder (SAD) has been repeatedly shown to be very prevalent in the Western society and is characterized by low self-esteem, pessimism, procrastination and also perfectionism. Very few studies on SAD have been done in the Middle East or in Arab countries, and no study tackled the relationship between social anxiety symptoms and perfectionism in non-Western samples.

METHODS

We examined social anxiety symptoms and perfectionism in a group of 132 Israeli Jewish (IJ) and Israeli Arab (IA) students. Subjects completed the Liebowitz Social Anxiety Scale (LSAS), the Multidimensional Perfectionism Scale (MPS), the Negative Automatic Thoughts Questionnaire (ATQ-N), the Positive Automatic Thoughts Questionnaire (ATQ-P) and a socio-demographic questionnaire.

RESULTS

The rate of SAD in our sample according to a LSAS score of 60 or more was 17.2% (IJ=13.8%, IA=19%, ns). The correlation between perfectionism and the LSAS was high in both groups, and in particular in the IJ group. The IA group had higher scores of social avoidance, of ATQ-P and of two of the MPS subscales: parental expectations and parental criticism. Concern over mistakes and negative automatic thoughts positively predicted social fear in the IJ group, whereas in the IA group being female, religious and less educated positively predicted social fear. Negative automatic thoughts and age positively predicted social avoidance in the IJ group. In general, the IJ and IA subjects showed higher social anxiety, higher ATQ-N scores and lower parental expectations as compared with non-clinical US samples.

CONCLUSIONS

Social anxiety symptoms and perfectionism are prevalent in Arab and Jewish students in Israel and seem to be closely related. Further studies among non-western minority groups may detect cultural influences on social anxiety and might add to the growing body of knowledge on this intriguing condition.

Prevalence of obesity among Arab school children in Nazareth, Israel: comparison with national (Jewish) and international data

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Lack of published data. Absence of Ethnic specific data. Lack of focus on obesity prevention in Arab schools.

WHAT THIS STUDY ADDS

First set of data on obesity for Arab children. Data will be used as reference data. Alert health/school official for intervention.

SUMMARY

Objective The objective is to produce the first set of obesity prevalence data and use the data as reference values of body mass index (BMI) trends for Arab children in Israel and compare with Jewish and international data. Methods A prevalence study was carried out in 2009 in which 4130 children aged 6-12, were selected from eight Arab sector schools representing the Nazareth Municipality. Height, weight and BMI measurements were obtained and presented by age, mean age, size, weight, gender and percentile. Appropriate epidemiological and statistical methods used for comparison. Results The obesity and overweight prevalence rates in Arab children by age ranges from 0% to 2.6% and 0% to 11.2%, respectively. Comparison with international and Jewish data revealed differences in almost all age groups but higher rates in Arabs, especially boys. Discussion The higher rates/trends in Arab children may be explained by more Arab women entering the workforce, increase in single-parent families and changes in food and physical activity environments. Conclusion Based on our data, we recommend either an ethnic-specific BMI reference curves and/or inclusion of Arab data in the Israeli data system. Research need to focus on reasons for the increase and interventions to reverse/slow the trend.

Shyness and social phobia in israeli jewish versus arab students

Background

Social Anxiety Disorder has been repeatedly shown to be very prevalent in the Western society with prevalence rates of 10% or above. However, very few studies have been performed in the Middle East and in Arab countries.

Methods

Three hundred Israeli students participated in our study and were administered the Liebowitz Social Anxiety Scale (LSAS), the Cheek Buss Shyness questionnaire (CBSQ) and a socio-demographic questionnaire.

Results

153 Jewish and 147 Arab students participated in the survey. SAD was found in 12.33% of the sample, according to the LSAS cutoff score of ≥60. The two subsamples had similar LSAS and CBSQ scores and similar positive SAD-positive rates (LSAS≥60). Females had higher scores on the LSAS, as were those without a spouse and those that had been in psychological treatment. Based on a regression analysis, the significant predictors of the LSAS score were the CBSQ score and female gender. A very high correlation was found between the LSAS score and the CBSQ score.

Conclusions

SAD and shyness are similarly prevalent in Jewish and Arab students in Israel. SAD scores were higher among females, those without a spouse and those that received psychological treatment. Further studies on the clinical and cultural characteristics of SAD in Israeli sub-cultures would add to the growing body of knowledge on SAD in various cultures.

Emergency surgery for complicated acute diverticulitis

AIM

Antecedent attacks of diverticulitis are thought to increase the risk of complicated diverticulitis, and unless elective surgery is performed, a high proportion of patients with recurrent symptoms will require emergency operations for complicated diverticulitis with its associated morbidity. In this multicentre study, we aim to assess impact of previous attacks of diverticulitis on patients requiring an emergency surgical intervention.

METHOD

All patients operated on as an emergency for complicated diverticulitis were retrospectively analysed. Patients were separated into two groups: group A included patients without previous history of diverticular disease, and group B those with previous attacks of diverticulitis.

RESULTS

A total of 96 patients were included in the study. Group A included 68 (70.8%) patients, and group B 28 (29.2%) patients. Generalized peritonitis was the reason for operation in 50 (73.5%) patients in-group A and only four (14%) patients in group B. Perforated diverticulitis occurred more often in group A, whereas pericolonic abscess and phlegmon formation occurred more commonly in group B. Resection was performed in all patients in group B; 50% had a Hartmann's procedure, and the other 50% patients had primary anastomosis. Hartmann's procedure was performed in 52 patients (76.5%) in group A, and 8 patients (11.7%) had resection and primary anastomosis. No difference in postoperative complications was identified between the groups.

CONCLUSION

Multiple attacks of diverticulitis are not associated with an increased risk of complicated diverticulitis. Recurrent episodes of diverticulitis are not associated with a less favourable outcome or an increased risk of fatality if complications ensue.

Dehydroepiandrosterone and monoamines in the limbic system of a genetic animal model of childhood depression

Monoamines and dehydroepiandrosterone (DHEA) levels were measured in a genetic animal model for childhood depression in four subcortical structures: nucleus accumbens (Nac), ventral tegmental area (VTA), amygdala and hypothalamus. The "depressive-like" strain was the Flinders Sensitive Line (FSL), compared to their controls, Sprague-Dawley (SD) rats. Prepubertal FSL rats showed abnormal levels of only a few monoamines and their metabolites in these brain regions. This is in contrast to former studies, in which adult FSL rats exhibited significantly higher levels of all the monoamines and their metabolites measured. These different abnormal monoamine patterns between the "depressed" prepubertal rats and their adults, may help to explain why depressed children and adolescents fail to respond to antidepressant treatment as well as adults do. On the other hand, FSL prepubertal rats exhibited the same pattern of abnormal DHEA basal levels as was found in adults in previous experiments. The results from the current study may imply that treatment with DHEA could be a promising novel therapeutic option for depressed children and adolescents that fail to respond to common (monoaminergic) antidepressant treatments.

Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study

BACKGROUND: Several surgical methods are accepted for the treatment of chronic anal fissure. The most popular are anal dilatation (AD) and left lateral sphincterotomy (LLS). The objective of the current study was to prospectively evaluate the results of these two procedures in terms of recurrence rate, complications and patient satisfaction. METHODS: The study enrolled all patients who required operation for chronic anal fissure in the Division of General Surgery, Campus Golda, Rabin Medical Center, between the years 1997 and 2001. Exclusion criteria were acute anal fissure or inflammatory bowel disease. RESULTS: A total of 108 patients participated in the study, at an average age of 42.4 years (SD=12.5). The patients were randomly assigned to two groups; one for LLS (53 patients, 49.1%) and one for AD (55 patients, 50.9%). The study protocol included a questionnaire and a physical examination performed 1, 2, 3, 6 and 12 months after operation. The questionnaire contained questions about pain, bloody stool, incontinence for gas, fluid or hard feces, during the day or night, and soiling. The patients were also asked about their satisfaction on an analog scale from 1 to 10. The average follow-up was 11.2 months (SD=4.1). Minor incontinence occurred in 8 patients of AD group and in 2 patients of LLS group (p<0.005). Recurrence occurred in 6 cases of the AD group and in one case of the LLS group (p<0.003). Satisfaction score was insignificantly higher in the LLS group (9.1+/-0.8 in the LLS group and 7.4+/-2.0 in the AD group). CONCLUSIONS: These results suggest that LLS is the preferred method for the treatment for chronic anal fissure.

Comparison of the Flexiblade levering laryngoscope with the English Macintosh laryngoscope in patients with a poor laryngoscopic view

The effectiveness of two laryngoscopes, the English Macintosh and the Flexiblade (a levering laryngoscope), were compared in a clinical setting. An investigation was carried out in 100 patients admitted for surgery under general anaesthesia, to compare intubation with the Flexiblade or the Macintosh laryngoscope. The patients had two anatomical characteristics that may predict difficult intubation - Mallampati score II and III, and a thyromental distance </= 6.5 cm. Patients were randomly allocated to receive intubation with one of the laryngoscopes. The laryngeal view obtained during laryngoscopy, the intubation time, and the need for optimization manoeuvres and assistance required were compared in the two groups. The correlation between intubation time and anatomical characteristics was determined. Only 49 patients had a poor laryngeal view during initial laryngoscopy and required additional facilitating manoeuvres. In these patients, successful intubation time (in seconds) using the Flexiblade was significantly shorter than using the Macintosh laryngoscope (median 14.3 s, IQR 12.0-18.4 s [corrected] vs. median 20.8 s, IQR 14.9-25.5 s (U = 165, [corrected] p , 0.01). Assistance and additional manoeuvres were required significantly less frequently in the Flexiblade group (21%) compared to Macintosh group (67%) (p < 0.01). No correlation was found between intubation time, Mallampati scores, thyromental distance, or body weight. We concluded that in patients with an initial poor laryngoscopic view, the Flexiblade may enable faster and easier tracheal intubation.

ATP receptor. A putative receptor-operated channel in PC-12 cells

External ATP induces [3H] dopamine [( 3H]DA) release in rat pheochromocytoma cells (PC-12 cells). The ATP-induced release is a saturable process with half-effective concentration of EC50 = 80 microM. ADP is a poor secretagogue of [3H]DA (one-sixth of ATP) and AMP is devoid of secretory capabilities. Adenosine and the non-hydrolyzable analogues of ATP, AppNHp and AppCp are ineffective as inducers of [3H]DA, release, or as inhibitors of the ATP-induced [3H]DA release. The most potent antagonist of ATP-induced release is Coomassie Blue (IC50 = 25 microM), compared to ADP beta S (IC50 = 500 microM). The overall rank order of potency is ATP greater than ADP much greater than AMP greater than adenosine, which is characteristic of the P2-purinergic receptor. ATP-induced secretion is absolutely Ca2+ dependent, indicating an exocytotic process and is independent of Mg2+ (up to 2 mM) suggesting that the active species is not ATP4-. (a) The ATP-induced 45Ca2+ influx into the cells is in good correlation to ATP induction of release (IC50 = 80 and 90 microM, respectively) and is carried over to ADP which has a diminished ability to induce both release and 45Ca2+ influx. (b) Divalent cations (Ba2+ greater than Sr2+ greater than Ln3+ greater than Mn2+) replace Ca2+ and support ATP-induced release similar to their effectiveness in supporting bradykinin- and K+ (50 mM)-induced release in PC-12 cells (Weiss, C., Sela, D., and Atlas, D. (1990) Neurosci. Lett. 119, 241-245). Combined together the absolute requirement of [Ca2+]ex for release, inhibition of release by Gd3+ (IC50 = 100 microM), Ni2+, and Co2+ (IC50 = 1 mM), and support of release by Ba2+, Sr2+, and Mn2+, we suggest that ATP induces Ca2+ entry via ligand-operated Ca2+ channels as previously suggested for ATP in smooth muscle cells (Benham, C.D., Bolton, T.B., Byren, N.G., and Large, W.A. (1987) J. Physiol. (Lond.) 387, 473-488). No significant inhibition by 1 microM verapamil, 10 microM nifedipine, or 2 mM Cd2+ argues against ATP activation of voltage-dependent Ca2+ channels as similarly shown for ATP-induced [3H]noradrenaline release (Inoue, K., Nakazawa, K., Fujimoro, K., and Takanaka, A. (1989) Neurosci. Lett. 106, 294-299). Thus, the widely distributed ATP receptor might play an essential role in Ca2+ homeostasis of the cell by introducing Ca2+ into the cell via specific ligand-gated Ca2+ channels.