Automatic Identification of Miscarriage Cases Supported by Decision Strength Using Ultrasound Images of the Gestational Sac

Ultrasound imaging is one of the most widely used multipurpose imaging modalities for monitoring and diagnosing early pregnancy events. The first sign and measurable element of an early pregnancy is the appearance of the Gestational Sac (GS). Currently, the size of the GS is manually estimated from ultrasound images. The manual measurements tend to result in inter- and intraobserver variations, which may lead to difficulties in diagnosis. This paper proposes a new method for automatic identification of miscarriage cases in the first trimester of pregnancy. The proposed method automatically segments the GS and calculates the Mean Sac Diameter (MSD) and other geometric features of the segmented sac. After classifying the image based on the extracted features into either a pregnancy of unknown viability (PUV) or a possible miscarriage case, we assign the decision with a strength level to reflect its reliability. The paper argues that the level of decision strength gives more insight into decision making than other classical alternatives and makes the automated decision process closer to the diagnosis practice by exper

Automated characterisation of ultrasound images of ovarian tumours: the diagnostic accuracy of a support vector machine and image processing with a local binary pattern operator

Introduction: Preoperative characterisation of ovarian masses into benign or malignant is of paramount importance to optimise patient management. Objectives: In this study, we developed and validated a computerised model to characterise ovarian masses as benign or malignant. Materials and methods: Transvaginal 2D B mode static ultrasound images of 187 ovarian masses with known histological diagnosis were included. Images were first pre-processed and enhanced, and Local Binary Pattern Histograms were then extracted from 2 × 2 blocks of each image. A Support Vector Machine (SVM) was trained using stratified cross validation with randomised sampling. The process was repeated 15 times and in each round 100 images were randomly selected. Results: The SVM classified the original non-treated static images as benign or malignant masses with an average accuracy of 0.62 (95% CI: 0.59-0.65). This performance significantly improved to an average accuracy of 0.77 (95% CI: 0.75-0.79) when images were pre-processed, enhanced and treated with a Local Binary Pattern operator (mean difference 0.15: 95% 0.11-0.19, p < 0.0001, two-tailed t test). Conclusion: We have shown that an SVM can classify static 2D B mode ultrasound images of ovarian masses into benign and malignant categories. The accuracy improves if texture related LBP features extracted from the images are considered

Аналіз ринку препаратів для консервативного лікування геморою з метою визначення маркетингових можливостей для вітчизняного виробника

The spread of diseases of the rectum, namely hemorrhoids, leads to the deterioration of the physical and psychological health of the working-age population, increases the budget costs of the healthcare system, insurance companies, and the population’s own funds. In this regard, the development of new complex medicinal products is always relevant for domestic pharmacy. Aim. To form a modern idea of the market structure and trends in the consumption of drugs for the conservative treatment of hemorrhoids, determine the possible potential for domestic developers and manufacturers. Materials and methods. The research was conducted using the structural analysis logical and graphic methods, methods of marketing analysis. Results. It was found that recently the market of antihemoroidal agents for topical application and capillary-stabilizing agents developed quite vigorously – the market growth rates in the period of 2020-2021 were from 15 to 23&nbsp;% in physical units and from 28 to 40&nbsp;% in monetary units. However, according to the structure of the producing countries, the market remains import-dependent. Drugs from France, Switzerland, Bulgaria, Germany, Spain, Slovenia, Italy, and the United States are available on the market. The leaders of sales are products manufactured by Servier (France), Innotek International (France), and Teva (Israel). The leaders in the supply of domestic drugs of this group are Borshchagovsky Chemical Pharmaceutical Plant, JSC “Galichpharm”, Kyiv Vitamin Plant, PJSC “Darnitsa” Pharmaceutical company”, PJSC “Monpharm”. The most popular dosage forms are tablets, capsules, gels, ointments, suppositories. Conclusions. Based on the changes identified, certain proposals have been developed for the domestic pharmaceutical industry – the market has a relatively small range of domestic complex medicines combining components of chemical and natural origin, including the plant raw material. The market has a positive development trend; therefore, further search for an effective complex drug is expedient.Поширення захворювань прямої кишки, а саме геморою, призводить до погіршення фізичного й психологічного здоров’я працездатного населення, підвищує витрати з бюджету&nbsp; системи охорони здоров’я, страхових компаній та власних коштів населення. У зв’язку із зазначеним&nbsp; розроблення нових комплексних лікарських засобів залишається завжди на часі для вітчизняної фармації. Мета – формування сучасного уявлення про структуру ринку та тенденції споживання препаратів для консервативного лікування геморою, визначення можливого потенціалу для вітчизняних розробників і виробників. Матеріали та методи. Дослідження проведено за допомогою структурного аналізу, з використанням логічного й графічного методів, методів маркетингового аналізу. Результати дослідження. Виявлено, що останнім часом ринок антигемороїдальних засобів для місцевого застосування і капіляростабілізувальних засобів розвивався достатньо енергійно – темпи зростання ринку в період 2020-2021 рр. склали від 15 до 23&nbsp;% у натуральних одиницях та від 28 до 40&nbsp;% у грошових. Однак за структурою країн-виробників ринок залишається імпортозалежним. На ринку присутні препарати Франції, Швейцарії, Болгарії, Німеччини, Іспанії, Словенії, Італії, США. Лідерами продажів є засоби виробництва фірми Серв’є (Франція), Іннотек Інтернасіональ (Франція), Тева (Ізраїль) тощо. Лідерами постачання вітчизняних препаратів цієї групи є Борщагівський ХФЗ, АТ «Галичфарм», Київський вітамінний завод, ПАТ «Фармацевтична фірма “Дарниця”», ПАТ «Монфарм». Найбільш популярними формами випуску є таблетки, капсули, гелі, мазі, супозиторії. Висновки. На базі виявлених змін розроблено певні пропозиції для вітчизняної фармацевтичної індустрії – ринок має відносно незначний асортимент вітчизняних комплексних лікарських засобів, що поєднують компоненти хімічного та природного походження, зокрема й рослинну сировину. Ринок має позитивну тенденцію розвитку, тому подальший пошук ефективного комплексного препарату є доцільним

Use of Laser Speckle Contrast Analysis during pelvic surgery in a uterine transplantation model

Aim: Uterine transplantation (UTx) is proposed for treatment of uterine factor infertility. Our aim was to assess whether Endoscopic Laser Speckle Contrast Analysis (eLASCA) could evaluate pelvic blood flow at anastomotic sites required for sheep and rabbit UTx. Results/methodology: eLASCA detected blood flow in rabbit UTx #7 and #9. In sheep UTx #2, #3 and #5, the results allowed us to conclude that blood flow was present in the uterine graft following transplantation; and post-UTx, the animal had heart and respiratory rates, and oxygen saturation compatible with a normal hemodynamic status. Conclusion: These preliminary results establish the potential of Laser Speckle Contrast Analysis as noncontact and real-time tool for observation of spatially-resolved blood flow from which other parameters can be derived

OC04.04 : A machine-learning algorithm to distinguish benign and malignant adnexal tumours from ultrasound images

The accurate preoperative diagnosis of adnexal tumours as benign or malignant is pivotal to optimise patient management. We developed a Machine Learning (ML) Algorithm to characterise adnexal tumours as benign or malignant from ultrasound images

Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study

Background: To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3. Methods: This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery. Results: The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917–0.942), 0.918 (0.905–0.930), 0.914 (0.886–0.936) and 0.875 (0.853–0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90–96%, specificity 74–79% and diagnostic odds ratio (DOR) 32.8–50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6–75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5. Conclusions: This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p&lt;00001), age 70 years or older versus younger than 70 years (230 [165-322], p&lt;00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p&lt;00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research