Diakonissenkrankenhaus

Handheld ultrasound (HHUS) devices are increasingly used in clinical practice due to their portability and cost-effectiveness. However, HHUS image quality remains variable, and a standardized expert-based evaluation protocol is lacking. This study compares the image quality of B-mode recordings of five HHUS models with a high-end reference system (HEUS) using a blinded assessment to identify differences, covariates, offering a standardized evaluation framework.In this blinded, multi-center study, video sequences of the liver, pancreas, and sigmoid colon were recorded in ten volunteers using 5 HHUS devices - Vscan Air, Butterfly iQ+, Philips Lumify, Clarius C3, and Clarius C3 HD3 - and one HEUS (GE Logiq E10). Twenty-two physicians with many years of abdominal ultrasound experience rated blinded clips for 5 image quality parameters.The HEUS consistently received the highest ratings. Image quality differed significantly between HHUS devices. Clarius systems showed the smallest deviation from the reference, followed by Vscan Air and Philips Lumify. All image parameters significantly correlated with the overall impression, without a single dominant factor. The patients' BMI had no relevant influence. Examiner experience was less impactful than device familiarity and personal preference.The image quality of HEUS remained superior to all tested HHUS devices. Further subdivision of image quality aspects did not provide additional information. Furthermore, we could not identify significant covariates in our setup. These findings could justify simplified setups with reduced questionnaires and requirements for examiners.

A 56-year-old man presented with low back pain radiating to the left leg.CT of the lumbar spine revealed reduced disc height and a vacuum phenomenon. MRI demonstrated a left-sided disc herniation at L3-L4, considered the cause of symptoms. Intraoperatively, however, the disc material appeared unusually dark and pigmented.Histological analysis confirmed ochronotic pigment deposits, leading to the diagnosis of alkaptonuria (AKU).The surgical procedure was completed as planned. Postoperatively, the patient was referred for further internal medicine evaluation and genetic counselling.When encountering atypically pigmented tissue, surgeons should consider rare metabolic disorders such as AKU, allowing early diagnosis and appropriate long-term management.

Chronic histiocytic intervillositis with recurrence risk and perinatal adverse outcome is defined by the detection of maternal CD68-positive macrophages. Intervillous accumulation of B lymphocytes is a rare finding in miscarriage specimens and preterm and term placentas. However, there are case reports with manifestation of maternal B cell lymphoma. We present a case with focal brisk intervillous accumulation of CD20-positive lymphocytes in a placenta of a stillbirth from the 21st gestational week with additional maternal floor infarction and umbilical hypercoiling. Immunohistochemically, staining for CD3, CD5, CD10, and CD23 was negative in the intervillous lymphocytic population. Furthermore, neither clonal B cell-proliferation nor lymphoma were found in molecular pathological investigations. Clinical and/or histological signs of an infectious etiology were also not present. Accumulation of intervillous lymphocytes without clinical signs of infectious or neoplastic disease is probably a rare form of intervillositis due to a pathological immune reaction. The uncommon lesion may have contributed to the adverse outcome in this case.

Background:Progress in artificial intelligence-based analysis of surgical videos has been constrained by reliance on manual frame-level annotations rather than patient-level outcomes. In addition, concerns about data privacy restrict the exchange of laparoscopic video data and, thereby, multicenter collaboration.Methods:To address these limitations, we developed a pipeline that integrates weakly supervised deep learning with Swarm Learning, a decentralized machine learning approach that enables collaborative model training without data centralization. We evaluate our pipeline using a newly curated dataset of 397 laparoscopic appendectomy recordings from six international surgical centers. We identified optimal modelling configurations (frame sampling rates and model architectures) and subsequently compared Swarm Learning to single-center and centralized learning across three novel patient-level disease staging tasks: (i) binary detection of perforated appendicitis, (ii) laparoscopic grading of appendicitis, and (iii) histopathologic inflammation grading. In addition, we surveyed participating centers to identify real-world barriers to the clinical implementation of our decentralized learning pipeline for surgical video analysis.Results:For appendicitis grading tasks, frame sampling at 1.0 frames per second and use of the SurgTempoNet architecture resulted in reliable classification performance, outperforming SurgFrameNet and Multiple Instance Learning. Across all three disease staging tasks, Swarm Learning consistently outperformed single-center training and achieved performance comparable to centralized learning, with stable generalization in external validation. The user survey identified hardware failure and limited integration of the decentralized learning pipeline with electronic patient records as key barriers to the clinical implementation of our decentralized learning pipeline for collaborative surgical video analysis.Conclusions:Weakly supervised deep learning enables the prediction of patient-level endpoints directly from surgical video data. Swarm Learning facilitates privacy-preserving multicenter collaboration and achieves performance on par with centralized learning, highlighting its potential for advancing clinically relevant, collaborative AI development in surgical video analysis, especially when integrated with patients’ electronic health records.

Rotational alignment of the tibial component during total knee arthroplasty (TKA) is critical for ensuring optimal tibiofemoral and patellofemoral joint function. Proper alignment minimizes the risk of tibiofemoral mismatch and patellofemoral instability, which can lead to increased joint stress and compromised kinematics. Traditionally, the tibial tubercle axis (TTA) has been the primary landmark for alignment. However, recent insights into knee three-dimensional anatomy reveal significant variability in TTA positioning, challenging its reliability. This study employs a Delphi consensus methodology among European Knee Society (EKS) experts to address key questions regarding tibial rotational alignment in TKA. Through a systematic literature review and expert discussions, a strong consensus was achieved on three main points: (1) optimal alignment should target both the perpendicularity of the anteroposterior tibial axis to the femoral flexion/extension axis and the accurate positioning of the tibial tubercle relative to the femoral trochlea; (2) while the TTA is effective in 70% of cases, its variability in 30% of knees necessitates alternative strategies; (3) current computer-assisted and robotic technologies do not significantly enhance alignment outcomes. These findings emphasize the importance of individualized assessment of rotational deformities and highlight the potential of advanced data analytics to improve future alignment strategies. The consensus underscores the complexity of achieving optimal tibial alignment and the need for continued research to refine surgical techniques and technologies.

The loss of breast cancer cell differentiation during metastatic progression leads to a down-regulation of class 1 human leukocyte antigen (HLA) expression, which in turn hinders cytotoxic T lymphocytes from effectively preventing tumor cell proliferation. Consequently, one would expect that decreased HLA expression would correlate with decreased 5-year survival. However, estrogen receptor alpha (ESR1) is known to be positively associated with overall survival. The study aimed to determine the expression levels of HLA-A, HLA-B/C, and ESR1 and to assess their influence on distant disease-free survival (DDFS). This retrospective subgroup analysis of the initial prospective, single-center, double-blind cohort study included a total of 34 patients who underwent a new treatment line for metastatic breast cancer (MBC). The MBC cells were examined using RT-qPCR. The acquired data and the subsequent survival and ROC analyses indicated a positive association of reduced expression of HLA-A and HLA-B/C with DDFS. A statistically significant association of ESR1 with DDFS could not be shown. A potential positive association between reduced expression of HLA-A and HLA-B/C and DDFS is observed. This contrasts with the generally observed association between HLA expression loss and poor prognosis, as reported in previous protein-based studies. In metastatic settings, reduced expression of particular HLA subsets, measured at the mRNA level, might have a protective effect against disease progression.

Joint cartilage damage is a common condition, and various approaches exist to address these defects. Whenever conservative treatments have been exhausted or are inadequate, surgery should be taken into consideration. However, it is essential to consider the size of the damage as well as the subchondral bone involvement. As joint replacement is not an appropriate treatment for young people, a joint-preserving technique should be preferred. One option is minced cartilage implantation. This surgical procedure is appropriate for defects of around 2 cm2. Studies demonstrated exceptional short-term and midterm outcomes in the knee and hip. This description of technique focuses on the implementation of AutoCart augmentation on the glenoid. The purpose of this note is to gain technical evidence of an all-arthroscopic cartilage implantation technique performed within the glenoid cavity.