Grand Rapids Women's Health

This article reports the results of the second iteration of the autoPET challenge on automated lesion segmentation in whole-body PET/CT, held in conjunction with the 26th International Conference on Medical Image Computing and Computer Assisted Intervention in 2023. In contrast to the first autoPET challenge, which served as a proof of concept, this study investigates whether machine learning-based segmentation models trained on data from a single source can maintain performance across clinically relevant variations in PET/CT data, reflecting the demands of real-world deployment. Methods: A comprehensive biomedical segmentation challenge on PET/CT domain generalization was designed and conducted. Participants were tasked to train machine learning models on annotated whole-body 18F-FDG data (n = 1,014). These models were then evaluated on a test set of 200 samples from 5 clinically relevant domains, including variations in institutions, pathologies, and populations and a different tracer. Performance was measured in terms of average dice similarity coefficient, average false-positive volume, and average false-negative volume. The best-performing teams were awarded in 3 categories. Furthermore, a detailed analysis was conducted after the challenge, examining results across domains and unique instances, along with a ranking analysis. Results: Generalization from a single-source domain remains a significant challenge. Seventeen international teams successfully participated in the challenge. The best-performing team reached an average dice similarity coefficient of 0.5038, a mean false-positive volume of 87.8388 mL, and a mean false-negative volume of 8.4154 mL on the test set. nnU-Net was the most commonly used framework, with most participants using a 3-dimensional U-Net. Despite competitive in-domain results, out-of-domain performance deteriorated substantially, particularly on pediatric and prostate-specific membrane antigen data. Detailed error analysis revealed frequent false-positives due to physiologic uptake and decreased sensitivity in detecting small or low-uptake lesions. A majority-vote ensemble offered minimal performance gains, whereas an oracle ensemble indicates hypothetical gains. Ranking analysis showed no single team consistently outperformed all others across ranking schemes. Conclusion: The second autoPET challenge provides a comprehensive evaluation of the current state of automated PET/CT tumor segmentation, highlighting both progress and persistent challenges of single-source domain generalization and the need for diverse public datasets to enhance algorithm robustness.

Familial adenomatous polyposis (FAP) is a rare inherited disorder characterized by numerous adenomatous polyps throughout the colon and rectum, leading to a significantly increased risk of colorectal cancer. We present the case of a 19-year-old male patient with a known family history of FAP who presented with recurrent lower abdominal pain, altered bowel habits, and rectal bleeding. Initial examination identified rectal polyps, and subsequent colonoscopy revealed multiple adenomatous polyps. Histopathological analysis initially raised the possibility of oxyntic adenomas due to the glandular tissue's anastomosing and cribriform pattern. However, further detailedevaluation, which identified a significant population of both chief and parietal cells within the glandular pits, supported the diagnosis of mixed hyperplastic/fundic gland polyps with focal low-grade dysplasia. This case highlights the diagnostic complexities in distinguishing between oxyntic adenomas and mixed hyperplastic/fundic gland polyps in FAP patients, emphasizing the importance of accurate diagnosis in guiding management, including surveillance, surgical intervention, genetic counseling, and lifestyle modifications.

Kaposi sarcoma (KS) represents a neoplastic proliferation primarily affecting endothelial cells, characterized by the development of cutaneous lesions. However, its pathogenesis can extend beyond the skin, involving internal organs, lymph nodes, and mucous membranes. KSisassociated with human herpesvirus 8 (HHV-8) and is often prevalent in immunocompromised patients, especially those with human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS). We present a case of a 29-year-old African American male who came into the emergency department (ED) with overall discomfort and a boil on his buttock, which was later found to be symptoms of KS in the context of progressed HIV infection. This case report highlights the complications that arise when HIV/AIDS is left untreated and subsequently leads to the development of KS. Early recognition and appropriate interventions are crucial in optimizing outcomes and guiding future care decisions.

Chronic obstructive pulmonary disease (COPD) represents a significant global health burden, characterized by progressive airflow limitation and exacerbations that significantly impact patient morbidity and mortality. Recent research has investigated the interplay between the gut and the lungs, known as the gut-lung axis, highlighting the role of the gut microbiome in COPD pathogenesis. Dysbiosis, characterized by microbial imbalance, has implications for COPD, influencing disease progression and susceptibility to exacerbations. This comprehensive review integrates current scientific literature on gut microbiota modulation as a therapeutic avenue for COPD management. Through a thorough discussion of studies investigating probiotics, prebiotics, synbiotics, antibiotics, dietary fiber, and fecal microbiota transplantation, this review summarizes the influence of these interventions on COPD via the gut-lung axis through the modulation of systemic inflammation, mucosal immunity, and metabolic processes. The interventions highlighted here show potential in preventing COPD exacerbations, preserving lung function, and improving patient quality of life. By compiling the latest scientific evidence, this review provides a comprehensive framework for physicians and researchers to deduce the effectiveness of gut microbiome modulation as an adjunctive therapeutic strategy in COPD management.

Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity and mortality. The optimal approach to managing AF, specifically rate control versus rhythm control, remains a topic of debate in clinical practice. This systematic review aims to compare the rate control and rhythm control strategies based on their clinical outcomes, quality of life, and adverse events associated with them. A comprehensive search was conducted using PubMed, Google Scholar, Science Direct, Research Gate, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Embase (Excerpta Medica dataBASE) databases. A total of 1657 research papers were identified through the search strategy, and after applying the eligibility criteria, 28 studies were selected for the analysis. The studies encompassed a range of methodologies, including randomized controlled trials, observational studies, and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study selection, data extraction, and analysis. The outcomes of interest included all: cause mortality, stroke, bleeding events, cardiovascular hospitalizations, quality of life, and adverse effects of treatment. Data were synthesized and presented in tables, charts, and forest plots for meta-analysis where appropriate. The results indicate that both rate control and rhythm control strategies have their own merits and limitations, with the outcomes varying based on patient characteristics and comorbidities. While rhythm control strategies may lead to better symptom control and improved quality of life, rate control strategies maybe associated with lower risks of adverse events and complications. This systematic review provides a comprehensive overview of the current evidence regarding rate and rhythm control strategies in AF management, offering insights for clinical decision-making and highlighting the need for individualized treatment approaches.

Sir: SERI Surgical Scaffold (Allergan, Inc., Irvine, Calif.) is a silk-derived, bioresorbable scaffold approved in the United States for use as a transitory scaffold for soft-tissue support and repair to reinforce deficiencies where weakness or voids exist, including use in plastic and reconstructive surgery and general soft-tissue reconstruction. Its biomechanical properties are similar to those of host tissue, with good biocompatibility and evidence of a mild, self-limiting foreign body response.1,2 SERI provides strong but pliable postoperative soft-tissue support with gradual enzymatic resorption,3 permits progressive ingrowth and replacement of SERI by host tissue that is 2–3 times that of the initial SERI thickness, and is stronger than native ovine fascia.1–3 The SERI Product Evaluation Program gathers feedback from surgeons who use this device. This report describes the first 12 months of surgeons’ ease of use and satisfaction with SERI. Fifty plastic surgeons were invited to participate in the SERI Product Evaluation Program. Participants provided reports on patients for whom they used SERI and completed a survey assessing SERI ease of use and postoperative satisfaction for each procedure. Four separate ease-of-use items were rated on a 4-point Likert scale (0–3). SERI use satisfaction items were rated on an 11-point Likert scale (0–10). Participants also reported postoperative repair-related adverse events (AEs). After 12 months of SERI use, 28 surgeons provided responses based on 141 patients undergoing 16 procedure types (Table 1). Mean ease-of-use scores exceeded 2.75 (Table 2). Ratings showed minimal variability between procedure types (mean ranges: preparation, 2.85–3.0; cutting/shaping, 2.87–3.0; position/draping, 2.50–3.0; suturing, 2.50–3.0). Mean satisfaction scores exceeded 9.2 for each item (Table 2). As with ease-of-use ratings, mean satisfaction scores showed low variability among procedure types (ranges: meeting expectations, 8.0–9.89; aesthetic result, 8.58–9.85; feel, 8.50–10.0; shape, 8.50–9.82). Lower scores within these ranges were associated with neck procedures, which comprised a small proportion of surgeries performed (Table 1). Over 12 months, overall satisfaction scores showed little variation (9.0−9.67), with no single procedure associated with clear trends or shifts over time.Table 1: Procedures for Which SERI Was Used over 12 MonthsTable 2: Ease-of-Use and Postoperative Satisfaction ScoresPotential device-related AEs included irritation/inflammation (n = 1; midface lift), visibility/palpability (n = 1; breast augmentation-revision), and induration (n = 1; blepharoplasty). However, AE reporting was voluntary and may be underreported. Non–device-related complications include 1 case of wound dehiscence at the inverted “T” incision. The patient (breast reduction) had SERI exposure and healed following minimal debridement. Other non–device-related AEs were seroma (breast revision-reconstruction), necrosis (abdominal wall repair), and erythema (breast revision-augmentation). Among cases with potentially device-related AEs, postoperative satisfaction ratings remained high and were similar to the overall case sample. In conclusion, surgeons who used SERI in procedures for soft-tissue support and repair reported consistently high levels of pre- and intraoperative ease of use and satisfaction with postoperative results. Few device-related AEs were reported, suggesting a positive safety profile with SERI use. Multiple prospective surgical procedures in breast, abdominal wall, and other sites are under way. Product performance evaluation data gathered at program completion will broaden our understanding of surgeons’ perceptions of SERI and whether patterns of SERI use and satisfaction change over time.

Grand Rapids, Mich. From Partners in Plastic Surgery. Received for publication August 8, 2012; accepted August 24, 2012. Disclosure:The author has no financial interest to declare in relation to the content of this Discussion or of the associated article. Dennis C. Hammond, M.D.; Partners in Plastic Surgery, 4070 Lake Drive, Suite 202, Grand Rapids, Mich. 49546, [email protected]

Grand Rapids, Mich. From Partners in Plastic Surgery. Received for publication February 20, 2012; accepted March 8, 2012. Disclosure:Dr. Hammond has a consulting agreement with the Mentor Corporation. Dennis C. Hammond, M.D.; Partners in Plastic Surgery, 4070 Lake Drive, Suite 202, Grand Rapids, Mich. 49546, [email protected]

This study was designed to evaluate clinical outcomes ≥2 years following surgery with polypropylene mesh and vaginal support device (VSD) in women with vaginal prolapse, in a prospective, multi-center setting. Patients re-consented for this extended follow-up (n = 110), with anatomic evaluation using Pelvic Organ Prolapse Quantification (POP-Q) and validated questionnaires to assess pelvic symptoms and sexual function. Complications were recorded (safety set; n = 121). Median length of follow-up was 29 months (range 24-34 months). The primary anatomic success, defined as POP-Q 0-I, was 69.1%; however, in 84.5% of the cases, the leading vaginal edge was above the hymen. Pelvic symptoms and sexual function improved significantly from baseline (p < 0.01). Mesh exposure rate was 9.1%. Five percent reported stress urinary incontinence and 3.3% required further prolapse surgery. These results indicate this non-anchored mesh repair is a safe and effective treatment for women with symptomatic vaginal prolapse in the medium term.