Acceptance of telepathology in daily practice.

The availability of pathology services differs greatly in our environment. Although pathology would be especially suitable for being practised at a distance by transporting digital image information, the spread of telepathology into everyday work still is relatively slow. The article describes the situation of diffusion of this innovative technology by reviewing the literature and discussing this in context to data based on questionnaires dealing with the acceptance of telepathology. The current situation of telepathology can be discussed by five items for innovation spead: (1) communication and influence; (2) economic costs and benefits; (3) knowledge barriers and learning; (4) feasibility of techniques offered for the demands of the users; (5) clarification of the legal status and other factors concerning international collaboration. All these head lines do not represent realistic obstacles for the more widespread use of telepathology. The real drawbacks may therefore be found behind certain professional habits of pathologists. The most important causes may be that (a) telediagnosis is not as easy as it may seem at the first glance; (b) telepathology is seen as a potential highway to a world-wide competition of pathology service providers. As soon as these mostly unjustified prejudices are corrected and telepathology is percepted as additional technique in pathology, it will become a diagnostic tool as common and as useful as the telephone.     

Peripheral nerve stimulation in intractable neuropathic pain

Peripheral nerve stimulation (PNS) is a neurostimulation analgesic technique. PNS is utilized to treat peripheral neuropathic pain. It is highly sophisticated and a specialized technique used where other forms of treatment have failed. This paper describes the PNS procedure, its therapeutic principles, indications, and the comprehensive care for patients after the PNS implant. First, we summarize our experience using this type of invasive treatment. In the second part, a case of intractable neuropathic pain following repeated surgery to the ulnar nerve is reported. Prior to PNS, the patient underwent multiple types of antineuralgic treatment with no significant result. Only after the PNS application, was a significant analgesic effect achieved.     

Peripheral nerve injuries; early surgical treatment

Injuries to the major nerves of the extremities are common.Surgical treatment should be undertaken soon after injury that completely or partly severs a peripheral nerve, because permanent changes appear in muscles that are deprived of nerve supply for more than a few months. The muscular changes may prevent restoration of normal function even though actual nerve regeneration is adequate. Injuries which do not completely sever a nerve may be hard to diagnose but special methods such as electromyography are helpful.     

The role of ibandronate in the daily oncological practice

Intravenous ibandronate at a dose of 6 mg every 3-4 weeks in patients with breast cancer and bone metastases produced a significant, 40% reduction in the relative risk of skeletal-related events. Oral ibandronate at a dose of 50 mg once daily for 96 weeks similarly reduced the overall skeletal morbidity, equating to a reduction in the relative risk of skeletal-related events of 38% relative to placebo. Ibandronate was generally well tolerated in clinical trials and their long-term extensions. Both type of administration significantly improve patients' health-related quality of life. There was no evidence of renal toxicity with iv. or oral ibandronate.     

Peripheral nerve magnetic stimulation: influence of tissue non-homogeneity

Background

Peripheral nerves are situated in a highly non-homogeneous environment, including muscles, bones, blood vessels, etc. Time-varying magnetic field stimulation of the median and ulnar nerves in the carpal region is studied, with special consideration of the influence of non-homogeneities.

Methods

A detailed three-dimensional finite element model (FEM) of the anatomy of the wrist region was built to assess the induced currents distribution by external magnetic stimulation. The electromagnetic field distribution in the non-homogeneous domain was defined as an internal Dirichlet problem using the finite element method. The boundary conditions were obtained by analysis of the vector potential field excited by external current-driven coils.

Results

The results include evaluation and graphical representation of the induced current field distribution at various stimulation coil positions. Comparative study for the real non-homogeneous structure with anisotropic conductivities of the tissues and a mock homogeneous media is also presented. The possibility of achieving selective stimulation of either of the two nerves is assessed.

Conclusion

The model developed could be useful in theoretical prediction of the current distribution in the nerves during diagnostic stimulation and therapeutic procedures involving electromagnetic excitation. The errors in applying homogeneous domain modeling rather than real non-homogeneous biological structures are demonstrated. The practical implications of the applied approach are valid for any arbitrary weakly conductive medium.

     

Safety of dual antiplatelet therapy in daily cardiology practice

Dual antiplatelet therapy has become the cornerstone of the treatment of acute coronary syndromes with or without stent implantation.     

Automatic identification and quantitative morphometry of unstained spinal nerve using molecular hyperspectral imaging technology

Quantitative observation of nerve fiber sections is often complemented by morphological analysis in both research and clinical condition. However, existing manual or semi-automated methods are tedious and labour intensive, fully automated morphometry methods are complicated as the information of color or gray images captured by traditional microscopy is limited. Moreover, most of the methods are time-consuming as the nerve sections need to be stained with some reagents before observation. To overcome these shortcomings, a molecular hyperspectral imaging system is developed and used to observe the spinal nerve sections. The molecular hyperspectral images contain both the structural and biochemical information of spinal nerve sections which is very useful for automatic identification and quantitative morphological analysis of nerve fibers. This characteristic makes it possible for researchers to observe the unstained spinal nerve and live cells in their native environment. To evaluate the performance of the new method, the molecular hyperspectral images were captured and the improved spectral angle mapper algorithm was proposed and used to segment the myelin contours. Then the morphological parameters such as myelin thickness and myelin area were calculated and evaluated. With these morphological parameters, the three dimension surface view images were drawn to help the investigators observe spinal nerve at different angles. The experiment results show that the hyperspectral based method has the potential to identify the spinal nerve more accurate than the traditional method as the new method contains both the spectral and spatial information of nerve sections.     

Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience

Aim of the work

To evaluate the feasibility and possible additional value of transthoracic real-time three-dimensional echocardiography (RT3D-TTE) for the assessment of cardiac structures as compared to 2D-TTE.

Methods

320 patients (mean age 45 ± 8.4 years, 75% males) underwent 2D-TTE and RT3D-TTE using 3DQ-Q lab software for offline analysis. Volume quantification and functional assessment was performed in 90 patients for left ventricle and in 20 patients for right ventricle. Assessment of native (112 patients) and prosthetic (30 patients) valves morphology and functions was performed. RT3D-TTE was performed for evaluation of septal defects in 30 patients and intracardiac masses in 52 patients.

Results

RT3D-TTE assessment of left ventricle was feasible and reproducible in 86% of patients while for right ventricle, it was (55%). RT3D-TTE could define the surface anatomy of mitral valve optimally (100%), while for aortic and tricuspid was (88% and 81% respectively). Valve area could be planimetered in 100% for the mitral and in 80% for the aortic. RT3D-TTE provided a comprehensive anatomical and functional evaluation of prosthetic valves. RT3D-TTE enface visualization of septal defects allowed optimal assessment of shape, size, area and number of defects and evaluated the outcome post device closure. RT3D-TTE allowed looking inside the intracardiac masses through multiple sectioning, valuable anatomical delineation and volume calculation.

Conclusion

Our initial experience showed that the use of RT3D-TTE in the assessment of cardiac patients is feasible and allowed detailed anatomical and functional assessment of many cardiac disorders.     

Testis morphometry,seminiferous epithelium cycle length,and daily sperm production in domestic cats (Felis catus)

There is very little information regarding the testis structure and function in domestic cats, mainly data related to the cycle of seminiferous epithelium and sperm production. The testis weight in cats investigated in the present study was 1.2 g. Compared with most mammalian species investigated, the value of 0.08% found for testes mass related to the body mass (gonadosomatic index) in cats is very low. The tunica albuginea volume density (%) in these animals was relatively high and comprised about 19% of the testis. Seminiferous tubule and Leydig cell volume density (%) in cats were approximately 90% and 6%, respectively. The mean tubular diameter was 220 microm, and 23 m of seminiferous tubule were found per testis and per gram of testis. The frequencies of the eight stages of the cycle, characterized according to the tubular morphology system, were as follows: stage 1, 24.9%; stage 2, 12.9%; stage 3, 7.7%; stage 4, 17.6%; stage 5, 7.2%; stage 6, 11.9%; stage 7, 6.8%; and stage 8, 11 %. The premeiotic and postmeiotic stage frequency was 46% and 37%, respectively. The duration of each cycle of seminiferous epithelium was 10.4 days and the total duration of spermatogenesis based on 4.5 cycles was 46.8 days. The number of round spermatids for each pachytene primary spermatocytes (meiotic index) was 2.8, meaning that significant cell loss (30%) occurred during the two meiotic divisions. The total number of germ cells and the number of round spermatids per each Sertoli cell nucleolus at stage 1 of the cycle were 9.8 and 5.1, respectively. The Leydig cell volume was approximately 2000 microm3 and the nucleus volume 260 microm3. Both Leydig and Sertoli cell numbers per gram of testis in cats were approximately 30 million. The daily sperm production per gram of testis in cats (efficiency of spermatogenesis) was approximately 16 million. To our knowledge, this is the first investigation to perform a more detailed and comprehensive study of the testis structure and function in domestic cats. Also, this is the first report in the literature showing Sertoli and Leydig cell number per gram of testis and the daily sperm production in any kind of feline species. In this regard, besides providing a background for comparative studies with other fields, the data obtained in the present work might be useful in future studies in which the domestic cat could be utilized as an appropriate receptor model for preservation of genetic stock from rare or endangered wild felines using the germ cell transplantation technique.