Δευτέρα, 2 Απριλίου 2018

Three-dimensional computer-assisted dissection of pancreatic lymphatic anatomy on human fetuses: a step toward automatic image alignment.

Three-dimensional computer-assisted dissection of pancreatic lymphatic anatomy on human fetuses: a step toward automatic image alignment.

Surg Radiol Anat. 2018 Mar 31;:

Authors: Bardol T, Subsol G, Perez MJ, Genevieve D, Lamouroux A, Antoine B, Captier G, Prudhomme M, Bertrand MM

Abstract
PURPOSE: Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment.
METHODS: We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin-eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions.
RESULTS: We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body-tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly.
CONCLUSION: In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.

PMID: 29605904 [PubMed - as supplied by publisher]



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Doctors Discuss Future of Medicine on eMedicoz: India's First Medical Education Centric Mobile app


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Note by Dr Sumer Sethi 

Recently we launched our unique medical education centric app for young Doctors called eMedicoz. On this in addition to routine discussions Doctors also discuss various aspects of the profession. In a recent discussion series young Doctors brainstormed and tried crystal balling the future of the medicine and technology. It is wonderful to hear their thoughts on future. It is for certain future looks really happening for medical profession, computers and machine learning will re- invent the way we practice medicine. Targeted therapy is another important area, 3D printing , understanding the value of gut flora are important areas that medico's have pointed out. Plus human touch in medicine will make a come back as well.  Download the eMedicoz app and follow more such discussions. Interact with future leaders in healthcare.

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Sumeet Roy: The trials on cancer treatment by monoclonal antibodies are on huge toll, specially for the apoptotic resistant cancers, that is gonna change the treatment protocols. The treatment trails of ibd by lactobacillus is also looking good, that's gonna change the way of immunology. Sumeet Roy Few days ago prof. Ranjeet sir told about a drug trail side effect of which made person young so that's gonna affect dematologist.  Elon musk's space program lead to trials for aging and effects of cosmic radiation the idea which lead to treatment of various cancer and autoimmune makes me think immunology is up for new revolution. The future orthopaedic surgeon may have to study prosthetic biometrics, as it has wide scope and drastically improves the quality of life.

Sushma Baishya:  aortic dissections are so fatal and fast.... If there can be a rapid blood test which can diagnose it much faster than CT.... I feel it can be worthy... Like something released by the intima at the time of separation...

Anurag Sai : We hear about AI advances everyday. Any chance they might soon replace radiologists, reducing the need for humans to just interventional procedures ? Wanted to know your view about this sir

Harshit Bansal : biggest cause of death in indian is heart attack. we indians are genetically more vulnerable for it.we have to think of some technical advances which can detect it at eary stage and at more economical level so that it can be made available to poorest of poor

Sarthak Sharma:  Whatever it may be in future, ranging from neoplasm to fever, it should be affordable, "a solution is not a solution untill it is affordable".

Aniketh Nagesh Shenoy:  Sir one of the rapidly expanding scientific endeavours which is steadfastly permeating almost every branch of job is AI. I don't know whether it is going to go any further or its just a hype of the millenium. But considering that we humans learn to make good use of a latest technology unlike our history where humans always have mastered using technology in bad ways before we suffered its consequences. So if AI is to permeate in health care as well firat of all i would like it to be used to predict epidemics or pandemics of any disease. Every secret service organizations have a network of informants that keep giving information of a potential threat so that the defence can be ready. But none of such network exists in medical field where even the most renowned doctor to predict the likelihood of any breakouts. So i think AI could help in that. Secondly AI can be used to predict the results of mang drug trials or even completely replace the preclinical phase of animal testing. By this we can spare use of animals as also a lot of money which probably could bring down the cost of pharmaceuticals drastically! The second technological advance that i think could change the medical care completely is the individualised therapy based on ones genetic makeup that would best suit for his or her condition. One example is the immunotherapy and the gene sequencing techniques before any treatment of a genetic disorder

K Pranay Teja:  may be a device which senses and improve mood n cognitive performance in old age people

Aniketh Nagesh: Shenoy But more than any technology i feel the dire need of the hour is to rekindle the sense of humanity, compassion and apt ways of communication. Although we are advancing on the scientific front the HUMAN part of every doctor is being slowly steadily erased.! No machine howmuchever developed is going to be able to convey a parent that their child is no more. Or that a person with cancer jas hardly got few months to live. What remains of a field if we sieve out the humanity in a profession that is meant to serve the humankind. Indeed the best study of humans are humans themselves. Good Doctor patient relationships which were once considered to be epitome of a physicians calibre is now being replaced by new yet falsified mirage of good marks and good ranks.

Kashish Arora:  Smart spectacles or goggles through which we can directly see inside the body replacing the need of large MRI, CT Scan machines , which should be available at low cost. Whole of circulatory system should be visible through it so that any internal bleeding can be stopped at faster rate and preventing the patient from landing into shock. It will also prevent from invasive procedures such as coronary and cerebral angiograghies. Venepuncture will become easier. Clean water(purified fit for drinking) water should be made available

Jyoti Mishra:  five points.....hope u read sir 1. Technology will kill the taste of clinical touch and respect for doctors... 2.early diagnosis and palliative methods will increase health burden 3.competitive atmosphere will enhance cost of treatment ...may be unaffordable to poor 4.over dominance of technology will reduce doc skill and human touch... 5.it will be no more noble than a mere field of business..if it continues the way it's discriminating affordability

Rabindra Kumar Singh: Hai sir,in today's world the number of pt are increasing progressively and we are still few so technology is helping us like a new hand to do much more beyond our capacity,we are able to give out service to large number of community .it is true but at the same time we are over dependent on these things and the price of health service is much more than before.if you see closely you find that technology is also leading cause of stress anxiety, people are spending more time on phone and they are away from real world.less communication with people is also making large amount of people developing depression ,obesity ,DM ,htn .and increase our burden and country ill,.so it is very important that technology should be very carefully used in right manner,thanku so much for giving opportunity to share our thoughts,love you sir

Nitin Kumar:  If technology of ORGAN BIOPRINTING will be there also, I agree to technology (with side effects) it will help terminal stage patients and organ trafficking will be solved also.

Subhasis Halder: Nanoparticles that can recognise specific unique receptors of organ/modified groups of cells and can stimulate/partially stimulate/block the receptor according to requirement.

Yashima Puri:  Sir I think the scenario will change completely if we have 3D holographic imaging techniques

Tanvi Das:  Empowering the rural population with adequate first aid training along with management of emergency cases. This can be done as an initiative between the private and public sector to Ensure that basic equipments are available at grassroots level

Gourav Sethy : Sir, I have an idea of a device which can be easily attached to the patients and can monitor vital things which are mostly investigated in emergency department ( for example- any changes in serum level of electrolytes or cardiac enzymes) And more over that machine can learn the changes in our body by time. Plus it can record the data also. This can help a doctor to save many patients life because by this means we can save a lot of time in emergency care and the doctors can diagnose better seeing the records from the device because most of the time the patients in emergency department are not able to tell the proper history. So this can help in many ways. This is an idea sir. May this be true in future of medicine.

Manish Goyal:  we should make no side effect drugs? This can be done by giving natural drugs like ayurveda....but ayurveda is not evidence based medicine....we can do ayurveda drugs trials...can extract the drugs from these natural sources...

Zahoor:  Emergency telemedicine for the rural areas

Puneet Kumar Acharya:  Artificial intelligence (AI) will bring a drastic change in modern medicine.the medicinal specialities will get significant impact except those with have an additional skills based specialitities.As the Dual camera's will improve day by day in the clarity and depth sensing nature coming in the future mobiles.it will be so helpful in reaching specially for the dermatological diagnosis even if the pt is at long distance (rural India)

Rakesh Maloth:  Prevention is better than cure.. people will start following it .. once the health education is started from the childhood in a intense manner.. fitness is given a main priority in all the recruitments. people will start focusing on healthy living style and depression free life.

Sonu Kumar:  Nanobots and cybernetics....

Deepak Lal: S B I think the next step shud be chimera creation...integration of human and animal DNAs to produce properties that we don't have...just like making bacteria produce antibiotics for us...we shud start working on how the lizard and the starfish regenerate on getting body parts cut and try to integrate it into ppl who hav lost their limbs..humans hav always been inspired by animals and I still think that is how we shud go. Also to enhance human abilities..we can use exoskeletons..that multiply the output of our arms and legs in proportion to the force we put...so that we can multiply our physical capacity and reach heights beyond imagination

Amitkumar Bose: Improve primary health care system with better technology this is enough for future

Neethu Divakaran:  Health education is of prime importance.coz v have a huge population stil in darkness n myths..at same time v have another group educated mass fighting against doctors as if v doctors r enemies f human race..so .creating awareness about various disease and prevention , regarding first aid etc ..n reducing d gap between d doctor and patient... so dat d faith on medical profession can b brought back..at d same time v can lift up d ones who r still in d darkness..

Rajashree Kundu: I don't even want to talk about technology. The first thing that needs to be done us a strict population control. And second making education the forest important agenda. All the problems we face are mostly due to overburden of ignorant patients.

Ankit Yadav: Everything should be digitalized , and each person should have a single unique identity , all his reports, xray scan should be linked to it and available on request or when patient gives his permission via biometrics.

Harikrishnan M: Machine learning and AI will surpass us in every achievable skill or skill with long learning curve.. IBM Watson has already developed radiology assistant and is in the process of expanding its diagnostic capabilities.. so is oncological diagnosis , cardiology, identifying new molecular targets, drug development to name a few.. diagnosis surpassing any human level skill will be achieved by AI within months or years of its implementation due to the ability of it to learn from enormous data base using machine learning.. Advanced diagnostic algorithm considering every possible DD will make misdiagnosis and non diagnosis a thing of past..The intial phase of growth will sweep through medical specialties initially.. surgical side takes few years more... All this is expected in next 30 or so years in Western world..In India it will take further 2-3 decade.. This will drastically reduce the workforce required to serve the entire population also cutting on cost as training a doctor to be a cardiologist or neurosurgeon requires atleast 15 years while reproducibility in AI system just takes minutes.. This allsounds farfetched to most.. I believe in next 10-20 years medical field will advance exponentially more than where it has reached from ground zero and the same thing will happen with healthcare delivery system..

Shreeprasad Chavan: A day where hormones will make skeletal muscle work!

Akshay: Technology and connectivity will play a huge role in standardising protocols and health care delivery , reducing cost better follow up and reducing errors

Devyani Dudeja : I think rather than diagonosing any disease by investigations we should focus more on clinical skills. what i have seen in last few years some doctors are just jotting down all the possible investigation not to confirm their clinical diagonosis but to diagonose as the clinical skills have went away. so what i think is to use technology to intervene rather than to diagonose. Then next thing health education. we all have studied that in our 3rd profs but stlii i think it is lacking bcoz the patients are ignorant so we should focus more on that. Next contraception it is such a boon but still no use as our population is still ahead. so what i think is there are technologies but they are not getting implemented or used bcoz of many reasons like poverty or illeteracy so if it is focussed we can do a lot without any relapse or recurrance.N ya of course bcoz of ton of investigations they just dont do even the needy ones bcoz of lack of money n then search google n become their own doctor or either go to some quack where they are bambarded with steroids. 

Kunj Gor:  With advent of teaching skills also like VR for surgery skills where inbuilt 200+ surgeries have been designed.. no doubt we will be one who would have to know equivalent to software developer in medicine field also... we will have a undergrad subject for it soon

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