Schistosomal appendicitis: a rare cause of a common surgical condition.

Despite the prevalence of schistosomiasis across the world, appendicitis secondary to schistosomiasis is a rarely encountered presentation even in endemic areas, let alone in developed Western countries. We report a case of a 34-year-old male in Australia with acute appendicitis and subsequent histopathology, demonstrating the presence of schistosome ova. The case highlights the difficulties in pre-operative diagnosis of this entity and the importance of its recognition for the practising surgeon, especially in the developed world, where this rare condition may be encountered because of changing global travel and migration patterns.

ConCeptCNN: A novel multi-filter convolutional neural network for the prediction of neurodevelopmental disorders using brain connectome.

BACKGROUND: Deep convolutional neural network (CNN) and its derivatives have recently shown great promise in the prediction of brain disorders using brain connectome data. Existing deep CNN methods using single global row and column convolutional filters have limited ability to extract discriminative information from brain connectome for prediction tasks. PURPOSE: This paper presents a novel deep Connectome-Inception CNN (ConCeptCNN) model, which is developed based on multiple convolutional filters. The proposed model is used to extract topological features from brain connectome data for neurological disorders classification and analysis. METHODS: The ConCeptCNN uses multiple vector-shaped filters extract topological information from the brain connectome at different levels for complementary feature embeddings of brain connectome. The proposed model is validated using two datasets: the Neuro Bureau ADHD-200 dataset and the Cincinnati Early Prediction Study (CINEPS) dataset. RESULTS: In a cross-validation experiment, the ConCeptCNN achieved a prediction accuracy of 78.7% for the detection of attention deficit hyperactivity disorder (ADHD) in adolescents and an accuracy of 81.6% for the prediction of cognitive deficits at 2 years corrected age in very preterm infants. In addition to the classification tasks, the ConCeptCNN identified several brain regions that are discriminative to neurodevelopmental disorders. CONCLUSIONS: We compared the ConCeptCNN with several peer CNN methods. The results demonstrated that proposed model improves overall classification performance of neurodevelopmental disorders prediction tasks.

Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation.

BACKGROUND: Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. METHODS: A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. RESULTS: Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133 min (range 45-290) and length of hospital stay 3 days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital-acquired pneumonia and pseudomembranous colitis. CONCLUSION: Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.

Management of Zenker's diverticulum using flexible endoscopy.

BACKGROUND AND AIMS: Zenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum. METHODS: We present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique. RESULTS: We demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events. CONCLUSIONS: Cricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.

The work environment of junior doctors: their perspectives and coping strategies.

OBJECTIVE: This study explores the associations between psychological distress in junior doctors and their work environment and how they cope with work stressors. METHODS: A cross-sectional survey designed by Health Education and Training Institute was delivered in 2014 to over 1900 junior doctors across 15 hospital networks through Australian Capital Territory and New South Wales. Psychological distress was evaluated using the Kessler Psychological Distress Scale-10 (K10). Numerous variables were assessed for associations with psychological distress to identify the strongest relationships and the coping strategies used. Potential associations between work demands, coping strategies and psychological distress were explored. RESULTS: 540 responses were analysed. 414 (81%) thought their workload was reasonable, 376 (75%) were enjoying their current job and 446 (82.6%) were content with their work life. However, 85 (15.7%) reported that they would not study medicine if given their time again, and 146 (27%) reported workplace bullying. The mean K10 score was 17.2 (σ=6.3) and the prevalence of elevated psychological distress was between 63% and 80% higher than the general community. Variables most strongly associated with distress were: being discontented with workload, lack of enjoyment from current job, taking time off work and having experienced workplace bullying. There was a preference to use social activities as a method of coping but at higher levels of psychological distress there is a greater proportion who took time off work. CONCLUSIONS: Psychologically distressed junior doctors need recognition, support and treatment. Future interventions should focus on improving work environment, job satisfaction, provision of supports, use of healthy coping strategies and improving work-related relationships. This could potentially reduce levels of psychological distress in junior doctors, optimise delivery of healthcare to patients and maximise workforce potential.

Peritonectomy and hyperthermic intraperitoneal chemotherapy as treatment for desmoplastic small round cell tumour.

INTRODUCTION: The St George Hospital specialises in peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of intra-abdominal malignancies. Despite performing around 800 peritonectomy and HIPEC procedures, we have rarely encountered desmoplastic small round cell tumours (DSRCT). We present our experiences with DSRCT, and propose peritonectomy and HIPEC as a treatment option for DSRCT. PRESENTATION OF CASE: This is a case series of 3 cases. The first case was a 26-year-old male who presented with appendicitis which we diagnosed as DSRCT and treated with peritonectomy and HIPEC. The second case was a 14-year-old male referred to our centre for peritonectomy and HIPEC after initial presentation with a pelvic mass and treatment with chemotherapy. The third case was a 21-year-old male referred to our centre for peritonectomy and HIPEC for recurrent DSRCT after previously being treated with neoadjuvant chemotherapy and surgery without HIPEC. DISCUSSION: DSRCT is a rare, almost exclusively intra-abdominal malignancy, which predominantly affects young males. Survival prognosis remains poor in DSRCT despite conventional treatment with surgery, chemotherapy and radiotherapy; however, HIPEC has offered promising survival results. Our recurrences with peritonectomy and HIPEC at 6 months and 15 months are comparable with the literature of 8.85 months. CONCLUSION: In our experience, patients with DSRCT who present with nodal involvement or recurrent disease tend to recur early despite treatment with peritonectomy and HIPEC. Longer term follow up of our patients and future studies involving HIPEC in DSRCT would be useful in assessing long-term clinical outcomes and survival.

Volumetric imaging of brain activity with spatial-frequency decoding of neuromagnetic signals.

BACKGROUND: The brain generates signals in a wide frequency range (∼2840 Hz). Existing magnetoencephalography (MEG) methods typically detect brain activity in a median-frequency range (1-70 Hz). The objective of the present study was to develop a new method to utilize the frequency signatures for source imaging. NEW METHOD: Morlet wavelet transform and two-step beamforming were integrated into a systematic approach to estimate magnetic sources in time-frequency domains. A grid-frequency kernel (GFK) was developed to decode the correlation between each time-frequency representation and grid voxel. Brain activity was reconstructed by accumulating spatial- and frequency-locked signals in the full spectral data for all grid voxels. To test the new method, MEG data were recorded from 20 healthy subjects and 3 patients with verified epileptic foci. RESULTS: The experimental results showed that the new method could accurately localize brain activation in auditory cortices. The epileptic foci localized with the new method were spatially concordant with invasive recordings. COMPARISON WITH EXISTING METHODS: Compared with well-known existing methods, the new method is objective because it scans the entire brain without making any assumption about the number of sources. The novel feature of the new method is its ability to localize high-frequency sources. CONCLUSIONS: The new method could accurately localize both low- and high-frequency brain activities. The detection of high-frequency MEG signals can open a new avenue in the study of the human brain function as well as a variety of brain disorders.

Single frequency inverse obstacle scattering: a sparsity constrained linear sampling method approach.

The linear sampling method (LSM) offers a qualitative image reconstruction approach, which is known as a viable alternative for obstacle support identification to the well-studied filtered backprojection (FBP), which depends on a linearized forward scattering model. Of practical interest is the imaging of obstacles from sparse aperture far-field data under a fixed single frequency mode of operation. Under this scenario, the Tikhonov regularization typically applied to LSM produces poor images that fail to capture the obstacle boundary. In this paper, we employ an alternative regularization strategy based on constraining the sparsity of the solution's spatial gradient. Two regularization approaches based on the spatial gradient are developed. A numerical comparison to the FBP demonstrates that the new method's ability to account for aspect-dependent scattering permits more accurate reconstruction of concave obstacles, whereas a comparison to Tikhonov-regularized LSM demonstrates that the proposed approach significantly improves obstacle recovery with sparse-aperture data.