An estimated one of every 10 gynecologic visits—and half of all diagnostic laparoscopies—are occasioned by chronic pelvic pain (CPP), a condition that often presents a difficult clinical problem. The most common disorders found at laparoscopy are pelvic endometriosis and adhesions, but no obvious cause of pain is identified in as many as 40% of women evaluated. Transvaginal sonography (TVS), in addition to disclosing ovarian cysts and hydrosalpinges, can provide more subtle information such as the degree of ovarian and uterine mobility and tenderness, findings characterized as “soft markers” of pelvic disease. This study sought soft markers in 120 consecutive premenopausal, nonpregnant women with CPP who were to have diagnostic or operative laparoscopy. They had experienced lower abdominal pain for at least 6 months, which was rated for intensity by visual analog scores. Pain was not associated exclusively with menses or intercourse. A single gynecologist experienced in TVS performed all the studies. Longitudinal and transverse views of the uterus and adnexa were obtained. All of the women subsequently had laparoscopy under general anesthesia. The patients, whose mean age was 31 years, had pain for 46 months on average. Seventy of the 120 participants (58%) had pelvic pathology: 51 of them, endometriosis alone; 7, endometriosis plus pelvic adhesions; 6, pelvic adhesions only; 5, hydrosalpinx plus adhesions; and one, hydrosalpinx with endometriosis. Hard markers were absent on TVS in 96 women. The most common such marker was a cyst consistent with endometrioma. Of 94 women lacking hard markers, 51 (53%) had soft markers. Laparoscopy confirmed abnormalities in 37 women having soft markers on TVS. Thirty of them had endometriosis; 6, adhesions; and one, endometriosis and adhesions. Nine women, most of them with low-grade endometriosis, had falsely negative TVS diagnoses. The likelihood ratio was infinity for hard markers (100% specificity); 1.9 (95% confidence interval [CI], 1.2–3.1) for soft markers; and 0.18 (95% CI, 0.09–0.34) for a “normal” sonogram. The pretest probability of pelvic disease was 58% overall, 100% when hard markers were present, and 73% with soft markers. With a normal sonogram, the figure fell to 20%. Seeking site-specific tenderness and ovarian mobility on TVS makes it easier to detect and exclude pelvic pathology in women with CPP. The investigators believe that taking both hard and soft markers into account may significantly lower the number of diagnostic laparoscopies required.

The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain- : Can we reduce the need for laparoscopy?

BACKGROUND AND OBJECTIVES
Advanced artificial intelligence and machine learning have great potential to redefine how skin lesions are detected, mapped, tracked and documented. Here, we propose a 3D whole-body imaging system known as 3DSkin-mapper to enable automated detection, evaluation and mapping of skin lesions.


METHODS
A modular camera rig arranged in a cylindrical configuration was designed to automatically capture images of the entire skin surface of a subject synchronously from multiple angles. Based on the images, we developed algorithms for 3D model reconstruction, data processing and skin lesion detection and tracking based on deep convolutional neural networks. We also introduced a customised, user-friendly, and adaptable interface that enables individuals to interactively visualise, manipulate, and annotate the images. The interface includes built-in features such as mapping 2D skin lesions onto the corresponding 3D model.


RESULTS
The proposed system is developed for skin lesion screening, the focus of this paper is to introduce the system instead of clinical study. Using synthetic and real images we demonstrate the effectiveness of the proposed system by providing multiple views of a target skin lesion, enabling further 3D geometry analysis and longitudinal tracking. Skin lesions are identified as outliers which deserve more attention from a skin cancer physician. Our detector leverages expert annotated labels to learn representations of skin lesions, while capturing the effects of anatomical variability. It takes only a few seconds to capture the entire skin surface, and about half an hour to process and analyse the images.


CONCLUSIONS
Our experiments show that the proposed system allows fast and easy whole body 3D imaging. It can be used by dermatological clinics to conduct skin screening, detect and track skin lesions over time, identify suspicious lesions, and document pigmented lesions. The system can potentially save clinicians time and effort significantly. The 3D imaging and analysis has the potential to change the paradigm of whole body photography with many applications in skin diseases, including inflammatory and pigmentary disorders. With reduced time requirements for recording and documenting high-quality skin information, doctors could spend more time providing better-quality treatment based on more detailed and accurate information.

Monitoring of Pigmented Skin Lesions Using 3D Whole Body Imaging

Objective
To observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction (FPFD) patients with constipation as chief complaint. 


Methods
One hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1) pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36) : if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL) : if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL) : if combined with fecal incontinence. 


Results
The mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2) (0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%) , and with two or more symptoms was observed in 80 cases (80%) . Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%) . The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0 (71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively. 


Conclusions
The symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.


Key words: 
Constipation; Female; Pelvic floor dysfunction; Severity; Quality of life

Symptom distribution of female pelvic floor dysfunction patients with constipation as chief complaint

To investigate the curative effect of modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrostimulation on early postpartum pelvic floor dysfunction disease (PFD) and its effect on the expression of transforming growth factor (TGF-β1), matrix metalloprotein (MMP-2), and tissue inhibitor of metalloproteinase (TIMP-2). A total of 186 PFD patients admitted to our hospital from March 2014 to December 2016 were selected in the study and were randomly divided into test group (n=93) and control group (n=93). The control group received pelvic floor muscle exercises-biofeedback-electrostimulation, while the test group was additionally treated with modified Buzhong Yiqi decoction based on the treatment in control group. Then the clinical efficacy was compared between two groups. The results showed that vaginal contractile electromyography (EMG), duration of vaginal constriction, dynamic vaginal pressure and pelvic floor myoelectric activity in the test group at 1, 3 and 6 months after treatment were significantly higher than those before treatment and the control group (P<0.05). The effective rate for urinary incontinence was 97.14% in test group, significantly higher than 75.68% in the control group (P<0.05). The effective rate for improvement of sexual life quality was 96.43% in test group, significantly higher than 74.07% in control group (P<0.05). 1, 3 and 6 months after treatment, the uterine prolapse, posterior wall prolapse and anterior wall prolapse grade in test group was slightly lower than that in the control group, but the difference was not statistically significant. After treatment, the levels of TGF-β1 and TIMP-2 in the test group were higher than those in the control group, while the levels of MMP-2 were lower than those in the control group (P<0.05). The results showed that modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrostimulation can effectively relieve the clinical symptoms, promote the body recovery and improve the quality of sexual life in PFD patients, with remarkable advantages, so it is worthy of popularizing.

[Effect of modified Buzhong Yiqi decoction combined with pelvic floor muscle exercise-biofeedback-electrical stimulation on early stage postpartum pelvic floor dysfunction].

Application of transperineal ultrasound combined with shear wave elastography in pelvic floor function assessment after hysterectomy

A survey, review, and future trends of skin lesion segmentation and classification

Impact of pelvic floor ultrasound in diagnosis of postpartum pelvic floor dysfunction: A protocol of systematic review.

Impact of ultrasound diagnosis for chronic pelvic pain.

The Computer-aided Diagnosis or Detection (CAD) approach for skin lesion analysis is an emerging field of research that has the potential to alleviate the burden and cost of skin cancer screening. Researchers have recently indicated increasing interest in developing such CAD systems, with the intention of providing a user-friendly tool to dermatologists in order to reduce the challenges that are raised by manual inspection. The purpose of this article is to provide a comprehensive literature review of cutting-edge CAD techniques published between 2011 and 2020. The Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) method was used to identify a total of 365 publications, 221 for skin lesion segmentation and 144 for skin lesion classification. These articles are analyzed and summarized in a number of different ways so that we can contribute vital information regarding the methods for the development of CAD systems. These ways include: relevant and essential definitions and theories, input data (datasets utilization, preprocessing, augmentations, and fixing imbalance problems), method configuration (techniques, architectures, module frameworks, and losses), training tactics (hyperparameter settings), and evaluation criteria (metrics). We also intend to investigate a variety of performance-enhancing approaches, including ensemble and post-processing. In addition, in this survey, we highlight the primary difficulties associated with evaluating skin lesion segmentation and classification systems using minimal datasets, as well as the potential solutions to these difficulties. In conclusion, enlightening findings, recommendations, and trends are discussed for the pur1 ar X iv :2 20 8. 12 23 2v 1 [ ee ss .I V ] 2 5 A ug 2 02 2 pose of future research surveillance in related fields of interest. It is anticipated that it will guide researchers of all levels, from beginners to experts, in the process of developing an automated and robust CAD system for skin lesion analysis.

Guang Yang

Papers

A survey, review, and future trends of skin lesion segmentation and classification

Impact of pelvic floor ultrasound in diagnosis of postpartum pelvic floor dysfunction: A protocol of systematic review.

Impact of ultrasound diagnosis for chronic pelvic pain.

Skin Lesion Analysis: A State-of-the-Art Survey, Systematic Review, and Future Trends