This is a case of a 33-year-old, G3P3(3003) female patient with a clinical presentation of vaginal bleeding associated with on and off hypogastric pain. The patient was diagnosed and managed as a case of tubo-ovarian abscess and subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO). Microscopic sections of both ovaries, however, showed dual population of tumor cells composed of medium-sized, mononucleated cells admixed with multinucleated giant cells with marked pleomorphism, extensive hemorrhage and necrosis. Immunohistochemistry studies using beta-hCG was diagnostic of ovarian choriocarcinoma, favoring non-gestational in origin. Classification of non-gestational choriocarcinoma (NGOC) was established using diagnostic criteria for NGOC established by Saito et al., and Mangla et al. DNA analysis, however, remains to be the gold-standard for differentiating between gestational (GOC) and non-gestational (NGOC) etiology.

Renal cell carcinoma (RCC) is notorious for its propensity to metastasize even after a prolonged period of remission following nephrectomy. The metastatic spread can occur months or even years after initial treatment, which necessitates a heightened level of clinical awareness and vigilance in patients with a history of renal malignancy, particularly who present with new or unexplained nasal symptoms. Although RCC most commonly metastasize to the lungs, bones and liver, its involvement in the nasal cavity is exceedingly rare, posing significant diagnostic challenges due to the non-specific nature of symptoms. We describe a case of metastatic renal cell clear cell carcinoma presenting with recurrent epistaxis and unilateral nasal obstruction. Immunohistochemistry studies play a crucial role in confirming the diagnosis and ruling out potential differential diagnoses, along with a comprehensive clinical history of the patient.

Objective: Serum 14-3-3eta are novel biomarkers of rheumatoid arthritis (RA). It is not clear whether 14-3-3eta may be present in other forms of inflammatory arthritis (IA). We evaluated the presence of 14-3-3eta as a diagnostic biomarker in the evaluation IA. Methods: A retrospective cohort study of adult patients who were evaluated for IA by a rheumatologist with a result for the lab test of 14-3-3eta was conducted. Results: Of 280 included patients, 30% were diagnosed with RA, 11% with psoriatic arthritis (PsA), and 59% with another condition. Twenty-four (9%) patients had positive results for 14-3-3eta. Fifty-two percent of positive patients were diagnosed with RA, with 48% having another diagnosis including axial spondyloarthritis, gout, Sjögren’s, undifferentiated IA, diabetic cheiroarthropathy, prostate cancer with bone metastasis, osteoarthritis, unspecified arthralgia. No patients with PsA had a positive value.RA patients had a higher value for 14-3-3eta compared to non-RA (5.44 [1.56~9.31] vs. 0.69 [0.40~0.98] ng/mL, p=0.03, square brackets are 95% confidence interval values). The mean value for the 14-3-3eta in seropositive RA trended higher than seronegative (8.0 [2.3~13.7] vs. 1.4 [0.4~2.4] ng/mL, p=0.06). In the RA cohort, elevated 14-3-3eta was associated with elevated erythrocyte sedimentation rate (odd ratio=6.62 [1.24~47.09], p<0.04), but not other variables. Conclusion 14-3-3eta may aid as a diagnostic biomarker of RA. However, it is not specific for RA, especially at low positive levels, and may be positive in other forms of IA. Ideal cutoff values need to be established for RA and non-RA conditions. It was not found in PsA.

Background: and Purpose Acute ischemic stroke (AIS) is a leading cause of disability worldwide. While intravenous thrombolysis is recommended within 4.5 hours of last known well (LKW) time, many patients present beyond this window. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating tenecteplase (TNK) administration in AIS patients within 4.5 to 24 hours of LKW. The primary outcomes assessed functional independence and ordinal modified Rankin Scale (mRS) shift at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Results: Three RCTs were included, comprising 1,054 patients (532 TNK and 522 standard medical therapy) with a mean age of 69 years, 59% males, and median baseline National Institutes of Health Stroke Scale score of 10.5. TNK treatment was associated with mRS 0–2 at 90 days (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.04–1.70, P=0.023), indicating a 33% higher likelihood of achieving functional independence. However, the ordinal mRS shift showed no significant difference (standardized mean difference: 0.01, 95% CI: -0.37–0.39, P=0.09). Safety outcomes indicated no difference in the rates of sICH (OR: 2.07, 95% CI: 0.86–5.00, P=0.1), and no difference in 90-day mortality (OR: 1.08, 95% CI: 0.76–1.53, P=0.67). Conclusion This meta-analysis suggests TNK might be safe and effective for selected AIS patients in the 4.5- to 24-hour time window, offering improved functional outcomes without a significant increase in hemorrhagic complications.

Haptic dental simulators are gaining recognition for training dental students. However, there needs to be more evidence of their pedagogical effectiveness. The primary aims were to (1) identify the published studies related to the application of virtual reality (VR) and haptic technology in the restorative dentistry training of dental students, (2) recognize the outcome criteria used in the published studies, and (3) determine the subjective evaluation of VR and haptic technology in the restorative dentistry training by the students. A comprehensive literature search was conducted to find scholarly articles that assessed the utilization of VR and haptics in training students in restorative dentistry. The investigation was performed via seven online databases: Scopus, Web of Science Core Collection, PubMed, Science Direct Freedom Collection, Latin American & Caribbean Health Sciences Literature (LILACS), EMBASE, and MEDLINE. Of the 268 potential articles assessed, 22 met the inclusion criteria. Findings demonstrated feasibility and acceptability. Additionally, there was improved motor skill acquisition and retention and less time for dental restoration after haptic virtual reality training. With the rising evidence of efficacy and increased utilization of digital technologies, virtual reality, and haptics has a role in improving students’ education outcomes.

Purpose: This study was performed to assess the performance and accuracy of artificial intelligence (AI) in the detection and diagnosis of maxillary sinus pathologies using computed tomography (CT)/cone-beam computed tomography (CBCT) imaging. Materials and Methods: A comprehensive literature search was conducted across 4 databases: Google Scholar, BioMed Central (BMC), ProQuest, and PubMed. Combinations of keywords such as “DCNN,” “deep learning,” “convolutional neural network,” “machine learning,” “predictive modeling,” and “data mining” were used to identify relevant articles. The study included articles that were published within the last 5 years, written in English, available in full text, and focused on diagnostic accuracy. Results: Of an initial 530 records, 12 studies with a total of 3,349 patients (7,358 images) were included. All articles employed deep learning methods. The most commonly tested pathologies were maxillary rhinosinusitis and maxillary sinusitis, while the most frequently used AI models were convolutional neural network architectures, including ResNet and DenseNet, YOLO, and U-Net. DenseNet and ResNet architectures have demonstrated superior precision in detecting maxillary sinus pathologies due to their capacity to handle deeper networks without overfitting. The performance in detecting maxillary sinus pathology varied, with an accuracy ranging from 85% to 97%, a sensitivityof 87% to 100%, a specificity of 87.2% to 99.7%, and an area under the curve of 0.80 to 0.91. Conclusion AI with various architectures has been used to detect maxillary sinus abnormalities on CT/CBCT images, achieving near-perfect results. However, further improvements are needed to increase accuracy and consistency.

Haptic dental simulators are gaining recognition for training dental students. However, there needs to be more evidence of their pedagogical effectiveness. The primary aims were to (1) identify the published studies related to the application of virtual reality (VR) and haptic technology in the restorative dentistry training of dental students, (2) recognize the outcome criteria used in the published studies, and (3) determine the subjective evaluation of VR and haptic technology in the restorative dentistry training by the students. A comprehensive literature search was conducted to find scholarly articles that assessed the utilization of VR and haptics in training students in restorative dentistry. The investigation was performed via seven online databases: Scopus, Web of Science Core Collection, PubMed, Science Direct Freedom Collection, Latin American & Caribbean Health Sciences Literature (LILACS), EMBASE, and MEDLINE. Of the 268 potential articles assessed, 22 met the inclusion criteria. Findings demonstrated feasibility and acceptability. Additionally, there was improved motor skill acquisition and retention and less time for dental restoration after haptic virtual reality training. With the rising evidence of efficacy and increased utilization of digital technologies, virtual reality, and haptics has a role in improving students’ education outcomes.

Purpose: This study aims to validate the use of ProAnalyst (Xcitex Inc.), a software for professional motion analysts to assess the performance of surgical interns while performing the peg transfer task in a simulator box for safe practice in real minimally invasive surgery. Methods: A correlation study was conducted in a multidisciplinary skills simulation lab at the Faculty of Medicine, Jordan University of Science and Technology from October 2019 to February 2020. Forty-one interns (i.e., novices and intermediates) were recruited and an expert surgeon participated as a reference benchmark. Videos of participants’ performance were analyzed through the ProAnalyst and Global Operative Assessment of Laparoscopic Skills (GOALS). Two results were s analyzed for correlation. Results: The motion analysis scores by Proanalyst were correlated with those by GOALS for novices (r=–0.62925, P=0.009), and Intermediates (r= –0.53422, P=0.033). Both assessment methods differentiated the participants’ performance based on their experience level. Conclusion The motion analysis scoring method with Proanalyst provides an objective, time-efficient, and reproducible assessment of interns’ performance, and comparable to GOALS. It may require initial training and set-up; however, it eliminates the need for expert surgeon judgment.

Purpose: To assess clinical outcomes in patients undergoing surgical excision and eyelid reconstruction for malignancies. Methods: This 17-year retrospective study (2004–2021) analyzed patients with malignant eyelid tumors who underwent excision and reconstruction. Data on tumor type, size, location, surgical techniques, complications, and prognostic factors for recurrence were evaluated. Results: A total of 152 patients underwent surgical excision and reconstruction for eyelid malignancies. Basal cell carcinoma was the most common (52.6%), followed by sebaceous cell carcinoma (32.2%). Direct lid closure was the most frequent reconstructive method. Postoperative complications, including ectropion, entropion, and canalicular obstruction, were minimal but required additional surgery in some cases. Recurrence occurred in 13 patients. Lymph node involvement (odds ratio, 21.291; p = 0.004) and positive intraoperative frozen margins (odds ratio, 7.083; p = 0.018) were significant risk factors for local recurrence. Conclusions Surgical excision and reconstruction are effective treatments for eyelid malignancies, with techniques tailored to tumor size, location, and extension to ensure proper lid function. Lymph node involvement and positive intraoperative frozen margins are key predictors of local recurrence.