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Backgrounds: Establishment of quantitative, objective evaluation tool for facial palsy has been a big issue for clinicians and researchers, and in an era of artificial intelligence, AI-driven video analysis can be considered a reasonable solution for this long-discussed issue. We introduced facial keypoint detection, which detects facial landmarks with 68 points, but existing models had been organized almost solely with images of healthy individuals and low accuracy was presumed in the prediction of asymmetric faces of facial palsy patients.The accuracy of existing model was assessed through applying it to the movies of 30 facial palsy patients. Qualitative review clearly showed its insufficiency; prone to detect patients' faces as symmetric, and unable to detect closure of the eyes. Thus, we decided to enhance the model through machine learning process of annotation (fine-tuning)., Methods: 1181 images extracted from the movies of 196 patients were enrolled in the training, and these images underwent manual correction of 68 keypoints. The annotated data was integrated into the previous model with a stack of two Hourglass networks combined with Channel Aggregation Block., Results: The post-annotation model showed improvement in normalized mean error from 0.026 to 0.018, and also qualitatively keypoint detection on each facial unit revealed improvements., Conclusion: Our strict control of the inter- and intra-annotator variability successfully fine-tuned the presenting model, and we consider our new model as one of promising solutions for objective assessment of facial palsy., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Objective: To describe the surgical technique for extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques (ETSUTT) for feline proximal ureteral obstruction and report clinical outcomes., Study Design: Retrospective case series., Animals: Ten privately-owned cats with ureteral obstruction near the ureteropelvic junction (UPJ)., Methods: Medical records were retrospectively reviewed for cats with ureteral obstruction close to the UPJ that underwent ETSUTT (2018-2021). The ETSUTT procedure consisted of a modified extravesicular technique (two-layer, side-to-side ureteroneocystostomy) and tension-relieving techniques (renal descensus, ureterocystopexy, and nephrocystopexy)., Results: All cats survived through discharge. In all cats, postoperative blood urea nitrogen and creatinine concentrations were decreased, compared with preoperative concentrations. Perioperative complications included ureteral catheter dislodgement (3), transient pollakiuria (2), and dysuria (1), but no specific treatments were required. Urinary tract infection was observed postoperatively in three of the 10 cats. The median follow-up was 648 days (min-max: 86-1229 days). Seven of the 10 cats were alive without recurrent ureteral obstruction at the end of this retrospective study., Conclusion: The ETSUTT procedure was successfully performed without major complications in cats with ureteral obstruction occurring near the UPJ. Use of ETSUTT provided a fair-to-good, long-term prognosis in cats that were otherwise difficult to manage., Clinical Significance: This novel procedure, ETSUTT, was feasible, safe, and could be a viable treatment option for feline proximal ureteral obstruction, including the UPJ, especially for obstructions caused by stricture., (© 2023 American College of Veterinary Surgeons.)

Cats exhibit high susceptibility to urinary organ-related diseases. We investigated the healthy ureter morphologies and compared these with ureters that were surgically resected distal to a urolithiasis obstruction in cats. Healthy ureters (total length 9.88 ± 0.38 cm) developed adventitia composed of collagen fibers (ADCF), containing a longitudinal muscular layer, toward the distal segment. The healthy ureter was the smallest in the middle segment (4.71-6.90 cm from the urinary bladder) with significantly decreased luminal and submucosal areas compared to those in the proximal segment. Diseased cats exhibited a high incidence of calcium oxalate urolithiasis with renal dysfunction, regardless of age, sex, and body size. Diseased ureters showed increased perimeters, inflammation, and decreased nerves in ADCF. Collagen fibers were increased in the submucosal area, intermuscular spaces, and ADCF, particularly near the obstructed lesion. The mean resected ureter length was 5.66 ± 0.49 cm, suggesting a high obstruction risk in the middle segment. The middle segment also increased the cross-sectional area of the ureter and ADCF, regardless of the distance from the obstructed lesion. The ureters in several cases either lacked the transitional epithelium, or exhibited transitional epithelial hyperplasia, and some of these formed the mucosal folds. In conclusion, we demonstrated the following characteristics and histopathological features of cat ureters: decreases in the ureter size, lumen area, and submucosa area from proximal to middle segment in healthy; ADCF changes in urolithiasis, including increased connective tissues with inflammation and decreased nerves. These data are important to understand the pathogenesis of feline ureteral obstruction., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)