Acute Lesions Research Articles

Clinical Implications of Alternating Hypointense Bands on OCT Angiography in Retinal Vascular Occlusive Disease

PurposeTo demonstrate the relationship between alternating hypointense signal bands on optical coherence tomography-angiography (OCTA), real-time fluorescein angiography (FA), and structural OCT findings in patients with retinal vascular occlusive disease (RVOD). DesignRetrospective, consecutive case series. SubjectsConsecutive patients with a clinical diagnosis of acute RVOD and alternating bands of hypointense OCTA flow signal on en face projections. MethodsComplete ophthalmic examination and multimodal imaging, including color fundus photography (CFP), real-time FA, SD-OCT, and OCTA performed with different instruments having different scan speeds and acquisition protocols. Main Outcome MeasurementsThe primary outcomes were: Hypointense OCTA band characteristics (number, width, orientation, and location), OCTA acquisition characteristics (speed and scan direction), and FA findings including delayed arteriovenous (AV) transit and pulsatile flow. Secondary outcomes were: Structural OCT changes including retinal fluid, paracentral acute maculopathy lesion (PAMM), and a prominent middle limiting membrane (p-MLM) sign. ResultsOCTA-hypointense bands were detected in the superficial and deep vascular plexuses in 9 eyes of 9 patients with either partial CRAO or nonischemic RVO. When obtained on the same device, hypointense bands were thinner and more numerous at lower (100 kHz) scan speeds compared with higher (200 kHz) scan speeds. Band orientation was parallel to the OCTA scan direction, and their extent correlated with the area of delayed AV transit on FA. Structural OCT showed multiple PAMM lesions in 78% of cases and a p-MLM sign centered in the fovea in 44% of cases. ConclusionsOCTA-hypointense bands are a novel biomarker in RVOD indicating delayed AV transit and pulsatile filling without the need for dye angiography. Structural OCT often shows PAMM in these eyes, and less commonly, a p-MLM sign.

The use of arthroscopy in diagnosing and treating sports-related cartilage lesions

Background: Sports-related cartilage lesions pose challenges for athletes. Cartilage, vital for smooth joint movement, can be damaged. Arthroscopy, a minimally invasive procedure, allows precise diagnosis and treatment of joint issues, offering quicker recovery and minimal scarring, enhancing orthopedic interventions. This study aimed to assess the use of arthroscopy in diagnosing and treating sports-related cartilage lesions. Methods: This prospective observational study was conducted at the department of orthopaedics and traumatology, Life Line Hospital Moulovibazar, Mount Adora Hospital Sylhet, MAG Osmani Medical College Hospital Sylhet, Bangladesh from January 2022 to December 2023. As the study subjects, a total of 58 patients with non-surgically treated acute or chronic sports-related cartilage lesions were enrolled by using a purposive sampling technique. After 6 months, a follow-up report was recorded. Data were analyzed by using Microsoft Office tools. Results: In this study, 72% of participants underwent cuff repair, with the remaining 28% opting for loop repair. The arthroscopic assessment revealed anterior medial cartilage lesions in 34% and anterior lateral lesions in 28%. Posterior medial, posterior lateral, and mid-talus dome cartilage lesions were observed in 17%, 5%, and 16%, respectively. Capsule repair was employed in 86% of cases. Significant improvement in hip range of motion, as well as radiological parameters like lateral center-edge angle, alpha angle (anteroposterior), and alpha angle (Dunn), was observed 6 months postoperatively (p<0.001). Conclusions: In detecting and treating sports-related cartilage lesions, arthroscopy is an effective method. This minimally invasive less painful treatment approach contributes to faster rehabilitation and a quicker return to normal activities.

Central Thromboangiitis Obliterans: A Case Report

A 47-year-old woman had inability to speak and swallow that had started 4-5 hours ago. She had necrotic lesions in the toes of both feet and had a history of smoking. Acute and chronic ischemic lesions were diagnosed on imaging. She was diagnosed with thromboangiitis obliter-ans by digital subtraction angiography. This report discusses a rare cause of ischemic stroke and the lack of data on diagnosis and treatment. Key Words: Buerger’s disease, Vasculitis, Stroke, Smoke, Neuroimmunology

Endovascular thrombectomy in wake-up stroke guided by arterial spin-labeling and fluid-attenuated inversion recovery versus diffusion-weighted imaging mismatch on MRI.

This purpose of this study is to investigate the effectiveness and safety of utilizing the arterial spin-labeling (ASL) combined with diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) combined with DWI double mismatch in the endovascular treatment of patients diagnosed with wake-up stroke (WUS). In this single-center trial, patients diagnosed with WUS underwent thrombectomy if acute ischemic lesions were observed on DWI indicating large precerebral circulation occlusion. Patients with no significant parenchymal hypersignal on FLAIR and ASL imaging showing a hypoperfusion tissue to infarct core volume ratio of at least 1.2 were included. The participants were divided into groups receiving endovascular thrombectomy plus medical therapy or medical therapy alone, based on their subjective preference. Functional outcomes were assessed using the ordinal score on the modified Rankin scale (mRs) at 90 days, along with the rate of functional independence. In this study, a total of 77 patients were included, comprising 38 patients in the endovascular therapy group and 39 patients in the medical therapy group. The endovascular therapy group exhibited more favorable changes in the distribution of functional prognosis measured by mRs at 90 days, compared to the medical therapy group (adjusted common odds ratio, 3.25; 95% CI, 1.03 to 10.26; P < 0.01). Additionally, the endovascular therapy group had a higher proportion of patients achieving functional independence (odds ratio, 4.0; 95% CI, 1.36 to 11.81; P < 0.01). Importantly, there were no significant differences observed in the incidence of intracranial hemorrhage or mortality rates between the two groups. Guided by the ASL-DWI and FLAIR-DWI double mismatch, endovascular thrombectomy combined with standard medical treatment appears to yield superior functional outcomes in patients with WUS and large vessel occlusion compared to standard medical treatment alone.

Age and Stroke Severity Matter Most for Clinical Outcome in Acute Arteriosclerotic Tandem Lesions.

Background: Tandem lesions (TLs) cause up to 15-30% of all acute ischemic strokes (AISs). Endovascular treatment (EVT) is regarded as the first-line treatment; however, uncertainties remain with respect to the treatment and predictive outcome parameters. Here, we aimed to identify the clinical and demographic factors associated with functional short- and long-term outcomes in AIS patients with arteriosclerotic TLs undergoing EVT. Methods: This was a retrospective, mono-centric cohort study of 116 consecutive AIS patients with arteriosclerotic TLs who were endovascularly treated at a stroke center, with analysis of the relevant demographic, procedural, and imaging data. Results: A total of 116 patients were included in this study, with a median age of 72 years (IQR 63-80), 31% of whom were female (n = 36). The median NIHSS on admission was 14 (IQR 7-19), with a median ASPECT score of 9 (IQR 8-10) and median NASCET score of 99% (IQR 88-100%). A total of 52% of the patients received intravenous thrombolysis. In 77% (n = 89) of the patients, an antegrade EVT approach was used, with a good recanalization (mTICI2b3) achieved in 83% of patients (n = 96). Symptomatic intracerebral hemorrhage occurred in 12.7% (n = 15) of patients. A favorable outcome (mRS0-2) and mortality at 3 months were obtained for 40% (n = 47) and 28% of patients (n = 32), respectively. Age and NIHSS on admission were strongly associated with outcome parameters. Diabetes mellitus and previous neurological disorders were independently associated with long-term mortality (median 11 months, IQR 0-42). Conclusions: Younger age, lower stroke severity, and good recanalization were found to be independently associated with a favorable outcome. In contrast, older age, higher stroke severity, previous neurological disorders, and diabetes were correlated with mortality. The endovascular treatment of acute arteriosclerotic tandem lesions is feasible and relatively safe.

Automated diagnosis of acute cerebral ischemic stroke lesions from diffusion-weighted magnetic resonance images in assessment with modified Rankin Scale

Purpose: Automated diagnosis of acute cerebral ischemic stroke lesions (ACISL) is an evolving science. Early detection and exact delineation of ACISL automatically from diffusion-weighted magnetic resonance (DWMR) images are crucial for initiating prompt treatment. Thus, this work aims to determine the appropriate slice out of 60 pieces using multi-fractal analysis (MFA) and to segment the lesions in DWMR images using a hybrid optimization method. Features extracted from the segmented images were clinically correlated with the modified Rankin Scale (mRS). Methods: Thirty-one real-time stroke patients’ images were collected from Rajiv Gandhi Government General Hospital, Chennai, India. Multiple MRI slices were taken from each patient and filtered using an anisotropic diffusion filter (ADF). These filtered images were skull-stripped automatically by the maximum entropy thresholding technique incorporating mathematical morphological operations (MEM). The multi-fractal analysis (MFA) identifies the prominent slice with the significant infarct lesion. An isodata algorithm that integrated differential evolution with the particle swarm optimization method based on Kapur’s (IDPK) and Otsu’s (IDPO) approaches was attempted to segment the ACISL. Finally, the geometric and moment features extracted from the segmented lesions categorized the stroke severity and were correlated with the mRS. Results: The findings of the experimental work confirm that the suggested IDPK approach achieved usual normalized values for image similarity indices such as Sokal-Michener Coefficient (98.51%), Roger-Tanimoto Coefficient (90.16%), Sokel-Sneath-2 (91.04%), and Sorenson Index (90.04%) are superior to IDPO. Statistical significance proved that the segmented lesions’ area (r = 0.820, p &lt; 0.0001) and perimeter (r = 0.928, p &lt; 0.0001) were strongly correlated with the mild and moderate criteria of mRS. Conclusion: The proposed work effectively detected ischemic stroke lesions and their severity within the studied image groups. It could be a promising and potential tool to aid radiologists in validating their diagnosis.

Clinical guidelines for prevention, diagnostics, treatment and recovery from acute radiation injuries: classification and basic pathology

The provision of state guarantees to citizens with medical care is achieved by compliance with clinical recommendations by medical organizations. However, acute diseases (conditions) caused by excess radiation were excluded from the relevant pathologies for the development of appropriate clinical recommendations. The current events increase the relevance of acute radiation pathology for the healthcare system and determine the high risk of such cases among the personnel of radiation-hazardous facilities and population. The necessity of developing national clinical guidelines for the prevention, diagnosis, treatment, and rehabilitation of acute radiation injury victims is substantiated. Based on an analytical review of the databases of NEB, PubMed, and Medline for 1970 to 2023 on the problem of prevention, diagnosis, treatment, and rehabilitation of individuals exposed to excess radiation and analysis of the regulatory framework governing the process of creating clinical recommendations in the Russian Federation on the provision of medical care to victims of acute radiation injuries, the main terms and their definitions relevant to acute radiation pathology were formulated, which must be unified when developing clinical recommendations. The basic classification of acute radiation lesions is presented, systematizing the variety of possible clinical forms of diseases (conditions) and their etiopathogenetic variants based on the characteristics of the types of ionizing radiation sources and individual characteristics of the conditions of acute radiation exposure. Variants of working clinical classifications of acute radiation lesions based on the generalization of the experience in the country and the world on the systematization of acute radiation pathology were determined. In general, the expediency of developing a group of clinical recommendations for the prevention, diagnosis, treatment, and rehabilitation of acute radiation injuries, covering all the various current clinical forms of diseases caused by excess (uncontrolled, unregulated, emergency) exposure, is justified. The task of determining the current list of diseases (conditions) and groups of diseases (conditions) caused by excessive human exposure in the dose range that can lead to the development of acute radiation lesions is of practical importance both for departmental medicine and the country’s healthcare system.

Chronic villitis as a distinctive feature of placental injury in maternal SARS-CoV-2 infection

BackgroundSARS-CoV-2 infection during pregnancy is associated with increased risk of stillbirth, preeclampsia and preterm birth. However, this does not appear to be due to intrauterine fetal infection, as vertical transmission is rarely reported. There is a paucity of data regarding associated placental SARS-CoV-2 histopathology and their relationship to timing and severity of infection. ObjectiveTo determine if maternal SARS-CoV-2 infection is associated with specific patterns of placental injury and whether these findings differ by gestational age at time of infection or disease severity. Study DesignA retrospective cohort study was performed at University of California San Diego between 03/2020 to 02/2021. Placentas from pregnancies with a positive SARS-CoV-2 test were matched to two sets of controls: one set was time-matched by delivery date and sent to pathology for routine clinical indications, and the other was chosen from a cohort of placentas previously collected for research purposes without clinical indications for pathologic examination prior to the SARS-CoV-2 outbreak. Placental pathologic lesions were defined based on standard criteria and included maternal and fetal vascular malperfusion, and acute and chronic inflammatory lesions. Bivariate analysis was performed with independent Student’s T test and Pearson’s chi-square. Logistic regression was used to control for relevant covariates. Regions of SARS-CoV-2-associated villitis were further investigated using protein-based digital spatial profiling (DSP) assays on the GeoMx platform, validated by immunohistochemistry, and compared to cases of infectious villitis and villitis of unknown etiology. Differential expression analysis was performed to identify protein expression differences between these groups of villitis. ResultsWe included 272 SARS-CoV-2 positive cases, 272 time-matched controls, and 272 historical controls. The mean age of SARS-CoV-2 affected subjects was 30.1 ± 5.5 years and the majority were Hispanic (53.7%) and parous (65.7%). SARS-CoV-2 placentas demonstrated a higher frequency of the four major patterns of placental injury (all p<.001), compared to historical controls. SARS-CoV-2 placentas also showed a higher frequency of chronic villitis (CV) and severe CV (p=.03 for both) compared to time-matched controls, which remained significant after controlling for gestational age at delivery (aOR 1.52, 95% CI 1.01-2.28; aOR 2.12, 95% CI 1.16-3.88, respectively). DSP revealed programmed death-ligand 1 (PD-L1) to be increased in villitis-positive regions of the SARS-CoV-2 (logFC 0.47, adj p-value=0.002) and VUE (logFC 0.58, adj p-value=0.003) cases, but conversely decreased in villitis-positive regions of the infectious villitis group (log FC -1.40, adj p-value<0.001). ConclusionsCV appears to the most specific histopathological finding associated with SARS-CoV-2 maternal infection. CV involves damage to the vasculosyncytial membrane of the chorionic villi, involved in gas/nutrient exchange, suggesting potential mechanisms of placental (and perhaps neonatal) injury, even in the absence of vertical transmission. Surprisingly, changes in protein expression in SARS-CoV-2-associated villitis appear to be more similar to VUE rather than infectious villitis.

Emergence of epizootic hemorrhagic disease in red deer (Cervus elaphus), Spain, 2022

Epizootic hemorrhagic disease (EHD) virus serotype 8 (EHDV-8) emerged in Spain in autumn 2022. In this study, we aimed to (1) characterize the clinical and lesional presentation of EHDV infection in European red deer (Cervus elaphus), and (2) study the spatial spread of the virus in wild ruminants in Spain after its introduction, in 2022/2023. We confirmed EHDV infection in two clinically compatible sick red deer by PCR and detection of anti-EHDV specific antibodies. EHDV infection occurred in red deer with hyperacute to acute clinical signs and lesions associated to vascular changes leading to death of the animals. Partial sequences of variable segment 2 (VP2) and segment 5 (NS1) genes of the detected viruses had >99% nucleotide identity with EHDV-8 sequences from Tunisia and Italy. In a cross-sectional serological study of EHDV in 592 wild ruminants, mainly red deer (n=578), in southwestern Spain, we detected anti-EHDV antibodies in 37 of 592 samples (6.3%; 95% confidence interval: 4.3–8.2), all from red deer and from the localities where clinical cases of EHD were confirmed in red deer. We conclude that EHDV-8 infection causes severe EHD in European red deer. The serosurvey revealed a limited spread of EHDV-8 in Spanish wild ruminant populations in the first year of virus detection in Spain.

Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics.

To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis.

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate. To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis. We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023, utilizing our medical record system. Data pertaining to general patient information, etiological factors, disease outcomes, and other relevant variables were meticulously collected and analyzed. Among the 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, with a higher prevalence among males. Notably, 43.6% of patients presented with black stool as their primary complaint, while 27.4% had hematemesis as their initial symptom. Upon admission, 17% of patients exhibited both hematemesis and black stool, while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent routine blood examinations at admission revealed that 75.8% of patients had anemia, with 63.4% experiencing moderate to severe anemia, and 1.5% having extremely severe anemia (hemoglobin < 30 g/L). With regard to etiology, 53.2% of patients experienced bleeding without a definitive trigger, 24.2% had a history of using gastric mucosa-irritating medications, 24.2% developed bleeding after alcohol consumption, 2.8% attributed it to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue preceding the bleeding episode. Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals, while bleeding due to alcohol consumption showed the opposite trend. Additionally, diet-related bleeding was more common among the young age group compared to the middle-aged group. Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB (73.3%), followed by gastrointestinal malignancies (10.9%), acute gastric mucous lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%) among inpatients with ANVUGIB. Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, resulting in an endoscopic treatment rate of 12.8%, with a high immediate hemostasis success rate of 94.1%. ANVUGIB patients exhibit diverse characteristics across different age groups, and endoscopic hemostatic treatments have demonstrated remarkable efficacy.

First report of the within-farm prevalence of bovine digital dermatitis in Chinese Holstein dairy cows in Jiangsu, China: A Bayesian modelling approach

Digital dermatitis is one of the most important causes of lameness in dairy cattle, particularly in housed, intensively-managed cattle. The number of modern intensive dairy farms in China has increased markedly in recent years; however, we lack research on digital dermatitis in Chinese dairy cattle. This preliminary study aimed to estimate the prevalence of digital dermatitis on three conveniently selected farms in Jiangsu, China. The washed hind feet of all lactating cows on all three farms were examined during milking with the aid of a mobile phone light source. True prevalence was then estimated from the apparent prevalence using a Bayesian superpopulation approach to account for the imperfect nature of identifying digital dermatitis in cows during milking. Despite none of the farms having thought it necessary to implement routine digital dermatitis monitoring or control, the disease was found on all three sampled farms. All lesions observed were either chronic M4 or M4.1 type-lesions, with no M2 lesions (i.e. acute ulcerated lesions) observed. The estimated true prevalences on the farms were 7.3% (95% credible interval [CrI]: 5.4%–9.6%), 8.3% (95%CrI: 6.3%–10.8%), and 29.8% (95%CrI: 22.9%–37.2%).

Graft-versus-host disease after autologous stem cell transplantation in a recipient who underwent allogeneic stem cell transplantation 20 years earlier.

A literature review does not provide information about the safety of autologous hematopoietic stem cell transplantation (HSCT) in a recipient who has previously received allogeneic HSCT. We treated a 69-year-old woman with diffuse large B cell lymphoma. The patient received autologous stem cell transplantation (ASCT) in the second complete remission of malignant lymphoma. The patient had undergone allogeneic hematopoietic SCT (allo-HSCT) for chronic myeloid leukemia 20 years ago. Chronic myeloid leukemia had been in complete remission for the previous 20 years. Thus, the patient received autologous and allogenic HSCT 20 years apart. ASCT involves the patient receiving "self" hematopoietic cells from an allogeneic donor. In other words, this is immunologically the second allo-HSCT. The allo-HSCT 20 years ago was undergone by a related healthy brother, a human leukocyte antigen (HLA) 8/8 full matched donor. The conditioning regimen was reduced-intensity consisting of fludarabine and busulfan. The patient did not experience acute or chronic graft-versus-host disease (GVHD) after allo-HSCT. The second transplantation, ASCT was performed to the MEAM conditioning regimen. Engraftment was uneventful, and complete donor chimerism had been achieved even after ASCT. She suffered from an acute gastric mucosal lesion 52 days after ASCT. Pathological finding of gastric mucosa was nonspecific acute gastritis with significant neutrophil infiltration. Sex chromosome analysis of gastric mucosa demonstrated that mucosal cells had XX signals, whereas infiltrating neutrophils had XY signals. We speculated the patient onset of an acute gastric GVHD in this recipient after the second transplantation. This case remarked infiltration of neutrophils triggered GVHD reaction by resetting allogeneic immune reaction after the second transplantation. We describe a rare occurrence of GVHD reaction in a recipient of ASCT following allo-HSCT.

Studying Edema Formation After Release of the Infraspinatus Muscle as an Experimental Model of Rotator Cuff Lesions in Sheep: A Histological Analysis

Background: Muscle edema formation and inflammatory processes are early manifestations of acute rotator cuff lesions in sheep. Histological analysis of affected muscles revealed edema formation, inflammatory changes, and muscle tissue disruption in MRs. Hypothesis: Edema contributes to inflammatory reactions and early muscle fiber degeneration before the onset of fatty infiltration. Study Design: Controlled laboratory study. Methods: Osteotomy of the greater tuberosity, including the insertion of the infraspinatus tendon, was performed on 14 sheep. These experimental animal models were divided into 2 groups: a nontrauma group with surgical muscle release alone (7 sheep) and a trauma group with standardized application of additional trauma to the musculotendinous unit (7 sheep). Excisional biopsy specimens of the infraspinatus muscle were taken at 0, 3, and 4 weeks. Results: Edema formation was histologically demonstrated in both groups and peaked at 3 weeks. At 3 weeks, signs of muscle fiber degeneration were observed. At 4 weeks, ingrowth of loose alveolar and fibrotic tissue between fibers was detected. Fatty tissue was absent. The diameter of muscle fibers increased in both groups, albeit to a lesser degree in the trauma group, and practically normalized at 4 weeks. Immunohistology revealed an increase in macrophage types 1 and 2, as well as inflammatory mediators such as prostaglandin E2 and nuclear factor kappa-light-chain-enhancer of activated B cells. Conclusion: Early muscle edema and concomitant inflammation precede muscle fiber degeneration and fibrosis. Edema formation results from tendon release alone and is only slightly intensified by additional trauma. Clinical Relevance: This study illustrates that early edema formation and inflammation elicit muscle fiber degeneration that precedes fatty infiltration. Should this phenomenon be applicable to human traumatic rotator cuff tears, then surgery should be performed as soon as possible, ideally within the first 21 days after injury.

Characterization of the Pro-Inflammatory and Pruritogenic Transcriptome in Skin Lesions of the Experimental Canine Atopic Acute IgE-Mediated Late Phase Reactions Model and Correlation to Acute Skin Lesions of Human Atopic Dermatitis.

Intradermal injection of anti-immunoglobulin E (IgE) antibodies in dogs grossly and histologically resemble naturally occurring atopic dermatitis (AD). However, the activated inflammatory and pruritic pathways have not been characterized. The objectives of this study were to characterize the inflammatory transcriptome of experimental acute canine IgE-induced lesions and to determine how these correlate to the transcriptome of naturally occurring human and canine acute atopic dermatitis. Biopsies were collected at 6 and 24 h after intradermal injections of anticanine-IgE antibodies to eight healthy male castrated Beagles; healthy and saline-injected skin served as controls. We extracted total RNA from skin biopsies and analyzed transcriptome using RNA-sequencing. Gene expressions of IgE-induced biopsies were compared to that of controls from the same subject (1.5-fold change, p-adjusted value ≤ 0.05). Acute IgE-mediated lesions had a significant upregulation of pro-inflammatory (e.g., LTB, IL-1B, PTX3, CCL2, IL6, IL8, IL18), T helper-(Th)1/IFNγ signal (e.g., STAT-1, OASL, MX-1, CXCL10, IL-12A) and Th2 (e.g., IL4R, IL5, IL13, IL33 and POSTN) genes, as well as Th2 chemokines (CCL17, CCL24). Pathway analysis revealed strong significant upregulation of JAK-STAT, histamine, IL-4 and IL13 signaling. Spearman correlation coefficient for the shared DEGs between canine anti-canine-IgE and human AD samples revealed a significant moderate positive correlation for anti-canine-IgE 6-h samples (r = 0.53) and 24-h samples (r = 0.47). In conclusion, acute canine IgE-mediated skin lesions exhibit a multipolar immunological axis upregulation (Th1, Th2 and Th17) in healthy dogs, resembling acute spontaneous human AD lesions.

Characteristics of innate and adaptive immune disorder in IgA nephropathy based on integrated bioinformatics.

Our study aims to investigate the immunological pathogenesis underlying immunoglobulin A nephropathy (IgAN) and explore potential biomarkers for IgAN diagnosis. Differentially expressed genes (DEGs) of formalin-fixed and paraffin-embedded (FFPE) samples were screened between IgAN patients and healthy people based on GSE115857. Gene oncology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis (GSEA) enrichment was performed to identify related biological processes and pathways. CIBERSORT was utilized to seek the relationship of immune cell infiltration with IgAN. Finally, the expression of paraoxonase 2 (PON2) related to innate immune response was verified in FFPE samples of minimal change disease and IgAN patients by immunohistochemistry and PAS staining. 25 down-regulated genes and 12 up-regulated genes were identified in IgAN patients, which mainly responded to endothelial cell proliferation, inflammatory response, and angiogenesis. Toll-like receptor signaling pathway and Epstein-Barr virus (EBV) infection might be involved in IgAN pathogenesis. In addition, the infiltration of macrophages M0, naïve B cells, and follicular helper T (Tfh) cells was positively correlated in IgAN patients. Macrophages M1 and M2 infiltration were up-regulated in IgAN patients, which indicated that innate immune response was closely associated with IgAN. Besides, the results of immunohistochemistry showed that PON2 was obviously positively expressed in acute and chronic lesions of IgAN patients. In addition to abnormalities in the adaptive immune response, macrophages M1/M2 and innate immune disorder may participate in IgAN pathogenesis. PON2 may become the feasible targets for further investigation of IgAN.

Ultrasonographic examination of acute soft tissue lesions in the elbow has good inter-rater reliability and acceptable agreement with magnetic resonance imaging

BackgroundUltrasound (US) has been suggested a valuable complement to clinical and radiological examinations in elbow trauma. Magnetic resonance imaging (MRI) has been the method of choice, despite fair to moderate interrater reliability (IRR). US has potential advantages but is assessor dependent and IRR scarcely examined. The primary aim of the present study was to investigate IRR for US and secondarily inter-observer agreement (IOA) between US and MRI in the acute phase after elbow trauma. Acute phase was defined as 2 weeks and, if applicable, the following weekend. The hypothesis was that US reliability would be at least substantial for complete muscle or ligament lesions. Methods116 patients (50 men, median age 47 [range 19-87] years) suffering an elbow trauma with dislocation and/or fracture were included. Exclusion criteria were prior injury to the same elbow, and US and/or MRI not possible within 16 days. During US the condition of muscle origins at the epicondyles and collateral and annular ligament complexes was recorded in a pre-designed protocol, with the alternatives intact, partially or completely torn. 72 patients had a second US examination the same day by an independent upper extremity surgeon. 58 of the 116 patients underwent an MRI before or after the US, evaluated by 2 radiologists using the same protocol. IOA and IRR between assessors and modalities were analyzed with kappa statistics and interpreted according to Landis and Koch. Perfect agreement (PA) was reported in percent. ResultsUS examination within 2 weeks was feasible with tolerable discomfort. Defining muscle origins and ligaments as intact or completely torn the US IRR ranged from substantial to near perfect (kappa 0,63-1; PA 93-100%). Intact tissues vs tear (partial and complete tear combined) or intact vs partial vs complete tear resulted in kappa values from moderate to substantial and PA 74%-96% with lowest reliability for the muscle origins. The IOA between MRI and US ranged from fair to near perfect for no tear vs complete tear (kappa 0,25-1; PA 65-100%). Agreement between no tear and tear (partial and complete together) ranged from fair to substantial (0,25-0,66; PA 63-89%) and no tear vs partial or complete tear ranged from fair to moderate (0,25-0,53; PA 50-79%). ConclusionUS in the acute setting is suitable and reliable for diagnosis of ligament injuries in the elbow and is in addition fast, cheap and easily accessible. The agreement with MRI seems to vary with the structure assessed and severity of the lesions, ranging from fair to near perfect.

Fratura de Stress do Colo do Fémur em Atleta de CrossFit

Femoral neck stress fractures are infrequent. They are more prevalent among athletes, with women being at a higher risk. A 29-year-old female amateur CrossFit athlete complained of right-sided groin pain after a high intensity training. An X-ray showed no signs of acute lesions, but further CT scan and MRI revealed a compression-type femoral neck stress fracture. The patient underwent conservative treatment, restricting full weight-bearing during six weeks. She became asymptomatic at four months and returned to sports at six months. Follow-up imaging confirmed fracture union. This diagnosis is crucial when assessing athletes, including amateurs, as early recognition is vital due to high complication and morbidity rates.

Magnetic Resonance Imaging Monitoring of Thermal Lesions Produced by Focused Ultrasound

Abstract Background: The main goal of the study was to find the magnetic resonance imaging (MRI) parameters that optimize contrast between tissue and thermal lesions produced by focused ultrasound (FUS) using T1-weighted (T1-W) and T2-weighted (T2-W) fast spin echo (FSE) sequences. Methods: FUS sonications were performed in ex vivo porcine tissue using a single-element FUS transducer of 2.6 MHz in 1.5 and 3 T MRI scanners. The difference in relaxation times as well as the impact of critical MRI parameters on the resultant contrast-to-noise ratio (CNR) between coagulated and normal tissues were assessed. Discrete and overlapping lesions were inflicted in tissue with simultaneous acquisition of T2-W FSE images. Results: FUS lesions are characterized by lower relaxation times than intact porcine tissue. CNR values above 80 were sufficient for proper lesion visualization. For T1-W imaging, repetition time values close to 1500 ms were considered optimum for obtaining sufficiently high CNR at the minimum time cost. Echo time values close to 50 ms offered the maximum lesion contrast in T2-W FSE imaging. Monitoring of acute FUS lesions during grid sonications was performed successfully. Lesions appeared as hypointense spots with excellent contrast from surrounding tissue. Conclusion: MRI monitoring of signal intensity changes during FUS sonication in grid patterns using optimized sequence parameters can provide useful information about lesion progression and the success of ablation. This preliminary study demonstrated the feasibility of the proposed monitoring method in ex vivo porcine tissue and should be supported by in vivo studies to assess its clinical potential.

The astrocyte-produced growth factor HB-EGF limits autoimmune CNS pathology

Central nervous system (CNS)-resident cells such as microglia, oligodendrocytes and astrocytes are gaining increasing attention in respect to their contribution to CNS pathologies including multiple sclerosis (MS). Several studies have demonstrated the involvement of pro-inflammatory glial subsets in the pathogenesis and propagation of inflammatory events in MS and its animal models. However, it has only recently become clear that the underlying heterogeneity of astrocytes and microglia can not only drive inflammation, but also lead to its resolution through direct and indirect mechanisms. Failure of these tissue-protective mechanisms may potentiate disease and increase the risk of conversion to progressive stages of MS, for which currently available therapies are limited. Using proteomic analyses of cerebrospinal fluid specimens from patients with MS in combination with experimental studies, we here identify Heparin-binding EGF-like growth factor (HB-EGF) as a central mediator of tissue-protective and anti-inflammatory effects important for the recovery from acute inflammatory lesions in CNS autoimmunity. Hypoxic conditions drive the rapid upregulation of HB-EGF by astrocytes during early CNS inflammation, while pro-inflammatory conditions suppress trophic HB-EGF signaling through epigenetic modifications. Finally, we demonstrate both anti-inflammatory and tissue-protective effects of HB-EGF in a broad variety of cell types in vitro and use intranasal administration of HB-EGF in acute and post-acute stages of autoimmune neuroinflammation to attenuate disease in a preclinical mouse model of MS. Altogether, we identify astrocyte-derived HB-EGF and its epigenetic regulation as a modulator of autoimmune CNS inflammation and potential therapeutic target in MS.