Atrophic Lesions Research Articles

Distinct imaging features of cerebral small vessel disease are related to rare NOTCH3 variants (S36.002)

<h3>Objective:</h3> To investigate the longitudinal imaging features of cerebral small vessel disease (SVD) in relation to rare <i>NOTCH3</i> variants, including spatial patterns, dynamic patterns, and the interaction between the cortical atrophy and white matter lesions. <h3>Background:</h3> Previous studies reported that rare <i>NOTCH3</i> variants were identified in over 10% of the general population and the carriers have a susceptibility to heavy SVD burden. The correlating imaging characteristics deserve in-depth investigation to uncover the important genetic predisposition in age-related SVD in the general population. <h3>Design/Methods:</h3> Rare <i>NOTCH3</i> variants were identified through Whole-Exome Sequencing. The White matter hyperintensities (WMH) volume and WMH probability maps were assessed through quantitative segmentation. Brain structural volumes and vertex-wise cortex maps were obtained from the longitudinal FreeSurfer analysis suite. Between-group differences were compared through data statistical analysis of global measurements, and voxel/vertex-wise analysis of WMH maps or cortex maps. <h3>Results:</h3> A total of 1054 patients were included in the baseline analysis (13.56% rare <i>NOTCH3</i> variant carriers), while 661 included in the longitudinal analysis (13.76% rare <i>NOTCH3</i> variant carriers). We found that rare <i>NOTCH3</i> variant carriers had heavier WMH burden (1.65 vs 0.85ml, P=0.025) and more presence of lacunes (23.78% vs 14.84, P=0.010). More importantly, rare <i>NOTCH3</i> variant carriers had a distinct WMH distribution and progression pattern in periventricular areas. These features appeared more prominent in the EGFr-involving subgroup. Also, we found that rare <i>NOTCH3</i> variant carriers showed susceptibility to worse cortical atrophy (β=−0.004, SE=0.002, adjusted for age and sex). Of most interest, the progressing of frontal brain atrophy is related to WMH progression, which indicated the role of rare <i>NOTCH3</i> variant in age-related SVD and a structural network disconnection phenomenon. <h3>Conclusions:</h3> Our findings posed a distinct MRI profile of age-related SVD in rare <i>NOTCH3</i> variant carriers and shed new light on the pathogenic mechanisms of rare <i>NOTCH3</i> SNPs. <b>Disclosure:</b> Zi-Yue Liu has nothing to disclose. Feifei Zhai has nothing to disclose. Jing-Yi Liu has nothing to disclose. Yi-Jun Zhou has nothing to disclose. Mei-jun Shu has nothing to disclose. Xiaohong Huang has nothing to disclose. Fei Han has nothing to disclose. Mingli Li has nothing to disclose. Lixin Zhou has nothing to disclose. Jun Ni has nothing to disclose. Ming Yao has nothing to disclose. Shuyang Zhang has nothing to disclose. Liying Cui has nothing to disclose. Zhengyu Jin has nothing to disclose. Yi-Cheng Zhu has nothing to disclose.

Deep phenotyping of PROM1-associated retinal degeneration

Background/aimsThe purpose of this study was to investigate retinal structure in detail of subjects with autosomal-dominant (AD) and autosomal-recessive (AR) PROM1-associated retinal degeneration (PROM1-RD), study design: institutional, cross-sectional study.MethodsFour eyes...

Surgical Strategy for Hemispherotomy.

Hemispherotomy is a radical treatment for drug-resistant epilepsy that targets developmental, acquired, and progressive diseases with widespread epileptogenic regions in one cerebral hemisphere. Currently, two main approaches are utilized after repeated improvements: lateral and vertical approaches. With the lateral approach, the surgical field is wide, and the approach to the lateral ventricle is relatively easy. On the other hand, the vertical approach has the advantage of reducing intraoperative bleeding and operating time as the resection line of the radial fiber is short, and understanding the three-dimensional anatomy is relatively easy. The lateral approach is generally used for atrophic lesions, whereas the vertical approach is for hypertrophic lesions. Hemispherotomy is expected to not only suppress epileptic seizures but also improve psychomotor development by protecting the unaffected cerebral hemisphere. However, this method is one of the most invasive surgeries in epilepsy surgery, and it is important to fully consider its indications. Furthermore, understanding the neural fiber pathway is important for actual surgery.

Vision-related quality of life is selectively affected by comorbidities in patients with geographic atrophy

BackgroundThe atrophic late stage of age-related macular degeneration (AMD) is termed geographic atrophy (GA), and affects visual acuity (VA) as well as quality of life (QoL). Previous studies have found that best-corrected VA (BCVA), the standard vision assessment often underrepresents functional deficits. Therefore, the purpose of this study was to evaluate the correlation between atrophic lesion size, VA and QoL measured with the National Eye Institute Visual Function Questionnaire (VFQ-39) in a Danish population. Moreover, we wanted to evaluate the correlation between comorbidities, behavioural factors, and QoL.MethodsThis was prospective clinical study of 51 patients with GA in one or both eyes, of these 45 patients had bilateral GA. Patients were consecutively included between April 2021 and February 2022. All patients filled in the VFQ-39 questionnaire except the subscales “ocular pain” and “peripheral vision.” Lesion size was measured from fundus autoflourescense images, and BCVA was assessed by the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol.ResultsWe found an overall low score in each VFQ-39 subscale scores reflected by GA. Lesion size and VA were both significantly associated with all VFQ-39 subscale scores except for “general health.” VA showed a larger effect on QoL than lesion size. Chronic obstructive pulmonary disease (COPD) was associated with a lower score in the subscale score “general health” but none of the other subscale scores were affected. Cardiovascular disease (CVD) was associated with a lower BCVA as well as in QoL reflected in the subscale scores “poor general vision,” “near activities,” and “dependency” of VFQ-39.ConclusionBoth atrophic lesion size and visual acuity affects QoL in Danish patients with GA, who reports an overall poor QoL. CVD seems to have a negative effect on disease, as well as in VFQ-39 in several subscales, whereas COPD did not affect disease severity or vision-related subscales in VFQ-39.

Retrospective analysis of histologic lesions in captive arachnids.

Invertebrates, including arachnids, are a common taxon in zoological collections. Invertebrate medicine and pathology are emerging subspecialties, but there is limited reference material or published resources describing histologic lesions in arachnids. Histopathology of 26 captive arachnids (20 spiders and 6 scorpions) from institutional collections was reviewed. Most animals were found dead with limited clinical signs. Tissues evaluated included body wall (cuticle and epidermis), skeletal muscle, book lungs, digestive tract (pharynx, esophagus, sucking stomach, midgut tube, midgut diverticula, and stercoral pocket), central and peripheral nervous system, heart, hemolymph vessels and sinuses, Malpighian tubules, coxal glands, and gonads. Inflammation was frequent (24/26, 92%), and seen in multiple organs (18/24, 75%) with the midgut diverticulum most commonly affected (14/24, 58%) followed by the book lungs (13/24 arachnids, 54%), and body wall (8/24 arachnids, 33%). Inflammation comprised hemocyte accumulation, hemocytic coagula, melanization, and nodulation. Infectious agents, including bacteria (11/26, 42%), fungi (10/26, 38%), and parasites (2/26, 8%), were seen within inflammatory aggregates. Coinfection with multiple infectious agents was common (6/24, 25%). No etiologic agent was identified in 7/24 (29%) cases with inflammatory lesions. Lesions suggestive of decreased nutritional status or increased metabolic rate included midgut diverticula atrophy in 11/26 (42%) animals and skeletal muscle atrophy in 6/26 (23%) animals. Atrophic lesions were seen in combination with infection (8/11, 73%), pregnancy (2/11, 18%), male sex (2/11, 18%), or without other lesions (1/11, 9%). Other suspected contributors to death included dysecdysis-associated trauma (2/26, 8%) and uterine intussusception (1/26, 4%). No animals had neoplasia.

Analysis of Clinical Characteristics of Patients with Recurrent Cytomegalovirus Retinitis after Hematopoietic Stem Cell Transplantation.

To analyze and summarize the clinical and imaging characteristics of patients with cytomegalovirus retinitis (CMVR) relapse after hematopoietic stem cell transplantation (HSCT). This retrospective case series study recruited patients with CMVR after HSCT. The study compared the patients with stable lesions and CMV-negative aqueous humor after treatment with those with relapse lesions and a CMV DNA load in aqueous humor which had increased again after treatment. The observation indexes were basic clinical information, best-corrected visual acuity, wide-angle fundus photography, optical coherence tomography (OCT), blood CD4+ T lymphocyte count, and aqueous humor CMV load of the patients. We summarized the data and statistically analyzed the differences between the relapse and non-relapse groups, as well as the correlations of the observed indicators. The study recruited 52 patients with CMVR (82 eyes) after HSCT, of whom 11 patients (15 eyes) had recurrence after treatment (21.2%). The recurrence interval was 6.4 ± 4.9 months. The final best-corrected visual acuity of recurrent patients was 0.3 ± 0.3. The number of CD4+ T lymphocytes in recurrence patients at the time of onset was 126.7 ± 80.2/mm3. The median CMV DNA load detected in aqueous humor at the time of recurrence was 8.63 × 103 copies/mL. There was a significant difference in the CD4+ T lymphocyte count between the recurrence and the non-recurrence groups at onset. The onset of visual acuity in recurrence patients was significantly correlated with final visual acuity and recurrence lesion area. The fundus of recurred CMVR showed increased marginal activity of the original stable lesion. Concurrently, yellow-white new lesions appeared around the stable, atrophic, and necrotic lesions. OCT showed new diffuse hyperreflexic lesions in the retinal neuroepithelial layer near the old lesions. Inflammatory punctate hyperreflexes were observed in the vitreous, with vitreous liquefaction and contraction. This study suggests that the clinical features, fundus manifestations, and imaging features of CMVR recurrence after HSCT are different from those at the initial onset. Patients should be closely followed up after their condition is stable to be alert for CMVR recurrence.

Abstract 4631: Multiplex IHC assay to explore regional heterogeneity of FAP and inflammatory cell density in localized prostatic adenocarcinoma

Abstract Cancer-associated fibroblasts (CAFs) expressing FAP promote tumor growth, invasion and immune suppression. FAP is a molecular imaging target in cancer and its protease activity is a potential anti-cancer drug target. While FAP expression was associated with biochemical recurrence after prostatectomy using tissue microarrays (TMAs)(DOI:10.1158/2767-9764.CRC-21-0183), its expression has not been comprehensively correlated with morphological features of disease aggressiveness beyond grade. 48 cases of localized prostatic adenocarcinoma were used for a multiplex immunohistochemical assay that included FAP, CD45, CD163, p63 and Keratin 8. Each of these markers were individually optimized by single-plex staining and were then performed as an iterative IHC assay (PMID:35188986) and quantification was performed using the HALO image analysis platform (Indica Labs). We developed a second multiplex assay including FAP, vimentin, smooth muscle actin, desmin, CD31, S100, keratin 8 and p63. FAP IHC staining was analytically validated using a series of positive and negative cell lines. In normal appearing (non-inflamed) prostate regions, FAP expression was negative. By contrast, upregulation of FAP was observed in the stromal compartment in regions of chronic inflammation and some proliferative inflammatory atrophy (PIA) lesions. In tumor regions, only 1 case was totally negative for FAP. Except for 2 cases, in which there was focal weak tumor cell staining, all FAP expression was present in the tumor stromal compartment (TSC). The vast majority of FAP expression was associated with Vim+/Des- fibroblasts, which at times were also positive for SMA (Vim+/Des-/SMA+), indicating they are myofibroblasts. There was very infrequent FAP expression associated with M2 macrophages, endothelial cells, nerves and vimentin-negative smooth muscle cells, indicating that the majority of FAP expression occurs in fibroblasts. Preliminary quantitative data using visual estimations of the fraction of TSC expressing FAP (range, 0-80%, mean=35.8%, median=30%, SD=23.7) was not associated with the overall GS/grade group, but was associated with non-organ confined disease. Furthermore, there was a trend towards increased FAP expression in cases showing intraductal carcinoma and large cribriform formation. Ongoing studies are in process to obtain quantitative data by image analysis and to correlate FAP expression with the presence of overall inflammatory cell density and the density of M2 macrophages. Additionally, we will characterize the cases in terms of molecular features including TMPRSS2-ERG status and PTEN genomic status. Future use of these panels will facilitate studies of associations of FAP with clinical outcome, MRI and PET imaging, response to specific treatments and to help characterize FAP as a predictor of response to emerging FAP inhibitors and FAP-targeted prodrugs. Citation Format: Fernanda Caramella Pereira, Alan K. Meeker, Kenneth Pienta, Qizhi Zheng, Tracy Jones, Srinivasan Yegnasubramanian, Jessica L. Hicks, Sujayita Roy, Angelo M. De Marzo, W. Nathaniel Brennen. Multiplex IHC assay to explore regional heterogeneity of FAP and inflammatory cell density in localized prostatic adenocarcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4631.

Green tea relieves erosive, atrophic, and ulcerative lesions in patients with oral lichen planus: a pilot clinical trial study

Green tea relieves erosive, atrophic, and ulcerative lesions in patients with oral lichen planus: a pilot clinical trial study

Chi cerca trova: il lichen sclero-atrofico

The case of a 7-year-old girl presenting with several cutaneous hypopigmented patches is described. The diagnosis of lichen sclerosus was finally made based on the presence of the typical perivulvar ivory white atrophic lesions.

Oral lichen planus: case series and experience in a tertiary dermatology service in Brazil

BackgroundLichen planus is an inflammatory disease that can affect both the skin and mucous membranes, including the oral mucosa. There is very little original Brazilian dermatology literature about oral lichen planus. ObjectiveTo describe the clinical, pathological, and treatment data of 201 patients diagnosed with oral lichen planus followed at the Stomatology Outpatient Clinic of Hospital das Clínicas, Universidade de São Paulo, from 2003 to 2021. MethodThe patients demographic profile, the morpho-topographic features of the lesions, the treatment employed, and the possible presence of squamous cell carcinoma were analyzed. ResultsThe disease was more common in women over 50 years of age, tending to be chronic, with a large number of cases showing cicatricial sequelae in the mucosa. Topical treatment with potent corticosteroids was shown to be effective in the vast majority of cases. Squamous cell carcinoma in oral lichen planus cicatricial sequelae was observed in eight cases. Study limitationsRetrospective study of medical records, with gaps regarding the filling out of data; unequal observation time among the studied cases. ConclusionsThis is the largest Brazilian dermatology series on oral lichen planus. The response to topical corticoid therapy was excellent in the vast majority of cases. The high prevalence of atrophic lesions, demonstrating the chronicity and tissue destruction potential of this disease, may explain the large number of cases of squamous cell carcinoma.

Examination of brain area volumes based on voxel-based morphometry and multidomain cognitive impairment in asymptomatic unilateral carotid artery stenosis.

Recent evidence has demonstrated that unilateral carotid artery stenosis (CAS) can contribute to the development of cognitive impairment. However, the features of cognitive dysfunction induced by unilateral CAS remain unclear. Sixty asymptomatic patients with unilateral CAS were divided into mild, moderate and severe stenosis groups. These patients and 20 healthy controls provided clinical data and serum, which was used to assess the levels of certain vascular risk factors. Then, they participated in a battery of neuropsychological tests. Additionally, all participants underwent a 3.0 T magnetic resonance imaging (MRI) scan of the brain. Chi-square tests and one-way ANOVA were used to determine significant differences in the risk factors and cognitive test scores between groups. Multiple logistic regression analysis and the receiver operating characteristic (ROC) curve analysis were performed to identify the independent risk factors for cognitive impairment in patients with CAS. Finally, fluid attenuated inversion recovery (FLAIR) T1-weighted MRI images were processed by voxel-based morphometry (VBM) analysis using the Statistical Parametric Mapping (SPM) 8 software. Compared with healthy controls, the scores of the Mini-Mental State Examination, Digital Span Test backward, and Rapid Verbal Retrieve were significantly reduced in patients with left CAS. The scores in all cognitive scales were significantly lower in patients with right CAS than in controls. Logistic regression analysis demonstrated that the degree of carotid stenosis was an independent risk factor for cognitive impairment in asymptomatic patients with unilateral CAS. Furthermore, VBM analysis showed that, compared with those in healthy controls, gray matter and white matter volumes in specific brain areas were markedly decreased in patients with severe unilateral CAS. However, in patients with moderate right CAS, there was a significant decline in the volume of gray matter in the left parahippocampal gyrus and supplementary motor area. Additionally, the volume of white matter in the left insula was obviously lower in patients with moderate right CAS than in healthy controls. Unilateral asymptomatic CAS, especially on the right side, contributed to cognitive impairment, including memory, language, attention, executive function and visuospatial function. In addition, based on VBM analysis, both gray matter atrophy and white matter lesions were found in patients with unilateral asymptomatic CAS.

A laser-induced mouse model of progressive retinal degeneration with central sparing displays features of parafoveal geographic atrophy

There are no disease-modifying treatments available for geographic atrophy (GA), the advanced form of dry age-related macular degeneration. Current murine models fail to fully recapitulate the features of GA and thus hinder drug discovery. Here we describe a novel mouse model of retinal degeneration with hallmark features of GA. We used an 810 nm laser to create a retinal lesion with central sparing (RLCS), simulating parafoveal atrophy observed in patients with progressive GA. Laser-induced RLCS resulted in progressive GA-like pathology with the development of a confluent atrophic lesion. We demonstrate significant changes to the retinal structure and thickness in the central unaffected retina over a 24-week post-laser period, confirmed by longitudinal optical coherence tomography scans. We further show characteristic features of progressive GA, including a gradual reduction in the thickness of the central, unaffected retina and of total retinal thickness. Histological changes observed in the RLCS correspond to GA pathology, which includes the collapse of the outer nuclear layer, increased numbers of GFAP + , CD11b + and FcγRI + cells, and damage to cone and rod photoreceptors. We demonstrate a laser-induced mouse model of parafoveal GA progression, starting at 2 weeks post-laser and reaching confluence at 24 weeks post-laser. This 24-week time-frame in which GA pathology develops, provides an extended window of opportunity for proof-of-concept evaluation of drugs targeting GA. This time period is an added advantage compared to several existing models of geographic atrophy.

Pathomechanisms of cognitive impairment in progressive supranuclear palsy.

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by early postural instability and falls, oculomotor dysfunction (vertical supranuclear gaze palsy), parkinsonism with poor response to levodopa, pseudobulbar palsy, and cognitive impairment. This four-repeat tauopathy is morphologically featured by accumulation of tau protein in neurons and glia causing neuronal loss and gliosis in the extrapyramidal system associated with cortical atrophy and white matter lesions. Cognitive impairment being frequent in PSP and more severe than in multiple system atrophy and Parkinson disease, is dominated by executive dysfunction, with milder difficulties in memory, and visuo-spatial and naming dysfunctions. Showing longitudinal decline, it has been related to a variety of pathogenic mechanisms associated with the underlying neurodegenerative process, such as involvement of cholinergic and muscarinergic dysfunctions, and striking tau pathology in frontal and temporal cortical regions associated with reduced synaptic density. Altered striatofrontal, fronto-cerebellar, parahippocampal, and multiple subcortical structures, as well as widespread white matter lesions causing extensive connectivity disruptions in cortico-subcortical and cortico-brainstem connections, support the concept that PSP is a brain network disruption disorder. The pathophysiology and pathogenesis of cognitive impairment in PSP, as in other degenerative movement disorders, are complex and deserve further elucidation as a basis for adequate treatment to improve the quality of life of patients with this fatal disease.

A protein-based subunit vaccine with biological adjuvants provides effective protection against Pasteurella multocida in pigs

Streptococcus suis (S. suis) and Pasteurella multocida (P. multocida) are pathogens that can cause zoonotic diseases. P. multocida toxin (PMT) is an important virulence factor that causes atrophic rhinitis in pigs. Suilysin (Sly) is an extracellular protein of S. suis and has been shown to be a potential adjuvant. Previous studies have indicated that subunit vaccines containing several fragments of PMT as antigens are safer than traditional inactivated or live-attenuated vaccines. However, protein-based vaccines need strong adjuvants to enhance their immunogenicity. In this study, recombinant PMT-NC (rPMT-NC) protein antigen was formulated with either recombinant Sly (rSly) or CpG oligodeoxynucleotides (CpG) as the adjuvant. The immune responses elicited by these vaccines and the protective efficacy after challenge with live P. multocida were evaluated in piglets. In the dose-dependent test, piglets immunized with the low dose (100 µg) of rSly had increased antigen-specific total IgG, interferon (IFN)-γ gene expression, and CD4+ and CD8+ T-cell populations. Compared to piglets in the commercial (Al-gel) adjuvant and the control groups (p < 0.05), piglets in the biological adjuvant groups showed significantly reduced turbinate atrophy, nasal distortion, and lung lesion scores after challenge with P. multocida serotype A. Vaccines containing rSly or CpG adjuvant enhanced humoral and cellular immune responses and protection against P. multocida. This combination of a protein-based antigen formulated with a biological adjuvant showed synergistic and protective effects against atrophic rhinitis and has potential to be developed as part of a bivalent vaccine.

Progression of Stargardt Disease as Determined by Fundus Autofluorescence Over a 24-Month Period (ProgStar Report No. 17)

To estimate the progression rate of atrophic lesions in Stargardt disease derived from fundus autofluorescence (FAF). International, multicenter, prospective cohort study. A total of 259 participants aged ≥6 years with disease-causing variants in the ABCA4 gene were enrolled from 9 centers and followed over a 24-month period. FAF images were obtained every 6 months, and areas of definitely decreased autofluorescence (DDAF) and decreased autofluorescence (DAF) were quantified. Progression rates were estimated from linear mixed models with time as the independent variable. A total of 488 study eyes of 259 participants (88.8% with both eyes) were enrolled and images from 432 eyes were followed for 24 months. The overall estimated progression of DDAF was 0.74 mm2/y (95% CI 0.64-0.85, P < .0001) and that of DAF was 0.64 mm2/y (95% CI 0.57-0.71) over a 24-month period in univariate analysis. Growth rates were strongly dependent on baseline lesion area. After square root transformation, the DDAF growth rate was not dependent on baseline lesion radius (P=.11), whereas the DAF growth rate was dependent (P < .0001). Genotype was not found to significantly impact the growth rate of DDAF or DAF lesions. FAF may serve as a convenient monitoring tool and suitable end point for interventional clinical trials that aim to slow disease progression. DDAF and DAF lesion sizes at baseline are strong predicting factors for lesion area growth and can be partially accounted for by square root transformation.

Atrophic Hyperpigmented Lesions Over Trunk in a Middle-Aged Female.

Atrophic Hyperpigmented Lesions Over Trunk in a Middle-Aged Female.

Quantitative multimodal imaging of extensive macular atrophy with pseudodrusen and geographic atrophy with diffuse trickling pattern

To compare clinical and imaging characteristics of extensive macular atrophy with pseudodrusen-like appearance (EMAP) versus diffuse-trickling geographic atrophy (DTGA) and non-diffuse-trickling geographic atrophy (nDTGA) phenotypes of age-related macular degeneration. Prospective, observational study performed in the Ophthalmology Department of IRCCS San Raffaele Hospital between January 2015 and January 2021. Patients examination included fundus autofluorescence (FAF) and optical coherence tomography at baseline and follow-up visits. We measured subfoveal choroidal thickness (SCT), Sattler/choroid ratio (SCR), choroidal vascularity index and ellipsoid zone disruption distance on OCT scans. We calculated progression rates and circularity of the atrophic lesions on FAF images. These variables were compared between the three groups and correlations with progression rates and visual acuity were assessed. Sixty-three eyes from 63 patients were included: 18 with EMAP, 18 with DTGA and 27 with nDTGA. Mean follow-up was 3.73 ± 2.12 years. EMAP and DTGA shared a faster progression, lower circularity and SCR, and higher EZ disruption distance than nDTGA, while SCT and CVI were similar between the three groups. Baseline circularity and SCR correlated with progression rates. EMAP and DTGA show similar OCT and FAF characteristics, which differ from nDTGA.

U-Net deep learning model for endoscopic diagnosis of chronic atrophic gastritis and operative link for gastritis assessment staging: a prospective nested case–control study

Background: The operative link for the gastritis assessment (OLGA) system can objectively reflect the stratification of gastric cancer risk in patients with chronic atrophic gastritis (CAG). Objectives: We developed a real-time video monitoring model for the endoscopic diagnosis of CAG and OLGA staging based on U-Net deep learning (DL). To further validate and improve its performance, we designed a study to evaluate the diagnostic evaluation indices. Design: A prospective nested case–control study Methods: Our cohort consisted of 1306 patients from 31 July 2021 to 31 January 2022. According to the pathological results, patients in the cohort were divided into the CAG group and the chronic non-atrophic gastritis group to evaluate the diagnostic evaluation indices. Each atrophy lesion was automatically labeled and the atrophy severity was assessed by the model. Propensity score matching was used to minimize selection bias. Results: The diagnostic evaluation indices and the consistency between OLGA staging and pathological diagnosis of the model were superior to those of endoscopists [sensitivity (89.31% versus 67.56%), specificity (90.46% versus 70.23%), positive predictive value (90.35% versus 69.41%), negative predictive value (89.43% versus 68.40%), accuracy rate (89.89% versus 68.89%), Youden index (79.77% versus 37.79%), odd product (79.23 versus 4.91), positive likelihood ratio (9.36 versus 2.27), negative likelihood ratio (0.12 versus 0.46)], areas under the curves (AUC) (95% CI) (0.919 (0.893–0.945) versus 0.749 (0.707–0.792), p &lt; 0.001) and kappa (0.816 versus 0.291)]. Conclusion: Our study demonstrated that the DL model can assist endoscopists in real-time diagnosis of CAG during gastroscopy and synchronous identification of high-risk OLGA stage (OLGA stages III and IV) patients. Trial registration: ChiCTR2100044458.

Bacak Ülserleri ve Degos Benzeri Lezyonlar Bulunan Sistemik Lupus Eritematozusun Nadir Bir Sunumu

Degos-like lesions (DLL) have been associated with connective tissue diseases. Till date only twelve cases of systemic lupus erythematosus (SLE) with DLL have been published. We describe a rare case of SLE with leg ulcers and DLL. A 23-year-old male presented with malar rash, photosensitivity, leg ulcers, joint pain, oral ulcers, altered sensorium and dyspnea. Cutaneous examination also revealed atrophic, porcelain-white scars over body previously unnoticed by patient. Dermoscopy of atrophic lesions was pathognomonic of Degos disease. Histopathology from various lesions were consistent with Degos disease and SLE. Patient was admitted in intensive care unit but succumbed to multiorgan failure two days later. This case highlights the importance of dermoscopy for immediate diagnosis of DLL. Appropriate investigations for early diagnosis and timely management can decrease mortality. Also a thorough examination in cases of connective tissue diseases may reveal uncommon lesions that can alter clinical course and outcome of patients.

Progression of Myopic Maculopathy in Patients With Myopic Traction Maculopathy After Vitrectomy.

To compare the progression of myopic maculopathy with or without vitrectomy in patients with myopic traction maculopathy (MTM). Seventy-seven eyes with MTM were classified into either the observation group (n = 38) or the vitrectomy (n = 39) group. Progression of myopic maculopathy was assessed with fundus photography using infrared images. Progression within stage was evaluated as an increase in area of atrophic lesions on infrared images using ImageJ software. The rate of progression was compared using the paired t test. The mean follow-up period was 60.0 ± 47.5 months. The initial mean stage of myopic maculopathy for the observation group was 1.86 ± 0.86, and it progressed to 2.00 ± 0.83 (p = 0.023) at the last visit. For the vitrectomy group, the stage progressed from 1.82 ± 0.96 to 2.05 ± 1.09 (p = 0.011). Four eyes (10.5%) in the observation group showed progression at 87.3 months, and seven eyes (17.9%) in the vitrectomy group showed progression at 31.3 months. Surgery in patients with MTM may accelerate the progression of myopic maculopathy. Therefore, care should be taken when considering surgery for patients with MTM.