Cobblestone Appearance Research Articles

Dariers Disease with Oral Manifestations : A Clinical Rarity : Case Report

Darier disease (DD), also known as keratosis folicularis and White disease , is an inherited autosomal dominant genodermatosis. DD often develops in childhood, persists through adolescence and causes small papules predominantly in seborrheic areas such as the face , chest and back. The oral lesions are asymptomatic and comprise multiple white papules in the buccal mucosa and the soft and hard palate , giving a cobblestone appearance. Histologically , DD is characterized by corps ronds and grains in addition to suprabasal cleavage. There are no currently validated curative treatments available for DD, with the majority of cases treated symptomatically. This is a case report of DD with varied manifestations intraorally and extraorally. Diagnosis was established on the basis of clinical , histopathological and dermatological findings. Patient reported to the OPD with a chief complaint of loose teeth. A holistic treatment approach was carried out based on clinical and histological findings. Functional and esthetic demands were met with satisfactory results.

Influence of Substrate Structure and Associated Properties on Endothelial Cell Behavior in the Context of Behaviors Associated with Laminar Flow Conditions.

In order to treat most vascular diseases, arterial grafts are commonly employed for replacing small-diameter vessels, yet they often cause thrombosis. The growth of endothelial cells along the interior surfaces of these grafts (substrates) is critical to mitigate thrombosis. Typically, endothelial cells are cultured inside these grafts under laminar flow conditions to emulate the native environment of blood vessels and produce an endothelium. Alternatively, the substrate structure could have a similar influence on endothelial cell behavior as laminar flow conditions. In this study, we investigated whether substrates with aligned fiber structures could induce responses in human umbilical vein endothelial cells (HUVECs) akin to those elicited by laminar flow. Our observations revealed that HUVECs on aligned substrates displayed significant morphological changes, aligning parallel to the fibers, similar to effects reported under laminar flow conditions. Conversely, HUVECs on random substrates maintained their characteristic cobblestone appearance. Notably, cell migration was more significant on aligned substrates. Also, we observed that while vWF expression was similar between both substrates, the HUVECs on aligned substrates showed more expression of platelet/endothelial cell adhesion molecule-1 (PECAM-1/CD31), laminin, and collagen IV. Additionally, these cells exhibited increased gene expression related to critical functions such as proliferation, extracellular matrix production, cytoskeletal reorganization, autophagy, and antithrombotic activity. These findings indicated that aligned substrates enhanced endothelial growth and behavior compared to random substrates. These improvements are similar to the beneficial effects of laminar flow on endothelial cells, which are well-documented compared to static or turbulent flow conditions.

Congenital Hepatic Fibrosis in an Aborted Holstein-Friesian Fetus

Abstract Congenital hepatic fibrosis (CHF) is a rare condition characterized by abnormal accumulation of fibrous tissue in the liver, leading to liver dysfunction. While CHF has been documented in various animal species, it has rarely been reported in cattle. This report presents a case of CHF in an aborted Holstein-Friesian fetus. During the necropsy, the most notable macroscopic findings included an enlarged liver with an irregular “cobblestone appearance” on the surface and firm parenchyma, as well as moderate ascites. Histopathological examination revealed extensive hepatic fibrosis in the portal areas, accompanied by bridging fibrosis extending between portal tracts and bile duct proliferation within the fibrous tissue. Screening for infectious agents as the cause of abortion or liver lesions was unremarkable. The necropsy and histopathological findings confirmed CHF, constituting the first case described in Holstein-Friesian calves in Serbia. Further research is required to determine whether this condition has a genetic basis or is influenced by yet to be identified factors in Holstein-Friesian cattle.

Shear Stress Induces Morphology Changes in Human Lung Microvascular Endothelial Cells via Calcium Influx

Introduction: The pulmonary vascular endothelium is in contact with laminar blood flow, resulting in a physiologic degree of shear stress exerted on endothelial cells (ECs). In vitro cell culture of ECs is typically performed under static conditions, leading to underappreciation of the impact of shear stress. Calcium signaling is among the most ubiquitous cell signaling mechanisms, and changes in intracellular calcium concentration ([Ca2+]i) have been linked to shear stress. The impact of shear stress on human lung microvascular endothelial cell (hLMVEC) morphology and cell signaling is not well described. We hypothesized that hLMVECs exposed to shear stress would undergo Ca2+-dependent morphologic changes. Methods: The effect of shear stress on [Ca2+]i was first tested using ratiometric measurement. Early passage (p≤8) primary hLMVECs from three unique donor lots were plated in gelatin-coated Ibidi 0.2 uM depth plates for 16 h, then incubated with the calcium indicator Fura-2 AM for 1 h. Measurement of [Ca2+]i was obtained over 15 minutes under static and physiologic shear stress (0 and 12 dyn/cm2, respectively), using validated flow rates from the Ibidi system. Measured [Ca2+]i was compared between cells treated vehicle or an inhibitor of the mechanosensitive Ca2+-permeable channel TRPV4 (HC-067047). HC treatment was for 1 h prior to and throughout the duration of shear exposure. Morphology changes were then assessed in hLMVECs from the same three cell lots grown in standard 6-well plates; one plate kept in static culture, while another was exposed to 24 h of 12 dyn/cm2 shear stress using an orbital shaker. Treatments in each plate were control, vehicle, and HC. Representative photos of each well were taken at 0 h and at 24 h. Average ratios of shortest to longest dimensions from 30 cells/field were measured using ImageJ and compared between treatments and shear conditions. A 2-way ANOVA with post-test was used to test for statistically significant changes in morphology. Results: Shear stress increased [Ca2+]i within 15 minutes, and both baseline [Ca2+]i and observed change in response to shear stress were decreased by TRPV4 inhibition with HC. Morphologic changes were observed after exposure to shear stress on microscopic examination, with cells grown in static culture having typical cobblestone appearance and shear-adapted cells having an elongated, spindle like appearance aligned in the direction of flow. The calculated ratio (shortest to longest dimension) of all wells at 0 h was ~0.70 with no significant differences between groups. 24 h of shear stress caused a nearly 80% decrease in ratio compared to static culture in untreated cells (p<0.05), with a decrease of only 30% in HC-treated cells after 24 h of shear (p<0.05). Conclusions: Exposure to shear stress at physiological levels results in a rapid increase [Ca2+]i through mechanosensitive, Ca2+-permeable TRPV4 channels as well as notable morphologic changes to hLMVECs with prolonged exposure to shear stress that appear to be mediated in large part by TRPV4. Further investigation into the impact of shear stress on hLMVECs is warranted to elucidate biochemical pathways and other downstream functional consequences of increased [Ca2+]i. NIH-T32HL007534. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

An 11-month-old boy with tuberculous meningitis presenting as progressive limb weakness, fever, developmental retardation, and loss of consciousness: a case report

BackgroundTuberculous meningitis (TBM) accounts for about 1% of all tuberculosis cases and about 5% of extrapulmonary tuberculosis cases. However, it poses major importance because approximately half of those affected die or become severely disabled. Herein, the successful treatment of an 11-month-old boy with progressive limb weakness, fever, developmental retardation, and loss of consciousness due to tuberculosis, was reported.Case presentationAn 11-month-old (Iranian Turk) boy was referred to Loghman Hakim hospital for progressive limb weakness and loss of previously attained developmental milestones for the past 2 months. He also had persistent fever and loss of consciousness for about 14 to 21 days. Before being referred to our center, the patient had been diagnosed with hydrocephalus at another center due to possible acute bacterial meningitis based on a CT scan and MRI imaging. On physical examination, anterior fontanel bulging and neck stiffness were observed on the admission. His body temperature and heart rate were 38.1 C and 86 beats per minute (bpm), respectively. He had left 6 cranial nerve palsy and spastic quadriparesis with a power of grade 3/5. Other systemic examinations were normal. Endoscopic third ventriculostomy (ETV) (and leptomeningeal biopsy) revealed diffuse thickening of the floor and lateral walls of the 3rd ventricle and also a cobblestone appearance in the form of multiple white patchy lesions was detected on the floor of the 3rd ventricle. CSF analysis and polymerase chain reaction confirmed the TB meningitis. During hospitalization, a temporary EVD (external ventricular drain) was initially inserted. Eventually, defervescence was denoted 5–6 days after initiation of anti-TB medications, and a permanent ventriculoperitoneal shunt was inserted due to hydrocephalus. Gradually his truncal and limb tone and motor function improved, as did his emotional responses to his parents and ability to eat. The patient can walk without help in the 15th month following the operation and resolved hydrocephalus demonstrated on follow-up imaging.ConclusionOver half of treated TB meningitis patients die or suffer severe neurological sequelae, mainly due to late diagnosis. Hence, early diagnosis and prompt initiation of TB treatment offer the best chance of a good neurological outcome.

Dermoscopy in Darier Disease: A Missing Link in an Unusual Hyperkeratotic Disorder

Darier disease is a rare autosomal dominant skin disorder resulting from mutation of the ATP2A2 gene on chromosome 12. Its progressive course makes its precise diagnosis crucial for a good prognosis. A 60-year-old female presented with multiple non-itchy papules over the face, trunk, and extremities since childhood and photosensitivity with similar lesions in the mother and two elder sisters. Examination revealed skin-coloured-to-hyperpigmented, firm and greasy papules with cobblestone appearance. Dirty yellowish-white wart-like lesions were noted over the toes. Histopathology revealed parakeratosis, papillomatosis, suprabasal acantholysis, and cleft with corps rounds in the granular layer. Dermoscopy revealed cobblestone appearance of the toes with tire-tread and cracked river-bed-like appearance and nails showing palmar hemorrhages and V-shaped nicking. The patient was diagnosed with Darier disease and treated accordingly. Uniquely, the cobblestone appearance was noted first over the dorsa of hands and feet. Dermoscopy may be used diagnose the disease while awaiting histopathological evidence.

Artificial intelligence-based diagnostic imaging system with virtual enteroscopy and virtual unfolded views to evaluate small bowel lesions in Crohn's disease.

Since even subtle mucosal changes may be depicted using virtual endoscopy created by the three-dimensional reconstruction of MDCT images, we developed a novel diagnostic imaging system that integrates and displays virtual enteroscopy, curved planar reconstruction, and a virtual unfolded view, the width of which changes with increases/decreases in the inner luminal diameter. The system is also equipped with artificial intelligence that superimposes and displays depressed areas, generates an automatic small bowel centerline that connects fragmented small bowel regions, and performs electronic cleansing. We retrospectively evaluated the diagnostic performance of this system for small bowel lesions in Crohn's disease, which were divided into two groups: endoscopically-observable and endoscopically-unobservable. Lesion detection rates for stenoses, longitudinal ulcers with a cobblestone appearance, and scars were excellent in both groups. This system, when used in combination with endoscopy, shows slight mucosal changes in areas in which an endoscope cannot reach due to strictures, thereby extending the range of observation of the small bowel. This system is a useful diagnostic modality that has the capacity to assess mucosal healing and provide extraluminal information.

Cobblestone Appearance in Point-of-Care Ultrasonography (POCUS)

Cobblestone Appearance in Point-of-Care Ultrasonography (POCUS)

#3475 NOVEL OPTIMISED PROTOCOL FOR ISOLATION OF PTEC AND SYSTEMATIC CHARACTERISATION FROM HUMAN KIDNEY BIOPSY

Abstract Background and Aims Human kidneys have a role in water homeostasis, acid-base control, reabsorption of compounds, and secretion of xenobiotics and endogenous metabolites, exposing them to substances that could cause harm. This results in an alarming number of acute kidney injuries (AKI) worldwide, estimated at 13%. Furthermore, one-quarter of hospitalised cases are due to drug-induced AKI [1]. Current methods for nephrotoxicity assays are based on animal testing and/or the use of simple human cell lines. Meta-analyses show that we can correctly predict human drug responses in only 10–50% [2]. Our work aimed to develop a novel and optimised protocol for isolating proximal tubular epithelial cells (PTEC) from human kidney biopsy to aid future research regarding AKI and nephrotoxicity studies. Method Isolation and cultivation of primary human adult PTEC obtained with biopsy during the regular diagnostic procedure was performed. We used a protocol consisting of micro-dissection of a tissue sample to get ∼1 mm3 fragments, enzymatic dissociation with 0.2% collagenase type 1, and use of selective culture media (Advanced DMEM/F12 with added insulin, transferrin, and selenite (all three together termed ITS), epidermal growth factor (EGF), and hydrocortisone). Light microscopy was used for morphologic characterisation. Some cells were cultured on Transwell inserts, and the transepithelial electric resistance (TEER) was measured in mature cells that formed a confluent culture. For phenotypic characterisation, several markers characteristic of PTEC were chosen [3], and immunocytochemical staining was performed using a fluorescent microscope to evaluate the PTEC phenotype. Results Following the described protocol resulted in isolating cells that formed first colonies after 24 h. Using light microscopy, the cells exhibited a cobblestone appearance, reached confluence after eight days, and showed dome (hemicysts) formation after 13 days. TEER reached 169 Ω/cm2 after 14 days. The isolated cells were marked positive using immunocytochemistry for sodium-glucose cotransporter 2 (SGLT2), multidrug-resistant protein 4 (MRP4), organic anionic transporter 1 and 3 (OAT1 and OAT3), organic cationic transporter 2 (OCT2), p-glycoprotein (p-gp), multidrug and toxin extrusion protein 1 (MATE1), and N-cadherin. Conclusion In this study, we developed a protocol for isolating and cultivating primary human PTEC from biopsy samples. To the best of our knowledge, we have performed the most extensive systematic characterisation following the isolation of PTEC from kidney biopsy reported to date.

Stiff skin syndrome: a clinicopathological study of 31 cases.

Stiff skin syndrome (SSS) is a rare disease characterized by sclerosis of the skin. Cases of both widespread and segmental SSS have been reported. To report the clinical and histopathological characteristics of a large series of SSS. We retrospectively analysed the clinical and histopathological characteristics of widespread and segmental SSS collected from a dermatology department. We also compared histopathology between segmental SSS and morphea. Thirty-one cases, including three widespread SSS and 28 segmental SSS, were collected. Skin lesions of widespread SSS generally showed skin sclerosis concentrating over the lumbar, buttocks, thighs, proximal part of limbs, and shoulders with specific abnormal gait and posture. Skin lesions of segmental SSS generally showed sclerotic plaques involving the thigh, lumbar area and buttocks, associated with hypertrichosis, hyperpigmentation and a cobblestone appearance. Segmental SSS did not typically cause joint limitation or serious physical discomfort. Histopathologically, SSS showed proliferation of fibroblasts and sclerosis of collagen in the dermis or subcutaneous tissue. Compared with morphea, SSS showed more prominent proliferation of fibroblasts and completely lacked lymphocyte infiltration. Segmental SSS represents the major variant of SSS. Histopathologically, SSS shows proliferation of fibroblasts, sclerosis and an absence of inflammation.

Ultrathin Skin Grafting Versus Suction Blister Epidermal Grafting in the Treatment of Resistant Stable Vitiligo: A Self-Controlled Comparative Study.

Surgical therapies are effective methods to treat resistant stable vitiligo, with each method having advantages and disadvantages. This study aimed to compare the efficacy and safety of ultrathin skin grafting (UTSG) and suction blister epidermal grafting (SBEG) to treat stable vitiligo. A total of 15 patients with 45 vitiligo patches were recruited. Each vitiligo patch was divided in half; 1 half was treated by UTSG, whereas the other half was treated by SBEG. The patients were followed up monthly for 3 months to assess the repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) at different timepoints. Excellent repigmentation was observed in 97.8% of patches that underwent UTSG and 93.3% that underwent SBEG. The RMI and REI at 1, 2, and 3 months after the grafting procedure did not significantly differ between the 2 methods. At the recipient site, incomplete fall-off of the graft occurred in 4.4% of patches that underwent UTSG, whereas a "cobblestone appearance" was observed in 66.7% of patches that underwent SEBG. UTSG caused fewer complications at the donor site than SBEG. Compared with SBEG, UTSG is faster and achieves better cosmetic outcomes at the recipient and donor sites.

An Unusual Case of Lower Gastrointestinal Hemorrhage

Question: A 53-year-old woman, who was in good health, presented with hematochezia for more than 20 days. Examination was unremarkable, with stable vital signs. Laboratory tests revealed a hemoglobin of 78 g/L (normal 120–160 g/L), and the rest of the laboratory tests were normal. Colonoscopy revealed multiple masses with a cobblestone appearance, obvious mucosal congestion, and edema in the junction of sigmoid and rectum (Figure A). Colonic biopsy precipitated active bleeding that required various measures to stop bleeding. Ice-cold saline solution and 8% norepinephrine (8 mg norepinephrine in 100 mL saline solution) was used to rinse the bleeding site repeatedly and to constrict the vessels, but failed to stop the bleeding. Titanium clip was then used to clamp the vessels, but blood still exudated. Lauromacrogol was injected to stop the bleeding eventually (Figure A). She recovered following fluid resuscitation, acid suppression and somatostatin therapy. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis is shown in Figure B–E. Three days later, she developed massive hematochezia with a hemoglobin level of 45 g/L. Owing to effective fluid resuscitation and blood transfusion, her blood pressure was relatively stable.

Grzybowski Type Generalized Eruptive Keratoacanthomas Covering 95% of the Body Surface and Bilateral Ectropion - Part 1: When Donor Site Options Become Scarce

Introduction: We treated a patient suffering from generalized eruptive keratoacanthomas, also known as Grzybowski syndrome. Since its first description in 1950, around 40 cases were reported worldwide. Materials and Methods: A 66-year old woman with bilateral eyelid cicatricial ectropions was referred to our plastic surgery department. This patient was previously diagnosed with generalized eruptive keratoacanthomas of Grzybowski type. Her periocular skin was thickened with a cobblestone appearance. Cicatricial ectropions involved both upper and lower eyelids on the left side and the lower eyelid on the right side. The most affected left side was treated first using a full-thickness skin graft harvested from the dorsum of the left foot, as 95 % of the body surface of the patient were covered by keratoacanthomas. Results: Stable results with reduced tearing and improved appearence were achieved after 6 weeks with delayed healing of the donor site after three months. Conclusion: A full-thickness skin graft is the best option to treat cicatricial ectropion, but in case of patients with Grzybowski’s syndrome, donor site options are scarce and wound healing difficulties may become a problem. Thinking out of the box for treatment of the second side and eventual further operations is key.

Abstract WMP115: Stroke Patient Cerebral Endothelial Cells And Their Exosomes Impair Cerebral Endothelial Cell Function

Background: Cerebral endothelial cells (CECs) play a key role in mediating cerebral vascular hemostasis. The biological function of CECs in stroke patients remains unknown due to technical challenges to acquire patient CECs. We isolated and analyzed the function of CECs from living stroke patients. Methods: Cells were isolated from stent retrievers used for mechanical thrombectomy (MT) for patients with large vessel occlusion (LVO) after completion of the intervention as part of an IRB approved protocol. Patient endothelial cells (pCECs) were analyzed. Results: We isolated 300-400 primary brain endothelial cells per retriever from 5 patients with LVO with ages ranging from 69 to 86 years. The pCECs exhibited a typical monolayer cobblestone appearance and expressed VE-cadherin, but not α-smooth muscle actin, indicating that these cells are CECs. Western blot analysis showed that compared to human primary brain microvascular endothelial cells (hBMECs, Cell System), pCECs expressed significantly increased iNOS, VEGF, and VEGFR2, but reduced eNOS and Ang1. In vitro endothelial permeability and angiogenesis assays showed that pCECs robustly increased cell leakage and angiogenesis, respectively. Moreover, treatment of healthy hBMECs with exosomes derived from patient CECs (pCEC-Exos) significantly increased cell leakage and reduced cell integrity, which were associated with the reduction of tight junction proteins ZO1 and Occludin. Blockage of the caveolin endocytotic pathway by nystatin abolished the effect of pCEC-Exos on hBMEC function. Conclusions: Our data demonstrate that: 1) pCECs from stroke patients can be harvested; 2) pCECs are dysfunctional, and 3) pCEC-Exos induce dysfunction of healthy CECs. These data provide novel insights into the mediation of stroke-induced neurovascular dysfunction by pCECs.

Pseudoxanthoma elasticum: a rare case report

<p class="abstract">Pseudoxanthoma elasticum (PXE) is a hereditary systemic connective tissue disease affecting mainly the skin, retina and cardiovascular system. Pathologically, it is characterized by mineralization and fragmentation of elastic fibers (so-called "elastorhexia"). PXE is associated with mutations in the ABCC6 (ATP binding cassette subtype C number 6) gene. Women are affected more than men. A 22-year-old woman came to our department with complaints of small, yellowish raised lesions in rows or lacy pattern on her neck since 2 years, some of which coalesced to form larger lesions. She also complains that the skin has been soft, flabby, and wrinkled since 2 years in the armpits, trunk, groin, and knees. On examination, the lesions were slightly pebbly in appearance; such papular lesions tend to coalesce gradually to form plaques with a cobblestone appearance. On histopathological examination, elastic fibers appear basophilic due to calcium deposition. The fibers were fragmented, swollen, and clustered in the middle and deep reticular dermis. The collagen fibers were split. Based on the above findings, a diagnosis of PXE was made. Due to the rarity of the disease, we are reporting this case. The course and prognosis were explained to the patient. Most of the pathological changes associated with PXE are irreversible, but prophylactic measures can be taken to minimize the course of the disease.</p>

Exhaled nitric oxide levels are associated with the severity of chronic epipharyngitis and decreased via epipharyngeal abrasion

ObjectiveThe author previously demonstrated that the levels of oral exhaled nitric oxide (NO) were reduced by repeated epipharyngeal abrasive therapy (EAT) for chronic epipharyngitis along with the patients’ symptoms, suggesting that exhaled NO may be a useful outcome parameter of repeated EAT. This study aimed to investigate whether the levels of oral exhaled NO indicate the severity of epipharyngitis and whether an epipharyngeal abrasion immediately influences the amount of exhaled NO. MethodsParticipants visited the author's clinic for the diagnosis and treatment of chronic epipharyngitis from November 2020 to March 2021. NO levels were measured orally before EAT, after nasal anesthesia and EAT without zinc chloride (ZnCl2), and after EAT with ZnCl2. The correlation between the endoscopic finding scores in conventional light and black spots and the cobblestone appearance with granular changes in band-limited light as well as the exhaled NO levels were determined. ResultsThe study included 102 patients (30 males, 72 females; median age, 45.7 years). NO levels were significantly lower (p < 0.01) in EAT without ZnCl2 (17.0 [11.0–25.3]) and even lower with ZnCl2 (12.0 [8.0–21.0]) than before EAT (21.5 [15.8–35.0]). NO was significantly higher (p <0.01) in chronic epipharyngitis with the cobblestone appearance with granular changes (23.5 [17.0–37.8]) than without it (19.0 [15.0–23.5]). The total number of endoscopic finding scores and the exhaled NO levels showed a positive correlation (r = 0.251; p = 0.015). Additionally, the cobblestone appearance with granular changes and exhaled NO levels showed a positive correlation (r = 0.256; p = 0.013). ConclusionEAT decreased immediately exhaled NO levels with or without ZnCl2, suggesting that physical stimulation with a cotton swab without ZnCl2 is therapeutic, and ZnCl2 may increase this effect. The endoscopic scores were significantly associated with the exhaled NO levels, suggesting that the exhaled NO levels represent the severity of epipharyngitis. The cobblestone appearance with granular changes, which indicates that pathologic ciliated epithelium, was significantly correlated and increased exhaled NO levels, suggesting that NO may be exhaled from ciliated epithelia. These results indicated that exhaled NO levels may be useful as an objective parameter to express the severity of epipharyngitis as well as the outcomes of repeated EAT.

Differential diagnosis of Crohn’s disease and intestinal tuberculosis: development and assessment of a nomogram prediction model

BackgroundChina is a region with a high incidence of tuberculosis, and the incidence of IBD has also been rising rapidly in recent years. Differentiating Crohn’s disease(CD) from intestinal tuberculosis (ITB) has become a very challenging issue. We aimed to develop and assess a diagnostic nomogram to differentiate between CD and ITB to improve the accuracy and practicability of the model.MethodsA total of 133 patients (CD 90 and ITB 43) were analyzed retrospectively. Univariate and multivariate logistic regression analysis was included to determine the independent predictive factors and establish the regression equation. On this basis, the nomogram prediction model was constructed. The discrimination, calibration and clinical efficiency of the nomogram were assessed using area under the curve(AUC), C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve.ResultsT-SPOT positive, cobblestone appearance, comb sign and granuloma were significant predictors in differentiating CD from ITB. Base on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity, specificity, accuracy of the prediction model are 94.4%, 93.0%, 94.0% respectively. The AUC and the C-index of the prediction model are both 0.988, which suggest that the model had a good discrimination power. The calibration curve indicated a high calibration degree of the prediction model. The DCA and clinical impact curve indicated a good clinical efficiency of the prediction model which could bring clinical benefits.ConclusionA nomogram prediction model for distinguishing CD from ITB was developed and assessed, with high discrimination, calibration and clinical efficiency. It can be used as an accurate and convenient diagnostic tool to distinguish CD from ITB, facilitating clinical decision-making.

Upper and Lower Respiratory Mucous Membrane Plasmacytosis with a Cobblestone Appearance: a Case Report.

A 53-year-old woman with a recurrent sore throat, xerostomia, nasal obstruction, and nasal discharge came to our hospital. At the first visit, she did not have a fever, but a blood test showed an intense inflammatory response. She had oral mucosal erosion. She developed dyspnea 2months later. Nasendoscopy, laryngoscopy, and bronchoscopy showed upper and lower respiratory mucosa cobblestone appearance. Microscopy of the nasal and pharyngeal mucosa biopsy found regular mononuclear inflammatory cell dense submucosal infiltrate, mainly plasma cells. A mucous membrane plasmacytosis diagnosis was made. Prednisolone 1mg/kg/day rapidly improved bronchial symptoms and cobblestone appearance.

Endoscopic imaging in inflammatory bowel disease.

In inflammatory bowel disease, including Crohn's disease and ulcerative colitis, an excessive immune response due primarily to T-cell lymphocytes causes inflammation in the gastrointestinal tract. Lesions in Crohn's disease can occur anywhere in the gastrointestinal tract, i.e., from the oral cavity to the anus. Endoscopically, aphthoid lesions/ulcers believed to be initial lesions progress to discrete ulcers, which coalesce to form a longitudinal array and progress to longitudinal ulcers with a cobblestone appearance, which is a typical endoscopic finding. Before long, complications such as strictures, fistulas, and abscesses form. Lesions in ulcerative colitis generally extend continuously from the rectum and diffusely from a portion of the colon to the entire colon. Endoscopically, lack of vascular pattern, fine granular mucosa, erythema, aphthae, and small yellowish spots are seen in mild cases; coarse mucosa, erosions, small ulcers, bleeding (contact bleeding), and adhesion of mucous, bloody, and purulent discharge in moderate cases; and widespread ulcers and marked spontaneous bleeding in severe cases.

Specificity and Sensitivity of Lung Ultrasound Examination in Patients with COVID-19 Induced Pneumonia

The coronavirus infection (COVID-19) is characterized by a high incidence of pneumonia. Extensive damage, high mortality associated with COVID-19 make the rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage a challenge. Lung ultrasound examination can be used as a tool to answer it.The objective: to compare the signs detected by lung computed tomography and ultrasound and to assess the sensitivity and specificity of ultrasound in the diagnosis of pneumonia induced by COVID-19.Subjects and Methods. The observational prospective clinical study included 388 patients aged 18–75 years old; they had a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest organs. During CT, pathological signs, infiltration and consolidation of the lungs were visualized which were documented by lung segments. Lung ultrasound was performed according to the Russian Protocol, ultrasound signs of B-lines and consolidation were also documented based on the projection of lung segments on the chest wall. The distributions of variables was analyzed, described and summarized. The sensitivity and specificity of ultrasound methods were evaluated on the basis of ROC analysis according to CT gold standard.Results. Bilateral involvement was found in 100% of cases. Typical CT signs of pneumonia caused by coronavirus infection were ground-glass opacity of the pulmonary parenchyma, thickened pleura, consolidation, interstitium, reticular induration, and cobblestone appearance. With ultrasound examination of the lungs and pleura, the detected signs corresponded to CT signs. B lines (multifocal, discrete or merging) and consolidation of various volumes of lung tissue were most common during ultrasound. The sign of consolidation was detected less frequently versus infiltration (p &lt; 0.001). The sensitivity of lung ultrasound in the diagnosis of lung lesions was 95.3%, and the specificity was 85.4%, the area under the curve was 0.976 with a confidence interval of 0.961–0.991 (p &lt; 0.001).Conclusion. The use of lung ultrasound during the COVID-19 pandemic makes it possible to identify, assess the volume and nature of lung damage. Lung ultrasound demonstrated accuracy comparable to CT of the chest organs in detecting pneumonia in patients with COVID-19.