Depressed Lesions Research Articles

First Report of Colletotrichum siamense causing Anthracnose on Pecan in China.

Pecan (Carya illinoinensis) is one of the important economic forest crops which has been widely cultivated in Anhui and Jiangsu Provinces, China. Since 2019, symptoms resembling anthracnose disease had been observed in 5-ha and 6.6-ha pecan orchards in Quanjiao ( 32°5'7.08″ N, 118°16'2.91″ E), Anhui Province, and Jintan (31°42'23.84″ N, 119°21'22.90″ E), Jiangsu Province. The disease severity was about 20 to 30% with 5 to 15% (about 500 trees) incidence. In May, symptoms of leaf initially appeared as small dark lesions, which gradually developed to irregular-shaped, sunken lesions (Figure S1, A). From August to October, similar symptoms were also observed on the fruits. Infected fruits appeared irregularly, dark and depressed necrotic lesions on which orange spore masses could be occasionally observed (Figure S1, B). As the disease progressed, the necrotic lesions gradually expanded and merged, resulting in abscission of the fruits. Small fragments (4 × 4 mm) from the necrotic borders of infected fruits or leaves were surfaced sterilized, plated on potato dextrose agar (PDA) and then incubated in darkness at 25°C for 3 days. Pure cultures were obtained from individual conidia by recovering single spores. On the PDA plate, the colonies surface was white and cottony. Observing from the back of the plate, the colonies were pale yellow at the centre and pale white at the margin (Figure S1, E). Spores were produced over PDA plates after 7 days growth. Conidia were hyaline, smooth walls, aseptate, guttulate, cylindrical with rounded ends with 14.8 to 17.5 × 3.3 to 4.7 μm (mean 16.5 × 4.1μm, n = 50) in size (Figure S1, F). These morphological characteristics were similar to those of the species of Colletotrichum siamense (Prihastuti et al. 2009; Weir et al. 2012; Fu et al. 2019). Thirty-two isolates Colletotrichum sp. were obtained from the infected leaves and fruits (isolation frequency about 80%). To further identify the isolates, the regions of internal transcribed spacer (ITS), calmodulin (CAL), actin (ACT), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), chitin synthase (CHSI), and beta-tubulin 2 (TUB2) were amplified and sequenced from genomic DNA for the four representative isolates (JS1 and AH1 from infected fruits; JS2 and AH2 from infected leaves), respectively (Weir et al. 2012). Sequences of them were deposited in GenBank under nos. OP389224 to OP389227 (ITS), OP413765 to OP413768 (CAL), OP413761 to OP413764 (ACT), OP413773 to OP413776 (GAPDH), OP413769 to OP413772 (CHSI), and OP413777 to OP413780 (TUB2). Blast analysis showed these sequences shared high identity with C. siamense (100% with ITS, CAL, CHSI, and TUB2; 98.94% with ACT; 98.19% with GAPDH). Multilocus phylogenetic analysis revealed that the four isolates and C. siamense were clustered in the same clade (Figure S2). Based on the results of morphological and molecular analysis, these isolates were identified as C. siamense. The pathogenicity of four isolates was tested on two-year-old container-grown pecan seedlings, which were grown in the nursery. The conidial suspension with a concentration of 5 × 106 conidia/ml was sprayed evenly on the surface of leaves of a healthy seedling, and each isolate inoculated three pecan seedlings. The pathogenicity experiment was repeated three times. For negative controls, pecan seedlings were sprayed with sterilized distilled water. Finally, all inoculated plants were kept in a greenhouse at 25°C under a 16 h/8 h photoperiod and 70% relative humidity. Three weeks after inoculation, the inoculated plants showed symptoms similar to those of the original diseased plants (Figure S1, C), while controls remained asymptomatic (Figure S1, D). Cultures were re-isolated from the infected leaves and were identified as C. siamense by both morphological characteristics and DNA sequence analysis. Previously, C. nymphaeae, C. siamense, C. fructicola and C. viniferum have been reported to cause anthracnose of Pecan worldwide (Zhang et al. 2019; Oh et al. 2021; Poletto et al. 2019; Zhao et al. 2022 ). To our knowledge, this is the first report of C. siamense causing anthracnose on pecan in China. The identification of this pathogen will facilitate the development of strategies for managing the disease in China.

Bilateral en coup de sabre morphea in a male child: A rare presentation.

En coup de sabre is a rare subtype of morphea. Only a few bilateral cases have been reported to date. We report a case of a 12-year-old male child with two linear brownish depressed asymptomatic lesions over the forehead with hair loss on the scalp. After thorough clinical, ultrasonography and brain imaging, a diagnosis of bilateral en coup de sabre morphea was made and the patient was treated with oral steroids and weekly methotrexate.

A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Colonic amyloidosis: Rare endoscopic findings mimicking a depressed neoplastic lesion.

A colonic depressed lesion was found in a 77-year-old man and suspected as a neoplastic lesion using conventional endoscopy. Magnifying endoscopy, however, did not support it and biopsy revealed the lesion to be AL amyloidosis.

Endoscopic Screening for Missed Lesions of Synchronous Multiple Early Gastric Cancer during Endoscopic Submucosal Dissection.

To evaluate the value of endoscopic screening during endoscopic submucosal dissection (ESD) in the detection of synchronous multiple early gastric cancer (SMEGC) and the risk factors for missed diagnosis of SMEGC. We conducted gastric endoscopic screening during ESD operation in 271 patients with early gastric cancer (EGC) referred for ESD, and endoscopic follow-up within 1 year after the operation. The detection and characteristics of SMEGC were analyzed in three stages: before ESD, during ESD operation, and within 1 year after ESD. SMEGC was detected in 37 of 271 patients (13.6%). Among them, 21 patients with SMEGC (56.8%) were diagnosed before ESD, 9 (24.3%) were diagnosed with SMEGC by endoscopic screening during ESD operation, and 7 (18.9%) were found to have EGC lesions in the stomach during postoperative endoscopic follow-up within 1 year. The preoperative missed detection rate of SMEGC was 43.2%, and the rate of missed detection could be reduced by 24.3% (9/37) with endoscopic screening during ESD operation. Missed SMEGC lesions were more common in flat or depressed type and smaller in size than the lesions found before ESD. The presence of severe atrophic gastritis and age ≥60 years were significantly correlated with SMEGC (P < 0.05), while multivariate analysis showed that age ≥60 years was an independent risk factor (OR = 2.63, P < 0.05) for SMEGC. SMEGC lesions are apt to be missed endoscopically. Special attention should be paid to small, depressed, or flat lesions in detecting SMEGC, especially in elderly patients or (and) patients with severe atrophic gastritis. Endoscopic screening during ESD operation can effectively reduce the missed diagnosis rate of SMEGC.

EFECTO DE LOS PARÁMETROS DE ADQUISICIÓN EN IMÁGENES SPECT CEREBRALES: UN ESTUDIO SIMIND MONTECARLO

In this work cerebral SPECT images were simulated using the SIMIND Monte Carlo code. The specific purpose was the detection of characteristic Alzheimer’s disease (EA) and Major Depression (DM) lesions in simulated brain images, modeling the data acquisition from a source of 99mTc with a gamma camera Picker Prism 2000XP. An anthropomorphic phantom with brain lesions compatible with EA and DM were configured. The operational scenarios were configured on the basis of the frequent parameters recommended by the protocols as well as in working conditions in local health centers. The simulations performed verified that with the setup of the camera gamma, the pathognomonic lesions ofEA and DM can only be visualized if LEHR collimators, patient/detector distance of 16 cm and post-administration waiting time of 45 minutes are used.

An Unusual Case of Chest Pain and Pyrexia

Question: A 44-year-old man with tearing retrosternal pain for 2 weeks was admitted to our department. A day before the onset of symptoms, he had pharyngalgia, cough, sputum production, moderate pyrexia, and fatigue, which he thought was due to a common cold. He then had sudden-onset severe chest pain, which lasted 4 to 6 seconds and occurred every 30 seconds, with acid reflux and heartburn. The patient had consumed nothing after the start of the symptoms until this consultation. He denied emesis, hematemesis, melena, dysphagia, odynophagia, history of esophageal disease, eating hurriedly, ingestion of hot or rough food, anticoagulants, or foreign body. His medical history was significant for alcohol consumption (100 g/d) for more than 20 years. He visited a local hospital and underwent chest computer tomography (CT); however, the diagnosis was unclear, and an attempt to insert a nasogastric tube failed. The patient visited another hospital, and a CT scan revealed dilation of the esophageal lumen and thickening of the esophageal wall, with exudation in the periesophageal areas and lung fields. Esophagoscopy revealed a large depressed lesion at 20 cm from the incisors, measuring 1 cm in diameter and covered with pus. The background esophageal mucosa was severely inflamed and edematous. Contrast esophagography performed a week later showed accumulation of contrast medium in the middle and lower esophagus, which formed a sac-like shadow beside the esophagus, without communication with the thoracic or gastric cavity. The patient was treated conservatively, and his symptoms were partially relieved. Because the pathogenesis was still unknown, the patient was referred to our institution for further evaluation. What is the correct diagnosis and management of this condition? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult According to his medical history from other hospitals, normal electrocardiography and cardiac enzyme levels excluded the diagnosis of myocardial infarction; absence of hypertension and no abnormalities in aortic anatomy disclosed by means of contrast CT argued against aortic dissection; absence of emesis and no extravasation of contrast medium demonstrated by contrast esophagography excluded Boerhaave’s syndrome. Then contrast chest CT scan, which revealed thickening and liquid accumulation in the middle and lower esophageal wall, with little extra-esophageal air leakage and pneumonia (Figures A and B), and upper endoscopy (Figures C and D) were performed. A diagnosis of spontaneous intramural esophageal dissection (SIED) complicated by infectious esophagitis and pneumonia was made. SIED is a rare disease entity characterized by transverse and longitudinal separation of the mucosal and submucosal layers from the esophageal wall. Sudden onset of severe retrosternal chest pain, odynophagia, dysphagia, and hematemesis are the most common symptoms. Contrast esophagography and chest CT are the preferred methods to establish the diagnosis, and endoscopy also proved to be safe and useful in this condition. In most cases, conservative treatment has a good prognosis. Endoscopic interventions and surgery are alternative therapies when patients are refractory to conservative management or when complex complications occur.1Khil E.K. Lee H. Her K. Spontaneous intramural full-length dissection of esophagus treated with surgical intervention: multidetector CT diagnosis with multiplanar reformations and virtual endoscopic display.Korean J Radiol. 2014; 15: 173-177Crossref PubMed Scopus (4) Google Scholar,2Jung K.W. Lee O.J. Extensive spontaneous submucosal dissection of the esophagus: long-term sequential endoscopic observation and treatment.Gastrointest Endosc. 2002; 55: 262-265Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The patient was treated conservatively and discharged on day 35. Seven weeks later, follow-up endoscopy showed complete mucosal healing (Figure E), and he was asymptomatic at the time of writing (August 1, 2022).

Endoscopic findings of gastric neoplasms in familial adenomatous polyposis are associated with the phenotypic variations and grades of dysplasia.

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric neoplasms. However, endoscopic findings have not been sufficiently investigated. We investigated the phenotypic expression of gastric adenoma (low-grade dysplasia) and gastric cancer (high-grade dysplasia or carcinoma) in patients with FAP and clarified their relationships to endoscopic findings. Of 29 patients with FAP who underwent esophagogastroduodenoscopy between 2005 and 2020, 11 (38%) had histologically confirmed gastric neoplasms, including 23 lesions of gastric adenoma and 9 lesions of gastric cancer. The gastric neoplasms were classified into 3 phenotypes (gastric, mixed, or intestinal type) according to the immunostaining results and evaluated for location (U or M region: upper or middle third of the stomach or L region: lower third of the stomach), color (same as the background mucosa, whitish, or reddish), macroscopic type (elevated, flat, or depressed), background mucosal atrophy (present or absent), fundic gland polyps in the surrounding mucosa (present or absent), and morphologic changes in tumor size. Elevated whitish gastric adenomas were further subdivided by macroscopic type (flat elevated, protruded, or elevated with a central depression) and color (milky- or pinkish-white). The gastric adenomas included gastric (11/23, 48%), mixed (4/23, 17%), and intestinal (8/23, 35%) phenotypes. In contrast, no lesions of gastric cancers showed a gastric phenotype (0/9, 0%), while 5 (56%) and 4 (44%) lesions were intestinal and mixed phenotypes, respectively. Gastric cancers were significantly more likely than gastric adenomas to present as reddish depressed lesions with gastric atrophy. All gastric-type adenomas occurred in non-atrophic mucosa, in mucosa with fundic gland polyps in the periphery, in the U or M region, and as flat elevated or protruded lesions with a milky-white color. Half of the lesions increased in size. Meanwhile, the typical endoscopic features of intestinal-type adenomas included occurrence in the L region and elevated pinkish-white lesions with central depression. None of the intestinal-type adenomas increased in size during the observation period. We believe that these endoscopic features will be useful for the prompt diagnosis and appropriate management of gastric neoplasms in patients with FAP.

P209 First report of Mycetoma due to Madurella fahalii from India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveTo describe the first case report of Madurella fahalii from India.MethodsA 70-year-old non-diabetic man from Bhadrak Odisha who worked as a soldier in past came to us with a history of pus discharge containing black grains the size of mustard seeds from multiple sinuses in the posterior aspect of the thigh for last 5 years. He had been operated 2 years back for the same complaints, however, finding no relief he visited us. On examination, a depressed lesion measuring 10 × 10 cm, containing 6-8 sinuses which discharged pinkish yellow colored pus containing black grains measuring 0.5 × 1 cm was found on the posterior aspect of the thigh. The lesion was painless, doughy in consistency, and associated with enlarged and non-matted and non-tender inguinal lymph nodes measuring 2 × 2 cms. General physical examination and routine hematological laboratory examination revealed no abnormalities. Serological tests did not reveal the presence of HIV, Hepatitis B, or Hepatitis C infection. A clinical diagnosis of black grain mycetoma was made and the patient was sent to mycology laboratory for fungal culture. Black hard grains were found on KOH mount and culture on inhibitory mold agar grew a brown colony which diffused a brown pigment into the medium after 15 days of incubation. LPCB examination showed brown non-sporulating mold. DNA was extracted using phenol-chloroform isoamyl alcohol after grinding the mycelial mat in liquid nitrogen and subjected to PCR using ITS4 and ITS5 primers as described previously. The product was subjected to sanger sequencing and subjected to blast and it showed 99.45% similarity to M. fahalii (MF980633). The patient was started on Itraconazole in lieu of voriconazole as the patient could not afford the drug. While there is no reduction in the size of the lesion the patient reported symptomatic relief and is still on follow-up.ConclusionTo the best of our knowledge this is the first case of Mycetoma due to M. fahalii from India.

Clinicopathological and molecular characterization of early gastric adenocarcinoma in Helicobacter pylori-uninfected patients: emphasis on differentiated gastric adenocarcinoma.

Recently, Helicobacter pylori (HP)-uninfected gastric mucosal cancer has been reported; however, the clinicopathological and molecular features of HP-uninfected gastric cancer have not been elucidated. We evaluated the clinicopathological, immunohistochemical, and genetic alterations in HP-uninfected early gastric adenocarcinoma using next-generation sequencing (NGS). Among 968 primary early gastric carcinomas, 64 (6.6%) were HP-uninfected gastric adenocarcinoma and were pathologically classified as gastric adenocarcinoma of fundic-gland type (GA-FG, n = 39), differentiated gastric adenocarcinoma (DGA, n = 16), and signet-ring cell carcinoma (SRCC, n = 9). Based on the expression profile of the mucin core protein, DGAs were classified into a gastrointestinal phenotype showing either MUC5AC or MUC6 expression and MUC2 or CD10 expression simultaneously (n = 5), and a gastric phenotype (n = 11) showing either MUC5AC or MUC6 expression. All DGAs with a gastrointestinal phenotype shared similar endoscopic characteristics, such as reddish depressed lesions in the antrum. In contrast, DGAs with a gastric phenotype exhibited several distinct endoscopic features, including a raspberry-shaped appearance and whitish flat-elevated appearance; the former expressed only MUC5AC and the latter exhibited co-expression of MUC5AC and MUC6. Among 16 HP-uninfected DGAs, seven were subjected to NGS. APC was recurrently mutated in DGA (42.9%) and was enriched in DGAs with a gastrointestinal phenotype (75%). Overall, HP-uninfected gastric adenocarcinomas showed distinct clinicopathologic and endoscopic characteristics. Furthermore, HP-uninfected DGAs, especially those with a gastrointestinal phenotype, may be characterized by recurrent APC mutations.

Anthracnose of Onion (Allium cepa L.): A Twister Disease

The onion (Allium cepa L.) is a lucrative and high-value vegetable–spice crop in India, but it is sensitive to several of diseases caused by fungi, bacteria, viruses, and nematodes, of which a fungal disease, anthracnose, caused by Colletotrichum spp., is a major issue for both onion producers and researchers since it severely affects the bulb production. Twister disease is currently one of the most common problems in onion production, particularly in humid regions, and it reduces productivity while also lowering the value and profitability. Twister disease is visualised by white or pale-yellow water-soaked oval depressed lesions on leaf blades, which are the first symptoms. Lesions expand as the disease advances, and numerous black-coloured, slightly elevated structures/fruiting bodies appear in the middle area, arranged in concentric rings. Curling, twisting, chlorosis of the leaves, and aberrant extension of the neck or pseudo-stem occurs, followed by rotting of the bulb. In an unmanaged crop, an excess gibberellin production by Colletotrichum gloeosporioides and Gibberella moniliformis is suspected to induce twisting and aberrant neck elongation, which will ruin onion productivity. It is difficult and environmentally unfriendly to control these infections. Since, to the best of our knowledge, this is the first review on onion anthracnose, we tried to consolidate information. This review updates our knowledge of the pathogen, including the disease cycle, infection pathways, and disease management techniques. As a result, growers will be benefit from the application of cultural, biological, and chemical measures and the use of resistant varieties.

A case of submucosal tumor- like lesion of the sigmoid colon with a hyalized and calcified mass

We report about a man in his seventies who developed anemia. He had been diagnosed with diabetes, dyslipidemia, hyperuricemia, and gastroesophageal reflux disease. Colonoscopic examination revealed an irregular surface submucosal tumor - like lesion, with the top being depressed in the sigmoid colon. We attemped to lift the lesion, to inject saline into the submucosal layer when the saline spouted from the top of the depressed lesion. Next, we snared and partially resected the lesion. After clipping to the cutting section, a yellow-whitish mass appeared from oral side of the lesion. Histopathological finding of the cut section revealed hyperplastic mucosa with lymphocyte infiltration and serrated structure glands in the submucosal layer. The yellow-whitish mass contained bacteria, feces, and inflammatory cell infiltration with hyaline and calcification. The patient is being followed up, his anemia has not progressed.

A case of superficial spreading type of poorly differentiated adenocarcinoma of the stomach with invasion to the esophagus

BackgroundInvasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions.Case presentationA 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas (por, sig) were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence.ConclusionWe encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal.

Morphological Analyses of Colorectal Adenocarcinomas in Japanese Familial Adenomatous Polyposis Patients.

Objectives: This retrospective study was conducted to clarify the morphological characteristics of colorectal cancer (CRC) in Japanese familial adenomatous polyposis (FAP) patients. Methods: This study was carried out by the study group for FAP of the Japanese Society for Cancer of the Colon and Rectum. FAP patients who underwent surgical resection between 2000 and 2012 were included in the study. Results: Of the 303 patients enrolled, 119 patients without CRC were excluded. Of 523 lesions, 49 lesions with missing morphological information were excluded; hence, only 474 CRC lesions in 178 patients (328 superficial lesions in 122 patients and 146 non-superficial lesions in 92 patients) were included in the study. Depressed lesions accounted for 3.0% of superficial lesions and ulcerated lesions accounted for 84.9% of non-superficial lesions. The depressed superficial lesions were observed only in patients with sparse and attenuated FAP (P = 0.003). The age of the patients at surgery differed between the two groups, with patients with depressed superficial lesions being significantly older than those with non-depressed superficial lesions (P = 0.009). Moreover, the age of the patients at FAP diagnosis differed between the two groups, with patients with ulcerated non-superficial lesions being significantly older than those with protruded non-superficial lesions (P = 0.006). Conclusions: In patients with FAP, depressed superficial CRC lesions rarely developed but were detected in our study group, and ulcerated non-superficial CRC lesions were also present with similar ratios. Clinicians should pay attention to depressed superficial lesions during endoscopic surveillance of FAP patients.

Usefulness of magnifying endoscopy with acetic acid and narrow-band imaging for the diagnosis of duodenal neoplasms: proposal of a diagnostic algorithm.

This study aimed to clarify the features of superficial non-ampullary duodenal epithelial tumors (SNADETs) on magnifying endoscopy with narrow-band imaging (M-NBI) and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI), and evaluate the efficacy of M-NBI/M-AANBI to distinguish high-grade adenomas or adenocarcinomas (HGA/AC) from low-grade adenomas (LGA). Clinicopathological data on 62 SNADETs in 58 patients who underwent preoperative M-NBI/M-AANBI and endoscopic resection were retrospectively reviewed. The pathological results were classified into two categories, LGA and HGA/AC. We evaluated microvascular patterns (MVPs) and microsurface patterns (MSPs) observed by M-NBI and MSPs observed by M-AANBI for characterizing LGA and HGA/AC. The kappa value was calculated to assess the interobserver and intraobserver agreements of evaluation of M-AANBI images. Pathologically, 38 lesions (61.3%) were LGA and 24 lesions (38.7%) were HGA/AC. HGA/AC tended to have irregular MVP and/or MSP on M-NBI. M-NBI diagnostic performance to distinguish HGA/AC from LGA showed 62.5% sensitivity, 68.4% specificity, and 66.1% accuracy. SNADETs had irregular MSP on M-AANBI. Three irregularity grades (iG) of MSP were observed by M-AANBI as follows: iG1, mild; iG2, moderate; iG3, significant. HGA/AC lesions had a significantly higher rate of iG3 than LGA lesions (p < 0.001). The iG2 was associated with HGA/AC in elevated lesions and LGA in depressed lesions. The diagnostic performance of M-AANBI was as follows: 95.8% sensitivity, 97.4% specificity, and 96.8% accuracy. The diagnostic accuracy of M-AANBI was significantly higher than that of M-NBI (p < 0.001). The kappa value for interobserver agreement on the diagnosis and irregularity grading of M-AANBI images was 0.742 and 0.719, respectively. These data indicate substantial interobserver agreement. Based on the above-mentioned results, we developed a M-AANBI diagnostic algorithm for SNADETs. The diagnostic algorithm for SNADETs using M-AANBI may be useful for differentiating between LGA and HGA/AC.

Buttocks' Skin Laxity Severity Scale.

Clinical scales are useful to assess skin laxity in different areas of the body. To elaborate and validate a photonumeric scale to assess buttocks skin laxity. The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial.

ObjectivesThree subcategories of high‐risk flat and depressed lesions (FDLs), laterally spreading tumors non‐granular type (LST‐NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post‐colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high‐risk FDLs are lacking. We aimed to explore whether a web‐based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high‐risk FDLs.MethodsThis was an international web‐based randomized control trial that enrolled non‐expert endoscopists in 13 Asian countries. The participants were randomized into either education or non‐education group. All participants took the pre‐test and post‐test to read 60 endoscopic images (40 high‐risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self‐education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high‐risk FDLs.ResultsIn total, 284 participants were randomized. After excluding non‐responders, the final data analyses were based on 139 participants in the education group and 130 in the non‐education group. The detection rate of high‐risk FDLs in the education group significantly improved by 14.7% (66.6–81.3%) compared with −0.8% (70.8–70.0%) in the non‐education group. Similarly, the detection rate of LST‐NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively.ConclusionShort self‐education focusing on detecting high‐risk FDLs was effective for Asian non‐expert endoscopists. (UMIN000042348).

Texture and Color Enhancement Imaging with Indigo Carmine Dye Accentuates Slightly Depressed Early Gastric Cancer Lesions

A 74-year-old man visited our hospital for follow-up esophagogastroduodenoscopy after eradication of Helicobacter pylori. Transnasal endoscopy (GIF-1200N with the EVIS X1 video system, Olympus Medical Systems, Tokyo, Japan) revealed a reddish lesion located in the anterior wall of the prepyloric region on white light imaging (Figure A) using indigo-carmine dye (Figure B). On texture and color enhancement imaging (TXI) mode 1 with indigo-carmine dye (chromo-TXI), the lesion was highlighted as being reddish and slightly depressed (Figure C). Endoscopic submucosal dissection was performed on the suspicion of a well-differentiated tubular adenocarcinoma for biopsy and endoscopic diagnosis. Histologic examination showed the lesion to be adenocarcinoma, well-differentiated, Paris type 0-IIc, measuring 5 × 5 mm, pT1a (M), no lymphovascular invasion (Figure D). TXI is a recently developed technique that enhances brightness, surface irregularities, and subtle color changes. Chromo-TXI facilitated the endoscopic diagnosis of early gastric cancer even with transnasal endoscopy, highlighting slightly depressed lesions, where reddish depressed lesions observed following H pylori eradication are often shown to be indistinguishable from gastric cancer lesions. Thus, chromo-TXI seems to be a more useful modality than white light imaging and may set a new standard for the detection of depressed early gastric cancer lesions.

SMALL AS WELL AS LARGE COLORECTAL LESIONS ARE EFFECTIVELY MANAGED BY ENDOSCOPIC MUCOSAL RESECTION TECHNIQUE.

Endoscopic mucosal resection (EMR) is an easy-to-use treatment option for superficial colorectal lesions, including lesions ≥20 mm. To evaluate the effectiveness of EMR. We evaluated 430 lesions removed by EMR in 404 patients. The lesions were analyzed according to their morphology, size, location, and histology. Lesions <20 mm were resected en bloc, whereas lesions ≥20 mm were removed by piecemeal EMR (p-EMR). Adverse events and recurrence were assessed. Regarding morphology, 145 (33.7%) were depressed lesions, 157 (36.5%) were polypoid lesions and 128 (29.8%) were laterally spreading lesions, with 361 (84%) lesions <20 mm and 69 (16%) ≥20 mm. Regarding histology, 413 (96%) lesions were classified as neoplastic lesions. Overall, 14 (3.3%) adverse reactions occurred, most commonly in lesions removed by p-EMR (P<0.001) and associated with advanced histology (P=0.008). Recurrence occurred in 14 (5.2%) cases, more commonly in lesions removed by p-EMR (P<0.001). EMR is an effective technique for the treatment of superficial colorectal lesions, even of large lesions.

Effects of spirulina as a functional ingredient in arsenic-induced broiler diet on growth performance and hematobiochemical parameters.

The purpose of this research was to look into the impacts after the implication of feeding broiler chickens with spirulina in arsenic-incited toxicities. Birds (n = 125) were distributed equally (n = 25) into four groups treated (T 1, T 2, T 3, T 4) and a group controlled, T 0 (normal feed and water without supplement), the group taking in arsenic trioxide (100 mg/l)-induced diet (T 1), and the groups T 2, T 3, and T 4 (feed supplemented with 50, 100, and 200 mg/l of spirulina along with Arsenic Trioxide, respectively). The body weight and hematobiochemical parameters were recorded every 7 days. Different growth development indicators, e.g., body weight, feed intake ratio, feed conversion ratio, depression, and skin lesions, were weak in arsenic trioxide groups and upstanding in the arsenic plus spirulina group. Over and above, the lack of body weight gain in chicken (2.7%-13.00%) in the arsenic-introduced groups given spirulina (T 2, T 3, and T 4) overtook the mere groups exposed to arsenic, where the lack of weight gain was optimum (54.90%). Thereafter, in arsenic-instituted groups given spirulina (T 2, T 3, and T 4), the drop in total erythrocyte count, total leukocyte count, hemoglobin, and packed cell volume values became less notable than in arsenic pollutant groups (T 1, p < 0.01). Two measurable factors (serum glutamate pyruvate transaminase and serum glutamic oxaloacetic transaminase) were substantially (p < 0.01) raised in the group (T 1) treated with arsenic, but in the arsenic-induced groups (T 2, T 3, and T 4) treated with spirulina, they were elevated less. This study demonstrates that arsenic is a threat to poultry. However, spirulina may be advantageous for alleviating the effects of arsenic in poultry.