Differential Diagnostic Significance Research Articles

Unveiling ficolins: diagnostic and prognostic biomarkers linked to the Tumor Microenvironment in Lung Cancer

BackgroundFicolins (FCNs) are a family of proteins, comprising FCN1, FCN2 and FCN3, and integral to the immune system which have been implicated in the onset and progression of tumors. Despite their recognized roles, a comprehensive analysis of FCNs in lung cancer remains elusive.MethodsWe employed a variety of bioinformatics tools, including UCSC, SangerBox, Ualcan, cBioPortal, String, Metascape, GeneMANIA, TIDE, CTD, and CAMP databases to investigate the differential expression, diagnostic and prognostic significance, genetic alterations, functional enrichment, immune infiltration, and potential immunotherapeutic implications of FCN1, FCN2, and FCN3 in lung squamous cell carcinoma (LUSC) and lung adenocarcinoma (LUAD). Additionally, RT-qPCR and immunohistochemistry were utilized to validate the expressions of FCNs at the mRNA and protein levels in LUSC and LUAD.ResultsOur comprehensive bioinformatic analysis, supported by RT-qPCR and immunohistochemistry, revealed that the expressions of FCN1, FCN2 and FCN3 were consistently downregulated in both LUSC and LUAD tumor tissues. FCNs demonstrated significant diagnostic potential for LUSC and LUAD, with the area under the receiver operating characteristic curve (AUC) for FCN1 and FCN3 exceeding 0.90. Furthermore, FCN2 and FCN3 showed a strong negative correlation with overall survival (OS) in LUSC, whereas FCN1 and FCN2 were positively correlated with OS in LUAD, suggesting their prognostic value in lung cancer. Gene enrichment analysis indicated that FCNs were predominantly associated with the complement system and complement activation pathways. Immune infiltration analysis further revealed a significant positive correlation between FCNs and the presence of neutrophils and resting mast cells. Our analysis of immunotherapy outcomes revealed a significant disparity in the immunophenoscore (IPS) among lung cancer patients treated with immune checkpoint inhibitors (ICIs), distinguishing those with high FCN expression from those with low FCN expression. Additionally, we identified small molecule compounds related to FCNs and drugs pertinent to LUSC and LUAD.ConclusionFCNs held promise as diagnostic and prognostic biomarkers for LUSC and LUAD. This study also elucidated the relationship of FCNs with the tumor microenvironment, offering novel insights into the immunotherapeutic landscape for LUSC and LUAD.

Diagnostic criteria of death cause from low temperature in air and water established by traditional expert examination methods

To clarify and supplement the complex of differential diagnostic macro- and microscopic signs of a fatal acute general cold trauma received when person is in the air and water. The conclusions of forensic medical experts on the bodies of people who died from hypothermia in the air and in water (by 150 observations) were analyzed. Methods of descriptive statistics, calculation of the frequency ratio of signs' occurrence were used. The article provides quantitative assessment of occurrence (detection) rate of diagnostically significant signs established with the help of traditional methods of expert examination. A new classification of diagnostic death signs from hypothermia taking into account their differential diagnostic significance and reflecting the conditions of a person's stay in the air and water in the pre-mortem and post-mortem periods, as well as terminal period mechanisms is proposed. The established complexes of signs provide an objective basis for determining death cause in non-obvious conditions when cold exposure is expected to be one of the most damaging factors.

Wounds caused by vasculitis-Current classification, diagnostics and treatment

Wounds of the skin can have very different causes. Especially in clinically atypical or non-healing wounds, the very heterogeneous group of vasculitides is of particularly important differential diagnostic significance. Nowadays, the classification of vasculitis is based on the affected vessels according to the Chapel Hill consensus conference. Thus, potentially any part of the vascular system can be affected. It becomes clear that there is often arisk of systemic diseases with high interdisciplinary relevance.Clinically, the usually very painful wounds in cutaneous vasculitis develop from necrosis and are typically surrounded by an erythematous-livid rim in the florid phase. In addition to clinical inspection, the histopathological examination of biopsies is of particular importance in the usually extensive diagnostic work-up.Therapeutically, adequate wound treatment should always be performed with afocus on pain prevention and infection prophylaxis. In the case of edema, compression therapy also supports wound healing. In addition, it is often necessary to initiate systemic treatment with immunosuppressive or immunomodulating drugs. Whenever possible, causally relevant factors and comorbidities should be diagnosed early and avoided or treated. Otherwise, there is arisk of severe or even fatal disease progression.

Advances in the differential diagnosis of transient hyperthyroidism in pregnancy and Graves' disease.

The occurrence of thyrotoxicosis during pregnancy is mainly attributed to gestational transient thyrotoxicosis (GTT) and Graves' disease (GD). It is important to distinguish between GTT and Graves' disease because the two diseases are treated very differently. However, a gold standard for the differential diagnosis of the two diseases is currently lacking, and the most common method of differentiation is based on past medical history and clinical presentation combined with thyroid-related antibodies. A literature search of the electronic databases PubMed, Embase, Medline, Google Scholar, Cochrane Library, China Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journals Full Text Database and China Biomedical CD-ROM was performed. The search period ranged from journal inception until 2022. We used the following search terms in "All fields": {["thyroid" (common field) OR "thyroid" (subject line)] OR "hyperthyroidism" (common field)} AND {["pregnancy" (title) OR "pregnancy" (title)] AND "one over" (common field)} OR {["pregnancy" (common field) OR "pregnancy" (common field) OR "pregnancy" (subject line)] AND "Graves'" (common field)}. In recent years, some clinical studies at home and abroad have proposed other meaningful differential indicators, such as thyroid stimulating hormone, chorionic gonadotropin, thyroid hormone levels and thyroid ultrasound. The differential diagnostic significance of each of these indicators is summarised here with the goal of providing a better reference for the differential diagnosis of hyperthyroidism during pregnancy in clinical practice.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

Prediction of BRAF mutation status in glioblastoma multiforme by preoperative ring enhancement appearances on MRI.

BackgroundRing enhancement on magnetic resonance imaging (MRI) is an important characteristic of GBM. Though patients suffering from glioblastoma multiforme (GBM) with BRAF mutation (MUT BRAF) in V600E benefit from BRAF-targeted inhibitors, the relationship between ring enhancement and MUT BRAF remains elusive. The purpose of this study was to investigate the relationship between BRAF mutation status and the appearance of ring enhancement so as to guide preoperative targeted therapy for MUT BRAF GBM.MethodsPatient’s population, clinical data and characteristic ring enhancement appearances on MRI were compared between GBM with MUT BRAF and GBM with WT BRAF. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the differential diagnostic significance. A nomogram was developed to predict the mutation status of BRAF. Moreover, all the variables were re-analyzed between epithelioid GBM (E-GBM) with or without MUT BRAF.ResultsCompared to GBM with WT BRAF, GBM with MUT BRAF had specific ring enhancement appearances with multiple rings, multiple located lobes, regular shape of ring, uniform thickness of ring and smaller diameter of ring. Area under the curve (AUC) of all the variables’ combination was 0.929. The nomogram was developed and validated. The re-analyzed results between E-GBM with or without MUT BRAF were similar to these above. AUC of the combination of quantity of ring, quantity of located lobe and shape of ring was 0.962.ConclusionThe characteristic ring enhancement appearances of GBM may play an important role in predicting BRAF mutation status preoperatively, especially in E-GBM. Further study with larger cases may provide more evidences to guide the pretreatment of targeted medicine for GBM patients with MUT BRAF in future.

Optical coherence tomography in the differential diagnostics of important neuro-ophthalmological disease patterns

There are many disease patterns that are treated jointly by neurologists and ophthalmologists, for which optical coherence tomography (OCT) is of important differential diagnostic significance. In this context neurologists are mainly confronted by two patient collectives: patients with an acute ischemic event, who present with an acute but painless monocular visual deterioration (for central retinal artery occlusion) or with a monocular visual field defect (for arterial branch occlusion or anterior ischemic optic neuropathy). The second collective is patients without ophthalmological symptoms but with conspicuous optic nerve findings (papilledema or optic disc drusen). In this overview article both patient collectives are considered separately. In addition, the most important OCT findings for optic neuritis are presented. Before the disease patterns are described in detail, the normal OCT findings and the diagnostic possibilities of OCT are explained.

On the differential diagnostic prospects of determining the profile of the lateral organization of the personality during assessment of the systematic alcohol abuse

The article is devoted to the question of the possible improvement of the psychological examination of persons previously examined in alcoholic intoxication (hereinafter—PEAI). The authors propose an original view on the definition of the target of «alcohol screening», the principles and methods of assessing psychological markers of the systematic substance abuse. Purpose of the study: to determine the differential diagnostic significance of identifying the profile of the lateral organization (hereinafter—PLO) when assessing of the systematic of alcohol abuse in those previously examined in a state of alcoholic intoxication. The researchers made an attempt to highlight the features of PLO of such a «risk group» as those previously examined in a state of alcoholic intoxication (based on data obtained during the study according to the typology of E.D. Khomskaya (with a combination of three types of asymmetries: manual, auditory-verbal and visual) of lateral preferences of 19 PEAI patients of the branch of the Moscow Research and Practical Center for Narcology). As a result, the tendency of those previously examined in the state of intoxication to the lack of a «leading ear» and «leading eye», significant differences in the distribution of the attribute «leading hand» among those previously examined in a state of alcoholic intoxication and in the population were revealed. Conclusion. According to the results of this study, it is difficult to assume the presence of a significant differential diagnostic significance of PLO detection during «alcohol screening» among those previously examined in a state of alcoholic intoxication. At the same time, it should be noted that taking into account lateral preferences can contribute to the improvement of preventive work programs in the narcological service, providing greater individualization of psychological support measures. Directly in the rehabilitation work with PEAI, it is advisable to actively apply social and psychological training (because of a significant part of the contingent among the main factors of relapse with a high degree of probability has social stressors). The creation of short-term (3-5 meetings) programs of group exercises of a preventive orientation, which have different targets depending on the «vulnerability factors» of the owners of certain lateral profiles, also seems justified.

Diagnostic significance of CyclinD1 and D2-40 expression for follicular neoplasm of the thyroid

ObjectivesTo evaluate the expression and differential diagnostic significance of CyclinD1 and D2–40 in follicular neoplasm (FN) and other thyroid adenomatoid lesions. MethodsA total of 144 cases of thyroid adenomatoid lesions were enrolled. Immunohistochemistry for CyclinD1 and D2–40 was performed. ResultsWe found two patterns of CyclinD1 expression: nuclear (N) and cytoplasmic (C). The expression of N-CyclinD1 / C-CyclinD1 in FN (77.4%, 48/62; 50.0%, 31/62) was much higher than that in multinodular goiters with dominant nodules (MNG-DN) (16.4%, 10/61; 4.9%, 3/61) (p < 0.05). In contrast, the expression of D2–40 in MNG-DN (82.0%,50/61) was much higher than that in FN (4.8%, 3/62) (p < 0.05). In addition, unique staining patterns were observed: CyclinD1 showed no immunostaining only in all 8 cases of oncocytic cell tumors (OCT); D2–40 staining showed the characteristic wide distribution of lymphatic vessels in all 8 cases of poorly differentiated thyroid carcinoma (PDTC). Finally, the expression of CyclinD1 and D2–40 did not differ among follicular thyroid adenoma and follicular thyroid carcinoma / noninvasive follicular thyroid neoplasm with papillary-like nuclear features (p > 0.05). ConclusionsCyclinD1 and D2–40 are helpful diagnostic markers of FN, which can assist to discern FN from MNG-DN / OCT / PDTC.

LncRNA AC136007.2 alleviates cerebral ischemic-reperfusion injury by suppressing autophagy.

Differential expression and diagnostic significance of the long noncoding RNA (lncRNA) AC136007.2 has been reported in patients with acute ischemic stroke (AIS). However, its role on disease progression and outcome remains unclear. Here, we employed an oxygen-glucose deprivation/reperfusion (OGD/R) model in neuronal SH-SY5Y cells and performed middle cerebral artery occlusion (MCAO) surgery in rats to investigate the function of AC136007.2 in ischemia-reperfusion (I/R) injury. AC136007.2 expression was determined by RT-qPCR and cell viability was examined using CCK-8, Edu, LDH, and apoptosis assays. Pro-inflammatory cytokine expression was assessed using ELISA. OGD/R downregulated AC136007.2 expression in SH-SY5Y cells, decreased viability by inducing apoptosis, and stimulated secretion of TNF-α, IL-6, and IL-1β. In turn, lentivirus-mediated AC136007.2 overexpression significantly reversed these phenomena. LC3 immunofluorescence and western blotting analyses of LC3-I/II and Beclin-1 expression and AMPK/mTOR phosphorylation status showed that AC136007.2 suppressed autophagy in SH-SY5Y cells via inactivation of AMPK/mTOR signaling. Notably, incubation with the AMPK activator AICAR abolished the pro-survival effect of AC136007.2 upon OGD/R treatment. Importantly, intraventricular injection of AC136007.2 significantly reduced cerebral infarction and brain edema in MCAO rats, as shown by TTC staining and water content measurements. We conclude that AC136007.2 alleviates cerebral I/R injury by suppressing AMPK/mTOR-dependent autophagy.

ДИФФЕРЕНЦИРОВАННАЯ ТРАНСФОРМАЦИЯ ФЕНОТИПА СУБПОПУЛЯЦИЙ НЕЙТРОФИЛЬНЫХ ГРАНУЛОЦИТОВ ПРИ ВИРУСНО-ВИРУСНЫХ И ГНОЙНЫХ БАКТЕРИАЛЬНЫХ ИНФЕКЦИЯХ У ИММУНОКОМПРОМЕТИРОВАННЫХ ДЕТЕЙ

Children with clinical signs of immunocompromise have impaired functioning of the immune system. At the same time, the state of subpopulations of multifunctional neutrophil granulocytes (NG), which provide antiviral and antibacterial protection, in such patients has been poorly studied. Objective of the study: to assess the features of the transformation of the phenotype of the three most significant subpopulations of NG, their association with impaired phagocytic and microbicidal activity in immunocompromised children with atypical viral-viral co-infections and bacterial infections, and to clarify their differential diagnostic significance. Materials and methods of research: the phenotypes of NG subpopulations expressing CD64, CD32, CD16, CD11b receptors, phagocytic and microbicidal activity of NG were studied in the peripheral blood of 43 immunocompromised children of both sexes aged of 5–9 years old suffering from recurrent ARVI, atypical chronic mono – or mixed herpes virus infections (HVI) and purulent bacterial infection. 3 study groups were formed: 1st – repeated ARVI/HVI mono, 2nd – repeated ARVI/HVI mixed, 3rd – minor purulent infection (MPI) and a comparison group (20 apparently healthy children). Results: different differentiated transformation of the phenotype of functionally significant subpopulations of NG associated with impaired functional activity of NG as well as with the incidence of viral co-infections (repeated ARVI and recurrent HVI mixed) and the severity of clinical manifestations of MPI has been identified in the studied groups. Conclusion. Еvaluation of the features of transformation of phenotype of NG subpopulations, their effector functions in immunocompromised children with atypical viral-viral co-infections and purulent bacterial infections, will allow in the future to optimize the methods of target immunotherapy aimed at remodulating the negatively transformed phenotype of NG subpopulations, correcting their dysfunctions and, thereby, significantly increase the clinical effectiveness of therapeutic and preventive measures.

Karakteristike bolesnika sa sekundarnom eritrocitozom u odnosu na bolesnike sa policitemijom verom

Introduction: Erythrocytosis represents elevated hemoglobin and hematocrit levels above the range of normal values. Primary erythrocytosis - polycythemia vera, is characterized by increased erythrocyte production, due to a disorder at the level of the multipotent stem cell in the bone marrow. On the other hand, secondary erythrocytosis (SE) is the result of bone marrow stimulation by an external factor. Aim: The aim of our study was to determine parameters which are significant in differentiating SE from primary erythrocytosis - polycythemia vera (PV). Materials and methods: This is a retrospective study involving 108 patients with SE and 111 patients with PV, who were diagnosed and treated at the Clinic of Hematology of the Clinical Center of Serbia (CCS), in the period: December 2005 - November 2018.From the patient records, the following data were extracted: demographic characteristics, laboratory parameters, spleen size, total red cell mass, serum erythropoietin (EPO) level, and spontaneous growth of the BFU-E colony. Results: Patients with SE were younger, with a predominance of the male gender and with significantly higher serum EPO values than patients with PV. Patients with PV had significantly higher values of BFU-E, leukocyte and platelet count, spleen size, and LDH level than patients with SE. Total red cell mass analysis did not show a differential diagnostic significance. Conclusion: Findings of normal spleen size, normal leukocyte and platelet count, normal serum LDH level, and elevated EPO, in patients, refer to the diagnosis of secondary erythrocytosis, while the findings of splenomegaly, leukocytosis, thrombocytosis, elevated serum LDH level, decreased EPO, and the presence of spontaneous BFU-E colony speak in favor of the diagnosis of polycythemia vera.

Evaluation of the diagnostic and differential diagnostic value of SOCT and microperimetry methods in patients with visual disturbances due to multiple sclerosis

Purpose: statistical evaluation of the diagnostic and differential diagnostic significance of spectral optical coherent tomography (SOCT) and microperimetry methods in patients with (1) optic neuritis (ON) with multiple sclerosis (MS) manifestation; (2) inflammation-related ON and (3) optic nerve atrophy (ONA) caused by MS. Materials and methods. The results of examination of the three groups of patients were processed by correlation and multivariate analysis and binary logistic regression. The threshold of electrical sensitivity (EST) and electrical lability (EL) were determined on a Fosphen-tester using a standard technique. S-OCT was performed on Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA) using the RNFL Thickness Analysis, Ganglion Cell Analysis programs. Computer microperimetry was done on MP-1 (Nidek technologies, Vigonza, Italy) using the macula 12º 10 dB program. Results . EST of the retina was found to have a strong bilateral correlation with the average retinal sensitivity, RNFL thickness and thickness of the upper temporal and upper segments layer of the complex GCL + IPL. Diagnostic parameters significant for visual analyzer disorders caused by MS were revealed and confirmed, including the average retinal sensitivity drop within 6º from the center of the visual field according to microperimetry (p &lt; 0.0005), the thinning of RNFL (p &lt; 0.005) and complex GCL-S + IPL, according to SOCT (p = 0.004). intragroup comparisons revealed the diagnostic significance of SOCT in early diagnosis of ONA due to MS (p &lt; 0.0005). It was found that if the RNFL was 62 microns or less, the GCL-S + IPL was 52 microns or less (in the inferior segment it was 50 microns or less, and in the upper segment it was 51 microns or less) then, with a sensitivity of 100 % and a specificity of 87.5–93 %, it is an evidence of the atrophy of the optic nerve. Conclusion: average retinal photosensitivity within 6º from the center of the visual field, RNFL thickness, thickness GCL-S + IPL, including that in the superior, superior temporal and inferior segments can be considered as diagnostically significant values in OH inflammatory-related and demyelinating OH and the development of ONA due to MS.

Differential expression and diagnostic significance of P53, MutS homologs 2, tropomyosin-4 in alpha-fetoprotein-negative hepatocellular carcinoma.

BackgroundCurrent study aimed to explore the value of P53, MutS homologs 2 (MSH2), and tropomyosin‐4 (Tm‐4) combined with inflammatory factors, life‐history traits in the differential diagnosis of alpha‐fetoprotein‐negative hepatocellular carcinoma (AFP‐Negative HCC).MethodsA testing cohort including 280 AFP‐Negative HCC patients and 300 controls was included. Three external validation cohorts from 3 centers were used to assess the novel logistic regression model including 400 AFP‐Negative HCC patients and 400 controls.ResultsCompared with the control group, the levels of P53, MSH2, and Tm‐4 protein in si‐P53 group, si‐MSH2 group, and si‐Tm‐4 group were significantly reduced (P < .05). The P53, MSH2, Tm‐4, neutrophil to lymphocyte ratio (NLR), monocytes to lymphocyte ratio (MLR), hypersensitive C‐reactive protein (hs‐CRP), tumor necrosis factor‐α (TNF‐α), interleukin 6 (IL‐6) levels, and the smoking, drinking, and occupational exposure to chemicals rates in patients were significantly higher than those in controls (P < .05). ROC analyses showed that the area under curve (AUC) of NLR, MLR, hs‐CRP, TNF‐α, IL‐6, P53, MSH2, Tm‐4, drinking, smoking, and occupational exposure to chemicals were 0.798, 0.803, 0.560, 0.644, 0.808, 0.681, 0.830, 0.694, 0.582, 0.581, and 0.567, respectively. A novel logistic regression model was built and has a high value in identifying AFP‐Negative HCC with AUC of 0.917, sensitivity of 85.2%, and specificity of 88.3%. In the validation cohorts, this model also showed good diagnostic efficiency (AUC = 0.898 with Dazu Branch cohort, AUC = 0.924 with Jinshan Branch cohort, and AUC = 0.907 with Liangping Branch cohort).ConclusionCurrent model has potential significance for the noninvasive diagnosis of AFP‐Negative HCC.

The differential diagnostic value and clinical significance of serum HE4 in ovarian disease with elevated CA125.

To determine the diagnostic value and clinical significance of serum HE4 levels in differentiating between benign and malignant ovarian disease in patients with elevated CA125 levels. The levels and positive expression rate of HE4 were compared between 371 patients with elevated CA125 levels and benign ovarian disease, and 132 patients with epithelial ovarian cancer to determine the diagnostic value of HE4. The level and positive expression rate of HE4 differed significantly between the benign and malignant groups, in that, there was no significant difference in HE4 expression between CA125 low- and high-level groups within the benign ovarian disease group, with levels of HE4 being in the normal range in both groups. However, the positive expression rates and levels of HE4 in the malignant group were significantly different between the serum CA125 low- and high-level groups. ROC curve analysis showed that optimal HE4 cutoff values for increased accuracy in diagnosis were 78.03pmol/L and 119.70pmol/L before and after menopause, respectively. Serum HE4 levels can potentially be used as a marker to differentiate between benign and malignant ovarian disease with elevated serum CA125 levels. The high specificity of HE4 was superior in identifying benign ovarian disease. We recommend increasing the cutoff values of HE4 in premenopausal patients and decreasing the cutoff values in postmenopausal patients for increased accuracy in the differential diagnosis of patients with elevated CA125 levels.

Peri-ictal responsiveness to the social environment is greater in psychogenic nonepileptic than epileptic seizures.

To look for evidence of peri-ictal social interaction in psychogenic nonepileptic seizures (PNES) and epileptic seizures exploring the notion of PNES as a form of nonverbal communication. Video recordings of typical seizures experienced by patients with epilepsy and PNES were obtained in a naturalistic social setting (residential epilepsy monitoring unit). Video analysis by three nonexpert clinicians identified 18 predefined semiological and interactional features indicative of apparent impairment of consciousness or of peri-ictal responsiveness to the social environment with assessment of interrater reliability using Fleiss κ. Features were compared between epileptic seizures and PNES. One hundred eighty-nine seizures from 50 participants (24 epilepsy, 18 PNES, eight combined) were analyzed. At least fair (κ>0.20) interrater agreement was achieved for 14 features. The PNES and epileptic seizures compared were of similar severity in terms of ictal impairment of consciousness (κ=0.34, odds ratio [OR]=1.11, 95% confidence interval [CI] = 0.62-1.96) and responsiveness (κ=0.52, OR=1.01, 95% CI = 0.55-1.86). PNES were more likely to be preceded by attempts to alert others (κ=0.52, OR =12.4, 95% CI = 3.2-47.7, P<.001), to show intensity affected by the presence of others (κ=0.44, OR=199.4, 95% CI = 12.0-3309.9, P<.001), and to display postictal behavior affected by the presence of others (κ=0.35, OR=91.1, 95% CI = 17.2-482.1, P<.001). Nonexpert raters can, with fair to moderate reliability, rate features characterizing ictal impairment of consciousness and responsivity in video recordings of seizures. PNES are associated with greater peri-ictal responsiveness to the social environment than epileptic seizures. These findings are consistent with a potential communicative function of PNES and could be of differential diagnostic significance.

Cystic Lateral Neck Lesions: Etiologic and Differential Diagnostic Significance in a Series of 133 Patients.

Patients presenting with a cystic lateral neck lesion may present diagnostic challenges against a backdrop of varied non-malignant and malignant etiologies. A total of 133 consecutive cases who underwent cystic neck tumor removal were evaluated for etiology and diagnostic procedure in order to develop an algorithm for therapeutic efficiency. In 92 of 133 cases, a non-malignant tumor was diagnosed. In 41 cases, malignant lymphadenopathy was found. In cases with malignancy, males (p=0.001) and the elderly (p=0.001) were affected more frequently. Primary tumors were discovered by pan-endoscopy before neck surgery or in a second pan-endoscopy (with tonsillectomy and mapping biopsies) in cases with histologically confirmed squamous cell carcinoma. During intraoperative frozen-section evaluation (40 cases), a total of 30 patients underwent neck dissection during the first neck operation. In patients older than 40 years who present with cystic neck lesions, we recommend pan-endoscopy and intraoperative frozen section in cases where malignancy is suspected in order to avoid secondary neck dissections and delays in therapy.

Hindbrain morphometry and choroid plexus position in differential diagnosis of posterior fossa cystic malformations.

To assess the differential diagnostic significance of a series of quantitative and qualitative variables of the cerebellar vermis in fetuses with posterior fossa cystic malformation, including Dandy-Walker malformation (DWM), vermian hypoplasia (VH) and Blake's pouch cyst (BPC). This was a retrospective study of confirmed cases of DWM, VH and BPC, diagnosed at the Fetal Medicine and Surgery Unit of the Federico II University between January 2005 and June 2013 or the Fetal Medicine and Surgery Unit of G. Gaslini Hospital between July 2013 and September 2017. All included cases had good-quality three-dimensional (3D) volume datasets of the posterior fossa, acquired by transvaginal ultrasound through the posterior fontanelle. The midsagittal view of the posterior fossa was the reference view for the study. We assessed brainstem-tentorium angle and brainstem-vermis angle (BVA), as well as craniocaudal (CCVD) and anteroposterior (APVD) vermian diameters and vermian area (VA), which were normalized by biparietal diameter (BPD) to take into account gestational age (CCVD/BPD × 100, APVD/BPD × 100 and VA/BPD × 100, respectively). Finally, the position of the fourth ventricular choroid plexus (4VCP) was defined as normal ('up') or abnormal ('down'), relative to the roof/cyst inlet of the fourth ventricle. We analyzed 67 fetuses with posterior fossa malformations (24 cases of DWM, 13 of VH and 30 of BPC). The mean gestational age at diagnosis was 23.6 weeks. Regardless of gestational age, the BVA differed significantly between the three groups, and the VA/BPD was able to differentiate between VH and BPC. In differentiating between VH and BPC, the greatest areas under the receiver-operating characteristics curve were those for VA/BPD ratio. The 4VCP position was down in all cases of DWM and VH, while it was up in all cases of BPC. Our data support the concept that VA/BPD ratio and 4VCP position may be used to differentiate between DWM, VH and BPC in the fetus. In our series, the position of the 4VCP had the highest accuracy, but a larger number of VH cases should be evaluated to confirm that an up position of the 4VCP indicates BPC while a down position indicates DWM or VH. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

CSF biomarkers distinguish idiopathic normal pressure hydrocephalus from its mimics

ObjectiveTo examine the differential diagnostic significance of cerebrospinal fluid (CSF) biomarkers reflecting Alzheimer’s disease-related amyloid β (Aβ) production and aggregation, cortical neuronal damage, tau pathology, damage to long myelinated axons...

Differential immunohistochemical expression of AMACR and ERG in prostatic lesions

Introduction Alpha-methylacyl-CoA (AMACR) is an enzyme of the mitochondria and perixosomes. It was found that it showed great overexpression in prostatic adenocarcinoma, even with minimal foci. TMPRSS2/ERG fusion is one of the common genetic anomalies affecting PCa. A great correlation between positive immunohistochemical (IHC) expression for ERG and the state of fusion has been found, but the diagnostic and prognostic importance of ERG IHC remains undetected. This study aimed to evaluate the differential diagnostic and prognostic significance of both AMACR and ERG in PCa with correlation to the clinicopathological variables.Materials and methods TThe authors reviewed 70 prostatic lesions. Prostatic adenocarcinoma (50 cases), prostatic intraepithelial neoplasia (PIN) (15 with high-grade PIN, five with low-grade PIN), and benign prostatic hyperplasia (10 cases) that were used as a control. Immunohistochemical staining for AMACR and ERG was done. Follow-up of the cases for 18 months was also done.Results A statistically significant difference in the expression of ERG among the examined cases was found. It was negative in control benign prostatic hyperplasia and low-grade PIN cases), positive in 20% of high-grade PIN, and 74% of prostatic adenocarcinoma cases (P<0.01). No statistically significant correlation was found between ERG expression and tumor volume, Gleason sum score, stage, surgical margin, presence of lymphovascular invasion, perinural invasion, distant metastasis, and survival (P>0.05). Regarding AMACR expression, a statistically significant difference in the expression of AMACR among the examined cases was found (negative in benign prostatic hyperplasia, and low PIN cases) to be positive in 33.3% of high-grade PIN and in 62% of prostatic adenocarcinoma cases (P<0.01). A statistically significant correlation was found between AMACR expression and tumor volume, Gleason sum score, surgical margin, presence of lymphovascular invasion, and survival (P<0.05).Conclusion The study provides an additional evidence that IHC expression of AMACR has a role in prostatic carcinoma development. IHC expression of AMACR was absent in benign prostatic lesions. AMACR is an essential tumor marker for the diagnosis and prognosis of prostatic lesions. IHC expression of ERG may have a role in the diagnosis and biological stratification of prostate cancer.