Edge Of Lesion Research Articles

First report ofNigrospora musaecausing white leaf spot ofBasella alba L in China.

Basella alba L, an edible annual twining herb of the genus Basella and the family Basella, has been widely introduced and cultivated in China. Basella alba L. as a leaf vegetable, is rich in vitamins A and C, iron, and calcium (FAO 1988). In May 2022, severe white leaf spots were observed in plantation located in Shuangfeng County (27°41'36" N, 111°56'60" E), Hunan Province, China. More than 50 Basella alba L plants were surveyed with over 80% disease incidence in an area of 300 square meters of greenhouse. The symptoms on leaves were initially small purplish-brown lesions from leaf margins or tips, with lesions expanded, the middle of the lesions was yellowish-white to yellowish-brown, slightly dented. The edge of lesions was purplish-brown, with obvious boundary between the diseased parts and the non-diseased ones. A total of 20 symptomatic samples were randomly collected. Lesion margins were surface sterilized in 2% sodium hypochlorite for 1 min, rinsed with sterile distilled water for three times, dried, placed on potato dextrose agar (PDA), and incubated at 25°C and 60% relative humidity in the dark for 3 days. Hyphal sections from colony edges were transferred to new PDA plates. Six isolates were obtained. Colonies were fast-growing, massive sparse aerial hyphae, initially white, turning gray and black after 7 days. Hyphae were branched, septa, and transparent. To induce sporulation, colonies were transferred to sodium carboxymethyl cellulose (CMC) plates (Z. M. Wen., & X. Y. Luo 1991). Conidia were single-celled, dark black, oblate, or nearly spherical, and measured 10.2 to 15.1 μm × 9.7 to 16.0 μm in diameter (n=50). For molecular identification, the rDNA internal transcribed spacer (ITS), the β-tubulin gene (TUB), and the translation elongation factor 1-alpha gene (TEF1) were amplified from genomic DNA by primers ITS1/ITS4 (White et al. 1990), Bt2a/Bt2b (Glass & Donaldson. 1995), and EF1-728F/EF1-986R (Carbone & Kohn, 1999). The sequences of six isolates (L1, L2, L7, L10, L11, L12) were deposited in GenBank with accession numbers OP703335, OP703336, OP703337, OP703338, OP703339, OP703340 (ITS), OP784252, OP784157, OP784253, OP784254, OP784255, OP784256 (TEF-1α), and OP724156, OP724158, OP779771, OP779772, OP779773, OP779774 (TUB2). A blast search of sequences showed the ITS, TEF-1α, and TUB2 sequences had >98% identity with homologue sequences from Nigrospora musae isolates BRJ2 (OP451019.1), CBS 319.34 (KY019419.1) and LC6385 (KY019567.1), respectively. These morphological features and molecular identification indicated that the pathogen possessed identical characteristics as Nigrospora musae (Wang, 2017). Pathogenicity test was carried out in plants. Strains were cultured on CMC plates for 14 days, then the mycelium was scraped to make conidial suspension (1×106 conidia/mL). After 5-6 leaves of the Basella alba L were sprouted, conidial suspension was sprayed directly on the leaves, with leaves sprayed by sterile distilled water as the control. All plants were kept in the greenhouse with temperature at 25/30°C (night/day) and 75% relative humidity. After 7 days, symptoms were observed on inoculated leaves of plants, which were the same as previously described samples, while the control plants showed no symptoms. The test was repeated three times with similar results. The strains reisolated from the inoculated leaves were morphologically identical to Nigrospora musae, conforming to Koch's postulates. symptoms of Nigrospora musae is similar to that of the other leaf diseases of Basella alba L reported in China. (H. P. Jiang.2000; S. Tan.1996). To our knowledge, this is the first report of Nigrospora musae causing white leaf spot of Basella alba L in China. The pathogen may severely threat the production of Basella alba L. The information on identification of this fungus may be helpful to the control and prevention of the disease.

Magnetic Resonance Imaging Features and Misdiagnosis of Spinal Epidural Cavernous Hemangioma.

Spinal epidural cavernous hemangiomas (SECHs) are rare, and merely a few have previously been described in case reports. The present study aims to explore the magnetic resonance imaging (MRI) features of SECHs and analyze the causes of their preoperative misdiagnosis. The present retrospective study included 11 patients (three male and eight female patients, mean age ± standard deviation: 47.55±17.39 years old) with histopathologically confirmed SECH between January 2015 and April 2021. The MRI features of SECH were analyzed by two radiologists. The cervical, thoracic and thoracolumbar segments were involved in 2, 7 and 2 patients, respectively. All lesions grew along the long axis of the spine. The tumors were shuttle-shaped in six patients, oval in two patients, pseudopodia-shaped in one patient, clamp-shaped in one patient, and growing outward along the intervertebral foramen in one patient. Nine SECHs had relatively uniform isointense or hypointense T1-weighted imaging (T1WI) and hyperintense T2-weighted imaging (T2WI) signals. On the T2WI, filamentary low-signal shadows (i.e., the hairline or grid sign) with significant contrast enhancement and asymptotic strengthening were observed. Two SECHs had mixed high and low signals on T1WI and T2WI, with significant heterogeneous enhancement, hemorrhage, and hemosiderin deposition. The SECH was misdiagnosed as meningioma, neurofibromatosis and schwannoma in 1, 1 and 4 patients, respectively, while this was not diagnosed in one patient. The preoperative diagnosis was correct in merely approximately 36% of patients. Among the four patients with a correct preoperative diagnosis, hemosiderin deposition was found in three patients and small tortuous vascular shadows were found in one patient. SECH presents as a long spindle-shaped mass, and the "'pen cap sign" is common at the lesion edges. SECH also exhibits a hairline or grid sign on T2WI. Furthermore, some lesions present with hemorrhage and hemosiderin deposition. Therefore, the hairline, grid sign and hemosiderin deposition are valuable diagnostic features of SECH.

Leptosphaerulina americana causing holing disease on tobacco in China.

Leptosphaerulina americana causing holing disease on tobacco in China.

Diagnostic value of mammography density of breast masses by using deep learning.

In order to explore the relationship between mammographic density of breast mass and its surrounding area and benign or malignant breast, this paper proposes a deep learning model based on C2FTrans to diagnose the breast mass using mammographic density. This retrospective study included patients who underwent mammographic and pathological examination. Two physicians manually depicted the lesion edges and used a computer to automatically extend and segment the peripheral areas of the lesion (0, 1, 3, and 5mm, including the lesion). We then obtained the mammary glands' density and the different regions of interest (ROI). A diagnostic model for breast mass lesions based on C2FTrans was constructed based on a 7: 3 ratio between the training and testing sets. Finally, receiver operating characteristic (ROC) curves were plotted. Model performance was assessed using the area under the ROC curve (AUC) with 95% confidence intervals (CI), sensitivity, and specificity. In total, 401 lesions (158 benign and 243 malignant) were included in this study. The probability of breast cancer in women was positively correlated with age and mass density and negatively correlated with breast gland classification. The largest correlation was observed for age (r = 0.47). Among all models, the single mass ROI model had the highest specificity (91.8%) with an AUC = 0.823 and the perifocal 5mm ROI model had the highest sensitivity (86.9%) with an AUC= 0.855. In addition, by combining the cephalocaudal and mediolateral oblique views of the perifocal 5mm ROI model, we obtained the highest AUC (AUC = 0.877P < 0.001). Deep learning model of mammographic density can better distinguish benign and malignant mass-type lesions in digital mammography images and may become an auxiliary diagnostic tool for radiologists in the future.

First Report of Leaf Spot on Ipomoea nil Caused by Alternaria alternata in China.

Ipomoea nil (Linnaeus) Roth, belonging to the Convolvulaceae family, is an ornamental and medicinal plant in China, which has the function of diuretic and expectorant, and it is also a common weed in the field. In October 2021, a leaf spot disease was observed on I. nil in a field as weed in Jingzhou (N 30° 21', E 112° 19'), Hubei Province, China. Symptoms began as small brown blotches, then developed into oval or irregularly shaped brown necrotic lesions. In severe cases, the leaves were completely necrotic and detached. In the surveyed area, the incidence was between 30% - 40%. To isolate the pathogen, twenty-one leaf pieces (5×5 mm) were cut from the lesion edges of seven symptomatic leaves, disinfected with 70% ethanol and 2% sodium hypochlorite (NaOCl), rinsed with sterile water five times, then placed on three potato dextrose agar (PDA) modified with 50 μg/mL kanamycin, and incubated at 25 °C in dark for 5 days. The isolates were subcultured by transferring mycelium tips. Sixteen fungal strains were isolated from the tissues, and nine of them showed similar morphological characteristics. After cultured 7 days on PDA at 25 °C, the nine colonies were initially white, then turned greenish brown to black in the center and had abundant fine villous aerial mycelia up to 61.5 mm in average diameter. To examine its conidial morphology, the fungi were cultured for 7 days on potato carrot agar (PCA) at 22°C with a light/dark period of 8/16 h. On PCA, conidia were brown or olive-brown, obclavate to obpyriform, with a short beak, one to five transverse and zero to three longitudinal septa. They formed chains of 1 - 8 conidia, with branches. Conidia were 16 - 46 µm long and 8 - 14 µm wide (n=50). These morphological features were similar to those described in Alternaria spp. (Simmons 2007). A single isolate "Q2" was selected for molecular identification because it was the most aggressive in preliminary leaf pathogenicity assays. The internal transcribed spacer (ITS) region of rDNA and histone 3 (H3) gene were amplified and sequenced using primers ITS1/ITS4 (White et al. 1990) and H3-1a/H3-1b (Zheng et al. 2015). BLAST analysis revealed that the sequences (ITS, ON360984; H3, ON375577) were 100% identical to Alternaria alternata (ITS, MK396607; H3, MN840996), respectively. Maximum likelihood analysis based on combined two gene sequences was conducted with an evolutionary model of GTR+I+G under 1000 bootstrap replicates. Phylogenetic tree showed that Q2 and Alternaria alternata 21-5 and BLH-YB-11 located in one clade supported with 99% bootstrap values. The pathogen was identified as A. alternata. To fulfill Koch's postulate, 10 ml conidia (106 spores/ml) of Q2 was sprayed on five healthy seedlings, with sterile distilled water as a control. All leaves were rinsed three times with sterile water before inoculation. All seedlings were placed in sealed plastic bags with air valves, and grown in a greenhouse (25 ± 2 ˚C, RH 65%). The test was repeated twice. After 10 days, symptoms typical of brown blotches similar to those observed in the field were observed on leaves of inoculated plants, while control remained healthy. A. alternata was re-isolated from the inoculated symptomatic leaves with a frequency of 100% based on morphological and molecular characters, thus Koch's postulate was confirmed. To the best of our knowledge, this is the first report of A. alternata causing leaf spot on I. nil in China. Our findings extended the host range of the pathogen A. alternata on characteristic plants.

Dynamically aggregating MLPs and CNNs for skin lesion segmentation with geometry regularization

Background and objectiveMelanoma is a highly malignant skin tumor. Accurate segmentation of skin lesions from dermoscopy images is pivotal for computer-aided diagnosis of melanoma. However, blurred lesion boundaries, variable lesion shapes, and other interference factors pose a challenge in this regard. MethodsThis work proposes a novel framework called CFF-Net (Cross Feature Fusion Network) for supervised skin lesion segmentation. The encoder of the network includes dual branches, where the CNNs branch aims to extract rich local features while MLPs branch is used to establish both the global-spatial-dependencies and global-channel-dependencies for precise delineation of skin lesions. Besides, a feature-interaction module between two branches is designed for strengthening the feature representation by allowing dynamic exchange of spatial and channel information, so as to retain more spatial details and inhibit irrelevant noise. Moreover, an auxiliary prediction task is introduced to learn the global geometric information, highlighting the boundary of the skin lesion. ResultsComprehensive experiments using four publicly available skin lesion datasets (i.e., ISIC 2018, ISIC 2017, ISIC 2016, and PH2) indicated that CFF-Net outperformed the state-of-the-art models. In particular, CFF-Net greatly increased the average Jaccard Index score from 79.71% to 81.86% in ISIC 2018, from 78.03% to 80.21% in ISIC 2017, from 82.58% to 85.38% in ISIC 2016, and from 84.18% to 89.71% in PH2 compared with U-Net. Ablation studies demonstrated the effectiveness of each proposed component. Cross-validation experiments in ISIC 2018 and PH2 datasets verified the generalizability of CFF-Net under different skin lesion data distributions. Finally, comparison experiments using three public datasets demonstrated the superior performance of our model. ConclusionThe proposed CFF-Net performed well in four public skin lesion datasets, especially for challenging cases with blurred edges of skin lesions and low contrast between skin lesions and background. CFF-Net can be employed for other segmentation tasks with better prediction and more accurate delineation of boundaries.

Malignant melanoma dermoscopy image classification method based on multi‐modal medical features

AbstractSkin cancer is one of the deadliest cancers, and it has been widely developed worldwide since the last decade. Malignant melanoma is currently the most deadly skin cancer. If malignant melanoma is diagnosed at an early stage, the probability of patients being cured will be greatly improved. At present, most existing skin lesion image classification methods only use deep learning. However, the multi‐modal features of skin lesions in the medical domain are not well utilized and integrated. To reduce the classification error of the skin lesion images caused by the complexity and subjectivity of visual interpretation, a malignant melanoma dermoscopy image classification method based on multi‐modal medical features is proposed in this paper which is inspired by the fuzzy decision‐making process of doctors. It can reduce the subjective difference in the image classification process and assist dermatologists to analyze the skin lesion area. Firstly, the feature detection method based on the extension theory can effectively quantify the difference between different colour features. Then, an interpretable segmentation edge of the skin lesion is established by using the neutrosophic theory which can convert the image into the neutrosophic space. The edge of the skin lesion is captured by applying the Hierarchical Gaussian Mixture Model (HGMM) method. Next, the edge sequence is established by segmenting the edge, and the contour regularity, symmetry, and uniformity of the edge of the skin lesion are analyzed. Finally, the extracted multi‐feature sets are used for dermoscopy image classification. Experiments are carried out on real datasets, and the classification accuracy of four kernel functions is verified. The experimental results show that the authors’ method can effectively improve the classification accuracy of benign dermoscopy images and malignant dermoscopy images.

"Nearly off-track lesions" or a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track does not seem to be accurate in predicting recurrence after an arthroscopic Bankart repair in a military population: a case-control study.

On-track lesions with a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track (nearly off-track) may predispose recurrence after arthroscopic Bankart repair (ABR) in the general population. The aim of this study was to determine if a shorter distance between the medial edge of the Hill-Sachs lesion and the medial edge of the glenoid track could accurately predict recurrence after an ABR in a high-demand military population. It was hypothesized that a shorter distance would not accurately predict recurrence. A retrospective monocenter case-control study was performed at the Dutch Central Military Hospital. Patients with an on-track Hill-Sachs lesion who underwent a primary ABR between 2014 and 2019 with a minimal follow-up of 2 years and a preoperative magnetic resonance imaging (MRI) assessment received a questionnaire. The primary outcome was recurrence, defined as a complete dislocation or subluxation. Glenoid bone loss was assessed using a linear-based method on MRI. The distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track was defined as the distance to dislocation (DTD). A receiver operating characteristic curve was created to determine the predictive value of the DTD for recurrence. Logistic regression was used to determine preoperative risk factors that predispose recurrence. Covariates were selected based on univariable analysis and included gender, body mass index, age at surgery and first dislocation, laterality, smoking habits, overhead shoulder activity during work, preoperative dislocations, sports type and level, bony or labral lesions on MRI, and DTD. In total, 80 patients with an average follow-up of 4.8±1.9 years completed the questionnaire and were included in the analyses. Seventeen patients (21%) experienced recurrence at the final follow-up. No difference in DTD was observed among patients who experienced recurrence (9 ± 4 mm) compared with patients who did not (9 ± 5 mm; P=.81). The receiver operating characteristic curve demonstrated no predictive power of DTD for recurrence (area under the curve=0.49). Smoking at the time of surgery (odds ratio: 3.9; confidence interval: 1.2-12.7; P=.02) and overhead shoulder movement during work (odds ratio: 9.3; confidence interval: 1.1-78.0; P=.04) were associated with recurrence according to the logistic regression analysis. A shorter DTD demonstrated no accuracy in predicting recurrence in a military population. Smoking at the time of surgery and overhead shoulder activity during work were associated with recurrence; however, these analyses were underpowered to draw valid conclusions.

Complement activation and increased anaphylatoxin receptor expression are associated with cortical grey matter lesions and the compartmentalised inflammatory response of multiple sclerosis.

The extent of cortical pathology is an important determinant of multiple sclerosis (MS) severity. Cortical demyelination and neurodegeneration are related to inflammation of the overlying leptomeninges, a more inflammatory CSF milieu and with parenchymal microglia and astroglia activation. These are all components of the compartmentalised inflammatory response. Compartmentalised inflammation is a feature of progressive MS, which is not targeted by disease modifying therapies. Complement is differentially expressed in the MS CSF and complement, and complement receptors, are associated with demyelination and neurodegeneration. To better understand if complement activation in the leptomeninges is associated with underlying cortical demyelination, inflammation, and microglial activation, we performed a neuropathological study of progressive MS (n = 22, 14 females), neuroinflammatory (n = 8), and non-neurological disease controls (n = 10). We then quantified the relative extent of demyelination, connective tissue inflammation, complement, and complement receptor positive microglia/macrophages. Complement was elevated at the leptomeninges, subpial, and within and around vessels of the cortical grey matter. The extent of complement C1q immunoreactivity correlated with connective tissue infiltrates, whilst activation products C4d, Bb, and C3b associated with grey matter demyelination, and C3a receptor 1+ and C5a receptor 1+ microglia/macrophages closely apposed C3b labelled cells. The density of C3a receptor 1+ and C5a receptor 1+ cells was increased at the expanding edge of subpial and leukocortical lesions. C5a receptor 1+ cells expressed TNFα, iNOS and contained puncta immunoreactive for proteolipid protein, neurofilament and synaptophysin, suggesting their involvement in grey matter lesion expansion. The presence of products of complement activation at the brain surfaces, their association with the extent of underlying pathology and increased complement anaphylatoxin receptor positive microglia/macrophages at expanding cortical grey matter lesions, could represent a target to modify compartmentalised inflammation and cortical demyelination.

Ultrasonographic features of retinal pigment epithelial adenoma

Objective: To investigate the ultrasonographic features of retinal pigment epithelium (RPE) adenoma. Methods: It was a retrospective case series study. The clinical clata of 15 patients (15 eyes) with pathologically confirmed RPE adenoma after local resection of intraocular tumor was collected at Beijing Tongren Hospital, Capital Medical University from November 2013 to October 2019. The general conditions of the patients and the location, size, shape, internal echo features of the lesions in the ocular ultrasound sonogram were analyzed, and the blood flow in the lesions was checked by color Doppler flow imaging (CDFI). Results: Of all the patients included in the study, 7 were male and 8 were female. Their age ranged from 25 to 58 years, with a mean age of (45.7±10.2) years. The most common symptom was vision loss or blurred vision (11 cases). Other symptoms included dark shadows or obscuration in front of the eyes (3 cases) and no symptoms (1 case). A history of previous ocular trauma was present in one case, and the rest of the patients had no history of ocular trauma.The location of tumor growth is scattered. The ultrasonographic features were as follows: the average maximum basal diameter was (8.07±2.75) mm and the average height was (4.02±1.81) mm; the ultrasonographic features mostly demonstrated abruptly elevated dome-shaped echo (6 cases); the lesion edge was not smooth, the internal echo was medium or low, and there could be hollow features (2 cases), with no choroidal depression; and the blood flow signal could be seen in the CDFI lesion, which could lead to retinal detachment and vitreous opacification. Conclusion: The ultrasound imaging features of RPE adenomas mostly demonstrate abruptly elevated dome-shaped echo, unsmooth lesion edge, with no choroidal depression, which may provide valuable evidence for clinical diagnosis and differentiation.

Artificial Intelligence-Aided Diagnosis Solution by Enhancing the Edge Features of Medical Images.

Bone malignant tumors are metastatic and aggressive. The manual screening of medical images is time-consuming and laborious, and computer technology is now being introduced to aid in diagnosis. Due to a large amount of noise and blurred lesion edges in osteosarcoma MRI images, high-precision segmentation methods require large computational resources and are difficult to use in developing countries with limited conditions. Therefore, this study proposes an artificial intelligence-aided diagnosis scheme by enhancing image edge features. First, a threshold screening filter (TSF) was used to pre-screen the MRI images to filter redundant data. Then, a fast NLM algorithm was introduced for denoising. Finally, a segmentation method with edge enhancement (TBNet) was designed to segment the pre-processed images by fusing Transformer based on the UNet network. TBNet is based on skip-free connected U-Net and includes a channel-edge cross-fusion transformer and a segmentation method with a combined loss function. This solution optimizes diagnostic efficiency and solves the segmentation problem of blurred edges, providing more help and reference for doctors to diagnose osteosarcoma. The results based on more than 4000 osteosarcoma MRI images show that our proposed method has a good segmentation effect and performance, with Dice Similarity Coefficient (DSC) reaching 0.949, and show that other evaluation indexes such as Intersection of Union (IOU) and recall are better than other methods.

First report of Colletotrichum truncatum causing anthracnose of dragon fruit (Hylocereus spp.) in India.

Dragon fruit (Hylocereus spp.) is gaining popularity due to high net return, medicinal importance and ability to survive under less water and poor quality soils. In year 2020 and 2021, H. undatus and H. polyrhizus plants at research field of ICAR-National Institute of Abiotic Stress Management, Baramati (18°09'30.62″N, 74°30'08″E) were affected with anthracnose disease. Out of 340 plants, 60 were symptomatic, showed disease severity up to 25 to 30%. Intermittent raining in July to September and untimely rain in November, 2021 favored the disease. Infected cladodes showed reddish to dark-brown, sunken lesions, with chlorotic haloes later converted to mature necrotic patches with prominent black acervuli. On fruits, small, light brown spots quickly turned to sunken water-soaked lesions with concentric rings of black acervuli. Infected stems were collected randomly from different plants. For pathogen isolation, lesion edge tissues (5 to 10 mm2) were excised and disinfected with 1% Sodium hypochlorite (2 min) followed by triple rinsed with sterilized water and plated on potato dextrose agar (PDA) amended with Streptomycin sulphate (30 mg/L) for 4 days at 27 ± 2°C with a 12 h photoperiod. Purified colonies of three isolates 2CT, 6CT, D6CT were obtained from successive isolation attempts. Colonies were round with smooth margins, initially pale white mycelia that changed to dark gray with pinkish-orange conidial masses. Average colony diameter was 58.3 mm at 7 DAI. Conidia were single-celled, hyaline, slightly curved, tapered tip and truncate base, with an oil globule at center. Average conidia size (n=50) was 25.7 (±2.3) μm × 3.7 (±0.2) μm, L/W ratio=6.9. Conidia were initiated from an acervular conidiomata with intermittent dark brown, septate, straight, pointed setae 114 (±35) μm long × 4.5 (±1.1) μm wide. Appressoria were dark brown, lobate or round, mostly in groups, measuring 11 (±2.4) × 6.6 (±0.8) μm. Morphological characters were consistent with Colletotrichum truncatum (Schwein.) Andrus & W.D. Moore (Damm et al. 2009). For molecular identity of three isolates, partial internal transcribed spacer (ITS) region, actin, β-tubulin (TUB2) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were amplified with ITS1/ITS4, ACT512F/ACT783R, BT2A/BT2B, and GDF1/GDR1 primers, respectively. Sequences were deposited in GenBank (ITS: OK639098 to OK639100; Actin: OM927967, OM927968, ON099061; TUB2: OM927969, ON099062, ON099063; GAPDH: ON099064, ON099065). A maximum likelihood phylogenetic tree based on all sequenced loci in MEGA11 shows the clustering of present isolates in the C. truncatum clade. For pathogenicity, 4 month old unwounded stems of H. undatus and H. polyrhizus were inoculated with a spore spray (1x106/ml conidia) of C. truncatum. For each isolate, three plants were inoculated. Plants inoculated with sterilized water represented the negative control. Inoculated and control plants were kept separately at 25 ± 2°C temperature and >85% relative humidity. Inoculated plants showed minute, sunken, water soaked, reddish brown spots which were converted to sunken patches with black acervuli at 15 DAI. No symptoms were observed in the negative control. Pathogenicity test was repeated twice and the pathogen was re-isolated from symptomatic stems showed similar morphology with C. truncatum. Based on morphological and molecular characteristics and pathogenicity test, pathogen identified as C. truncatum. Previously, dragon fruit anthracnose caused by C. truncatum was reported from China (Guo et al. 2014) and Malaysia (Vijaya et al. 2015). To our knowledge, this is the first report of C. truncatum cause of dragon fruit anthracnose in India. Detailed pathogen diagnostics may help in formulating effective, on time, appropriate disease management strategies.

A diagnostic scoring model of ENKTCL in the nose-Waldeyer's ring based on logistic regression: Differential diagnosis from DLBCL.

To establish a logistic regression model based on CT and MRI imaging features and Epstein-Barr (EB) virus nucleic acid to develop a diagnostic score model to differentiate extranodal NK/T nasal type (ENKTCL) from diffuse large B cell lymphoma (DLBCL). This study population was obtained from two independent hospitals. A total of 89 patients with ENKTCL (n = 36) or DLBCL (n = 53) from January 2013 to May 2021 were analyzed retrospectively as the training cohort, and 61 patients (ENKTCL=27; DLBCL=34) from Jun 2021 to Dec 2022 were enrolled as the validation cohort. All patients underwent CT/MR enhanced examination and EB virus nucleic acid test within 2 weeks before surgery. Clinical features, imaging features and EB virus nucleic acid results were analyzed. Univariate analyses and multivariate logistic regression analyses were performed to identify independent predictors of ENKTCL and establish a predictive model. Independent predictors were weighted with scores based on regression coefficients. A receiver operating characteristic (ROC) curve was created to determine the diagnostic ability of the predictive model and score model. We searched for significant clinical characteristics, imaging characteristics and EB virus nucleic acid and constructed the scoring system via multivariate logistic regression and converted regression coefficients to weighted scores. The independent predictors for ENKTCL diagnosis in multivariate logistic regression analysis, including site of disease (nose), edge of lesion (blurred), T2WI (high signal), gyrus like changes, EB virus nucleic acid (positive), and the weighted score of regression coefficient was 2, 3, 4, 3, 4 points. The ROC curves, AUCs and calibration tests were carried out to evaluate the scoring models in both the training cohort and the validation cohort. The AUC of the scoring model in the training cohort were 0.925 (95% CI, 0.906-0.990) and the cutoff point was 5 points. In the validation cohort, the AUC was 0.959 (95% CI, 0.915-1.000) and the cutoff value was 6 points. Four score ranges were as follows: 0-6 points for very low probability of ENKTCL, 7-9 points for low probability; 10-11 points for middle probability; 12-16 points for very high probability. The diagnostic score model of ENKTCL based on Logistic regression model which combined with imaging features and EB virus nucleic acid. The scoring system was convenient, practical and could significantly improve the diagnostic accuracy of ENKTCL and the differential diagnosis of ENKTCL from DLBCL.

Early gastric cancer segmentation in gastroscopic images using a co-spatial attention and channel attention based triple-branch ResUnet

Background and objectiveThe artificial segmentation of early gastric cancer (EGC) lesions in gastroscopic images remains a challenging task due to reasons including the diversity of mucosal features, irregular edges of EGC lesions and nuances between EGC lesions and healthy background mucosa. Hence, this study proposed an automatic segmentation framework: co-spatial attention and channel attention based triple-branch ResUnet (CSA-CA-TB-ResUnet) to achieve accurate segmentation of EGC lesions for aiding clinical diagnosis and treatment. MethodsThe input gastroscopic image sequences of the triple-branch segmentation network CSA-CA-TB-ResUnet is firstly generated by the designed multi-branch input preprocessing (MBIP) module in order to fully utilize massive correlation information among multiple gastroscopic images of the same a lesion. Then, the proposed CSA-CA-TB-ResUnet performs the segmentation of EGC lesion, in which the co-spatial attention (CSA) mechanism is designed to activate the spatial location of EGC lesions by leveraging on the correlations among multiple gastroscopic images of the same EGC lesion, and the channel attention (CA) mechanism is introduced to extract subtle discriminative features of EGC lesions by capturing the interdependencies between channel features. Finally, two gastroscopic images datasets from different digestive endoscopic centers in the southwest and northeast regions of China respectively were collected to validate the performances of proposed segmentation method. ResultsThe correlation information among gastroscopic images was confirmed to be able to improve the accuracy of EGC segmentation. On another unseen dataset, our EGC segmentation method achieves Jaccard similarity index (JSI) of 84.54% (95% confidence interval (CI), 83.49%-85.56%), threshold Jaccard index (TJI) of 81.73% (95% CI, 79.70%-83.61%), Dice similarity coefficient (DSC) of 91.08% (95% CI, 90.40%-91.76%) and pixel-wise accuracy (PA) of 91.18% (95% CI, 90.43%-91.87%), which is superior to other state-of-the-art methods. Even on the challenging small lesions, the segmentation results of our CSA-CA-TB-ResUnet-based method are consistently and significantly better than other state-of-the-art methods. We also compared the segmentation result of our model with the diagnostic accuracy with junior/senior expert. The comparison results indicated that our model performed better than the junior expert. ConclusionsThis study proposed a novel CSA-CA-TB-ResUnet-based EGC segmentation method and it has a potential for real-time application in improving EGC clinical diagnosis and minimally invasive surgery.

First report of Neofusicoccum parvum causing leaf spot disease on Macadamia integrifolia in China.

The macadamia industry is developing rapidly in China. A brown leaf spot disease was noted in six Macadamia integrifolia plantations in Lincang, Yunnan, in October 2021. Over 60% of trees sampled had brown leaf spot symptoms, among approx.15,000 trees planted in these areas. Lesions (3 to 5 mm dia.) were small round brown spots with yellow edges. Lesions on severely infected leaves were darker and larger, with irregular shape (8 to 10 mm long, 3 to 6 mm wide). About 10% of diseased leaves had lesions characterized by a shot hole surrounded by a yellow halo. Potential pathogens were isolated from four randomly-selected symptomatic leaves from each of the six plantations by cutting lesion edges into small pieces. The pieces were surface sterilized, placed onto water agar containing 100 ppm aureomycin and incubated for 5 days at 24°C in the dark. Subculturing microbial growth on potato dextrose agar produced single-hyphal isolates with white fluffy aerial mycelia that turned pale olivaceous gray after 4 to 5 days. In four randomly-selected cultures, conidia were single celled, hyaline, spindle shaped to oval, and measured 10.9 to 16.3 µm long and 4.0 to 6.2 µm wide (n = 50). These characteristics matched those of Neofusicoccum parvum (Pavlic et al. 2009). Isolate LC013 was randomly selected as a representative individual for molecular identification. Internal transcribed spacer (ITS; ITS1/ITS4 primers; White et al. 1990), beta-tubulin gene (tub2; BT2A/BT2B primers; Glass and Donaldson 1995) and translation elongation factor 1-alpha gene (tef1-α; EF1-728F/EF2 primers; Carbone and Kohn 1999; O'Donnell et al. 1998) regions were PCR amplified from genomic DNA. Sequences of the products were used to BLAST probe the type specimen nucleotide sequences in GenBank. The LC013 sequences (GenBank accessions OM392021 (ITS); OM453641 (tub2); OM567656 (tef1-α)) had >99% sequence identity with analogous sequences from the type specimen of N. parvum CBS 138823 (accessions AY236943 (ITS); AY236917 (tub2); AY236888 (tef1-α)). Isolate LC013 was sister to N. parvum type strain in a maximum-likelihood (ML) tree constructed from analogous concatenated ITS, tef1-α, and tub2 sequences of 27 species that are phylogenetically closely-related to LC013 based on the ITS single locus ML tree. Koch's postulates were tested twice with two isolates by wounding leaves of four 14-month-old M. integrifolia seedlings with a sterile needle and placing a 5-mm-diameter agar plug containing N. parvum on the wound site. PDA plugs alone were used as uninoculated controls. Leaves were covered with sealed bags to maintain >90% humidity for 24 hours. All plants were kept in the same glasshouse under natural conditions. Leaves of inoculated plants began to discolor at 5 days post-inoculation (dpi). Brown spot symptoms were observed at 9 dpi. Control plants were symptomless. N. parvum was re-isolated from leaf lesions of the infected plants, but not from control plants, thus fulfilling Koch's postulates. N. parvum is an aggressive pathogen that causes severe disease on important tree and woody species, including M. integrifolia (Liddle et al. 2019). In China, it has been reported to cause leaf spot disease on 26 plant species (Farr and Rossman 2022), but this is the first report of N. parvum causing leaf spot disease on M. integrifolia. Further investigation is required to estimate the importance of this pathogen to the macadamia industry in China.

First Report of Brown Spot of Dekopon Fruit Caused by Cladosporium tenuissimum in China.

Dekopon citrus (Citrus reticulata Shiranui) is a three-way hybrid (Citrus unshiu Marcov. × C. sinensis Osbeck × C. reticulata Blanco) developed in Japan in 1972. This citrus is popular in China due to its sweet and tender taste (Lim 2012). In November of 2021, a brown spot disease on Dekopon fruits with about 20% disease incidence was observed in an orchard of the Institute of Citrus Research in Ganzhou, Jiangxi Province, China. Initially, the symptoms appeared as slightly sunken deep red to purple spots on the fruit surface, with the disease progression, lesions became brown to brown-black large necrotic regions covered with a fluffy layer of gray spores. Infected fruits were surface sterilized with 70% ethanol for 30 sec and rinsed three times with sterile distilled water. Diseased tissues from the edge of lesions were cut into small segments, placed onto potato dextrose agar and incubated at 25℃ for 7 days. Ten single-spore isolates were obtained in total. Fungal colonies were olive green to dark green, velvet-like in texture and sporulated abundantly, surrounded by grayish-white hyphae. Conidiophores were subcylindrical, straight, septate, solitary or in clusters of two to three, and ranged in size from 65 to 550 × 3.8 to 6.3 µm (x ̅= 261.7 ± 60.5 × 5.2 ± 0.4 µm, n=50). Ramoconidia were cylindrical，aseptate, and 10 to 22 × 2.8 to 4.5 µm (x ̅= 15.5 ± 1.4 × 4.0 ± 0.9 µm, n=50). Conidia were lemon-shaped to oval-shaped, smooth-walled, and 1.8 to 5.0 × 1.4 to 2.5 µm (x ̅= 3.9 ± 0.4 × 2.2 ± 0.2 µm, n=50). The morphological characteristics of the pathogen were consistent with those of Cladosporium tenuissimum Cooke (Li et al. 2021). For further identification, DNA was extracted from two representative isolates. The internal transcribed spacer (ITS) region, translation elongation factor (EF1-α), and actin (ACT) were amplified by using primers ITS1/ITS4, EF1-728F/EF1-986R, and ACT-512F/ACT-783R (Bensch et al. 2012), respectively. ITS (OM232067, OM232068), EF1-α (OM256525, OM256526) and ACT (OM256529, OM256530) sequences were deposited in GenBank. Multi-gene (combined data set of ITS, EF1-α and ACT) phylogenetic analysis was conducted using the Maximum Likelihood method (Nguyen et al. 2015). Based on the morphological characteristics and the molecular data, two fungal isolates were identified as C. tenuissimum. To evaluate pathogenicity, fifteen fruits were surface sterilized with 1% NaClO solution for 30 sec, rinsed twice with sterile distilled water and dried. Dekopon fruits (n=10) were wounded with a sterile needle and inoculated with a 10 µL drop of conidial suspension (1 × 106 conidia/mL) of isolate GZCJ-1, followed by incubation at 25℃ and 80% relative humidity. The controls (n=5) were treated with sterile water and maintained under the same conditions. Five days after inoculation, small brown sunken spots were observed on the wounded and inoculated fruits. After 7 days, lesions were coated by a layer of brown conidia that were similar to those described above, whereas control remained symptomless. Pathogenicity test was repeated twice. Cladosporium tenuissimum was consistently re-isolated from inoculated fruits and confirmed by morphological and molecular data, fulfilling the Koch's postulates. To our knowledge, this is the first report of C. tenuissimum causing the brown spot of dekopon fruit in China and perhaps the world. The disease may become the potential risk for fruit production, making fruits unfit for marketing purposes, and the appropriate management actions will be necessary.

A model for predicting degree of malignancy in patients with intraductal papillary mucinous neoplasm.

There is no predictive model available to address early stage malignant intraductal papillary mucinous neoplasm (IPMN) including high grade dysplasia (HGD) and pT1a (invasive component≤0.5 cm). The aim of this study was to establish an objective and sufficient model to predict the degree of malignancy in patients with IPMN, which can be easily applied in daily practice and adopted for any type of lesion. A retrospective cohort study of 309 patients who underwent surgical resection for IPMN was performed. Members of the cohort were randomly allocated to the training or testing set. A detection tree model and random forest model were used for a 3-class classification to distinguish low grade dysplasia (LGD), HGD/pT1a IPMN, and invasive intraductal papillary mucinous cancer (I-IPMC) beyond pT1a. Of the 309 patients, 54 (17.4%) had early stage malignancy (19 HGD, 35 pT1a), 49 (15.9%) had I-IPMC beyond pT1a, and 206 (66.7%) had LGD IPMN. We proposed a 3-class classification model using a random forest algorithm, and the model had an accuracy of 99.5% with the training set, and displayed an accuracy of 96.0% with the testing set. We used SHAP for interpretation of the model and showed the top five factors (mural nodule size, main pancreatic duct diameter, CA19-9 levels, lesion edge and common bile duct dilation) were most likely to influence the 3-class classification results in terms of interpretation of the random forest model. This predictive model will help assess an individual's risk for different stages of IPMN malignancy and may help identify patients with IPMN who require surgery.

First report of Colletotrichum fioriniae causing anthracnose on pear fruit in Serbia.

European pear (Pyrus communis L.) is one of the most important fruits in Serbia, with a total production of 55,938 tonnes in 2021 (Statistical Office of the Republic of Serbia). In November 2021, pear fruits (cv. Santa Maria) with typical anthracnose symptoms were collected in one storage facility in the area of Smederevo, Serbia. The disease incidence was about 2%. A total of nine infected fruits had dark, circular, sunken necrotic lesions with concentric rings of orange conidial masses produced in black acervuli. The tissue pieces from the edges of lesions (3 to 5 mm2) were surface-sterilized in 1% sodium hypochlorite for 1 min, rinsed twice in sterilized distilled water, air-dried, and incubated on potato dextrose agar (PDA) at 25°C. One isolate/diseased fruit was obtained (nine in total). Colony morphology of all isolates on PDA was light gray to pinkish on the upper side, and pink to vinaceous on reverse after 7 days of incubation at 25°C in the dark. Average growth rate was 64 ± 2 mm. The conidia were hyaline, fusiform, aseptate, smooth-walled, with both ends acute, and measured 12.8 to 16.6 µm × 3.5 to 4.5 µm (n =100). Appressoria were single, smooth-walled, dark brown, clavate to irregular outline, 5.5 to 9.6 × 4.8 to 7.2 μm (n =20). These morphological characterstics are consistent with the description of Damm et al. (2012) for Colletotrichum fioriniae. To confirm this identification, genomic DNA of representative isolate SZ-21-36 was extracted and the ITS region of the rDNA, partial beta-tubulin gene (BenA), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and partial actin gene (ACT) were amplified using the primers ITS1/ITS4, Bt2a/Bt2b, GDF1/GDR1, and ACT512F/ACT783R, respectively (Hassan et al. 2019). The nucleotide sequence of each locus has been deposited in GenBank under Accession Nos. ON171625 (ITS), ON186696 (BenA), ON186697 (GAPDH), and ON186698 (ACT). Multilocus phylogenetic analysis based on the above mentioned molecular markers placed Serbian isolate of C. fioriniae with other isolates of this species deposited in GenBank (bootstrap support of 100%). Pathogenicity test was conducted on symptomless, detached pear fruits (cv. Santa Maria). Five surface-sterilized fruits were wound-inoculated with 50 μl of a conidial suspension (1 × 106 conidia/ml). After 10 days of incubation in a plastic chamber (25°C, 90% relative humidity, and 12-h photoperiod), typical anthracnose lesions developed on inoculated fruits. Five control fruits inoculated with sterile distilled water remained asymptomatic. The experiment was repeated once. Fungal colonies reisolated from the lesions showed the same morphological features as the original isolate. Pathogen was not reisolated from the control fruits. C. fioriniae was previously reported on European pear fruits in Croatia (Ivić et al. 2013), France (Da Lio et al. 2017), China (Fu et el. 2019), and in the USA (Pavlović et al. 2019). To our knowledge, this is the first report of anthracnose of pear fruit caused by C. fioriniae in Serbia. Currently, the economic impact of anthracnose caused by this pathogen is minimal, but its presence decreases commercial value and quality of pear fruits, and can be a risk to the further spread of C. fioriniae to other plant species.

OCT classification of choroidal nevi

The study aims to determine the types of OCT patterns of CN and to evaluate their prognostic value. The study included 50 patients with CN (53 nevi). The height of 19 nevi evaluated with ultrasonography was 1.33±0.43 mm, diameter - 5.47±1.68 mm. CN is an area of local increase in reflectivity of the choroid; its widening and elevation of the tomographic section were observed in 72% of nevi. In more than half of all cases a distinct hyperreflective border was revealed between the CN and adjacent choroid. In two thirds of all cases the choriocapillaris layer was preserved and visualized mainly along the edge of lesion. Analysis of OCT scans showed distinct differences, which allowed designation of four OCT types of CN: 1) nevi with typical OCT pattern; 2) nevi with changes in retinal pigment epithelium (RPE); 3) nevi with neuroepithelial detachment; 4) nevi with atypical OCT pattern. Based on the analysis of OCT images of the determined types of nevi, it can be assumed that all of them initially had typical OCT pattern. With enlargement of the nevi and increase in the duration of its presence in the choroid, dystrophic processes in the adjacent retina and changes in RPE begin to occur. Disturbed pumping ability of the damaged RPE results in disruption of the trophism of adjacent retina, which leads to development of atrophic changes. Nevi with atypical OCT pattern should be considered as a sign of long-term benign process in the choroid that will cause atrophic changes in the choroid and adjacent retina, while nevi with changes in RPE and with neuroepithelial detachment - as a risk factor for transition to choroidal melanoma.

An Intriguing Case of Chronic Peristomal Ulcer.

An Intriguing Case of Chronic Peristomal Ulcer.