Homogeneous Echo Research Articles

Combination of Conventional Ultrasound with Quantitative and Qualitative Analyses of CEUS for the Differentiation of Benign and Malignant Breast Solid Lesions: A Modified Breast Cancer Model

ObjectiveBreast cancer has become one of the main diseases threatening women’s health and lives. Ultrasound (US) is the first diagnostic option for several patients because of its non-radiation, convenient, and low-cost features. Conventional US combined with contrast-enhanced US (CEUS) has improved diagnostic accuracy, while due to the presence of numerous parameters, no international consensus on diagnostic criteria could be attained. Therefore, it is necessary to develop a reliable diagnostic model with the involvement of a few parameters while increasing the diagnostic accuracy. MethodsData from 265 patients, including conventional US, CEUS, and postoperative pathological results, were collected. 21 parameters from the conventional US and both qualitative and quantitative aspects of CEUS were analyzed through univariate and multivariate logistic regression analyses. Specific parameters with independent influential factors were identified. A nomogram was subsequently developed to visually represent the contribution and linear weighting of each parameter. The effectiveness of the new model was assessed through calibration curves and the Hosmer-Lemeshow goodness-of-fit test. ResultsSix independent influential factors for breast malignant tumors were identified, including homogeneous echo, lesion vascularity, enhancement mode, enhancement shape, nourishing vessels, and slope. The area under the curve (AUC) values in the training and test datasets were 0.933 and 0.860, respectively. The modified model exhibited satisfactory diagnostic accuracy and operability. ConclusionThe modified model, despite incorporating fewer parameters, maintained diagnostic accuracy. It is exhibited as a convenient, effective, and easily deployable model for diagnosing malignant breast nodules.

Endoscopic Retrograde Cholangiopancreatography-Related Procedures for the Differential Diagnosis of Isolated Immunoglobin G4-Related Sclerosing Cholangitis and Perihilar Cholangiocarcinoma.

Differential diagnosis of isolated immunoglobin (Ig)G4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma is challenging. We aimed to clarify the role of endoscopic retrograde cholangiography (ERCP)-related procedures in the differential diagnosis of isolated IgG4-SC and perihilar cholangiocarcinoma (PHCC). Seven patients with hilar-type isolated IgG4-SC diagnosed at Hiroshima University Hospital and sixty-five patients with surgically resected invasive PHCC were enrolled, and the diagnostic yields of intraductal ultrasonography (IDUS), peroral cholangioscopy (POCS), and pathological examinations were determined. In six of seven (86%) patients with isolated IgG4-SC, the stricture was in the perihilar bile duct. IDUS showed that symmetrical wall thickening (40% vs. 5%, p = 0.04), homogeneous internal echo (80% vs. 5%, p < 0.001), and smooth outer margins (80% vs. 6%, p < 0.001) were more frequent in isolated IgG4-SC than in PHCC. POCS showed a smooth mucosal surface more frequent in isolated IgG4-SC (75% vs. 7%, p = 0.006). Only one patient had two pathological findings characteristic of IgG4-SC. The sensitivity for diagnosing PHCC was 81% using two or more combined sampling methods. Pathological examinations have limitations in the differential diagnosis of isolated-IgG4-SC and PHCC, and a diagnostic strategy that combines multiple ERCP-related procedures, including IDUS and POCS, is recommended.

Developing and validating a prediction model of live birth in patients with moderate-to-severe intrauterine adhesions: a new approach with endometrial morphology measurement by 3D transvaginal ultrasound.

There is no reliable method to predict the live birth rate among patients with moderate-to-severe intrauterine adhesions (IUA) after second-look hysteroscopy. Therefore, we aimed to construct a practical prediction model mainly based on the features of 3D transvaginal ultrasound (3D-TVUS). and other clinical characteristics. From January 2018 to February 2020, a total of 870 IUA patients with fertility requirements were retrospectively enrolled based on the same method. First, the predictors were screened by logistic regression analysis. A nomogram was constructed based on the screened predictive factors in the derivation cohort. Next, receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA) were used to assess the predictive accuracy and discriminability of the model. Finally, correlation analysis was performed to analyze the correlation between the results of 3D-TVUS and second-look hysteroscopy. A total of 558 (64.14%) participants had live births. Age, endometrial thickness, assisted reproductive technology, a homogeneous endometrial echo, a lower segment of scar contraction, and upper segmentation of the endometrial absence were included in the model. The predictive model showed good predictive performance in the derivation cohort (area under the curve, 0.837) and validation cohort (0.857). DCA demonstrated its clinical utility. A homogeneous endometrial echo was related to no segmentation of scar contraction (r=0.219; P<0.001) or no segmentation of the endometrial absence (r=0.226; P<0.001). Thicker endometrium was associated with no segmentation of the endometrial absence (r=-0.145; P=0.007). The proposed method can effectively predict live birth. 3D-TVUS should be an important means for evaluating the endometrium of moderate-to-severe patients with IUA preparing for pregnancy after operation.

A comparative study on the features of breast sclerosing adenosis and invasive ductal carcinoma via ultrasound and establishment of a predictive nomogram.

To analyze the clinical and ultrasonic characteristics of breast sclerosing adenosis (SA) and invasive ductal carcinoma (IDC), and construct a predictive nomogram for SA. A total of 865 patients were recruited at the Second Hospital of Shandong University from January 2016 to November 2022. All patients underwent routine breast ultrasound examinations before surgery, and the diagnosis was confirmed by histopathological examination following the operation. Ultrasonic features were recorded using the Breast Imaging Data and Reporting System (BI-RADS). Of the 865 patients, 203 (252 nodules) were diagnosed as SA and 662 (731 nodules) as IDC. They were randomly divided into a training set and a validation set at a ratio of 6:4. Lastly, the difference in clinical characteristics and ultrasonic features were comparatively analyzed. There was a statistically significant difference in multiple clinical and ultrasonic features between SA and IDC (P<0.05). As age and lesion size increased, the probability of SA significantly decreased, with a cut-off value of 36 years old and 10 mm, respectively. In the logistic regression analysis of the training set, age, nodule size, menopausal status, clinical symptoms, palpability of lesions, margins, internal echo, color Doppler flow imaging (CDFI) grading, and resistance index (RI) were statistically significant (P<0.05). These indicators were included in the static and dynamic nomogram model, which showed high predictive performance, calibration and clinical value in both the training and validation sets. SA should be suspected in asymptomatic young women, especially those younger than 36 years of age, who present with small-size lesions (especially less than 10 mm) with distinct margins, homogeneous internal echo, and lack of blood supply. The nomogram model can provide a more convenient tool for clinicians.

Deliberative Qualities of Online Abortion Discourse: Incivility and Intolerance in the American and Irish Abortion Discussions on Twitter

This paper provides a big-data-scale assessment of the deliberative qualities of online abortion discussions on Twitter in the United States (2020) and Ireland (2018) by specifically focusing on two standards: civility and tolerance for constructive disagreements. Using diverse computational methods and classification, our regression analysis provides mixed evaluations. We find that incivility and intolerance are uncommon behaviours in American and Irish abortion discourse on Twitter, but we also find that these anti-deliberative behaviours are (a) generating more engagements and thereby distorting the overall discussion atmosphere; (b) largely coming from the pro-life tweets; (c) dominated by a small set of hyperactive participants; and that (d) intolerant users tend to communicate within homogeneous echo chambers. Our results indicate that it is crucial for online deliberation to curtail the capabilities of these superparticipants distorting and radicalising the overall online political discourse. By studying two national contexts, our results provide comparability of our findings and insights that can improve our understanding of other contentious and polarised issues more broadly.

Participatory conspiracy culture: Believing, doubting and playing with conspiracy theories on Reddit

The popularization and normalization of conspiracy theories over the last decade are accompanied by concerns over conspiracy theories as irrational beliefs, on the one hand; and their advocates as radical and extremist believers on the other hand. Building on studies emphasizing that such accounts are one-sided at best, and pars pro toto stigmatizations at worst; we propose to study what we call “ participatory conspiracy culture”—the everyday, mundane online debates about conspiracy theories. Based on a 6-month ethnography on Reddit’s r/conspiracy subreddit, an analysis of 242 selected discussions, and supported by digital methods tool 4CAT, this article addresses the question of how people participate in online conspiracy culture. It shows that among the plethora of conspiracy theories discussed online, discussions are heterogeneous, and their participants relate to each other primarily through conflict. Three epistemological positions occur: belief (particularly leading to constant discreditation of others’ beliefs), doubt (particularly as opposed to belief), and play (particularly with the fun of entertaining conspiracy theories without taking them too seriously). We conclude that the participatory conspiracy culture of r/conspiracy is not a homogenous echo chamber of radical belief, but a heterogeneous participatory culture in which belief is fundamentally contested, rather than embraced.

Gastric lymphangioma: a case report and review of literature

BackgroundGastric lymphangioma is one of the highly rare benign tumors characterized by multilocular or unilocular lymphatic spaces. Herein, we report a case of lymphangioma in the gastric antrum.Case presentationA 77-year-old male patient who had been experiencing epigastric discomfort for a year was presented to our hospital. A gastric subepithelial lesion was diagnosed by upper endoscopy and was entirely excised via diatal subtotal gastrectomy. Endoscopic ultrasonography revealed an echoless homogenous echo pattern in the third wall layer. A lymphangioma was diagnosed by pathologic investigation of the resected specimen. The PubMed, Embase and Web of Science databases were reviewed for literature in English while using the keywords of “gastric lymphangioma” or “lymphangioma of stomach” or “gastric lymphatic cyst” or “lymphatic cyst of stomach” and the results were discussed.ConclusionGastric lymphangioma is a rarely occurring submucosal tumor that should be considered when diagnosing subepithelial lesions in the stomach.

Polar Vessel: A New Ultrasound Sign for Complementary Diagnosis of Major Salivary Gland Adenoid Cystic Carcinoma.

To investigate the characteristic ultrasonographic findings of adenoid cystic carcinoma (ACC) in major salivary glands and identify the value of polar vessel in color Doppler flow imaging (CDFI) for the diagnosis of ACC. From January 2017 to December 2021, 76 patients with parotid and submandibular gland tumors, including 14 patients with ACC, as confirmed by surgery and histopathology, were enrolled. Their clinicopathologic information and ultrasound (US) features were recorded and analyzed. The performance of polar vessel in CDFI for differentiating ACC from non-ACC (benign tumors and mucoepidermoid carcinoma [MEC]) was analyzed. ACC in the major salivary gland was more likely to be associated with pain symptoms (P=.027) and unclear borders and rough edges in grayscale US (P=.002, .015, respectively) than benign tumors. Compared to MEC, ACC tended to feature a homogeneous internal echo (P=.008). ACC of the major salivary gland had a significantly higher incidence of polar vessel sign than that of non-ACC (benign tumors and MEC) (P <.0001, .0001, respectively). The polar vessel sign showed good performance in distinguishing between ACC and non-ACC, with an area under the receiver operating characteristic curve of 0.857, a sensitivity of 71.4%, a specificity of 100%, and an accuracy of 94.7%. Positive predictive value and negative predictive value were calculated at 100% and 93.9%, respectively. The US sign of polar vessel has high diagnostic efficiency, and it may have important potential for use as a new complementary sign for the diagnosis of ACC in major salivary glands.

A case of esophageal neuromuscular choristoma

BackgroundNeuromuscular choristoma (NMC) is a rare peripheral nerve lesion that is composed of ectopic mature muscle fibers and nerve fascicles, typically involving major nerve roots or trunks, such as the cranial nerves, brachial plexus, and sciatic nerves. The onset of NMC frequently occurs in the first decade of life. Here, we present the first documented case of a case of esophageal NMC in an adult patient.Case presentationA 46-year-old male patient presented in 2018 with a submucosal tumor of the esophagus. Upon presentation, the tumor was approximately 10 mm in diameter, covered by normal mucosa, and located in the left posterior wall of the esophagus in a position that was 30 cm from the incisor. The tumor was discovered incidentally during gastroscopic examination. In March 2021, endoscopic re-examination revealed no significant changes in the tumor. Endoscopic ultrasound revealed an oval hypoechoic mass with a homogeneous internal echo that originated from the muscularis propria with a maximum cross section of 13 mm × 6 mm. Resection was performed under gastroscopy. The resection specimen was 12 mm × 5 mm in size and was a well-demarcated, elastic, hard, and tough with a gray section. Histologically, the specimen consisted of an abundance of smooth muscle fiber bundles intercalated among nerve fibers, but without malignancy. Immunohistochemical examinations revealed positivity for S-100 protein, caldesmon, NSE and desmin, but negativity for CD117, DOG-1, HMB45, and Melan A. There was also aberrant nuclear localization of beta-catenin. Collectively, these findings led to a diagnosis of esophageal NMC.ConclusionsNMC is extremely rare, especially esophageal NMC, and is very challenging to accurately diagnose prior to resection. It is important that we can differentiate NMC from other types of tumors.

Association Between Thyroid Parenchymal Echogenicity and Thyroid Function in Pediatric Population

Background: The association between the thyroid echo pattern and thyroid function has an important impact on the diagnosis and treatment of thyroid diseases in children. Objectives: The present study aimed to compare thyroid parenchymal echogenicity with thyroid function tests and evaluate the value of a thyroid ultrasound (US) in predicting thyroid function parameters in the pediatric population. Methods: A total of 434 children (age range: 5 - 18 years; mean age: 13.18 ± 3.42 years) were categorized into two groups based on the thyroid parenchymal appearance on the US as subjects with homogeneous (group 1) and heterogeneous (group 2) echo patterns. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin antibody (Tg-Ab), and thyroperoxidase antibody (TPO-Ab) levels were evaluated and compared between the two groups. Results: The levels of TSH, fT3, fT4, Tg-Ab, and TPO-Ab were significantly different between the two groups (P &lt; 0.0001). All thyroid function tests were within normal ranges in 73.4% (168/229) and 14.6% (30/205) of children with homogeneous and heterogeneous echo patterns, respectively. The homogeneous thyroid gland on the US had 73.8% sensitivity in predicting normal TSH and 100% sensitivity in predicting normal fT3 and fT4. The sensitivity for predicting negative Tg-Ab and TPO-Ab were 78.7 and 85.3%, respectively. Conclusions: The current study compared the homogeneous and heterogeneous thyroid echo patterns with the thyroid function tests in children. The obtained results confirmed the value of the thyroid US in predicting thyroid function in the pediatric population.

Concomitant uveal melanoma and papillary thyroid carcinoma: a case report

BackgroundMelanoma develops in the cells that produce melanin; ocular melanoma accounts for 3–4% of all malignant melanomas. Thyroid tumors are the most common endocrine neoplasms, with more than 95% of cases arising from follicular cell origin. Previous studies have reported associations between malignant melanoma and a wide variety of malignancies.Case presentationWe report a 54-year-old Iranian woman who was diagnosed with ocular melanoma based on a mushroom-shaped filling defect with homogeneous echo pattern arising from the anterior third of the temporal side of the globe detected on ocular sonography during routine ophthalmological examination. She underwent right globe enucleation and implant replacement. During tumor surveillance, fluorodeoxyglucose positron emission tomography/computed tomography scan showed low-grade metabolically active tumoral involvement in the anterolateral aspect of the right lobe of thyroid. The patient subsequently underwent thyroidectomy and submandibular lymphadenectomy. Pathologic report demonstrated micropapillary carcinoma (9 × 8 mm2), tall cell variant without lymphovascular or perineural invasion in the base of lymphocytic thyroiditis.ConclusionThis case illustrates the importance of precise active surveillance in case of papillary carcinoma of thyroid or malignant melanoma to avoid missing other associated pathologies and emphasizes the simultaneous treatment of two tumors.

Ultrasound Assessment for Thyroid Examination in Patients with Hypothyroidism

Patients with overt hypothyroidism show decreased echogenicity of the thyroid at ultrasonography . The purpose of the present study was to evaluate the effectiveness of ultrasonography for diagnosing the most common hypothyroidism and to guide patients to appropriate treatment show decreased echogenicity of the thyroid by ultrasonography. This study have been conducted on 80Patients, the age group between 20-70 years, in the period of January 2020 to October 2021. Thyroid ultrasonography was carried out by the type of ultrasound (US) machine used in the study is a sameness -X300 ultrasound device with 7.5MHz probe. The volume of the thyroid lobe noticed calculations according to the formula of the: width x length x thickness. The assessment of the 80 patients with hypothyroidism who were included in our study, (57) patients with decreased echogenicity, 23 patients had been with normal echogenicity, the lowest was found in patients homogenous enhancement 42.5%, non- homogenous 57.5%, thyroid the gland has a medium gray scale homogeneous echo pattern and the level of echogenicity is higher than Size of thyroid, The higher percentage of nodules (51.3%) of the size of the thyroid was normal. But the higher percentage of nodules type (40.0%) for the study group was solid compared to the lower percentage (2.5%) was solid and cystic. Ultrasound had high specificity and more accuracy to assess patients with hypothyroidism. An association between hypo echogenicity at thyroid US and high level of thyroid stimulation hormone (TSH suggesting decreased echogenicity at the ultrasonography diagnostic.

Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography in the diagnosis of autoimmune pancreatitis and IgG4-related sclerosing cholangitis.

Endoscopic retrograde cholangiopancreatography is used to evaluate the narrowing of the main pancreatic duct in autoimmune pancreatitis (AIP) and biliary stricture in IgG4-related sclerosing cholangitis (IgG4-SC). Intraductal ultrasonography enables detailed visualization of the thickening of the bile duct wall in IgG4-SC. Pancreatic cancer, cholangiocarcinoma, and primary sclerosing cholangitis are important mimicking conditions of AIP and IgG4-SC. Diffuse or segmental stricture without marked upstream dilatation is a typical pancreatographic finding in AIP. By contrast, a single, short stricture with marked upstream dilatation is a typical finding in pancreatic cancer. The cholangiogram of IgG4-SC is classified into four types based on biliary stricture location, and this cholangiogram classification is useful for the differential diagnosis of IgG4-SC. Endoscopic retrograde cholangiography can be used to distinguish between IgG4-SC and primary sclerosing cholangitis. A segmental/long and intrapancreatic stricture is a characteristic finding of IgG4-SC, whereas band-like strictures, a beaded or pruned-tree appearance, and diverticulum-like outpouching are characteristic of primary sclerosing cholangitis. The characteristic intraductal ultrasonographic findings of circular-symmetrical wall thickening, smooth outer and inner margins, and homogeneous internal echo at the biliary stricture site are useful for diagnosis of IgG4-SC. Thickening of the bile duct wall at non-stricture sites is also a typical intraductal ultrasonographic finding of IgG4-SC and can be used for differential diagnosis from cholangiocarcinoma. Transpapillary bile duct and duodenal papilla biopsy during endoscopic retrograde cholangiopancreatography are also useful in the diagnosis of IgG4-SC.

Surgical Techniques to Reduce the Diminished Ovarian Reserve Risk of Endometrial Cyst

AIM: The objective of the study was to report the endometriosis case and surgical technique to reduce the diminished ovarian reserve risk. CASE PRESENTATION: A 32-year-old woman was presented with the lower abdominal pain since 1 year ago, intermittent, and got worse during menstruation. The mobile cystic mass was palpable on the abdomen without pain during palpation. Vaginal examination showed mobile and smooth surface cystic mass was palpable, the upper pole was three fingers below the umbilicus, and lower pole was in line with pubic symphysis. Transvaginal ultrasonography (TVUS) showed uterus and right ovary enlargement; and unilocular cyst with homogenous echo pattern. There was a marked increase in CA-125. Based on International Tumor Analysis, the tumor was classified as B1 unilocular cyst and the malignancy risk index was 600. The patient was diagnosed with endometriosis and laparotomy cystectomy was performed. CONCLUSION: Patient was diagnosed with endometrial cyst and laparotomy cystectomy was performed as treatment. Ovarian cystectomy in infertile women was shown to have comparable ovarian reserve (OR), reduced pain symptoms, and increased conception among infertile patients.

Lenvatinib-Induced Destructive Thyroiditis in a Patient With Hepatocellular Carcinoma

Lenvatinib is an antineoplastic oral agent that acts as a multi-kinase inhibitor against vascular endothelial growth factor (VEGF). This drug is commonly known for its use against radioiodine-refractory differentiated thyroid cancer, but it is also approved for unresectable hepatocellular carcinoma (HCC). Side effects such as fatigue, hypertension, palmar-plantar erythrodysesthesia, diarrhea, decreased appetite, and hypothyroidism are frequently reported adverse effects. However, the incidence of hyperthyroidism is a less known phenomenon. This case describes a patient with HCC on lenvatinib therapy who develops destructive thyroiditis. A 69-year-old man with hepatitis c cirrhosis complicated by progressive hepatocellular carcinoma (Child-Pugh class A6) presented with generalized weakness, unintentional weight loss, heat intolerance, palpitations, and tremors. He had been started on chemotherapy with lenvatinib 12 mg/day four weeks prior to presentation. Endocrinology was consulted due to abnormal thyroid function tests (TFTs). He had no previous history of thyroid function abnormalities or family history of thyroid disease. Laboratory tests revealed a hyperthyroid state [total thyroxine (T4), 14.3 µg/dL (normal range 4.5-11.7); free thyroxine (FT4), 1.9 ng/dL (normal range 0.9-1.7); thyroid-stimulating hormone (TSH), 0.07 µIU/mL (normal range 0.27-4.20), and negativity for antibodies [anti-thyroid peroxidase antibody (TPO Ab), 0.8 IU/mL (normal range 0.0-9.0); thyroglobulin antibody (Tg Ab), < 0.9 IU/mL (normal range 0.0-4.0); thyroid stimulating immunoglobulin (TSI), 90% (normal range < 122)]. Ultrasonography revealed a mildly prominent thyroid gland, a homogenous echo texture, and no suspicious thyroid nodules. In addition, a 99m-technetium (99mTc) scintigraphy demonstrated reduced radioactive uptake that was consistent with thyroiditis. Therefore, this patient was diagnosed with lenvatinib-induced destructive thyroiditis. Palpitations improved with a beta-blocker and the patient was resumed on a lower dose of lenvatinib, 8 mg/day, one week later. About six weeks after the initial dose of lenvatinib, his TFT results normalized. Lenvatinib disrupts cell proliferation which can affect many organs, including the thyroid gland. Although several theories have been proposed, the exact underlying mechanism by which this occurs remains unknown. It is important to note that in addition to hypothyroidism, lenvatinib may also cause hyperthyroidism in the form of a transient destructive thyroiditis. This emphasizes the need to routinely check TFTs prior to the initiation of lenvatinib and throughout the course of therapy.

Splenic myelolipoma in a dog

ABSTRACT: Myelolipoma is a benign neoplasm composed of mature adipocytes and hematopoietic elements. This tumor is rare in dogs and cats and can develop in several organs and tissues. This report describes a case of splenic myelolipoma in a dog characterizing its clinical-pathological and ultrasonography aspects. A 9-year-old, female, mixed-breed, castrated dog was referred to the veterinary hospital with increased abdominal circumference. Ultrasonography revealed splenomegaly with masses of not measurable dimensions along the entire length of the parenchyma. The spleen was removed, and a fragment was sent for histopathological analysis. Macroscopically, the spleen was enlarged, with irregularly nodular growths that project above the surface of the organ. Nodules were red with small yellow areas. Microscopically, the spleen was effaced by a well-demarcated and not encapsulated mass composed of histologically well-differentiated neoplastic adipose tissue with islands and nests of varying proportions of hematopoietic elements. Histological examination confirmed the diagnosis of myelolipoma. Myelolipomas are observed on ultrasound images as hyperechoic masses or nodules with homogeneous echo texture. Here, ultrasound appearance involved mixed echogenicity and heterogeneous echotexture, due to the mixture of fat and non-fatty material components of the tumor.

Texture Analysis of Ultrasound Images to Differentiate Simple Fibroadenomas From Complex Fibroadenomas and Benign Phyllodes Tumors.

American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions can be distinguished from BI-RADS 3 lesions with main ultrasound (US) findings such as a well-defined contour, round/oval shape, and parallel orientation with a homogeneous echo pattern. Breast Imaging Reporting and Data System 4A solid masses might be diagnosed as simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), or benign phyllodes tumors (BPTs). Complex fibroadenomas have an increased risk of invasive cancer development than SFAs, and BPTs have a risk of borderline-malignant phyllodes tumor transformation; both of them are surgically treated, whereas follow-up procedures are applied in SFAs. It is essential to differentiate SFAs from CFAs and BPTs. Grayscale features of these lesions include a prominent overlap. Texture analyses in breast lesions have contributions in benign-malignant lesion differentiation. In this study, we aimed to use texture analysis of US images to differentiate these benign lesions. Grayscale US features of lesions (32 SFAs, 31 CFAs, and 32 BPTs) were classified according to the BI-RADS. Texture analysis of US images with LIFEx software (http://www.lifexsoft.org) was performed retrospectively. First- and second-order histogram parameters were evaluated. In grayscale US, the shape, orientation, and posterior acoustic characteristics had statistical significance (P < .05). In the statistical analysis, skewness, kurtosis, excess kurtosis, gray-level co-occurrence matrix (GLCM)-energy, GLCM-entropy log 2, and GLCM-entropy log 10 revealed significant differences among all 3 groups (P < .05). As grayscale US features show prominent intersections, and treatment options differ, correct diagnosis is essential in SFAs, CFAs, and BPTs. In this study, we concluded that texture analysis of US images can discriminate SFAs from CFAs and BPTs. Texture analyses of US images is a potential candidate diagnostic tool for these lesions, and accurate diagnoses will preclude patients from undergoing unnecessary biopsies.

Disinformation by Design: The Use of Evidence Collages and Platform Filtering in a Media Manipulation Campaign

Disinformation campaigns such as those perpetrated by far-right groups in the United States seek to erode democratic social institutions. Looking to understand these phenomena, previous models of disinformation have emphasized identity-confirmation and misleading presentation of facts to explain why such disinformation is shared. A risk of these accounts, which conjure images of echo chambers and filter bubbles, is portraying people who accept disinformation as relatively passive recipients or conduits. Here we conduct a case study of tactics of disinformation to show how platform design and decentralized communication contribute to advancing the spread of disinformation even when that disinformation is continuously and actively challenged where it appears. Contrary to a view of disinformation flowing within homogeneous echo chambers, in our case study we observe substantial skepticism against disinformation narratives as they form. To examine how disinformation spreads amidst skepticism in this case, we employ a document-driven multi-site trace ethnography to analyze a contested rumor that crossed anonymous message boards, the conservative media ecosystem, and other platforms. We identify two important factors that filtered out skepticism and contested explanations, which facilitated the transformation of this rumor into a disinformation campaign: (1) the aggregation of information into evidence collages—image files that aggregate positive evidence—and (2) platform filtering—the decontextualization of information as these claims crossed platforms. Our findings provide an elucidation of “trading up the chain” dynamics explored by previous researchers and a counterpoint to the relatively mechanistic accounts of passive disinformation propagation that dominate the quantitative literature. We conclude with a discussion of how these factors relate to the communication power available to disparate groups at different times, as well as practical implications for inferring intent from social media traces and practical implications for the design of social media platforms.

Differentiation of solid-pseudopapillary tumors of the pancreas from pancreatic neuroendocrine tumors by using endoscopic ultrasound

To differentiate solid-pseudopapillary tumors (SPTs) of the pancreas from pancreatic neuroendocrine tumors (pNETs) by endoscopic ultrasound. We retrospectively reviewed all patients with SPTs and pNETs who underwent endoscopic ultrasound (EUS) from May 2012 to August 2018 at the Fudan University Shanghai Cancer Center. We included patients confirmed pathologically with a surgical biopsy or with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The demographic data of the patients, characteristics of the lesions and overall survival data of patients with these two diseases were further compared. A total of 147pNET patients and 21SPT patients were included in our study. The mean ages of the patients in the SPT and pNET groups were 35.95years and 54.30years, respectively. There were more females in the SPT group than in the pNET group (71.43% vs. 40.82%). The patients in the pNET group had significantly more lymphatic metastases and visceral organ metastases than the patients in the SPT group. A larger proportion of pNET lesions than SPT lesions had homogeneous echo patterns and were hypervascular. Cystic components and calcification components were more often observed in the SPT lesions than in the pNET lesions. In the multivariate logistic regression analysis, the hypervascularization (OR: 6.528, 95% CI: 1.562-27.285, P=0.010) and cystic component (OR: 0.106, 95% CI: 0.019-0.597, P=0.011) variables resulted in the best discrimination of patients with SPTs from patients with pNETs. Survival among patients with SPTs was higher than that among patients with pNETs at all points in the follow-up period. SPTs tended to occur in younger people and were more common in women. Pancreatic neuroendocrine tumors tended to form metastases more often than SPTs. The blood supply and cystic components of the lesions may have novel potential diagnostic utility for differentiating SPTs from pNETs.

The ultrasonic appearances of primary testicular lymphoma

Objective To explore the sonographic features of primary testicular lymphoma(PLT). Methods The sonographic features of 16 PLT patients confirmed by surgery and pathology were retrospectively analyzed. Results Sixteen PLT patients were typed into 3 ultrasonic patterns: ①The diffuse homogeneous echo type: 2 cases, the ultrasonic features were homogeneous sieve-like hypoechoic echo, the blood flow signal was rich and radially distributed, with interstisial fibrosis inapparently under-microscope. ②The diffuse uneven homogeneous echo type: 9 cases, the ultrasonic features lobulated or map-like heterogeneous hypoechoic features, the blood flow signal was rich in linear distribution, and interstisial fibrosis proliferated to form fibrous septa under-microscope. ③The focal nodular pattern echo type: 5 cases, the ultrasonic features were homogeneous hypoechoic nodules, the blood flow signal was few, interstisial fibrosis hyperplasia surrounding the tumor under-microscope. Conclusions Ultrasonic appearances of primary testicular lymphoma are closely related to its pathologic characteristics, the recognization of their relations contributes to improve the diagnostic value of ultrasound. Key words: Ultrasonograghy; Lymphoma, testis, primary