Distribution Of Lesions Research Articles

Prevalence and Distribution of Gastric Endoscopy Findings in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases: Influence of Atrophic Gastritis.

Objective The impact of Helicobacter pylori infection on gastric endoscopic findings in non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) remains unclear. This study investigated the influence of H. pylori infection on the prevalence and distribution of gastric lesions. Methods The details of 75 patients diagnosed with non-EoE EGIDs were retrospectively reviewed. Of the 56 patients with a definitive diagnosis according to the Japanese criteria (any GI tract; ≥20 eosinophils/high-power field), 25 patients with pathologic gastric eosinophil infiltration (gastric EI; ≥30 eosinophils/high-power field) were investigated in detail. The prevalence and distribution of gastric endoscopy findings were assessed according to the gastric mucosal atrophy status, an indicator of H. pylori infection. Results Erythema (76%) was the most common finding in the gastric EI-positive group, followed by erosions (36%), ulcers (28%), ulcer scars (28%), and edema (24%). None of these lesions differed significantly in frequency between the patients with and without gastric atrophy. When erosions, ulcers, and ulcer scars were unified, they were slightly more common in the gastric bodies of patients with gastric atrophy than those without gastric atrophy; however, no preferential site was found in those without gastric atrophy. We identified six patients with active gastric ulcers, and half had large, deep ulcers with marginal swelling/irregularity. Conclusion Gastric endoscopy findings in non-EoE EGIDs with gastric EI were evenly observed in the stomach, with no specific trend in frequency or distribution depending on atrophic gastritis, an indicator of H. pylori infection. Gastric ulcers in patients with non-EoE EGIDs should be considered in the differential diagnosis of idiopathic peptic ulcers.

P53 Expression in Gallbladder Lesions: A Cross-sectional Study from a Tertiary Care Centre in Northern India

Introduction: Gallbladder lesions comprise inflammatory, benign, pre-malignant, and malignant lesions. The progression of benign lesions into malignant ones involves a complex process. The p53 gene is commonly disrupted in carcinogenesis. Malignant lesions may exhibit p53 overexpression compared to benign and inflammatory lesions. Aim: To investigate the distribution of gallbladder lesions and the expression of the p53 nuclear protein in these lesions. Materials and Methods: A cross-sectional study was conducted at the Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, from June 2020 to December 2022. A total of 249 specimens of gallbladder lesions, including congenital, inflammatory, benign, pre-malignant, and malignant lesions, were included. All samples underwent Haematoxylin & Eosin(H&E) staining and Immunohistochemistry (IHC) with p53 antibody using the peroxidase-antiperoxidase method. The association of P53 expression with histopathological diagnosis was analysed using Fisher’s Exact test. The final analysis was performed using Statistical Package for Social Sciences (SPSS) software, version 25.0. A p-value <0.05 was considered statistically significant. Results: Out of 249 specimens, there were 217 (87.14%) inflammatory lesions, 9 (3.6%) benign lesions, 2 (0.8%) premalignant lesions, and 21 (9.26%) malignant lesions. The main inflammatory lesions were Chronic Cholecystitis (CC) with 132 cases (60.83%) and CC with cholesterosis with 36 cases (16.59%). The most common pre-malignant lesion was choledochal cyst with 3 cases (3.33%). Benign tumours (leiomyoma) were present in 2 (0.8%) patients. Among the 21 (8.46%) malignant tumours, 4 (19.05%) were moderately differentiated adenocarcinoma, 13 (61.9%) were poorly differentiated adenocarcinoma, and 4 (19.05%) were well-differentiated adenocarcinoma. P53 overexpression was significantly higher in patients with malignant tumours (9 cases, 42.86%) compared to inflammatory lesions (26 cases, 11.98%), benign lesions (0 cases, 0%), and pre-malignant lesions (0 cases, 0%) (p=0.003). Conclusion: Gallbladder lesions exhibit a wide range of histopathological presentations. Inflammatory lesions are the most common, followed by pre-malignant and malignant lesions. P53 can serve as a novel marker for differentiating inflammatory lesions from malignant lesions in the gallbladder.

Characterizing upper extremity fine motor function in the presence of white matter hyperintensities: A 7 T MRI cross-sectional study in older adults

BackgroundWhite matter hyperintensities (WMH) are a prevalent radiographic finding in the aging brain studies. Research on WMH association with motor impairment is mostly focused on the lower-extremity function and further investigation on the upper-extremity is needed. How different degrees of WMH burden impact the network of activation recruited during upper limb motor performance could provide further insight on the complex mechanisms of WMH pathophysiology and its interaction with aging and neurological disease processes. Methods40 healthy elderly subjects without a neurological/psychiatric diagnosis were included in the study (16F, mean age 69.3 years). All subjects underwent ultra-high field 7 T MRI including structural and finger tapping task-fMRI. First, we quantified the WMH lesion load and its spatial distribution. Secondly, we performed a data-driven stratification of the subjects according to their periventricular and deep WMH burdens. Thirdly, we investigated the distribution of neural recruitment and the corresponding activity assessed through BOLD signal changes among different brain regions for groups of subjects. We clustered the degree of WMH based on location, numbers, and volume into three categories; ranging from mild, moderate, and severe. Finally, we explored how the spatial distribution of WMH, and activity elicited during task-fMRI relate to motor function, measured with the 9-Hole Peg Test. ResultsWithin our population, we found three subgroups of subjects, partitioned according to their periventricular and deep WMH lesion load. We found decreased activity in several frontal and cingulate cortex areas in subjects with a severe WMH burden. No statistically significant associations were found when performing the brain-behavior statistical analysis for structural or functional data. ConclusionWMH burden has an effect on brain activity during fine motor control and the activity changes are associated with varying degrees of the total burden and distributions of WMH lesions. Collectively, our results shed new light on the potential impact of WMH on motor function in the context of aging and neurodegeneration.

Cobb Syndrome, A Rare Disease – Case Report

Cobb syndrome is a rare genetic disorder characterized by dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). It is also known as spinal arteriovenous metameric syndrome (SAMS) and cutaneous meningospinal angiomatosis. We present a case of a 36 years old male presented to OPD with Complain of progressive weakness of Right upper limb for 5 years. On examination, Patient had large cutaneous port wine stain on the right side of the chest, nape of neck, and along the whole right upper limb in a dermatomal distribution with ulnar claw hand wasting of thenar muscles on right side. MRI cervical spine with contrast showed aggressive vertebral hemangioma involving anterior and posterior arch of C1 vertebra, vertebral body of C2 to C5, right half of vertebral body of C2 and C6 and right pedicle of C2 to C5 vertebra. Abnormal thickened and T2WI /STIR hyperintense skin and subcutaneous tissue involving right half of scalp and right half of neck which showing post contrast enhancement, possibility of subcutaneous hemangioma. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. Treatment decision is guided by the patient’s symptoms and imaging features.

Histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center, Jimma, Southwest Ethiopia: A two-year cross-sectional study.

The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal. This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019. A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020. In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases. The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps. We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.

Optical Biopsies Using Probe-Based Confocal Laser Endomicroscopy for Autoimmune Pulmonary Alveolar Proteinosis

Introduction: Increasing numbers of cases of mild asymptomatic pulmonary alveolar proteinosis (PAP) are being reported with the recent increase in chest computed tomography (CT). Bronchoscopic diagnosis of mild PAP is challenging because of the patchy distribution of lesions, which makes it difficult to obtain sufficient biopsy samples. Additionally, the pathological findings of mild PAP, particularly those that differ from severe PAP, have not been fully elucidated. This study aimed to clarify the pathological findings of mild PAP and the usefulness of optical biopsy using probe-based confocal laser endomicroscopy (pCLE). Methods: We performed bronchoscopic optical biopsy using pCLE and tissue biopsy in 5 consecutive patients with PAP (three with mild PAP and two with severe PAP). We compared the pCLE images of mild PAP with those of severe PAP by integrating clinical findings, tissue pathology, and chest CT images. Results: pCLE images of PAP showed giant cells with strong fluorescence, amorphous substances, and thin alveolar walls. Images of affected lesions in mild PAP were equivalent to those obtained in arbitrary lung lesions in severe cases. All 3 patients with mild PAP spontaneously improved or remained stable after ≥3 years of follow-up. Serum autoantibodies to granulocyte-macrophage colony-stimulating factor were detected in all 5 cases. Conclusion: Optical biopsy using pCLE can yield specific diagnostic findings, even in patients with mild PAP. pCLE images of affected areas in mild and severe PAP showed similar findings, indicating that the dysfunction level of pathogenic alveolar macrophages in affected areas is similar between both disease intensities.

Exploring the efficacy of laser speckle contrast imaging in the stratified diagnosis of rosacea: a quantitative analysis of facial blood flow dynamics across varied regions.

Rosacea has a high incidence, significantly impacts quality of life, and lacks sufficient diagnostic techniques. This study aimed to investigate the feasibility of laser speckle contrast imaging (LSCI) for measuring facial blood perfusion in patients with rosacea and to identify differences in blood flow among various facial regions associated with different rosacea subtypes. From June to December 2023, 45 patients were recruited, with 9 excluded, leaving 36 subjects: 12 with erythematotelangiectatic rosacea (ETR), 12 with papulopustular rosacea (PPR), and 12 healthy controls. The Think View multispectral imaging analyzer assessed inflammation via gray reading values across the full face and five facial areas: forehead, nose, cheeks, and chin. LSCI measured and analyzed blood perfusion in the same areas. Plasma biomarkers interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were tested in different groups. Both ETR and PPR groups showed increased average blood perfusion and facial inflammation intensity by gray values compared to controls, with statistically significant differences. Average blood perfusion of ETR and PPR groups showed increased values in the forehead, cheeks, and nose, compared to controls, and the values in the cheeks were statistically different between ETR and PPR. The facial inflammation intensity of the ETR group showed increased values in the forehead and cheeks, and the PPR group showed increased gray values in the forehead, cheeks, nose, and chin compared to controls, and the values for the cheeks, nose, and chin were statistically significantly different between ETR and PPR. Plasma biomarkers IL-6, IL-1β, and TNF-α were significantly elevated in both ETR and PPR groups compared to controls. LSCI is a valuable, non-invasive tool for assessing blood flow dynamics in rosacea, providing a data foundation for clinical research. Different rosacea subtypes exhibit distinct lesion distribution and blood flow patterns, and both ETR and PPR could affect all facial areas, particularly the cheeks in ETR and the forehead, nose, and chin in PPR.

Histopathological Spectrum of Pigmented Skin Lesions in a Tertiary Care Centre of Nepal

IntroductionPigmented skin lesions are defined as altered pigmentation of the skin as well as mucous membrane which can present as flat or raised growth and can be blue, brown, black or grey in color. The main aim of the study was to see the histopathological spectrum of pigmented skin disease and compare the clinical and histopathological diagnoses. MethodsIt is observational cross-sectional study conducted in the Department of Pathology of Gandaki Medical College and Teaching hospital from January 2022 to December 2022 and 80 cases were included. ResultsAge of the patient ranged from seven to 89 years and mean ± SD was 49.55 ± 21.73 years. There were 34 (42.6%) males and 46 (57.4%) females with a female: male ratio 1.3:1. The most common site of distribution of pigmented lesions of the skin were face in 44(55%) followed by trunk in 15(18.7%), extremities in 13(16.2%), scalp in 7(8.8%) and genitalia in 1 (1.3%). Histopathological study revealed the most common lesion as melanocytic nevi 14(17%) followed by basal cell carcinoma 11(13.8%), seborrheic keratosis 6(7.6%), Keratoacanthoma 5(6.3%), verrucous epidermal nevus 4(5%) and others cases in few numbers. Clinicopathological agreement was seen in 44 (55%). Conclusions Melanocytic nevi were the most common among the pigmented skin lesion. Other causes of pigmented lesions were due to keratinocytic, vascular and reactive changes. Malignant tumors can sometimes mimic benign lesions. Therefore, histopathological examination remains the gold standard in diagnosing these conditions and provide proper guidance for further management of patients.

Investigation of the prevalence of potentially malignant and malignant oral lesions in the Southeastern Anatolia Region of Turkey: A 5-year retrospective study

Aim: The aim of this study was to determine the region, frequency, distribution, age, and sex of histopathologically diagnosed oral malignant and oral potentially malignant lesions obtained from patients admitted to the Department of Pathology, Dicle University Faculty of Medicine, Southeastern Anatolia Region of Turkey. Material and Method: The pathological data of oral malignant and potentially malignant lesions histopathologically diagnosed at the Department of Pathology, Dicle University Faculty of Medicine, between 2018 and 2023, were retrospectively reviewed. Potentially malignant and malignant oral lesions were classified, and their distribution according to region, age, and sex was analyzed. The Shapiro-Wilk test was used to analyze the conformity of continuous variables to the normal distribution. The type I error level was accepted as 5% in statistical analyses. Results: Among 161 patients with oral or potential malignancy, 76 (47.2%) were female, and 85 (52.8%) were male, with a mean age of 53.9 ± 17.4 years. The most common lesions were found in the buccal mucosa (40.4%). When 104 malignant lesions were analyzed, the most common lesion was oral squamous cell carcinoma with a rate of 75%, and when 57 potentially malignant lesions were analyzed, 38 (66.7%) of the patients had lichen planus, and 19 (33.3%) had leukoplakia. Conclusion: This retrospective study shows the distribution, frequency, and characteristics of malignant lesions in the oral cavity in a group of populations, especially in the Southeastern Anatolia Region of Turkey, and allows comparison with studies in different populations. How to cite this article: Kaplan B, Alabalık U, Akşahin C, Çolak M, Ortaç H. Investigation of the prevalence of potentially malignant and malignant oral lesions in the Southeastern Anatolia Region of Turkey: A 5-year retrospective study. J Med Dent Invest 2023; 4: e230348. https://doi.org/10.5577/jomdi.e230348

Transformer guided self-adaptive network for multi-scale skin lesion image segmentation

BackgroundIn recent years, skin lesion has become a major public health concern, and the diagnosis and management of skin lesions depend heavily on the correct segmentation of the lesions. Traditional convolutional neural networks (CNNs) have demonstrated promising results in skin lesion segmentation, but they are limited in their ability to capture distant connections and intricate features. In addition, current medical image segmentation algorithms rarely consider the distribution of different categories in different regions of the image and do not consider the spatial relationship between pixels. ObjectivesThis study proposes a self-adaptive position-aware skin lesion segmentation model SapFormer to capture global context and fine-grained detail, better capture spatial relationships, and adapt to different positional characteristics. The SapFormer is a multi-scale dynamic position-aware structure designed to provide a more flexible representation of the relationships between skin lesion characteristics and lesion distribution. Additionally, it increases skin lesion segmentation accuracy and decreases incorrect segmentation of non-lesion areas. InnovationsSapFormer designs multiple hybrid transformers for multi-scale feature encoding of skin images and multi-scale positional feature sensing of the encoded features using a transformer decoder to obtain fine-grained features of the lesion area and optimize the regional feature distribution. The self-adaptive feature framework, built upon the transformer decoder module, dynamically and automatically generates parameterizations with learnable properties at different positions. These parameterizations are derived from the multi-scale encoding characteristics of the input image. Simultaneously, this paper utilizes the cross-attention network to optimize the features of the current region according to the features of other regions, aiming to increase skin lesion segmentation accuracy. Main resultsThe ISIC-2016, ISIC-2017, and ISIC-2018 datasets for skin lesions are used as the basis for the experiment. On these datasets, the proposed model has accuracy values of 97.9 %, 94.3 %, and 95.7 %, respectively. The proposed model's IOU values are, in order, 93.2 %, 86.4 %, and 89.4 %. The proposed model's DSC values are 96.4 %, 92.6 %, and 94.3 %, respectively. All three metrics surpass the performance of the majority of state-of-the-art (SOTA) models. SapFormer's metrics on these datasets demonstrate that it can precisely segment skin lesions. Notably, our approach exhibits remarkable noise resistance in non-lesion areas, while simultaneously conducting finer-grained regional feature extraction on the skin lesion image. ConclusionsIn conclusion, the integration of a transformer-guided position-aware network into semantic skin lesion segmentation results in a notable performance boost. The ability of our proposed network to capture spatial relationships and fine-grained details proves beneficial for effective skin lesion segmentation. By enhancing lesion localization, feature extraction, quantitative analysis, and classification accuracy, the proposed segmentation model improves the diagnostic efficiency of skin lesion analysis on dermoscopic images. It assists dermatologists in making more accurate and efficient diagnoses, ultimately leading to better patient care and outcomes. This research paves the way for advances in diagnosing and treating skin lesions, promoting better understanding and decision-making in the clinical setting.

Risk prediction of CISS classification in endovascular treatment of basilar artery stenosis

ObjectiveTo investigate the incidence of ischemic stroke complications after endovascular treatment for basilar artery stenosis used preoperative high-resolution magnetic resonance vascular wall imaging (HRMR/VWI) and diffusion-weighted imaging (DWI). MethodsThe clinical data of 47 patients with severe symptomatic basilar artery stenosis (stenosis rate ≥70 %) treated with endovascular therapy at the Neuro-interventional Center from December 2017 to December 2021 were retrospectively analyzed. High-resolution magnetic resonance angiography (HRMR VWI) and DWI were used to evaluate the location of atherosclerotic plaque at basilar artery stenosis and the distribution of cerebral infarction lesions in all patients before surgery.According to the CISS classification system for ischemic stroke, patients were divided into a perforation group and a hypoperfusion group, and the general situation, plaque distribution, and incidence of ischemic stroke complications 7 days after endovascular treatment in the two groups were analyzed. ResultsThere was no significant difference in baseline data between the two groups. After 7 days of intravascular treatment, the incidence of ischemic stroke was higher in the perforation group (20.0 %) than in the hypoperfusion group (0.0 %), and the difference was statistically significant (P = 0.027). A significant association was found between the perforation group and the hypoperfusion group for the incidence of ischemic stroke at 7 days (P = 0.003, OR = 2.347; 95 % CI = 2.056–4.268). There were a higher proportion of ventral plaques (74.1 %) and a lower proportion of dorsal plaques (33.3 %) in the hypoperfusion group, which were 15.0 % and 90.0 % in the perforation group, respectively (χ2 = 16.045, P < 0.001; χ2 = 15.092, P < 0.001). There was no significant difference in the proportion of left and right plaques between the two groups. ConclusionsThe risk of ischemic stroke is greater in patients with perforator artery obstruction undergoing endovascular therapy, and lower in patients with hypoperfusion/embolus removal.

Clinical spectrum and clinicopathological correlation of pediatric orbital tumors: 20 years' experience from a tertiary eye care center.

To study the epidemiological profile of various pediatric orbital tumors and determine their clinicopathological correlation over 20 years. A retrospective analysis of all pediatric patients with orbital tumors from the medical records between 1995 and 2015 was done. Tumors were categorized based on their cellular origin. Demographic details, clinical and histopathological diagnoses, frequency, and clinicopathological correlation were studied. A total of 265 pediatric patients with orbital tumors were analyzed, of which 145 (54.7%) patients were males and 120 (45.3%) were females. The mean age was 7 years (median: 6 years; range: 10 days-16 years). The distribution of lesions in each group was as follows: vasculogenic, 76 (28.7%); lipogenic and myxoid, 66 (25%); myogenic, 31 (11.7%); optic nerve and meningeal, 22 (8.3%); lymphoid and lymphoproliferative, 18 (6.8%); secondary orbital tumors, 14 (5.2%); histiocytic, 9 (3.4%); miscellaneous, 9 (3.4%), lacrimal gland, 8 (3%); mesenchymal with neural differentiation, 6 (2%); osseous, 4 (1.5%), and fibrocystic, 2 (0.8%). The most common benign and malignant pediatric orbital tumors were dermoid cysts (65, 24.5%) and rhabdomyosarcoma (31, 11.7%). A statistically significant ( P < 0.0001) clinicopathological correlation was observed in 208 (83.2%) out of 250 biopsy-proven cases. Pediatric orbital neoplasms include a broad spectrum of benign and malignant lesions. Vasculogenic tumors constitute the majority of them, followed by lipogenic and myxoid tumors. A thorough knowledge of the incidence, clinical profile, imaging features, and histopathology of specific orbital tumors aids in accurate diagnosis and their successful management.

Some Risk Factors of Atopic Dermatitis in Adults

Atopic dermatitis (AD) is an inflammatory skin disorder characterized by intense itching and eczematous lesions. The onset of AD usually occurs in childhood and AD symptoms can last into adulthood. An increasing prevalence of AD has been observed worldwide. The causes of AD are multifactorial and there are still not many systematic reviews of AD-related risk factors. This study uses a literature review method. Literature search was conducted using Google Scholar and PubMed. using keywords: atopic dermatitis, risk factors, adults, and observational studies. All literature was selected using inclusion and exclusion criteria to assess the suitability of the content and quality of the study. Patients with atopic dermatosis had a filaggrin mutation cause loss/change in the function of filaggrin (Filament Aggregating Protein). Risk factors for atopic dermatitis in adults include a history of atopy, food allergies, a history of atopy in the father or mother or both, history of AD in parents, having pets at home, younger age or early onset, being a former smoker, gender women and active smoking, as well as passive smokers, low education level (&lt;=12 years), socioeconomic status, and living in small places. Symptoms and clinical manifestations include pruritus, morphology and wide distribution of lesions, chronic and recurrent dermatitis, history of atopy and family history of atopy. Management of atopic dermatitis begins with education and skin care by taking regular baths and using emollients/moisturizers. Atopy and family history of atopy, smoking, low education, and socioeconomic are risk factors for AD in adults.

The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series.

In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern wasnot associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. IV Laryngoscope, 134:2609-2616, 2024.

The effect of fibrinoid necrosis on the clinical features and outcomes of primary IgA nephropathy

BackgroundTo explore the clinicopathologic features and outcomes of IgAN patients who presented with fibrinoid necrosis (FN) lesions or not and the effect of immunosuppressive (IS) treatment in IgAN patients with FN lesions as well.MethodsThis was a retrospective cohort study with 665 patients diagnosed with primary IgAN from January 2010 to December 2020 in Tianjin Medical University General Hospital and having detailed baseline and follow-up characteristics. Patients were divided into two groups depending on the appearance of FN lesions. Patients with FN lesions were recruited into Group FN1, while patients who were not found FN lesions in their renal biopsy specimens were recruited into Group FN0. Compare the differences between Group FN0 and Group FN1 in baseline clinicopathologic features, treatment solutions and follow-up data as well. To evaluate the impact of different fractions of FN lesions on baseline characteristics and prognosis of IgAN, we subdivided patients in Group FN1 into 3 groups depending on the FN lesions distribution, Mild Group: 0 < FN% < 1/16; Moderate Group: 1/16 < FN% < 1/10; Severe Group: FN% > 1/10. Furthermore, we compared the differences in baseline clinicopathologic features, treatment solutions and follow-up data among these three groups. Kidney endpoint event was defined as patients went into end-stage kidney disease (ESKD), which estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m^2, regularly chronic dialysis over 6 months or received renal transplantation surgery. The kidney composite endpoint was defined by a ≥ 30% reduction in eGFR, double Scr increase than on-set, ESKD, chronic dialysis over 6 months or renal transplantation. Compare the survival from a composite endpoint rate in different groups by Kaplan-Meier survival curve. The univariate and multivariate Cox models were used to establish the basic model for renal outcomes in patients with FN lesions.Results(1) A total of 230 patients (34.59%) were found FN lesions in all participants. Patients with FN lesions suffered more severe hematuria than those without. On the hand of pathological characteristic, patients with FN lesions showed higher proportions of M1, E1, C1/C2 and T1/T2 lesions compared with those without FN lesions. (2) The 1-year, 3-year, and 5-year survival of the composite endpoint were lower in the FN1 group than FN0 group. (3) After adjusting for clinicopathological variables, the presence of FN lesions was a significantly independent risk factor for composite endpoint. By using multivariate Cox regression analyses, we also found when the fraction of FN lesions exceeded 10%, the risk of progression into composite endpoint increased 3.927 times.ConclusionFibrinoid necrosis of capillary loops is an independent risk factor of poor renal outcomes. More effective treatment should be considered for those who had FN lesions.

Epidemiology of horse pythiosis in the Pantanal of Mato Grosso: Exploring the host-parasite-vector relationship

Horse pythiosis is considered an endemic disease in the Brazilian Pantanal region, causing devastating health and economic losses. This study aimed to enhance the understanding of pythiosis epidemiology, map the distribution of horse body lesions, and investigate the correlation between these lesions and warm body surface areas, potentially implicating hematophagous vectors in the disease's transmission. A prospective study was conducted on equids in the Pantanal Mato-grossense and adjacent areas from 2012 to 2022, with 112 horses and three mules diagnosed with pythiosis. Clinical and epidemiological data, lesions' photographic records, and healthy equids' thermal imaging were collected. Most pythiosis cases occurred between January and March, correlating with regional flood cycles. Most lesions were found on limbs and the ventral abdomen, with dark-colored horses exhibiting a higher frequency of lesions. Interestingly, the thermal mapping revealed that warm areas on a healthy horse's body overlapped significantly with lesion distribution – blood-sucking insects also prefer these areas. The results suggest that pythiosis lesions in horses correlate with warmer areas of the animal body, reinforcing the hypothesis of vector involvement in disease transmission. This study underscores the need for further observational research to fully understand the complex epidemiological dynamics of pythiosis in horses.

An Unusual Presentation of Sarcoidosis: The Great Mimicker

ABSTRACT Sarcoidosis is a very well-known disease for its variable clinical and radiological presentation. Thoracic involvement is the commonest manifestation of sarcoidosis followed by skin. We present here an interesting case report of an old-age patient with an unusual presentation of sarcoidosis. He was previously treated for leprosy based on skin biopsy with partial relief only. The unusual things in this patient were clinical and radiological findings. Clinically, he had only complaints of weight loss which had not been reported earlier; second, the skin lesions were not typical. The unusual radiological things were a disproportionate distribution of radiological lesions and predominant consolidation. Lower lobe consolidation in sarcoidosis is rarely reported, which was present in this patient. The perilymphatic micronodules were more concentrated on the right upper lobe as compared to the left upper lobes. Based on this case report we cannot deny the wrong diagnosis of leprosy because both diseases share common clinical and histopathological features.

Some aspects of the diagnosis and treatment of eosinophilic granuloma in cats.

Eosinophils represent the most active cells in mammals that show protective and assistive activity in the host immune defence against helminth parasites. These cells are also responsible for the reduction of allergic and inflammatory reactions. The eosinophils play a key role in allergic reactions by secretion of different chemical molecules leading to swelling, lesions and granuloma onset. The study was carried out on 30 cats with inflammatory skin lesions. The cats ranged in age from seven months to 13 years, and had an average age of three years. The research methodology included information on the disease, dermatological conclusions, concomitant disorders, medical and laboratory data and the treatment strategy. In total, 30 cats were diagnosed with eosinophilic granuloma complex. The distribution of lesions was 87.1% in the skin and 12.9% at the skin-mucosal junction. The lesions increased and decreased with the seasons of spring and summer, and the onset of the disease usually coincided with exposure to fleas. Eosinophilic granuloma complex in cats is a serious pathology and frequently requires lifelong treatment, so it is important to diagnose it quickly and accurately to ensure optimal treatment of affected animals.

Volumetric B-mode ultrasound and Doppler Imaging: Automatic Tracking With One Single Camera.

Vascular diseases may occur in the upper extremities, and the lesions can span the entire length of the blood vessel. One of the most popular methods to identify vascular disorders is ultrasound Doppler imaging. However, traditional two-dimensional (2D) ultrasound Doppler imaging cannot capture the entire length of a long vessel in one image. Medical professionals often have to painstakingly reconstruct three-dimensional (3D) data using 2D ultrasound images to locate the lesions, especially for large blood vessels. 3D ultrasound Doppler imaging can display the morphological structure of blood vessels and the distribution of lesions more directly, providing a more comprehensive view compared to 2D imaging. In this work, we propose a wide-range 3D volumetric ultrasound Doppler imaging system with dual modality, in which a high-definition camera is adopted to automatically track the movement of the ultrasound transducer, simultaneously capturing a corresponding sequence of 2D ultrasound Doppler images. We conducted experiments on human arms using our proposed system and separately with X-ray computerized tomography (X-CT). The comparison results prove the potential value of our proposed system in the diagnosis of arm vascular diseases.

Diagnostic value of the combination of circulating serum miRNAs and CA125 in endometriosis.

Circulating microRNAs (miRNAs) can serve as noninvasive biomarkers for endometriosis, but their diagnostic and prognostic values require investigation. This study evaluated the potential of 6 miRNAs in diagnosing endometriosis and predicting fertility. The study included patients with endometriosis (stages I-IV) and controls admitted to Sun Yat-Sen Memorial Hospital between May 2013 and March 2014. The serum expression levels of 6 miRNAs (miR-199a, miR-145*, miR-122, miR-9*, miR-141*, and miR-542-3p) were determined using qRT-PCR. Receiver operating characteristics curves were used to determine the diagnostic accuracy. The study included 155 patients with endometriosis and 77 controls. The model combining miR-199a, miR-122, miR-145*, and miR-141* with the carbohydrate antigen 125 (CA125) exhibited 81.8% sensitivity and 92.6% specificity and an area under the curve of 0.939 for diagnosing endometriosis. When combining miR-199a, miR-122, miR-145*, miR-542-3p, and CA125, the receiver operating characteristics curve showed an area under the curve of 0.759 and 79.6% sensitivity and 73.5% specificity for stage I/II versus III/IV endometriosis. Circulating miRNA levels were associated with pelvic adhesions (miR-199a, P < .05), lesion distribution (miR-9*, miR-145*, and miR-141*; all P < .05), and the presence of deep infiltrating endometriosis (miR-199a and miR-122; both P < .001). The expression levels of miR-199a, miR-122, and miR-542-3p decreased with an increasing endometriosis fertility index. The model combining circulating miRNAs (miR-199a, miR-122, miR-145*, and miR-141*) and CA125 is promising for diagnosing endometriosis and its severity. miR-199a, miR-122, and miR-542-3p were associated with the endometriosis fertility index and might be used to predict fertility preoperatively, but these results require confirmation.