Lesion Location Research Articles

Feasibility of a deep-inspiration breath-hold [18F]AlF-NOTA-LM3 PET/CT imaging on upper-abdominal lesions in NET patients: in comparison with respiratory-gated PET/CT

PurposesTo explore the clinical feasibility and efficacy of a deep inspiration breath-hold (BH) PET/CT using [18F]AlF-NOTA-LM3 on upper abdominal lesions in patients with neuroendocrine tumors (NETs).MethodsTwenty-three patients underwent a free-breath (FB) whole-body PET/CT, including a 10 min/bed scan for the upper abdomen with a vital signal monitoring for respiratory gating (RG) followed by a 20-second BH PET/CT covering the same axial range. For the upper abdomen bed, the following PET series was reconstructed: a 2-min FB PET; RG PET (6 bins); a 20-second and 15-second BH PET (BH_15 and BH_20). Semi-quantitative analysis was performed to compare liver SUVmean, lesion SUVmax, MTV, its percentage difference and target-to-background ratio (TBR) between both BH PET and RG PET images. Subgroup analysis considered lesion location, MTV and SUVmax. A 5-point Likert scale was used to perform visual analysis and any missed or additional lesions were identified compared with RG PET.ResultsQuantitative analysis on overall lesions (n = 78) revealed higher SUVmax and TBR, and smaller MTV for both BH PET compared to FB and RG PET, with lesion location-specific variations. Neither significant difference was observed in all metrics between RG and FB PET in larger lesions, nor in MTV in lower-uptake lesions. However, both BH PET significantly enhanced these measurements. In the visual analysis, both BH PET showed noninferior performance to RG PET, and were evaluated clinically acceptable. Additional and missed lesions were observed in FB and both BH PET compared with RG PET, but didn’t alter the clinical management. The BH_15 PET showed comparable performance to BH_20 PET in any comparison.ConclusionThe BH PET/CT using [18F]AlF-NOTA-LM3 is effective in detecting upper abdominal lesions, offering more accurate quantitative measurements. Using a novel PET/CT scanner, a 15-second BH PET can provide comparable and superior performance to RG PET, indicating potential feasibility in clinical routines.

Quantifying Bevacizumab Efficacy in Recurrent Respiratory Papillomatosis.

To develop and validate a novel method for quantifying the efficacy of Bevacizumab (Bev) in treating Recurrent Respiratory Papillomatosis (RRP), and to evaluate the clinical outcomes of a three-dose Bev induction therapy followed by surgical intervention. Twenty-one RRP patients treated with a three-dose Bev regimen were included. A novel efficacy evaluation method using ImageJ software was developed to calculate the standardized lesion volume from laryngoscopic images. This was compared with the Derkay score. Clinical outcomes, including reduction rate, cumulative reduction rate, efficacy grading, recurrence, and adverse reactions, were analyzed. In the study cohort, the reduction rate was significantly higher after the first treatment compared with subsequent treatments. The overall response rate increased from 75% after the first treatment to 100% after the third. Among patients with localized lesions who underwent surgery, 76% experienced recurrence with a mean recurrence time of 114.23 days. Most recurrent lesions were smaller than at baseline. Adverse reactions included increased blood pressure in seven patients, which resolved without intervention. The new method showed a significant positive correlation with the Derkay score. In conclusion, based on the above findings, systemic Bev treatment for RRP is a safe and effective therapeutic approach, though further research is needed. Moreover, the new efficacy evaluation method we developed can significantly aid in studying the effectiveness of Bev treatment for RRP. 2 Laryngoscope, 2024.

Use of artificial intelligence algorithms to analyse systemic sclerosis-interstitial lung disease imaging features

The use of artificial intelligence (AI) in high-resolution computed tomography (HRCT) for diagnosing systemic sclerosis-associated interstitial lung disease (SSc-ILD) is relatively limited. This study aimed to analyse lung HRCT images of patients with systemic sclerosis with interstitial lung disease (SSc-ILD) using artificial intelligence (AI), conduct correlation analysis with clinical manifestations and prognosis, and explore the features and prognosis of SSc-ILD. Overall, 72 lung HRCT images and clinical data of 58 patients with SSC-ILD were collected. ILD lesion type, location, and volume on HRCT images were identified and evaluated using AI. The imaging characteristics of diffuse SSC (dSSc)-ILD and limited SSc-ILD (lSSc-ILD) were statistically analysed. Furthermore, the correlations between lesion type, clinical indicators, and prognosis were investigated. dSSc and lSSc were more prevalent in patients with a disease duration of < 1 and ≥ 5 years, respectively. SSc-ILD mainly comprises non-specific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), and unclassifiable idiopathic interstitial pneumonia. HRCT reveals various lesion types in the early stages of the disease, with an increase in the number of lesion types as the disease progresses. Lesions appearing as grid, ground-glass, and nodular shadows were dispersed throughout both lungs, while those appearing as consolidation shadows and honeycomb were distributed across the lungs. Ground-glass opacity lesion type was absent on HRCT images of patients with SSc-ILD and pulmonary hypertension. This study showed that AI can efficiently analyse imaging characteristics of SSc-ILD, demonstrating its potential to learn from complex images with high generalisation ability.

A high-order focus interaction model and oral ulcer dataset for oral ulcer segmentation

Computer-aided diagnosis has been slow to develop in the field of oral ulcers. One of the major reasons for this is the lack of publicly available datasets. However, oral ulcers have cancerous lesions and their mortality rate is high. The ability to recognize oral ulcers at an early stage in a timely and effective manner is a very critical issue. In recent years, although there exists a small group of researchers working on these, the datasets are private. Therefore to address this challenge, in this paper a multi-tasking oral ulcer dataset (Autooral) containing two major tasks of lesion segmentation and classification is proposed and made publicly available. To the best of our knowledge, we are the first team to make publicly available an oral ulcer dataset with multi-tasking. In addition, we propose a novel modeling framework, HF-UNet, for segmenting oral ulcer lesion regions. Specifically, the proposed high-order focus interaction module (HFblock) performs acquisition of global properties and focus for acquisition of local properties through high-order attention. The proposed lesion localization module (LL-M) employs a novel hybrid sobel filter, which improves the recognition of ulcer edges. Experimental results on the proposed Autooral dataset show that our proposed HF-UNet segmentation of oral ulcers achieves a DSC value of about 0.80 and the inference memory occupies only 2029 MB. The proposed method guarantees a low running load while maintaining a high-performance segmentation capability. The proposed Autooral dataset and code are available from https://github.com/wurenkai/HF-UNet-and-Autooral-dataset.

Abdominal ultrasound has inconsistent agreement with subsequent surgery or necropsy findings in dogs and cats with septic peritonitis.

To evaluate whether abdominal ultrasound correctly diagnosed septic peritonitis and correctly identified its causative lesion in dogs and cats. 84 client-owned dogs and 10 cats that underwent an abdominal ultrasound and had confirmation of septic peritonitis via exploratory laparotomy or necropsy. This retrospective case series documented abdominal ultrasound findings, surgical or necropsy findings, and method for initial diagnosis of septic peritonitis, if different from surgery or necropsy. The surgical report and necropsy findings were compared to sonography results to confirm a diagnosis of septic peritonitis. The frequency at which sonography diagnosed septic peritonitis and its causative lesion was calculated for each type of lesion pathology and organ system. Secondary aims included evaluating the effect of patient characteristics (body weight and species) on sonographic results and whether lesion type or location affected mortality. Most lesions causing septic peritonitis (70.2%) were gastrointestinal in origin and were nonneoplastic ulcerations or perforations (50%). Abdominal ultrasound diagnosed 56.3% of cases of subsequently confirmed septic peritonitis and correctly identified 67% of the causative lesions. Lesions of the gastrointestinal tract and ulcerations/perforations were the most frequent correct sonographic diagnoses and most likely to lead to a correct sonographic diagnosis of septic peritonitis. Lesions located in the hepatobiliary system and lesion types other than neoplasia or ulcerations/perforations were the most frequently missed by abdominal ultrasound. Abdominal ultrasound often fails to diagnose septic peritonitis or the underlying causative lesion, and its accuracy depends on the affected organ and type of lesion.

Cocaine- and Levamisole-Induced Vasculitis: Defining the Spectrum of Autoimmune Manifestations.

Drug-induced or associated vasculitis is a prevalent form of vasculitis that resembles primary idiopathic antineutrophil cytoplasmic autoantibody (ANCA) vasculitis (AAV). Cocaine is a diffuse psychostimulant drug and levamisole is a synthetic compound used to cut cocaine. Their abuse may result in a spectrum of autoimmune manifestations which could be categorized into three overlapping clinical pictures: cocaine-induced midline destructive lesion (CIMDL), levamisole-adulterated cocaine (LAC) vasculopathy/vasculitis, and cocaine-induced vasculitis (CIV). The mechanisms by which cocaine use leads to disorders resembling AAV are not well understood. Cocaine can cause autoimmune manifestations ranging from localized nasal lesions to systemic diseases, with neutrophils playing a key role through NETosis and ANCA development, which exacerbates immune responses and tissue damage. Diagnosing and treating these conditions becomes challenging when cocaine and levamisole abuse is not suspected, due to the differences and overlaps in clinical, diagnostic, therapeutic, and prognostic aspects compared to primary idiopathic vasculitides.

Detection of Leishmania RNA Virus 2 (LRV2) among Clinical Isolates of Leishmania Major in Four Endemic Regions of Iran.

Leishmania RNA viruses (LRV) are double-stranded RNA viruses (dsRNA viruses) that play a role in the pathogenesis of Leishmania parasites. Cutaneous leishmaniasis (CL) is endemic in various parts of Iran. Our aimed was to investigate presence of LRV among the Leishmania major isolates in four endemic regions of Iran. In a cross-sectional study, we assessed the presence of LRV1 and LRV2 in 181 clinical isolates of L. major from four endemic cities in Iran using reverse transcription polymerase chain reaction (RT-PCR). After RNA extraction and cDNA synthesis, RT-PCR tests were conducted with LRV1 and LRV2 specific primers. Human beta-actin and kmp genes served as internal and external controls, respectively, and the Allele ID software was used to optimize melting curves. LRV2 was detected in 27.6% (50 out of 181) of L. major isolates, while no LRV1 was found. We did not observe a statistically significant difference in the presence of LRV2 based on age group, number, or location of lesions. This study confirms the presence of LRV2 in clinical isolates of L. major from endemic regions of Iran. Further researches with larger sample sizes is recommended to explore the association between LRV and clinical symptoms as well as treatment response.

Lesion Localization and Pathological Diagnosis of Ovine Pulmonary Adenocarcinoma Based on MASK R-CNN.

Ovine pulmonary adenocarcinoma (OPA) is a contagious lung tumour caused by the Jaagsiekte Sheep Retrovirus (JSRV). Histopathological diagnosis is the gold standard for OPA diagnosis. However, interpretation of traditional pathology images is complex and operator dependent. The mask regional convolutional neural network (Mask R-CNN) has emerged as a valuable tool in pathological diagnosis. This study utilized 54 typical OPA whole slide images (WSI) to extract 7167 typical lesion images containing OPA to construct a Common Objects in Context (COCO) dataset for OPA pathological images. The dataset was categorized into training and test sets (8:2 ratio) for model training and validation. Mean average specificity (mASp) and average sensitivity (ASe) were used to evaluate model performance. Six WSI-level pathological images (three OPA and three non-OPA images), not included in the dataset, were used for anti-peeking model validation. A random selection of 500 images, not included in the dataset establishment, was used to compare the performance of the model with assessment by pathologists. Accuracy, sensitivity, specificity, and concordance rate were evaluated. The model achieved a mASp of 0.573 and an ASe of 0.745, demonstrating effective lesion detection and alignment with expert annotation. In Anti-Peeking verification, the model showed good performance in locating OPA lesions and distinguished OPA from non-OPA pathological images. In the random 500-image diagnosis, the model achieved 92.8% accuracy, 100% sensitivity, and 88% specificity. The agreement rates between junior and senior pathologists were 100% and 96.5%, respectively. In conclusion, the Mask R-CNN-based OPA diagnostic model developed for OPA facilitates rapid and accurate diagnosis in practical applications.

People living with HIV presenting with hemiparesis: what are the possible causes?

People living with HIV (PLWH) are commonly associated with opportunistic infections, particularly with low CD4 count, less than 200 cells/μL. Neurological manifestation can be occurred 70% in PLWH and the most symptoms is hemiparesis, seizure, headache, behavioural changes, decrease of consciousness, and cognitive impairment but depends on the localization of the brain lesions. We present a case of 53-year-old man with initial presentation of right hemiparesis and was on highly active antiretroviral therapy (HAART). With laboratory and CT-scan result, the patient diagnosed with stroke ischemic and occurred at the same time with toxoplasma encephalitis (TE) as an opportunistic infection. In PLWH, many possible causes involve central nervous system-caused hemiparesis. The initial differential diagnosis should be considered to prevent delayed treatment and potential of severe complications.

Smartphone App to Detect Pathological Myopia Using Spatial Attention and Squeeze‐Excitation Network as a Classifier and Segmentation Encoder

ABSTRACTPathological myopia (PM) is a worldwide visual health concern that can cause irreversible vision impairment. It affects up to 20 crore population, causing social and economic burdens. Initial screening of PM using computer‐aided diagnosis (CAD) can prevent loss of time and finances for intricate treatments later on. Current research works utilizes complex models that are too resource‐intensive or lack explanations behind the categorizations. To emphasize the significance of artificial intelligence for the ophthalmic usage and address the limitations of the current studies, we have designed a mobile‐compatible application for smartphone users to detect PM. For this purpose, we have developed a lightweight model, using the enhanced MobileNetV3 architecture integrated with spatial attention (SA) and squeeze‐excitation (SE) modules to effectively capture lesion location and channel features. To demonstrate its robustness, the model is tested against three heterogeneous datasets namely PALM, RFMID, and ODIR reporting the area under curve (AUC) score of 0.9983, 0.95, and 0.94, respectively. In order to support PM categorization and demonstrate its correlation with the associated lesions, we have segmented different forms of PM lesion atrophy, which gave us intersection over union (IOU) scores of 0.96 and fscore of 0.97 using the same SA+SE inclusive MobileNetV3 as an encoder. This lesion segmentation can aid ophthalmologists in further analysis and treatment. The optimized and explainable model version is calibrated to develop the smartphone application, which can identify fundus image as PM or normal vision. This app is appropriate for ophthalmologists seeking second opinions or by rural general practitioners to refer PM cases to specialists.

Relationship Between Brain CT Scan Findings, Consciousness Levels, and Outcomes in Brain Trauma Patients: A Cross-Sectional Study

Background: Trauma is the fourth leading cause of mortality worldwide. The Glasgow Coma Scale (GCS) is a crucial tool for evaluating the consciousness levels of trauma patients, serving as a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. The study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS. Methods: This cross-sectional descriptive-analytical study investigated 200 brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients’ consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS 22, were employed to examine the relationship between consciousness levels and CT scan results. Results: Three out of 200 patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was 27.94 ± 11.25. Results showed that 67.5% of all patients survived, while 32.4% succumbed to injuries. The initial GCS score was 14-15 for 83 patients (42.1%), 9-13 for 69 patients (35%), and 3-8 for 45 patients (22.8%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in 48 patients (24.3%). In the examination of the relationship between the mechanism of brain trauma and mortality, 75% of patients involved in falls and 65.5% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=0.318). Furthermore, all patients with a GCS score of 14-15 (100%), 85.6% with a GCS score of 9-13, and 35.5% with a GCS score of 3-8 survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=0.001). Statistical analysis indicated that 66.7% of patients with subdural hematomas, 75% with epidural hematomas, 81% with cerebral contusions, 35.3% with intracerebral hemorrhages (ICH), and 92.3% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=0.01). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of 64.7%. Conclusions: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient’s treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality.

Elongated morphology of osteoid osteoma is associated with radiofrequency ablation failure in children.

To compare the frequency of elongated morphology of osteoid osteoma (OO) in children compared to adolescents and to determine if this elongated morphology is associated with radiofrequency ablation treatment failure. Retrospective review of first-time CT-guided radiofrequency ablation performed for presumed OO in patients < 21years old between 1990 and 2023. Children were considered 0 to 10years old, and adolescents were considered 11 to 20years old. Treatment failure was considered symptomatic recurrence requiring follow-up intervention. The largest tumor dimensions in three orthogonal planes were measured using multiplanar reformatted technology. Maximum tumor dimension, tumor volume, and eccentricity index were calculated. Elongated morphology criteria were (a) largest dimension > 10mm and (b) eccentricity index ≥ 3. Lesion locations were recorded. Statistical analyses included the chi-square test, Fisher's exact test, nonparametric Wilcoxon rank-sum test, receiver operating characteristic analysis, and Spearman's nonparametric rank correlation. Of 366 included patients (median 15years, IQR 11-18years, 254 male), there were 86 (23.5%) children, 280 (76.5%) adolescents, and 24 (6.6%) cases of treatment failure. Elongated morphology was more common in children (19.7%) than adolescents (8.6%) (p = 0.004) and associated with younger age (p = 0.009). Elongated morphology was associated with treatment failure in children (p = 0.045) but not adolescents (p > .99) or all patients (p = 0.17). Treatment failure was not associated with age, largest dimension, eccentricity index, volume, or location. Elongated morphology of OO is associated with younger age and radiofrequency ablation treatment failure in children. Identifying this morphology may assist with counseling and treatment planning.

Radiofrequency as a method of localizing impalpable breast lesions

BackgroundThe incidence of early stage breast cancer has risen as a result of increased detection of non-palpable tumors through the implementation of screening programs and greater public awareness. Performing breast-conserving surgery can be challenging due to the need for accurate localization of non-palpable breast lesions, particularly given the logistical difficulties associated with wire localization. After implementing a new technique for localizing non-palpable breast lesions (LOCalizerTM Radiofrequency identification TAG-Hologic®), a radiofrequency identification tag localization device manufactured by Hologic, Inc. in Marlborough, MA, was launched in 2017, our objective was to investigate its impact on surgical outcomes, whether there was an increase in re-excision rates for positive margins and whether the attainment of clear margins was dependent on the exact positioning of the RFID device. MethodA single-center single-arm interventional study, data were gathered both in a forward-looking manner for 1 year (prospectively) and by looking back at past records for 1 year (retrospectively) for a total period of two years. Individuals who were diagnosed with non-palpable breast lesions, as confirmed by histological analysis, or invasive breast cancer and who were scheduled to undergo breast-conserving surgery were eligible for inclusion in the study. The RFID (Radiofrequency Identification) method was used to localize the lesions prior to surgery. Either with a mammogram or ultrasound scan position of the Tag was recorded, including the distance of the lesion from the center of the lesion and the lesion depth from the skin in millimeters. The rate of re-excision was documented and examined in relation to the parameters mentioned above. ResultsTwo hundred and twenty RFID Tags were inserted in two hundred and seventeen (three patient had bilateral tags insertion), patients aged between 30 and 85 had a localizer Tag inserted between Oct 2020 and Oct 2022. Three patients had non-palpable breast lesions in both breasts. Fourteen were inserted under stereotactic guidance and two hundred and six under ultrasound guidance. Ten patients subsequently had wire insertion also due to Tag position. Of 210 procedures, RFIF Tags within the lesion was seen in hundred and sixty patients (76.19 %). An additional 50 procedures were performed using the RFID Tag system, which were not directly related to the lesion but were deemed appropriate to proceed with.Out of a total of 220 procedures, positive margins were observed in 38 cases (17.27 %). Among these cases, eleven (28.94 %) involved the use of the RFID Tag system, not within the lesion but adjacent to it (within 15 mm surrounding the lesion). ConclusionRFID is a good alternative to wire localization of non-palpable breast lesions. Re-excision rates are higher in patients with Tag outside the lesion compared to those with Tag within the lesion.

Predictors of pharyngeal electrical stimulation treatment success in tracheotomised stroke patients with dysphagia: Secondary analysis from PHADER cohort study

Pharyngeal electrical stimulation (PES) has emerged as a promising intervention for neurogenic dysphagia, with potential benefits in reducing dysphagia severity in stroke patients. PES may facilitate decannulation in tracheotomised stroke patients with dysphagia, yet the predictive factors for treatment success have not been investigated in detail. This study used data from the PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) study to identify predictive factors for PES treatment success among patients with post stroke dysphagia who required mechanical ventilation and tracheotomy. Multiple linear regression was performed to predict treatment success, as measured in improvement in dysphagia severity rating scale (DSRS), accounting for age, sex, stroke type, lesion location, baseline National Institutes of Health Stroke Scale (NIHSS) score, feeding status, time from stroke onset to PES, PES perceptual threshold and PES stimulation intensity at the first session. Cox regression was conducted to identify the predictors for decannulation for all participants. Ninety-eight participants (mean [SD] age ​= ​66.6 [13.0]; male 73.5%) were included in the analyses. Regression analyses showed that early intervention (p ​= ​0.004) and younger age (p ​= ​0.049) were significant predictors for treatment success. For participants who received PES during tracheotomy (n ​= ​60; mean [SD] age ​= ​66.6 [11.2]; male 73.3%), supratentorial stroke (p ​= ​0.033) and feeding status at baseline (p ​= ​0.025) were predictors of treatment success. Among all participants, early intervention was associated with higher likelihood of decannulation (p ​= ​0.026). These results highlight the importance of timely intervention, age and stroke location in PES treatment success for stroke patients with mechanical ventilation and tracheotomy.

Ictal-onset localization through effective connectivity analysis based on RNN-GC with intracranial EEG signals in patients with epilepsy

Epilepsy is one of the most common clinical diseases of the nervous system. The occurrence of epilepsy will bring many serious consequences, and some patients with epilepsy will develop drug-resistant epilepsy. Surgery is an effective means to treat this kind of patients, and lesion localization can provide a basis for surgery. The purpose of this study was to explore the functional types and connectivity evolution patterns of relevant regions of the brain during seizures. We used intracranial EEG signals from patients with epilepsy as the research object, and the method used was GRU-GC. The role of the corresponding area of each channel in the seizure process was determined by the introduction of group analysis. The importance of each area was analysed by introducing the betweenness centrality and PageRank centrality. The experimental results show that the classification method based on effective connectivity has high accuracy, and the role of the different regions of the brain could also change during the seizures. The relevant methods in this study have played an important role in preoperative assessment and revealing the functional evolution patterns of various relevant regions of the brain during seizures.

Nevus Spilus, Partial Unilateral Lentiginosis, and Linear and Whorled Nevoid Hypermelanosis: A Comparison of Clinical Features, Course, and Treatment Response.

Skin diseases manifesting as agminated pigmented lesions have overlapping clinical manifestations. Therefore, accurate differentiation is challenging. The clinical characteristics, histopathological findings, and treatment response of patients diagnosed with partial unilateral lentiginosis, nevus spilus, or linear and whorled nevoid hypermelanosis were retrospectively analysed. Each disease demonstrated distinct demographic and clinical characteristics, and the responses to laser treatment varied. The median age at onset varied significantly among the groups: 0.1, 6.6, and 0.5 years in patients with nevus spilus, partial unilateral lentiginosis, and linear and whorled nevoid hypermelanosis, respectively. Regarding the locations of the skin lesions, partial unilateral lentiginosis occurred predominantly on the head and neck, while approximately half of nevus spilus and linear and whorled nevoid hypermelanosis were observed on the extremities. Although linear and whorled nevoid hypermelanosis and partial unilateral lentiginosis share a similar histological feature of basal hyperpigmentation, patients with linear and whorled nevoid hypermelanosis showed the best response to laser treatment, while patients with partial unilateral lentiginosis demonstrated a poor treatment response. The study's data may provide important clues for the differential diagnosis and clinical decision-making regarding the treatment of these agminated pigmented lesions.

Therapeutic Potential of a Biodynamic Supplement on Skin Pressure Ulcers: A Randomized Clinical Study.

Pressure ulcers (PUs) are a debilitating and often painful condition. They are localized lesions on the skin and/or underlying tissues and are common in the elderly, people with mobility difficulties, diabetics, and vascular disease or malnutrition, as well as in those requiring intensive or palliative care. The prevention and treatment of PUs involve strategies to optimize hydration, circulation, and nutrition. Nutrition plays a key role in pressure ulcer care because wounds require macronutrients and micronutrients to heal. Reports relating to the effectiveness of "Complementary Enzyme Therapy" also in the vulnological field led us to this study, the aim of which was to test the activity of a biodynamic food supplement (Citozym®) rich in carbohydrates, vitamins, and amylase and lactase and characterized by marked antioxidant activity. Citozym® administered topically and/or systemically, and in particular in both administrations, in patients suffering from Pus, has shown a marked reduction in bedsores and, in many cases, complete healing. Furthermore, it was possible to observe a lower incidence of side effects compared to conventional therapies. The results obtained, confirmed by various tests and recognized by the scientific community, allow us to conclude that treatment with Citozym® could represent a new and effective strategy for the treatment of PUs.

Spatio-temporally controlled all-in-one hydrogel microspheres for ulcerative colitis treatment based on cocktail strategy

Due to the complex pathogenesis of ulcerative colitis (UC), particularly excessive reactive oxygen species (ROS), gut microbiota dysbiosis, and hyperpolarization of M1 macrophages, the cocktail strategy is urgently needed to obtain a sufficient therapeutic outcome. Meanwhile, the accurate lesion location targeting of these combined therapeutic agents is still crucial. Herein, based on NPs-in-MPs approach, a novel integrated “all-in-one” oral delivery system (BMM/MPs), containing the natural gut microbiota regulator berberine, MnO2 nanoenzymes, and cell penetrating peptides-decorated magnolol liposomes to regulate macrophage polarization, was constructed to address these above issues in sequence. BMM/MPs could non-destructively cross the gastrointestinal tract, enduringly detain, and dissociate in the colon site due to the pH-sensitive properties. Conceivably, the released MnO2 nanoenzymes depleted the excess ROS at the colitis location into O2, sequentially promoting the acceleration of hydrogel microspheres rupture and oxidative damage remission. Accordingly, the oral administration of BMM/MPs exhibited remarkably satisfactory therapeutic effects against DSS-induced UC mice, by ameliorating the representative symptoms, scavenging ROS, relieving inflammation, and inhibiting M1 macrophage polarization at colon sites. Meanwhile, the dysbiosis of microbes was effectively regulated by facilitating SCFAs production. This study provides a feasible strategy for administration in the treatment of UC.

Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study

BackgroundAccuFFRct (ArteryFlow Technology) is a novel noninvasive method for calculating fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA). The accuracy of AccuFFRct has not been adequately assessed. ObjectivesThis study sought to evaluate the diagnostic performance of AccuFFRct in detecting lesion-specific ischemia. MethodsThis prospective study enrolled 339 patients with 404 vessels. CCTA-derived FFR was calculated using an on-site computational fluid dynamics–based method and compared with invasive FFR. The performance of AccuFFRct was comprehensively analyzed in all lesions and subgroups, including “gray zone” lesions, various lesion classifications, clinical presentations, stenosis severities, and lesion locations. ResultsUsing FFR ≤0.80 as a reference standard, the overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for AccuFFRct were 90.6% (95% CI: 87.3%-93.3%), 90.9% (95% CI: 85.1%-94.9%), 90.4% (95% CI: 86.1%-93.8%), 85.3% (95% CI: 79.8%-89.5%), and 94.2% (95% CI: 90.8%-96.4%), respectively. Good correlation and agreement were found between the computed AccuFFRct and measured FFR. AccuFFRct showed superior discrimination ability to CCTA (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.77 [95% CI: 0.72-0.81]; P < 0.001) and quantitative coronary angiography (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.89 [95% CI: 0.85-0.92]; P = 0.048) for identifying functionally significant stenosis. Notably, AccuFFRct maintained high diagnostic accuracy across the spectrum of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the “gray zone”. Furthermore, in the cohort with ≥70% stenosis, AccuFFRct could significantly reduce the rate of un-necessary invasive tests (33.1% vs 6.6%; P < 0.001). ConclusionsThe study confirms the potential of AccuFFRct as a noninvasive alternative to invasive FFR for detecting ischemia in coronary artery disease and to risk stratify patients. The results highlight AccuFFRct’s robust diagnostic ability across a wide range of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the “gray zone”. (Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography [ACCURATE-CT]; NCT04426396)

Content of ascorbic acid in different skin phototypes in children with vitiligo

Aim. To evaluate the blood level of ascorbic acid in children with vitiligo according to skin phototype.Material and Methods. Blood ascorbic acid levels were analysed in children of different ages (6-15 years) with different types of vitiligo, depending on skin phototype. Patients were divided into two groups according to the degree and localisation of the vitiligo lesions: with non-segmental (n=116) and with segmental (n=134) vitiligo. The area of distribution of the dermatosis and its stage of development were calculated using the VIMAN and VIDA indices, respectively. Serum ascorbic acid levels were determined by liquid chromatography-mass spectrometry. Patients were classified by phototype according to T. Fitzpatrick’s classification.Results and discussion. Among the children with vitiligo studied, skin phototypes II, III and IV were identified, with a predominance of phototype III over the others. Their percentages differed in the two groups studied. In non-segmental vitiligo, there were more children with a light phototype and fewer with a dark phototype compared to the group of children with segmental vitiligo. Ascorbic acid levels were significantly reduced in children with vitiligo compared to a group of healthy children. The most pronounced decrease was observed in the group with non-segmental vitiligo in the 7-9 year age group. In both groups of patients, there was a tendency for ascorbic acid levels to decrease with age.Conclusion. The data obtained indicate that children with vitiligo have lower ascorbic acid levels than healthy children. The tendency to decrease increases with age, especially in patients with a dark phototype. This fact indicates the need to correct vitamin C levels in the body of children with vitiligo.