Mild Enhancement Research Articles

Abstract 14421: Avoid Pericardiectomy in Transient Constrictive Pericarditis

Case Presentation: A male in his 40s presented for chest pain, dyspnea and bilateral leg edema. He has a history of hypertrophic cardiomyopathy treated with septal myectomy complicated by constrictive pericarditis (CP) that was treated with right-sided pericardiectomy, NSAIDs, colchicine, and steroids. Echo showed LVEF of 55% with thickening of the pericardium, abnormal septal bounce, tethering of the right atrium, respiratory variation in flow across the mitral and tricuspid valves and IVC plethora. Cardiac MRI showed diffuse mild thickening of residual left-sided pericardium, mild diffuse circumferential pericardial enhancement, mild diastolic septal bounce, diastolic restraint, exaggerated inspiratory flattening and conical deformity of the ventricles without evidence of myocardial inflammation or scarring. Right heart catheterization showed near equalization of RV and LV pressures, RV and LV respiratory concordance, aortic pulsus paradoxus with an inspiratory decrease of 15 mmHg, and Kussmaul’s sign with an inspiratory increase in RA pressure of 68 mmHg. Left heart catheterization showed normal coronaries. The patient was diagnosed with CP and underwent repeat pericardiectomy and was treated with NSAIDs and diuretics. On follow-up, patient had symptomatic improvement but still had evidence of residual constriction on echocardiogram. Discussion: Pericardiectomy is the definitive treatment for CP, however it carries high morbidity and mortality rates. Recurrence of constrictive pericarditis requiring repeat pericardiectomy is very rare and risk factors for recurrence are not well-defined. His initial pericardiectomy was complicated with evidence of active visceral epicarditis with epicardial constriction. This case suggests that active inflammation at the time of pericardiectomy is a potential risk factor for recurrent CP requiring repeat pericardiectomy, and surgery should be deferred until the active inflammation has subsided.

Morphologic, dynamic and high-resolution microscopy MRI in early-onset spondyloarthritis finger dactylitis

ObjectiveUp to now, the pathophysiology of SpA dactylitis has not been entirely clarified. It is not clear which are the involved tissues and which is the primary lesion of the “sausage-like” digit. The aim of our study was to examine the finger structures in early-onset finger dactylitis using high-resolution microscopy MRI together with morphologic and dynamic MRI.Subjects and methodsIn a 6-month period, 13 SpA patients (7 females and 6 males), mean age 54.07 years (range 37–73 years) and mean disease duration 7.07 years (range 1–44 years) with early-onset finger dactylitis (less than 3 months) were recruited. Nine patients had PsA, 3 HLA-B27-positive uSpA and 1 HLA-B27-negative uSpA. One patient had 2 dactylitis fingers. Ten healthy volunteers matched for age and sex with no personal and family history of SpA were enrolled. All dactylitis fingers and randomly selected fingers of the normal control subjects were imaged by morphologic, dynamic and high-resolution microscopy MRI.ResultsWe have found flexor tenosynovitis in all the 14 dactylitis fingers, joint synovitis in 5 and oedema in the finger soft tissue in 10. In 2 dactylitis fingers, there was oedema at the insertion of the joint capsule suggesting enthesitis. In 5 dactylitis fingers, there was only mild enhancement at the enthesis organ (collateral ligament, flexor and extensor tendons).ConclusionsOur MRI study on early-onset dactylitis demonstrates that flexor tenosynovitis, joint synovitis and oedema of the digit soft tissue are the predominant alterations visible in the early phase of evolution of dactylitis and that, therefore, enthesitis may not be considered the primary lesion of dactylitis.

S3246 Streptococcus Anginosus Causing Simultaneous Infections in an Elderly Male: Empyema and Infrahepatic Abscess: Case Report and Literature Review

Introduction: Streptococcus Anginosus is a gram-positive bacterium of the Streptococcus Viridians group. Usually presents as normal flora in the oral cavity and the gastrointestinal tract, S. Anginosus can cause pyogenic infections in multiple organs in the body especially in the immunocompromised host. We present a case of S. Anginosus multiple sites infection in an immunocompetent host that was successfully treated. Case Description/Methods: A 75-year-old male with history of diabetes, coronary artery disease, and heart failure with reduced ejection fraction presented to ER with worsening lower abdominal pain associated with poor appetite and decreased oral intake over 3 weeks. He had cholecystectomy about a year prior to presentation. He was clinically stable on examination with mild right upper quadrant tenderness without rebound. CT abdomen with intravenous contrast showed 10*7 cm low-density fluid collection with mild rim enhancement inferior to the right hepatic lobe. He underwent CT-guided drainage of the infrahepatic collection with removal of 50 cc of purulent material and placement of an intraabdominal drain. Also, a loculated right pleural effusion was noted on CT, and 350 cc of purulent pleural fluid was drained, with analysis compatible with empyema. Both fluid cultures grew S. anginosus. Empirical antibiotics were changed to ceftriaxone, but patient had recurrence of right pleural effusion and required repeat thoracentesis. He gradually improved and completed 6 weeks of Ceftriaxone. Discussion: S. anginosus is a normal flora that can cause infection in any organ. Most of the patients reported to have S. anginosus infection were immunosuppressed by cancer, long term steroid use, diabetes or splenectomy. It is less common for this organism to cause concurrent multiple organs infections. Published cases of simultaneous S. anginosus infection of multiple organs were limited and usually ended in poor prognosis like death or turned out to be the same infection with an anatomic connection between the organs. Our patient had the infrahepatic collection diagnosed first before the right sided pleural effusion enlarged. When the infrahepatic collection was drained, the pleural effusion size did not go down, suggesting lack of connection between both collections. S. anginosus is commonly sensitive to antibiotics. Thus, it is commonly treated with Ceftriaxone. Penicillin-intermediate or resistant S. anginosus is rare comprising < 2% of infections and does not usually lead to treatment failure.

An Experimental Study to Assess the Effectiveness of Acupressure on Dysmenorrhea Pain among Adolescents in a Selected Colleges, Karnataka

Dysmenorrhea, on the other hand, is pelvic or lower abdominal cyclic or recurrent pain, associated to menstruation. It is the most common gynaecological complaint among young women, with prevalence between 43% and 93%. According to symptoms intensity, it is also major cause for school or work absenteeism.The objectives of the study was to assess the level of dysmenorrhea pain in experimental and control group of adolescent girls, compare the pre and post-test scores within and between the experimental and control group, evaluate the effectiveness of acupressure on the level of dysmenorrhea pain in experimental and control group and to find out an association between the pre-test dysmenorrhea pain scores in both experimental and control group with their selected socio-demographic variables. The research design for the study was quasi experimental design with pretest-posttest having nonequivalent control group. The study was conducted in nursing colleges. Regarding effectiveness of acupressure, the overall median score of experimental group in the pre-test was 7.5 and 2 in the post test with enhancement of 4.81and it was significant at P&lt;0.001% level and the overall median score of control group in the pre-test was 8 and 4.5 in the post with mild enhancement of 4.85 with the Z-value of 8.58 in Pre test and Z-value of 3.88 in post test, this shows that there was significant at P&lt;0.001% level. Analysis of socio-demographic variables showed that there is no significant association at 5% level (P&gt;0.05) both in experimental group and control group. The findings of this study support the need for nurses to conduct the experiment to decrease the level of dysmenorrhea pain of adolescent girls in selected nursing colleges a Bangalore. And had a remarkable decrease in the level of dysmenorrhea pain when compared to their level of dysmenorrhea pain, prior to the application of the acupressure

Signs of environmental effects on star-forming galaxies in the Spiderweb protocluster at z = 2.16

ABSTRACT We use multi-object near-infrared spectroscopy with VLT/KMOS to investigate the role of the environment in the evolution of the ionized gas properties of narrow-band-selected H α emitters (HAEs) in the Spiderweb protocluster at z = 2.16. Based on rest-frame optical emission lines, H α and [N ii]λ6584, we confirm the cluster membership of 39 of our targets (i.e. 93 per cent success rate), and measure their star formation rates (SFR), gas-phase oxygen abundances, and effective radius. We parametrize the environment where our targets reside using local and global density indicators based on previous samples of spectroscopic and narrow-band cluster members. We find that star-forming galaxies embedded in the Spiderweb protocluster display SFRs compatible with those of the main sequence and morphologies comparable to those of late-type galaxies at z = 2.2 in the field. We also report a mild gas-phase metallicity enhancement (0.06 ± 0.03 dex) at intermediate stellar masses. Furthermore, we identify two UVJ-selected quiescent galaxies with residual H α-based star formation and find signs of extreme dust obscuration in a small sample of starbursty submillimetre galaxies based on their FIR and H α emission. Interestingly, the spatial distribution of these objects differs from the rest of HAEs, avoiding the protocluster core. Finally, we explore the gas fraction–gas metallicity diagram for seven galaxies with molecular gas masses measured by ATCA using CO(1−0). In the context of the gas-regulator model, our objects are consistent with relatively low mass-loading factors, suggesting lower outflow activity than field samples at the cosmic noon and thus, hinting at the onset of environmental effects in this massive protocluster.

Imaging features of juvenile xanthogranuloma.

Juvenile xanthogranuloma is rare in children and there are limited data on its imaging features. To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of juvenile xanthogranuloma in children. A retrospective review was performed of clinical and radiographic data of histologically confirmed juvenile xanthogranuloma between January 2009 and June 2020. Fourteen children (4 girls, 10 boys; age range: 1day to 13years, mean age: 73months) were included in thestudy: 4/14 had CT only, 5/14 had MRI only and 5/14 had CT and MRI. Sites of extracutaneous juvenile xanthogranuloma involvement included subcutaneous soft tissue (8/14), liver (2/14), lungs (2/14), kidney (2/14), nose (2/14), pancreas (1/14), central nervous system (1/14) and greater omentum (1/14), mainly manifested as single or multiple nodules or masses in different organs. On CT, the lesions mainly manifested as an iso-hypo density mass with mild or marked enhancement. On MRI, the lesions mainly manifested as slightly hyperintense on T1 and slightly hypointense on T2, with decreased diffusivity and homogeneous enhancement. Juvenile xanthogranuloma was not included in the imaging differential diagnosis in any case. Juvenile xanthogranuloma mainly manifests as single or multiple nodules or masses in different organs. Slight hyperintensity on T1 and slight hypointensity on T2 with decreased diffusivity and homogeneous enhancement are relatively characteristic imaging findings of juvenile xanthogranuloma. Combined with its typical skin lesions and imaging features, radiologists should include juvenile xanthogranuloma in the differential diagnosis when confronted with similar cases.

AGN accretion and black hole growth across compact and extended galaxy evolution phases

ABSTRACT The extent of black hole growth during different galaxy evolution phases and the connection between galaxy compactness and active galactic nucleus (AGN) activity remain poorly understood. We use Hubble Space Telescope imaging of the CANDELS fields to identify star-forming and quiescent galaxies at z = 0.5–3 in both compact and extended phases and use Chandra X-ray imaging to measure the distribution of AGN accretion rates and track black hole growth within these galaxies. We show that accounting for the impact of AGN light changes ∼20 per cent of the X-ray sources from compact to extended galaxy classifications. We find that ∼10–25 per cent of compact star-forming galaxies host an AGN, a mild enhancement (by a factor ∼2) compared to extended star-forming galaxies or compact quiescent galaxies of equivalent stellar mass and redshift. However, AGNs are not ubiquitous in compact star-forming galaxies and this is not the evolutionary phase, given its relatively short time-scale, where the bulk of black hole mass growth takes place. Conversely, we measure the highest AGN fractions (∼10–30 per cent) within the relatively rare population of extended quiescent galaxies. For massive galaxies that quench at early cosmic epochs, substantial black hole growth in this extended phase is crucial to produce the elevated black hole mass-to-galaxy stellar mass scaling relation observed for quiescent galaxies at z ∼ 0. We also show that AGN fraction increases with compactness in star-forming galaxies and decreases in quiescent galaxies within both the compact and extended subpopulations, demonstrating that AGN activity depends closely on the structural properties of galaxies.

Successful early diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma manifesting as chronic diarrhea and hypokalemia using video capsule endoscopy and double-balloon enteroscopy.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), formerly known as enteropathy-associated T-cell lymphoma (EATL) type II, is a rare disease with a poor prognosis that is often diagnosed when patients present with intestinal perforation or obstruction. Our patient, a man in his 60s, had a 5-month history of persistent watery diarrhea. Upper and lower gastrointestinal endoscopy, abdominal computed tomography (CT), and stool culture results were unremarkable. He was admitted to our hospital 8 months later with a weight loss of 20kg, general fatigue, and hypokalemia. Contrast-enhanced CT of the abdomen revealed mild thickening and contrast enhancement of the small intestinal wall. Video capsule endoscopy and double-balloon enteroscopy were performed to reveal a broad ulcer in the jejunum and multiple erosions throughout the small intestine. Examination of the biopsy specimens showed infiltration of atypical lymphocytes with pale cytoplasm in the glandular epithelium. The atypical lymphocytes were positive for CD3, CD8, CD56, granzyme B, and T-cell intracellular antigen-1 by immunostaining. Early diagnosis of MEITL was made, and the patient survived for 21months with continuous chemotherapy. Aggressive examination of the small intestine is effective for the early diagnosis of serious diseases, such as MEITL, in patients with chronic diarrhea of unknown origin.

Acute Disseminated Encephalomyelitis with Prefrontal Cortex Involvement in a 9-Year-Old Child after COVID-19 Infection: A Case Report

AbstractThe aim of the study was to present the rare co-occurring radiological findings of a child presenting with acute disseminated encephalomyelitis (ADEM) with a spinal cord and prefrontal cortex involvement after coronavirus disease 2019 (COVID-19) illness. The patient, who had COVID-19 a few weeks earlier, presented with progressive weakness in the right upper and lower extremities. Neurological examination of the patient was performed, and cranial magnetic resonance imaging (MRI) was taken on the same day. Serum severe acute respiratory syndrome coronavirus immunoglobulin M antibody testing was positive. MRI of the brain parenchyma and thoracic spine revealed fluid-attenuated inversion recovery and T2-weighted hyperintense lesions. Additionally, mild contrast enhancement was observed in both the prefrontal cortexes. The patient was discharged 10 days later with complete clinical recovery. Unlike other post-COVID-19 ADEM cases presenting in the literature, prefrontal cortex involvement makes our case rare.

An Unusual Finding on a Plain Abdominal Radiograph

Question: A 65-year-old woman presented with epigastric pain and fever for 3 days. A plain abdominal radiograph revealed massive calcification spots over the epigastric area (Figure A). She had a history of intermittent epigastric pain, which was relieved by medications prescribed by local clinics. A chest radiograph conducted 19 years ago at our hospital had revealed no calcification spot in the epigastric area (Figure B). An abdominal computed tomography (CT) scan revealed a low-density zone with calcified content on the left hepatic lobe, with marked atrophy and mild enhancement in some areas of the low pole after postcontrast study (Figure C, D). Laboratory findings indicated an increase in serum gamma glutamyl transferase (82 U/L; reference range, 9–64 U/L) and C-reactive protein (10.8 mg/dL; reference range, <1 mg/dL) levels. Total bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase levels were all within normal ranges. What was the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The patient underwent a left lobectomy after her fever subsided. Pathology revealed left intrahepatic calcification stones and atrophy (Figure E). The patient was discharged on postoperative day 7 without any complications. Primary hepatolithiasis is defined as the presence of stones in the intrahepatic ducts (IHD) of the liver. This condition is endemic in the Asian population, and its prevalence is increasing in Western countries. Although hepatolithiasis is benign, the frequent development of biliary obstruction and cholangitis can lead to sepsis. Early diagnosis and aggressive treatment are key to a good prognosis. Ultrasound examination remains the method of choice for detecting gallbladder stones, but relatively low sensitivity in detecting IHD stones. CT scans can detect IHD stones, but their positivity rate (63%–81%) is unsatisfactory. Magnetic resonance cholangiopancreatography is the gold standard for evaluating IHD stones. Only approximately 15% to 20% of IHD stones contain sufficient calcium to be visible on plain radiographs.1Mikolajčík P. Ferko A. Demeter M. et al.The difficult path to correct diagnosis of hepatolithiasis: a case report.Acta Medica. 2021; 64: 125-128Google Scholar,2Kim T.K. Kim B.S. Kim J.H. et al.Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography.AJR. 2002; 179: 429-434Crossref PubMed Scopus (65) Google Scholar In our case, IHD stones could be easily detected through plain radiography and confirmed through a CT scan. Endoscopic retrograde cholangiopancreatography is applied to remove IHD stones is difficult and may lead to recurrence. The definitive treatment for IHD stones is surgery, which can relieve abdominal pain and prevent recurrence and disease progression.3Hong K.S. Noh K.T. Min S.K. et al.Selection of surgical treatment types for intrahepatic duct stones.Korean J Hepatobiliary Pancreat Surg. 2011; 15: 139-145Crossref PubMed Google Scholar

Acquired cystic disease subtype renal cell carcinoma (ACD-RCC): prevalence and imaging features at a single institution.

Acquired cystic kidney disease (ACKD) is commonly seen in patients with end-stage renal disease (ESRD), and patients with ACKD have an increased risk of renal cell carcinoma (RCC). Acquired cystic disease-associated RCC (ACD-RCC) was incorporated into the 2016 World Health Organization Classification. This study aims to describe the imaging features of ACD-RCC, which are not well reported previously. Retrospective review of patients with ACKD who underwent total nephrectomy for concern of a renal mass between 2016 and 2021 yielded 122 nephrectomies in 107 patients. Pathology reports were searched for type and subtype of mass. In ACD-RCC subtypes, imaging studies were evaluated for modality and contrast enhancement (CE). Imaging findings assessed included cystic/solid nature, unenhanced CT (NECT) attenuation, enhancement characteristics [non-enhancing (< 10 HU difference), equivocal (10-20 HU), enhancing (> 20 HU)], subjective MRI enhancement, T1 and T2 signal intensity, restricted diffusion, ultrasound (US) echogenicity, and subjective CEUS enhancement. 148 masses were identified, 122 (82%) of which were malignant and 26 (18%) benign. The three most common tumors were clear cell RCC (n = 47), papillary RCC (n = 35), and ACD-RCC (n = 21). Of the 21 cases of ACD-RCC, 16 had preoperative imaging: CT (15: 6 NECT only, 2 CECT only, 7 combined NECT and CECT), MRI (4), CEUS (5). Ten of these tumors were solid/mostly solid and 6 mixed cystic/solid. On NECT, the average attenuation was 35 HU (range 13-52). Of those with multiphasic CTs, 1 was non-enhancing, 3 were equivocal, and 3 enhanced. All 3 masses imaged with CE-MRI showed enhancement. All 4 tumors evaluated by MRI demonstrated T2 hypointensity and restricted diffusion. All five masses enhanced on CEUS. ACD-RCC subtype was the third most common renal neoplasm in ACKD patients. Our findings found that no single imaging feature is pathognomonic for ACD-RCC. However, ACD-RCCs are typically solid masses with most demonstrating equivocal or mild enhancement on CT. T2 hypointensity and restricted diffusion were the most common MRI features.

Primary results of ANZ 1002: Post-operative radiotherapy omission in selected patients with early breast cancer trial (PROSPECT) following pre-operative breast MRI.

572 Background: Selective use of radiotherapy (RT) after surgery for early breast cancer (EBC) has been an elusive goal. The role of breast MRI in localised EBC is controversial. We aimed to determine if preoperative MRI could identify patients with EBC in whom the ipsilateral invasive recurrence (IIR) rate was sufficiently low without RT, such that RT might be safely omitted. Here we report primary and secondary outcomes, and imaging/biopsy findings for occult lesions. Methods: PROSPECT is a prospective single-arm study. Criteria for omission of RT included age at least 50, nil/minimal or mild Background Parenchymal Enhancement (BPE) on MRI, unifocal pT1N0 cancer, not Triple Negative (TNBC), no LVI. All patients who underwent PROSPECT MRI were included in the analysis. Imaging findings on MMG, US and MRI were documented and all biopsies were recorded. Pathology of lesions identified by MRI was described. The primary outcome was the IIR at 5 years of those treated without RT. An IIR rate of 5% or less was considered acceptable. The protocol specified primary analysis occurred after the 100th patient reached 5 years follow up in May 2021. Results: Between 9/2011 and 5/2019, 443 patients had MRI after diagnosis. BPE was nil/minimal or mild in 344 patients. MRI detected 194 occult lesions in 144 (33%) patients; 139 (72%) were ipsilateral. 61 MMG/US occult malignant lesions - 36 invasive and 25 DCIS - were identified in 48 patients (11% of total cohort). Of 38 ipsilateral lesions in 32 patients (7% of total cohort), 23 were DCIS, 4 were T1a, 7 T1b and 4 T1c. 201 patients were treated on trial without RT. The median age was 63 years (range: 50 to 84), median tumour size 11 mm (range: 2 to 20), grade 1 (104), grade 2 (86) or grade 3 (11). The rate of IIR at 5 years was 1% (1/101). There were 2 IIRs at 4.6 and 7.7 years follow up, 1 regional recurrence, and 1 patient with both a regional and distant recurrence with 1 breast cancer death. There was 1 contralateral (CL) breast cancer, 1 CL DCIS, 2 other cancer diagnoses and 1 death from other causes. Of 242 patients undergoing MRI but not in the main study, median age was 63 range: 50-80, median tumour size, 13mm (range: 4-145). 9 underwent mastectomy (2% of total cohort). Followup is complete for 235. There was 3 IIR, 3 CL primary and no distant metastases or breast cancer deaths. Conclusions: Breast MRI in selected, low risk patients identified occult malignancy in 11% of patients. At a median of 5 years follow up the IIR and other breast cancer events was very low. This suggests that local recurrences may be due to occult breast cancers, and MRI may allow the identification of truly localised cancers for which radiation may be safely omitted. The event rate for the entire cohort was very low, suggesting that identification of occult malignancy in apparently unifocal EBC is beneficial. Confirmatory trials are needed. Clinical trial information: 12610000810011.

P393 MULTIMODALITY IMAGING IN ACROMEGALIC CARDIOMIOPATHY: A CASE REPORT

Abstract Background Acromegaly is a disease caused by an excessive production of GH. Cardiac involvement, called acromegalic cardiomyopathy, is present in 90% of cases. Clinical Presentation A 56–year–old woman with acromegaly from pituitary adenoma, hypertension and obesity undewent angioCT showing thoracic aortic aneurysm (Figure 1). She was referred to a cardiological visit to evaluate the possible presence of acromegalic heart disease. The EKG showed signs of left ventricular hypertrophy (LVH) and so transthoracic echocardiogram (TTE) was prescribed: it showed slightly dilated, very hypertrophic left ventricle with ejection fraction of about 50% and signs of diastolic dysfunction. The exam also highlighted moderate to severe aortic valve regurgitation (Figure 2). In order to better characterize the cardiomyopathy a Cardiac magnetic resonance with contrast media (CMR) was performed: cine images confirmed severe left ventricular hypertrophy associated with mild dilatation, global biventricular hypertrophy and hypokinesia. After contrast media administration, a diffuse mild–enhancement pattern was found, a possible expression of diffuse interstitial fibrosis (Figure 3). In consideration of the dilatation of the ascending aorta and the contextual valve insufficiency, the patient was referred for cardiac surgery outpatient visit. Discussion The most frequent manifestations of acromegalic cardiomyopathy are bi–ventricular hypertrophy, the presence of diastolic and systolic dysfunction and the presence of valve regurgitation. Concentric hypertrophy is due to the increase in cardiomyocytes secondary to the GH stimulus and it is often bi–ventricular. Another characteristic finding is diffuse interstitial fibrosis with consequent systo–diastolic dysfunction and heart rhythm abnormalities. Aortic valve anomalies are linked to matrix abnormalities and myxoid degeneration. Conclusions this case can be considered an example of acromegalic heart disease. Multimodality imaging plays a key role in the early diagnosis of cardiac involvement and therefore it allows an early start of therapeutic strategy. Additionally, it is useful for the risk stratification of acromegalic patient.

Differential Diagnosis of Crohn's Disease and Ulcerative Primary Intestinal Lymphoma: A Scoring Model Based on a Multicenter Study.

BackgroundDifferential diagnosis of Crohn’s disease (CD) and ulcerative primary intestinal lymphoma (UPIL) is a tough problem in clinical practice.AimsOur study identified key differences between CD and UPIL patients and aimed to further establish a scoring model for differential diagnosis.MethodsA total of 91 CD and 50 UPIL patients from 9 tertiary inflammatory bowel disease centers were included. Univariate and multivariate analyses were used to determine significant markers for differentiating CD and UPIL. A differential scoring model was established by logistic regression analysis.ResultsThe differential model was based on clinical symptoms, endoscopic and imaging features that were assigned different scores: intestinal bleeding (−2 points), extraintestinal manifestation (2 points), segmental lesions (1 point), cobblestone sign (2 points), homogeneous enhancement (−1 point), mild enhancement (−1 point), engorged vasa recta (1 point). A total score of ≥1 point indicates CD, otherwise UPIL was indicated. This model produced an accuracy of 83.66% and an area under the ROC curve of 0.947. The area under the ROC curve for validation using the 10-fold validation method was 0.901.ConclusionThis study provided a convenient and useful model to differentiate CD from UPIL.

North Ecliptic Pole merging galaxy catalogue

Aims.We aim to generate a catalogue of merging galaxies within the 5.4 sq. deg. North Ecliptic Pole over the redshift range 0.0 &lt;z &lt;0.3. To do this, imaging data from the Hyper Suprime-Cam are used along with morphological parameters derived from these same data.Methods.The catalogue was generated using a hybrid approach. Two neural networks were trained to perform binary merger non-merger classifications: one for galaxies withz&lt; 0.15 and another for 0.15 ≤z&lt; 0.30. Each network used the image and morphological parameters of a galaxy as input. The galaxies that were identified as merger candidates by the network were then visually checked by experts. The resulting mergers will be used to calculate the merger fraction as a function of redshift and compared with literature results.Results.We found that 86.3% of galaxy mergers atz&lt; 0.15 and 79.0% of mergers at 0.15 ≤z&lt; 0.30 are expected to be correctly identified by the networks. Of the 34 264 galaxies classified by the neural networks, 10 195 were found to be merger candidates. Of these, 2109 were visually identified to be merging galaxies. We find that the merger fraction increases with redshift, consistent with literature results from observations and simulations, and that there is a mild star-formation rate enhancement in the merger population of a factor of 1.102 ± 0.084.

Paratesticular metastasis arising from colonic mucinous adenocarcinoma: a rare case report

Colonic mucinous adenocarcinoma rarely metastasizes to the paratesticular region, highlighting the importance of a correct diagnosis. We herein present a case involving a 65-year-old man with paratesticular carcinoma associated with scrotal swelling 1 year after radical resection of colon cancer. Computed tomography revealed a low-density tumor in the right scrotum and mild enhancement of the mass after administration of a contrast agent. The patient underwent radical surgery to remove the right testis. Pathology and immunohistochemistry revealed mucinous adenocarcinoma of the paratesticular tissue. The patient was discharged from the hospital 6 days after surgery. We reviewed the recent literature to summarize the clinical manifestations, treatments, and prognosis of this disease.

Targeting the Diagnosis in an Adolescent with Epilepsy and Intellectual Disability through Next-Generation Metabolic Screening.

A 16-year-old boy, born to consanguineous parents in Syria and living as a refugee in the Netherlands since the age of 14 years, was admitted to our tertiary pediatric intensive care unit with status epilepticus after discontinuation of valproic acid. He was treated with valproic acid since early infancy for seizures of unknown cause, but as he had been seizure-free for many years, discontinuation was attempted. Brain magnetic resonance imaging showed nonspecific white matter abnormalities and changes attributable to prolonged seizures or meningitis, such as brain fullness with mildly effaced ventricles and mild meningeal enhancement in the precentral gyri. Chromosomal microarray analysis showed a normal XY profile. Biochemical screening for inherited metabolic disorders (IMD) was performed through next-generation metabolic screening (NGMS) (1), an ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry (Agilent 6545 QTOF) metabolomics approach, validated under ISO15189 accreditation as first-tier diagnostic screening for IMD in our laboratory. In short, a panel of known IMD-related metabolites is filtered from the untargeted metabolomics data for initial diagnostic interpretation. For each patient, significantly altered metabolites are identified, and a semiquantitative fold change compared to controls is evaluated. The NGMS IMD-metabolite panel is frequently updated to include novel diagnostic metabolites encountered in the untargeted metabolomics data in a research setting. For example, the metabolites 2S, 6S- and 2S; 6R-oxopropylpiperidine-2-carboxylic acid; 6-oxopiperidine-2-carboxylic acid; and 6-(carboxymethyl)piperidine-2-carboxylic acid were recently added to the panel as novel biomarkers for pyridoxine dependent epilepsy due to deficiency of α-aminoadipic semialdehyde dehydrogenase, encoded by ALDH7A1 (PDE-ALDH7A1) (2, 3). PDE-ALDH7A1 is a defect in lysine catabolism (Fig. 1), leading to secondary deficiency of pyridoxine (vitamin B6) through complexation with accumulating piperideine-6-carboxylic acid.

Overcoming Shockley-Queisser limit using halide perovskite platform?

<h2>Summary</h2> Single-junction photovoltaics have a theoretical efficiency limit of 33.7%, with over 50% energy losses in thermalization and in-band transparency. Prior engineering at system levels has been developed to reduce these losses and break the Shockley-Queisser (SQ) limit; many require high-standard manufacturing but deliver mild efficiency enhancement. A breakthrough can be found from the materials perspective. Halide perovskites with various physical merits may provide the platform to overcome both thermalization and in-band transparency losses and thus elevate efficiency by two factors. For example, long-lived hot carriers in perovskite could boost the photovoltage to exceed its band gap or to execute a multi-exciton generation process to double the photocurrent. A delicately designed quantum structure could overcome the in-band losses by mechanisms such as intermediate band, multiple quantum well cascade, and photoferroic effect. Here, we discuss the opportunity, feasibility, and challenges of overcoming the SQ limit by designing upon a perovskite platform.

Exophytic cystic gastrointestinal stromal tumor mimics hepatic abscess or tumor

A middle-aged patient presented with epigastric pain, elevated white blood cell count, and mild anemia. Computed tomography (CT) revealed an exophytic gastric mass that mimicked a hepatic abscess or tumor, with intraperitoneal hemorrhage. The mass had heterogeneous texture, interstitial bleeding, and cystic change that showed delayed mild enhancement on multiphase CT. This was consistent with gastrointestinal stromal tumor that was confirmed by pathological and immunohistochemical analysis.

MRI enhancement patterns in 28 cases of clival chordomas

Clival chordomas are classically thought of as locally aggressive tumors of the skull base and differentiate themselves from their benign counterparts by demonstrating moderate to marked contrast enhancement, reported as 95–100% in prior studies. The purpose of this review was to evaluate the imaging characteristics of lesions from a single institution classified as clival chordomas with an emphasis of highlighting lesions that do not follow the prevalent current description for chordoma. We searched our institutional databases for all patients with pathologically proven clival chordomas from 1997 to 2017 who had pre-operative imaging available. The images were evaluated for degree of contrast enhancement, MRI signal characteristics, osseous involvement, location, aggressiveness of appearance, and presence of calcifications. 28 cases were identified that had preoperative imaging available for review. Over half of the patients demonstrated either no/minimal (11/28, 39%) or mild enhancement (7/28, 25%). The remaining cases demonstrated moderate (4/28, 14%) and marked enhancement (6/28, 21%). The 4 lesions measuring less than 20 mm all had mild to minimal/no enhancement and lacked aggressive features on CT. Our experience finds that over half (64%) of clival chordomas will demonstrate mild or no enhancement at all. These findings suggest that the lack of MRI contrast enhancement should not be synonymous with a benign clival mass.