Moderate Lesions Research Articles

Comparative pathology of mice infected with high and low virulence of Indonesian Trypanosoma evansi isolates.

Mice infected with T. evansi cause various clinical manifestations and histopathological changes. The aim of this study was to compare the histopathological lesions of mice infected with T. evansi Bang 87 isolates (high virulence) and Pml 287 isolates (low virulence). A total of 15 susceptible mice (DDY) were divided into three groups (five mice/group): Groups I and II each were infected with 104 T. evansi of high virulence (Bang87) and low virulence (Pml 287), respectively, whereas group III served as a control group. A total of three mice from group I, and one mouse from each group II and III were killed at 4 dpi. A total of two mice from each group II and III were killed at 24 dpi. Two remaining mice from each group were observed until succumb. Mice of group I and group II at 4 dpi showed no gross lesions. However, mice of group I showed very acute animal death at 5 dpi and showed mild to moderate histopathological lesions at 4 dpi, namely non-suppurative encephalitis, non-suppurative pneumonia, hepatitis non-suppurative with intravascular trypanosomiasis, tubular degeneration and necrosis. Group II showed chronic death at 26 dpi with significant gross pathological changes at 24 dpi in spleen (swelling 10 times than normal size) accompanied by severe non-suppurative encephalitis, cholangiohepatitis non-suppurative and bile duct proliferation, diffused splenic necrosis. The result of this study is expected to be used as a basis for improved treatment management in cattle infected with high virulence T. evansi isolates that are need to be handled appropriately to avoid fatal consequences.

Management of Volkmann's Ischemic Contracture: Case Series of 32 patients.

Introduction: Volkmann’s contracture condition is of high prevalence in our population and is linked to therapeutic faults. The treatment and its results are determined according to the severity of the lesions. Methods: This retrospective study was performed in three centers and was conducted over 30 years (1987–2018); it included 32 patients. The disabilities of the arm, shoulder and hand (DASH) score and the Weber test were used to evaluate the functional outcome looking at mid and long-term results. Results: Thirty-two patients were treated for Volkmann’s Ischemic Contracture (VIC). The age ranged from 4 to 58 years, with 19 patients aged under 15. Wrist fracture was the predominant cause in 16 cases. Fourteen patients obtained a completely functional hand, seven good functional results, four fair functional results, and seven poor results. Discussion: In comparison with other studies, we noticed significant differences: apart from the dominant male sex and right side, this is one large case series conducted over 30 years (1987–2018) looking at mid-and long-term results. All the patients presented with severe or moderate lesions on the first visit. In our study, the wrist fracture is predominant compared to elbow fractures and soft trauma. X-rays are especially helpful and are a first-line investigation for identifying displaced fractures and other associated lesions. Our study population is not large, and the treatment methods are varied, so it is impossible to provide statistically relevant correlations between the treatment method and outcome. But this work is based on the experience of more than 30 years, which makes it possible to help adequate decision making according to the state of the lesions. This study is a level IV case series.

Salmonellosis in Calves by Serovar Dublin in Paraná State, Brazil - Clinicopathological Aspects

Background: Calf diarrhea remains one of the main diseases affecting the cattle industry. Persistence of this significant problem is associated with the complexity of factors that may be involved (infectious, environmental). An accurate diagnosis is essential for confirming the cause and helping clinicians and cattle producers to apply appropriate strategies in a timely manner. This report describes the histological changes according to the degree of salmonellosis severity, which is a contagious infectious disease caused by Salmonella enterica subsp. enterica, a Gram-negative bacterium, in two beef calves in northern Paraná State, southern Brazil. Cases: Two 90-day-old crossbred Angus and Nellore calves from a beef farm in northern Paraná State were referred to a Veterinary Hospital. Animal 1- developed acute clinical signs (enteritis, ataxia, and muscle rigidity) and died the day after the signs began. Gross findings included heavy and non-collapsed lungs, pulmonary oedema, hepatomegaly, enteritis, and severe diffuse typhlitis. Microscopic analysis revealed severe diffuse necrotic enteritis, typhlitis, severe diffuse interstitial pneumonia, moderate centrilobular hepatic necrosis, mild multifocal nephritis, and severe spleen and lymph node necrosis. Paratyphoid nodules were evidenced on the liver, spleen, and mesenteric lymph nodes. Animal 2- presented apathy, green fibrinous diarrhea, and died three days after the onset of clinical signs. The macroscopic examination showed moderate diffuse enteritis and hepatosplenomegaly. At the microscopic examination, many paratyphoid nodules were observed on the liver, spleen, kidneys, and Peyer's patches, which were associated with intralesional and intravascular bacilli. Additional findings included severe diffuse fibrinous necrotic enteritis with intralesional bacilli, diffuse interstitial pneumonia, multifocal splenic necrosis, lymphoid depletion, and moderate multifocal to coalescent lymphocytic nephritis. Histological Gram staining was performed on selected samples, revealing intralesional Gram-negative bacilli in the liver and intestine. Thus, liver and intestine fragments were used for the microbiological examination. Microbiological culture, isolation and biochemical tests identified the genus Salmonella spp. Then, the colonies were subjected to serological tests for serovar identification, according to ISO/TR 6579-3, which determined the serovar Dublin. After identifying the disease etiological agent, the outbreak was controlled by appropriate antibiotic therapy combined with the correction of sanitary measures.Discussion: Enteritis is a frequent disease in calves, posing a diagnostic challenge in identifying the etiological agent. In the present case, the histological, microbiological, and serological results confirmed a disseminated Salmonella spp. infection. The microscopic findings, such as interstitial pneumonia, fibrinous necrotic enteritis markedly in ileum and paratyphoid nodules in various organs, are the most common aspects of the disease. However, fibrinous cholecystitis, which is considered pathognomonic for salmonellosis, was not observed in this study. Therefore, the absence of such a lesion should not exclude the disease in sick animals. A microscopic injury score was used to determine lesion severity by assigning values from 1 to 4, wherein: 1 = no apparent lesions, 2 = mild lesions, 3 = moderate lesions, and 4 = severe lesions. Both calves were scored as 4. Multiple predisposing factors for the condition were identified in this farm such as different age animals in the same paddock and no specific paddock for sick animals, given that the infectious agent remains in feces, saliva, and nasal discharge. The serovar Dublin induces several clinical signs such as septicemic, respiratory, and enteric manifestations, making a clinical diagnosis a challenge. Keywords: dysbiosis, calf diarrhea, infection, paratyphoid nodules, septicemia.Descritores: disbiose, diarreia neonatal, infecção, nódulos paratifoides, septicemia.Título: Salmonelose em bezerros pelo sorovar Dublin no estado do Paraná, Brasil - aspectos clínico-patológicos

Assessment of the Efficacy and Safety of the Instantaneous Wave-Free Ratio in a Real-World Setting

Background: The limitations of visual angiographic assessment in coronary artery disease are well known. When intermediate lesions are submitted for functional assessment, there is a reclassification in the initial therapeutic decision in up to 33% of patients. Additional diagnostic modalities have been developed, such as the instantaneous wave-free ratio (iFR) evaluation, to characterize these patients with intermediate lesions better. Methods: This prospective single-center study investigated the prognosis of intermediate coronary stenoses assessed by the iFR. Consecutive patients from January 2017 to January 2020, whose iFR was assessed in our hospital and had one or more moderate coronary lesions were included. Patients were divided into Group A (deferred lesions [65 patients with 93 assessed lesions]) and Group B (revascularized lesions [25 patients with 37 lesions]). Results: There was no difference in demographic characteristics and clinical symptoms at presentation between the groups. The radial artery approach was performed in both groups, with crossover rates of the arterial access of 4.61% in Group A and 4% in Group B, although this was not statistically different. The volume of contrast used (p = 0.001) and fluoroscopy time (p = 0.05) were higher in Group B than in Group A. The average duration of late follow-up was 390.1 + 289.1 days, with no significant difference between the groups (p = 0.202). The variables associated with the need for new urgent revascularization and death (cardiac and non-cardiac) were not different between the groups (p = 0.689 and p > 0.999, respectively). There was no case of infarction in either group. Conclusion: Our study showed the safety of the iFR-based invasive physiology method in patients deferred from coronary revascularization in daily clinical practice. Both groups of patients had low rates of adverse cardiac events and death at the late follow-up.

Diagnostic value of lung ultrasound in COVID-19: systematic review and meta-analysis

BACKGROUND:Effective and safe tools assisting triage decisions for COVID-19 patients could optimize the pressure on the healthcare system. COVID-19 often has respiratory manifestations, and medical imaging techniques provide an opportunity to assess the diseases severity.
 AIMS:To estimate the sensitivity and specificity of lung ultrasound for different degrees of pulmonary involvement in COVID-19 patients by a systematic review of English articles using PubMed and Google Scholar databases. Search terms included lung ultrasound, chest ultrasound, thoracic ultrasound, ultrasonography, COVID-19, SARS-CoV-2, coronavirus, diagnosis, diagnostic value, specificity, and sensitivity. Only studies addressing lung ultrasound diagnostic accuracy for patients with suspected COVID-19 using thoracic computed tomography, reverse transcription polymerase chain reaction, or laboratory data as a reference standard were included. Independent extraction of articles was performed by two authors using predefined data fields with subsequent assessment of study quality indicators. The random-effect model was used to analyze and pool lung ultrasound sensitivity and specificity across the included studies. Sixteen studies met our inclusion criteria, but only three of them divided patients into distinct and defined groups depending on the disease severity. We used the remaining studies data to assess the secondary outcomes: the values of sensitivity and specificity of lung ultrasound for COVID-19 regardless of the patients clinical status. Heterogeneity for primary and secondary outcomes was observed that remained when pooling for different scenarios (screening, assessing severity) and cohorts of participants. Lung ultrasound had the highest accuracy for confirmed COVID-19 patients with severe disease (sensitivity 87.6% 12.3%, specificity 80.5% 7.1%), and the lowest accuracy for the patients with mild disease (sensitivity 72.8% 7.1%, specificity 74.3% 2.7%).
 CONCLUSIONS:Lung ultrasound can be used in patients with confirmed COVID-19 to detect serious damage to the lung tissue. The diagnostic value of the method for assessing mild and moderate lung lesions is relatively low.

Epidemiological and Clinical Features of 156 Cases of COVID-19: A Prospective Study in Algerian Population

Background: COVID-19 is an emerging disease caused by SARS-CoV-2. It has caused millions of infected cases and thousands of deaths since January 2020. In Algeria, the situation seems less alarming with 58,272 confirmed cases and 1,973 deaths as of November 1, 2020. Aim of Study: To describe the clinical, biological and radiological profiles of our patients with COVID-19 during the first two months of the epidemic. Methods: Our study is prospective over two months (April 12-June 10, 2020) including 156 patients based on clinical, radiological and/or immunological criteria. Results: The study involved 77 men and 79 women with COVID-19 having a mean age of 48.97 ± 14.350 years. Common symptoms included asthenia (54.5%), anorexia (26.9%), fever (19.9%) and dry cough (52.6%). Biological inflammatory syndrome occurred in 32% of patients and Lymphopenia in 46%. Chest computed tomographic scans showed minimal to moderate lesions in 85.9% of cases. 56% of patients present at least one comorbidity: diabetes (25.6%), arterial hypertension (23.7%), obesity (21%), asthma (3.1%) and cancer (1.9%). The rapid serology test was positive in only 29% of 76 patients tested while RtPCR was positive in 35 of 55 patients tested. Length of hospital stay was 10 days for a half of patients while the rest received outpatient care. All patients were treated with hydroxychloroquine, azithromycin and preventive heparin and were followed closely until the end of treatment. The use of another antibiotic or corticosteroid was rare (3.8% and 1.3% respectively). Only one death was recorded and no transfer to an intensive care unit. Conclusion: Our study showed that the situation was not very worrying in our population during the first two months of the epidemic. A very close surveillance of new infected cases and the analysis of their clinical profile during the following months are the subject of work in progress.

Pulp Vitality and Longevity of Adhesive Restorations Are Not Affected by Selective Carious Removal: A Multicenter Clinical Trial

The aim of this multicenter randomized clinical trial was to evaluate the pulp vitality and survival rate of adhesive restorations performed on posterior deciduous teeth after non-selective (NSCR) or selective (SCR) carious tissue removal over 33 months. One hundred and seven children (average age 4–8 years, SD 1.4) with at least two active moderate cavitated lesions in dentin were included. Teeth were randomized and submitted to NSCR or SCR before composite resin restoration. Restorations were clinically and radiographically assessed at baseline, 6, 12, 18, 24, and 33 months by a blinded, trained, and calibrated operator in each center. The characteristics of the restorations were recorded according to FDI criteria and were considered as restorative failures when scores 4 or 5 were presented. Pulp vitality was measured by clinical and radiographic examinations, and those teeth that presented any signs or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. Data were analyzed by a Cox regression model with shared frailty, considering two outcomes: pulp and restorative. A total of 278 restorations (137 after NSCR and 141 after SCR) were performed at baseline in four different centers and there was no loss in the follow-up period. Survival rate was 97.1 and 87.1% for pulp and for restorative outcome, respectively. The overall annual failure rate was 7%. There were no differences in the failure risk according to the treatment group, center, and all the clinical and demographic variables, regardless of outcome. Composite restorations of active moderate deep carious lesions performed on posterior primary teeth show satisfactory survival for restorative and pulp outcome after a 33-month follow-up, regardless of the technique executed for carious tissue removal.

Comparison of Chest X-Ray Assessment in Multi-Drug Resistance to Drug- Sensitive Tuberculosis Patients

Introduction. Indonesia ranks third in tuberculosis cases, with 23,000 new dualdrug-resistant tuberculosis patients. The delay in predicting tuberculosis resistanceoccurs because sputum tools are not yet available. This study aimed to determinethe differences in chest x-rays for drug-sensitive multiple drug-resistanttuberculosis in Palembang. Method. A case-control design to compare theradiological characteristics of multiple drug resistance with drug-sensitive atPalembang during January-July 2020. One hundred thirty-eight patients consistedof cases of drug-sensitive tuberculosis and multidrug-resistant tuberculosis basedon the rapid molecular test that met the inclusion criteria, analyzed forposteroanterior chest X-rays by a radiologist without knowing the diagnosis—comparative chi-square using SPSS 22. Result. Multidrug resistance tuberculosishad more extensive or moderate lesions than drug-sensitive tuberculosis 89.8% vs72.4%. The multidrug-resistant group has more infiltrate detected, namely 84.1% vs69.6% and cavity 37.6% vs 30.4%. Atelectasis and pleural effusion are common indrug-resistant tuberculosis. Bivariate analysis showed that multidrug-resistanttuberculosis lesion infiltrates compared to drug-sensitive tuberculosis with p =0.025; OR 2,6 (CI 95% 1,1-6,0) sensitivity 85.5%, specificity 30.4%. Multivariateanalysis showed the presence of infiltrates p = 0.028; OR 2.58 (CI 95% 1.1-6.003).Consolidation, nodules, cavities, fibrosis, atelectasis, pleural effusion were notsignificant differences in the two groups. Conclusion. Multidrug-resistanttuberculosis has a more expansive lesion, the presence of infiltrates and cavities thatis more dominant than drug-sensitive tuberculosis.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) Is Related with the Proteinuria Degree and the Microscopic Kidney Findings in Leishmania-Infected Dogs.

Early diagnosis of renal damage in Leishmania infected dogs may allow appropriate treatments and prevent some deaths. This study investigates neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of kidney disease in dogs experimentally infected with Leishmania infantum. Serum, urine, and kidney samples were collected from 30 infected beagle dogs and six uninfected control dogs. Based on proteinuria and azotemia values, dogs were initially classified. NGAL was measured in urine and serum samples. Then, the urinary NGAL to creatinine ratio (uNGAL/C) was calculated. Kidney samples were taken for histopathological studies, and the dogs were classified according to the severity of glomerular and tubulointerstitial lesions. In Leishmania-infected dogs, the uNGAL/C was significantly higher in proteinuric non-azotemic dogs compared with non-proteinuric non-azotemic dogs (p = 0.038). Serum NGAL (sNGAL) concentration did not differ between groups. Microscopic studies revealed several degrees of glomerulonephritis and slight focal lymphoplasmacytic interstitial nephritis in 89% and 55% of infected dogs, respectively. Urinary protein to creatinine ratio (UPC) and uNGAL/C were significantly higher in dogs with affected glomeruli compared to infected dogs without renal lesions (p = 0.045 and p = 0.043, respectively). The results show that uNGAL/C correlates with proteinuria and the presence of moderate glomerular lesions in non-azotemic dogs experimentally infected with L. infantum.

PA1 Different Levels of Care for Follow-up of Adults with Congenital Heart Disease

Objectives Previous research in adult congenital heart disease (ACHD) patients suggested better clinical and managerial outcomes following specialized over general cardiac follow-up. The impact of different care levels, such as shared care, remained uninvestigated. Methods Propensity score analyses were performed on the BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC). Adult patients who ever attended a specialized congenital cardiology clinic (N=6,579) were categorized in five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medium-term (2011-2015) economic outcomes were medical costs and resource use (i.e., hospitalizations and emergency department visits). Results Respectively 51.5% and 80% of patients with moderate and mild lesions were categorized in the general cardiac care (GCC) or no cardiac care group (NCC). In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and GCC. In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (-33%) and less pharmaceutical costs (-46.3%) compared to SC+. Patients with mild and moderate lesions in the NCC group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. Conclusions More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized

Comparative Immunopathological Study of Various Intra-Cloacal Infectious Bursal Disease Vaccine Doses.

Infectious bursal disease (IBD) is a contagious immunosuppressive viral infection of young chickens. Intra-cloacal approach is effective for vaccinating chicks with high maternally derived IBD antibodies; however, the vaccinal traditional dose may be unsuitable for this route. A total of 60 one-day-old specific-pathogen-free (SPF) chicks were randomly distributed into four groups. Group-1: was control and chicks in group-2: were vaccinated with 103.5 TCID50 of D78 strain/ bird via intra-cloacal route, chicks in group-3: were vaccinated with a ten-fold higher dose (104.5 TCID50/bird) and chicks in group-4: were vaccinated with a dose of 102.5 TCID50 of D78 strain/bird using same approach. IBD antibody titers were measured at the 14th and 21st days of age. The immunosuppressive effects of different doses were determined through humoral immune response to avian influenza and Newcastle disease vaccines, the relative weight of primary lymphoid organs, and histopathologically evaluated bursal lesions. The results indicated that a dose even ten-fold higher than the usual dose to SPF chicks via intra-cloacal route caused neither morbidity nor mortality. All vaccine doses induced potent immune responses against IBD, but the highest IBD antibodies titers were observed in group-4 while IBD antibodies titers were decreased with increasing vaccine doses in other experimental groups. Even the vaccinated birds showed moderate histopathological lesions and the diminutive relative weight of bursae; there was no immunosuppressive effect in the immune response to other vaccines in group-4 and transient immunosuppressive effect in groups-2 and-3. All that proves the safety and effectiveness of various intra-cloacal vaccination approach doses.

Abstract 14549: Outcome of Radiofrequency Catheter Ablation of Cavo-tricuspid Isthmus Dependent Flutter in Patients With Adult Congenital Heart Disease

Introduction: Both typical cavo-tricuspid isthmus (CTI) dependent (or its equivalent) and atypical atrial flutter (AFL) are common in adults with congenital heart disease (CHD) either due to its inherent cardiac anatomy or as a result of prior surgical procedures. Radiofrequency catheter ablation is routinely used as a therapeutic option. Hypothesis: Patients with CHD will have an improvement in systemic ventricular ejection fraction and a decreased incidence of atrial arrhythmias after ablation. Methods: A retrospective study was conducted on 99 patients with CHD who underwent ablation for clinical AFL at a single institution between 2010 and 2019. Of these patients, 62 had CTI-AFL. The 2 patients with unspecified CHD were excluded. CHD was divided into 3 categories according to the American College of Cardiology Task Force 1 of the 32nd Bethesda Conference - simple, moderate severity, and great complexity lesions. Outcomes of ablation at 1 year follow up were assessed. Results: Typical counterclockwise CTI-AFL was seen in 50 patients. The mean age was 49.1±13.6 years old with 29 (48.3%) females. Of the 60 patients, 35% (n=21) had simple lesions, 51.7% (n=31) had moderate lesions, and 13.3% (n=8) had great complexity lesions. The mean left or systemic ventricular ejection fraction (EF) significantly improved on follow-up echo among patients with simple CHD (49.1±13.1 to 56.5±4.7%, p=0.018) and moderate CHD (49.5±14.9 to 54±8.5%, p=0.02), but did not change among patients with great complexity CHD (52.5±6 to 52.5±9.25%, p=0.9). There was a significantly increased incidence of atrial fibrillation (9.5% vs. 16.1% vs. 50%, p=0.04) post ablation among simple, moderate, and great complexity lesions, respectively, but no significant difference in the recurrence rate of atrial flutter (p=0.3). Conclusions: Patients who underwent CTI-AFL ablation showed an improvement in EF in patients with simple and moderate CHD. There was also a significantly increased incidence in the development of atrial fibrillation post ablation in CHD with great complexity compared to simple or moderate CHD.

EVALUATION OF DIAGNOSTIC ACCURACY OF ULTRASOUND-GUIDED SEMI-AUTOMATED CORE NEEDLE BIOPSY OF BREAST SUSPICIOUS MICROCALCIFICATIONS

Back ground: Breast microcalcifications are considered an early mammographic sign of breast cancer which are present with tiny bright spots of different morphology. In an ultrasound (US) image, the presence of microcalcifications within breast is an important indicator of malignancy.With an improved sonographic detection of microcalcification, ultrasound could be used for biopsy guidance for target sampling of tissue containing suspicious microcalcifications. If the biopsied lesions had a suspicious microcalcifications, specimen radiograph is mandatory to confirm the presence of microcalcifications in which a core containing any calcification on specimen radiography was defined as asuccessfully retrieved core. 14-G(Gauge) semi-automated core needle biopsy(CNB) device is less costly than other biopsy device. Methods:A prospective study was conducted on thirty female patients with thirty- two lesions their mean age was 48.53 years (age range, 21-75 years) radiologically classified as BIRADS (Breast Imaging Reporting and Data system) 4 (b, c) and5 from those referred to women imaging health unit in Radiology department for Sono- Mammography and those patients were referred from the inpatient wards and outpatient clinics of the surgery departments during the period from September 2018 till May 2019.All patients underwent conventional digital mammography and B-mode ultrasound examination and Ultrasound guided biopsy, specimen radiography then tissue samples were sent to histopathology department in which slide picture was done.Then (28) females done surgery and (2) patient still for follow up. Results: Radiological diagnosis of our lesions using BIRADS(Breast Imaging Reporting and Data system) categorical method were identified as two intermediate suspicious lesions (BIRADS 4B 6.3 %), twelve moderate suspicious lesions (BIRADS 4C 34.4 %), and 19 highly suggestive of malignancy lesions (BIRADS 5 59.4 %). Retrieval rate of calcifications according to specimen radiography were successfully retrieved in 30/32 lesions (93.8 %) and confirmed on specimen radiography .CNB( core needle biopsy) identified 28 lesions (87.5 %) malignant and four (12.5 %) benign lesions. Distribution of lesions according to pathological diagnosis in successful and fail retrieval group, the successful retrieval group comprised 26 malignant (22 IDC(Invasive ductal carcinoma), 2 DCIS(Ductal carcinoma Insitu), 2 ILC(Invasive Lobuler carcinoma) ) and four benign lesions.After CNB( core needle biopsy), 30 lesions underwent surgical excision and final pathology results were provided. All 24 IDC on 14-G semi-automated CNB (core needle biopsy) were confirmed to be IDC(Invasive ductal carcinoma) on final pathology. Of the two DCIS(Ductal carcinoma Insitu) on US(Ultrasound) guided CNB( core needle biopsy), one DCIS, were upgraded to IDC, the other one confirmed to be DCIS on final pathology,the two ILC were confirmed to be ILC on final pathology.Of the four benign lesions, the two ADH(Atypical Ductal hyperplasia) underwent surgical excision, finally diagnosed as DCIS,the other two benign lesions (fibroadenoma and fibroadenosis) their BIRADS assessments were category 4C and were recommended for follow-up.The overall accuracy of US-guided 14-G(Gauge) semi-automated CNB( core needle biopsy) was 90.0 % (27/32). Conclusion: The present study confirms the good retrieval rate (93.8%) of US-guided 14-G semi-automated CNB and diagnostic accuracy of (90.0%). Thus, this could be useful procedure for suspicious microcalcifications apparent on sonography.Specimen radiography proved to be a great help in deciding the accurate retrieval of microclcifications by core biopsy. It should be done in all cases of core biopsy for calcifications with marking of the core containing calcifications to be specially assessed by histopathology. We should try to do core biopsy before using VAB (Vaccum-Assisted Biobsy)for calcifications if well seen by ultrasound.

Co-existing patterns of MRI lesions were differentially associated with knee pain at rest and on joint loading: a within-person knee-matched case-controls study

BackgroundTo assess the association of co-existing MRI lesions with knee pain at rest or on joint loading.MethodsWe included participants from Osteoarthritis Initiative whose pain score, measured by WOMAC sub-scales, differed by ≥1 point at rest (in bed at night, sitting/lying down) or on joint loading (walking, stairs) between two knees. Cartilage morphology, bone marrow lesions, meniscus extrusion, meniscus morphology, Hoffa’s synovitis and synovitis-effusion were assessed using the compartment-specific MRI Osteoarthritis Knee Score. We performed latent class analyses to identify subgroups of co-existing MRI lesions and fitted a conditional logistic regression model to examine their associations with knee pain.ResultsAmong 130 eligible participants, we identified five subgroups of knees according to patterns of co-existing MRI lesions: I. minimal lesions; II. mild lesions; III. moderate morphological lesions; IV. moderate multiple reactive lesions; and V. severe lesions. Compared with subgroup I, the odds ratios (ORs) and 95% confidence intervals (CI) of greater pain in bed at night were 1.6 (0.3, 7.2), 2.2 (0.5, 9.5), 6.2 (1.3, 29.6) and 11.2 (2.1, 59.2) for subgroups II-V, respectively. A similar association was observed between aforementioned subgroups and pain with sitting/lying down. The ORs (95% CI) of greater pain with walking were 1.0 (reference), 1.7 (0.5, 6.1), 0.7 (0.2, 2.3), 5.0 (1.4, 18.6) and 7.9 (2.0, 31.5) for subgroup I-V, respectively. The corresponding analysis for pain on stairs showed similar results.ConclusionsDistinct patterns of co-existing MRI lesions have different implications for the pathogenesis of osteoarthritic knee pain occurring with/without joint loading.

Computer stabilometry for evaluation of the habilitation effectiveness of children with movement disorders in their first twelve months of life

Objective: To develop new objective criteria for assessing the effectiveness of medical habilitation for children aged 3—6 months with movement disorders based on a dynamic quantitative assessment of the ability to maintain the first antigravity postures. Characteristics of children and research methods . 85 children aged 3—6 months underwent clinical and functional examination, including neurological examination and computer stabilometry according to our methodology. The test group consisted of 69 children with movement disorders after moderate and severe perinatal lesions of the central nervous system. The control group consisted of 16 children without neurological pathology. The children of the test group underwent a dynamic examination, before and after a course of medical habilitation. In a retrospective analysis, they were divided into 2 subgroups depending on the dynamics of movement disorders: Group I — children with positive dynamics (n=50), Group II — children without positive dynamics ((n=19). Results and conclusion . The authors found that on the background of the treatment activities the dynamics of computer stabilometry was associated with the dynamics of neurological disorders. The authors described a new method for assessing the effectiveness of medical habilitation in children aged six months with movement disorders using the computer stabilometry. This method is characterized by a high diagnostic significance.

Obesity across the lifespan in congenital heart disease survivors: Prevalence and correlates

BackgroundCongenital heart disease (CHD) survivors are at risk for cardiovascular comorbidities exacerbated by obesity. ObjectivesDetermine relationships between overweight/obesity and medical factors across the lifespan of CHD. MethodsLesion severity, weight, blood pressure, cardiac and other comorbidities, and cardiac medications were abstracted from the medical records of 3790 CHD patients, aged ≥6 years, who attended CHD care in the Midwestern U.S. ResultsThe proportion of patients with overweight/obesity increased across the lifespan, with 73% of adults affected by overweight/obesity. Obesity was more prevalent among patients with moderate lesions (29%). Overweight/obesity was associated with elevated blood pressure across age and lesion severity. Young adults with obesity and simple or moderate lesions had more comorbidities (simple: IRR = 3.1, moderate: IRR = 2.3) and cardiac medications (simple: IRR = 2.2, moderate: IRR = 1.7). ConclusionsObesity and its cardiovascular correlates are present across the lifespan for CHD survivors, highlighting the need for early prevention and intervention.

Biochemical and histomorphological findings in Swiss Wistar rats treated with potential boron-containing therapeutic - K2[B3O3F4OH

BackgroundBoron and boron containing compounds are known for their biological and protective roles being non-toxic and non-mutagenic in low concentrations. Male rats were exposed to halogenated boroxine (HB), dipotassium-trioxohydroxytetrafluorotriborate K2[B3O3F4OH], a potential new boron-containing therapeutic, aiming to determine concentrations with no adverse effects on selected serum biochemical parameters and histomorphological features. MethodsHB was prepared by reacting potassium hydrofluoride (KHF2) with boric acid in molar ratios 2:3 at room temperature and its primary structure contains 4 fluorine atoms substituted in 6-membered ring. In concentrations of 10, 25, 35 and 45 mg/kg, HB was administered intraperitoneally as a single dose. Biochemical parameters were observed 24 and 96 h following the treatment. Effects of HB on biochemical blood parameters were also observed 24 h following continuous nine days application in concentrations of 10 mg/kg intraperitoneally and 50 mg/kg per os. Histomorphological observation of kidneys, liver, spleen, lungs and heart was performed for all treated animals. ResultsAdministration of single high dose of HB (35 mg/kg–45 mg/kg) effected high levels of urea and creatinine, which indicated renal injury that appeared to be temporary. Possible cause of concern is pancreatic injury indicated by elevated levels of serum amylase in the groups of animals that received the highest dosages of the substance. Histopathological examination of selected tissues revealed mild to moderate lesions in the kidneys and livers associated with administration of HB. ConclusionObservation of biochemical serum parameters or histopathology of examined tissues revealed no adverse effects of HB either after the administration of single dose lower than 35 mg/kg or following repeated administration at 10 mg/kg. These dosages should be further considered for potential therapeutic applications.

OCT and CMR for the Diagnosis of Patients Presenting With MINOCA and Suspected Epicardial Causes

ObjectivesAmong all patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA), epicardial causes may be suspected when there is a correlation between electrocardiogram (ECG) changes and regional wall motion abnormalities (WMAs). We evaluated the diagnostic yield of intravascular optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) in this specific setting. BackgroundOCT is able to identify different morphologic features of coronary plaques that are well known causes of MINOCA. Furthermore, CMR has become the gold standard for detection of myocardial infarction in the setting of MINOCA. MethodsIn a prospective 2-center study, consecutive patients with MINOCA including ECG features of ischemia associated with corresponding WMAs underwent OCT and CMR. ResultsForty patients (mean age: 50 ± 11 years, 62.5% male, 32.5% with ST-segment elevation) were enrolled. Coronary arteries were normal on coronary angiography in 10 patients (25%); 18 patients (45%) presented minimal lumen irregularities, whereas the remaining 12 patients (30%) showed mild to moderate (≥30% but <50%) coronary lesions. Plaque rupture, eruptive calcific nodule, plaque erosion, lone thrombus, and spontaneous coronary artery dissection were found in 14 (35%), 1 (2.5%), 12 (30%), 3 (7.5%), and 2 (5%) patients, respectively. Acute myocardial infarction was evident at CMR in 31 of 40 patients (77.5%). Twenty-three patients (57.5%) had a substrate and/or diagnosis supported by both techniques with an evident relationship between the findings obtained by the 2 techniques. By coupling OCT with CMR, a substrate and/or diagnosis was found in 100% of cases. ConclusionsOCT coupled with CMR can provide a clear substrate and/or diagnosis in the vast majority of patients presenting with MINOCA including ECG features of ischemia associated with corresponding WMAs.

Strength of association between isolation of Pasteurella multocida and consolidation lesions in ovine pneumonic pasteurellosis

This study investigated the association of Pasteurella multocida isolation and the molecular characteristics of the isolates with the presence of pneumonic lesions in lambs at slaughter to assess its importance as a causative agent of pneumonic pasteurellosis compared with Mannheimia haemolytica. P. multocida was isolated from the 13.9% and 2.7%, and M. haemolytica from the 36.4% and 26.8%, of lungs with and without lesions, respectively (P < 0.05). Both microorganisms were frequently coisolated (23.2% and 12.5% from lungs with and without lesions, respectively). Isolation of P. multocida alone exhibited greater strength of association with pneumonic lesions (OR 11.4; 95% CI 3.2–40.6) than that exhibited by M. haemolytica alone (OR 3.0; 95% CI 1.6–5.4). Cluster analysis grouped the lungs into four clusters characterized by the isolation of M. haemolytica or P. multocida alone (clusters 1 and 4), coisolation of both microorganisms (cluster 3), and isolation of neither (cluster 2). Cluster 4 lungs exhibited higher frequencies of pneumonic lesions (87.5%) and severe (20.8%) and moderate (25.0%) lesions. Lungs coinfected with both pathogens (cluster 3) did not exhibit a higher frequency of severe and moderate consolidation lesions (6.1% and 14.3%, respectively), suggesting that P. multocida and M. haemolytica do not act synergically to cause more severe pneumonic infections. The greater strength of association of P. multocida isolation with pneumonic lesions together with the higher severity of the lesions caused could indicate a greater role played by this pathogen in the aetiopathogenesis of pneumonic pasteurellosis in sheep than is commonly assumed.

Cross-sectional study of histopathology and piscine orthoreovirus during a marine production cycle of farmed Atlantic salmon (Salmo salar L.) in British Columbia, Canada.

Two cohorts of farmed Atlantic salmon, Salmo salar L., in British Columbia, Canada, were sampled for histopathology (nine organs) and piscine orthoreovirus (PRV-1) PCR after seawater entry at 2, 4, 6, 8, 10, 13, 16 and 19months (20 fish per cohort per date). One cohort-from a PRV+ hatchery-remained PRV+ throughout the study (sample prevalence 80%-100%). In an adjacent pen, the other cohort-from a PRV- hatchery-was 0% PRV+ at 78days, 30% PRV+ at 128days and ≥95% PRV+ thereafter. Among sample cohorts that were ≥80% PRV+, median Ct values were nominally less among fish sourced from the PRV- hatchery (28.7-33.3) than the PRV+ hatchery (30.8-35.2). No microscopic lesions were associated with PRV Ct value (minimum=25.6). About 3% of fish in both cohorts had moderate inflammatory heart lesions; among these fish, only one had skeletal muscle inflammation (mild), and PRV Ct values were similar to unaffected cohorts sampled the same day. Also, among 16 moribund or freshly dead fish sampled opportunistically during the study, 14 were PRV+, and none had significant inflammatory heart lesions. These data support the hypothesis that British Columbia PRV-1 does not contribute to mortality.