Pattern Of Lesions Research Articles

SCDet: A Robust Approach for the Detection of Skin Lesions.

Red, blue, white, pink, or black spots with irregular borders and small lesions on the skin are known as skin cancer that is categorized into two types: benign and malignant. Skin cancer can lead to death in advanced stages, however, early detection can increase the chances of survival of skin cancer patients. There exist several approaches developed by researchers to identify skin cancer at an early stage, however, they may fail to detect the tiniest tumours. Therefore, we propose a robust method for the diagnosis of skin cancer, namely SCDet, based on a convolutional neural network (CNN) having 32 layers for the detection of skin lesions. The images, having a size of 227 × 227, are fed to the image input layer, and then pair of convolution layers is utilized to withdraw the hidden patterns of the skin lesions for training. After that, batch normalization and ReLU layers are used. The performance of our proposed SCDet is computed using the evaluation matrices: precision 99.2%; recall 100%; sensitivity 100%; specificity 99.20%; and accuracy 99.6%. Moreover, the proposed technique is compared with the pre-trained models, i.e., VGG16, AlexNet, and SqueezeNet and it is observed that SCDet provides higher accuracy than these pre-trained models and identifies the tiniest skin tumours with maximum precision. Furthermore, our proposed model is faster than the pre-trained model as the depth of its architecture is not too high as compared to pre-trained models such as ResNet50. Additionally, our proposed model consumes fewer resources during training; therefore, it is better in terms of computational cost than the pre-trained models for the detection of skin lesions.

Hyphae, pseudohyphae, yeasts, spherules, spores, and more: A review on the morphology and pathology of fungal and oomycete infections in the skin of domestic animals.

Fungi are among the most common infectious agents affecting the skin of animals. The skin can serve as a port of entry for fungal infections, which can eventually become disseminated. In some regions of the world, oomycetes, such as Pythium and Lagenidium, are also responsible for a significant number of severe cutaneous infections. Histologic evaluation of fungal morphology, including size, shape, septation, branching, and budding characteristics, combined with the distribution of inflammatory infiltrates within different skin layers can potentially identify etiologic agents, guiding selection of antifungals and additional diagnostics. Fungal infections of the skin surface are typically caused by Malassezia and rarely Candida, with opportunistic fungi also capable of colonizing the skin surface, especially when the barrier is broken. Folliculocentric infections, caused by dermatophytes, result in mild to severe inflammation and can occasionally penetrate deep into the skin. A wide range of fungi, including agents of hyalohyphomycosis, phaeohyphomycosis, and dimorphic fungal infections, as well as oomycetes, result in nodular cutaneous and subcutaneous lesions. With the occasional exception of dimorphic fungi, fungal speciation often requires cultures performed on fresh tissues. However, molecular techniques such as pan-fungal polymerase chain reaction on paraffin blocks is becoming an increasingly useful tool to distinguish between cutaneous fungal pathogens. This review focuses on describing the clinical and histologic features of the most common fungal and oomycete infections affecting the skin of animals, divided according to distribution patterns of lesions and fungal or oomycete morphology.

Atypical Shoulder Instability Patterns in Adolescents Following Traumatic Anterior Shoulder Dislocation

Background: Traumatic anterior shoulder instability is common in the adolescent athlete, and when it is untreated, the recurrence rate is high. Atypical lesions—such as anterior glenoid periosteal sleeve, humeral glenohumeral ligament, and insertional tendon avulsions—may occur within this population, and accurate diagnosis and appropriate lesion management are key to treatment success. Purpose: To evaluate the age, skeletal immaturity, bone loss, and uncommon soft tissue lesions as correlates of posttraumatic anterior shoulder instability lesion patterns in an adolescent population. Study Design: Cross-sectional study, Level of evidence, 3. Methods: Consecutive patients ≤18 years of age (160 shoulders) treated within a single institution for traumatic anterior shoulder instability between June 2013 and June 2021 were reviewed. Demographics, injury mechanism, radiographic and magnetic resonance imaging of lesions, the presence of any bone loss, operative findings, and physeal status were recorded. An overall 131 shoulders met the inclusion criteria. Instability lesion type was analyzed categorically by age <15 or ≥15 years; individual age was assessed for correlation with any bone loss present. Atypical lesions—anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligament, subscapularis avulsion—were assessed for correlations with age, open physeal status, and the presence of any bone loss. Results: An overall 131 shoulders (mean, 15.3 years; range, 10.5-18.3) were identified for this study: 55 in patients <15 years old and 76 in patients ≥15 years old. Bony injuries such as Bankart and Hill-Sachs lesions were more common in the ≥15-year-old group (P = .044 and P = .024, respectively). Bony Bankart injuries were found at a rate of 18.2% in the <15-year-old group, as compared with 34.2% in the ≥15-year-old group (P < .05). Anterior labral periosteal sleeve avulsions were more common in the <15-year-old group (n = 13 [23.6%] vs n = 8 [10.5%]; P < .044), as were all atypical lesions combined (n = 23 [41.8%] vs n = 13 [17.1%]; P < .0018]. Conclusion: In this series of anterior shoulder instability in children and adolescents, instability lesions varied significantly by age. Bone loss was associated with older age at presentation, and atypical lesions were more common in patients <15 years of age. Treatment teams should be aware of less common soft tissue injuries in this young age group and ensure careful review of adequate imaging for proper diagnosis and treatment in these younger patients.

Comparison of neuroimaging features of histiocytic neoplasms with central nervous system involvement: a retrospective study of 121 adult patients

ObjectivesTo compare neuroimaging characteristics of three types of histiocytoses, namely Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), with central nervous system (CNS) involvement.MethodsA total of 121 adult patients with histiocytoses (77 LCH, 37 ECD, and 7 RDD) and CNS involvement were retrospectively included. Histiocytoses were diagnosed based on histopathological findings combined with suggestive clinical and imaging features. Brain and dedicated pituitary MRIs were systematically analyzed for tumorous, vascular, degenerative lesions, sinus, and orbital involvement and for hypothalamic pituitary axis involvement.ResultsEndocrine disorders, including diabetes insipidus and central hypogonadism, were more common in LCH patients than in ECD and RDD patients (p < 0.001). In LCH, tumorous lesions were mostly solitary (85.7%), located in the hypothalamic pituitary region (92.9%), and without peritumoral edema (92.9%), while in ECD and RDD, tumorous lesions were often multiple (ECD: 81.3%, RDD: 85.7%), their distribution was more widespread with meninges mostly involved (ECD: 75%, RDD: 71.4%), and they most likely presented with peritumoral edema (ECD: 50%, RDD: 57.1%; all p ≤ 0.020). Vascular involvement was an exclusive imaging characteristic of ECD (17.2%), which was not observed in LCH or RDD; this was also associated with a higher risk of death (p = 0.013, hazard ratio = 11.09).ConclusionThe typical characteristic of adult CNS-LCH was endocrine disorders with radiological findings limited to the hypothalamic pituitary axis. The pattern of multiple tumorous lesions with predominant involvement of meninges was the main manifestation of CNS-ECD and CNS-RDD, while vascular involvement was pathognomonic for ECD and associated with poor prognosis.Clinical relevance statementInvolvement of the hypothalamic-pituitary axis is the typical imaging characteristic of Langerhans cell histiocytosis. Multiple tumorous lesions, predominantly involving but not limited to meninges, occur in most Erdheim-Chester disease and Rosai-Dorfman disease patients. Vascular involvement occurs only in Erdheim-Chester disease patients.Key Points• The different distribution patterns of brain tumorous lesions can help differentiate among LCH, ECD, and RDD.• Vascular involvement was an exclusive imaging finding of ECD and was associated with high mortality.• Some cases with atypical imaging manifestations were reported to further expand the knowledge on these diseases.

LUNG LESIONS: CORRELATION OF ITS HISTOPATHOLOGY WITH IMMUNOHISTOCHEMISTRY

Background The anatomical and histological features oblige the Lungs to be most susceptible to invasions. Lung lesions are common due to exposure to various risk factors. A few of them are pollution, smoking, human immunodeciency virus (HIV), infections, tuberculosis, and malnutrition. An increasing trend in cases of lung cancer is being seen in India. Lung biopsy is a simple, relatively safe, rapid and reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. We wanted to study the histopathological pattern of lung lesions along with its distribution with regard to age, sex, and site. Methods This is an observational study conducted at the Department of Pathology, ESIC Medical College, Kalaburagi from January 2020 to December 2022. Material for the study consisted of all the biopsies submitted for histopathological and immunohistochemical study. Results 164 cases were included in the study, out of which 104 cases (63.41%) were malignant, 10 cases (6.10%) were of inammatory origin and 50 cases (30.49%) showed no evidence of malignancy. Male to Female ratio was 3:1. Most common age group was 51 to 60 years (31.71%). Most common histological type of malignancy was adenocarcinoma (36.54%), followed by squamous cell carcinoma (30.77%). Conclusions Lung biopsy is reliable with high accuracy for diagnosis and subtyping of lung lesions. Immunohistochemistry is an important complimentary tool for routine diagnosis of lung cancers.

Role of Multiparametric Magnetic Resonance Imaging of the Brain in Differentiating Neurocysticercosis From Tuberculoma.

The two most common infectious causes of ring-enhancing lesions are neurocysticercosis (NCC) and tuberculoma. It is a challenge to differentiate NCC and tuberculomas radiologically since they show the same imaging findings on computed tomography (CT). Hence, this study was performed to assess the role of magnetic resonance imaging (MRI) as an additional advanced modality to aptly characterize the lesion. Conventional MRI with additional advanced imaging sequences like diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), magnetic resonance spectroscopy (MRS), and post-contrast T1-weighted imaging (T1WI) aids in characterizing the lesion and helps in differentiating NCC and tuberculomas. To compare the findings of DWI, ADC cut-off values, spectroscopy, and contrast-enhanced MRI in differentiating NCC from tuberculoma. Individuals who matched the inclusion criterion underwent an MRIof the brain (plain and contrast) in a 1.5 Tesla, 18-channel, magnetic resonance scanner (Magnetom Avanto®, Siemens Healthineers, Erlangen, Germany). The following imaging sequences were included: T1WI (axial and sagittal), T2-weighted imaging (axial and coronal), fluid-attenuated inversion recovery, DWI at 0, 500, and 1000 mm2/sb-values with corresponding ADC values, and single-voxel MRS. Based on MRI features such as number, size, location, margins of lesions, scolex, surrounding edema, DWI features with corresponding ADC values, enhancement pattern of lesions, and spectroscopy findings, we evaluated and differentiated the lesions as NCC or tuberculoma. Radiological diagnoses were correlated in terms of clinical symptoms and response to treatment. In our study, 42 subjects were included, of which the total number of NCC cases was 25 (59.52%) and tuberculoma was 17 (40.47%). The mean age of patients included was 42.85 ± 14.76 years (21 to 78 years). On post-contrast imaging, all 25 cases of NCC (100%) showed thin ring enhancement whereas the majority of tuberculomas (64.7%) showed thick irregular ring enhancement. On MRS, all 25 cases (100%) of NCC showed an amino acid peak and all 17 cases (100%) of tuberculoma showed a lipid lactate peak. On DWI, out of 25 NCC cases, restriction of diffusion was absent in the majority of cases (88%) and out of 17 cases of tuberculoma, restriction of diffusion was present in 12 cases (70.5%) (T2 hyperintense tuberculoma, indicative of caseating tuberculoma with central liquefaction) and was absent in the rest. In our study, the mean ADC value of NCC lesions (1.30 ± 0.137 x 10-3 mm2/s) was found to be greater than that of tuberculoma (0.74 ± 0.090 x 10-3 mm2/s). ADC value of 1.2 x 10-3 was obtained as a cut-off to differentiate NCC and tuberculoma. The ADC cut-off value of 1.2 x 10-3 mm2/s showed a sensitivity of 92% and specificity of 94.1% in differentiating NCC from tuberculoma. Conventional MRI with additional advanced imaging sequences likeDWI, ADC, MRS, and post-contrast T1WI aids in characterizing the lesion and thereby helps in differentiating NCC and tuberculomas. Hence, multiparametric MRI assessment is useful in making a prompt diagnosis and eliminating the need for a biopsy.

Mycobacterium bovis naturally infected calves present a higher bacterial load and proinflammatory response than adult cattle.

Granulomas are characteristic bovine tuberculosis lesions; studying this structure has improved our understanding of tuberculosis pathogenesis. However, the immune response that develops in granulomas of young cattle naturally infected with Mycobacterium bovis (M. bovis) has not been fully studied. Our previous work described an atypical pattern in granulomatous lesions of cattle younger than 4 months (calves) naturally infected previously M. bovis that did not correspond to the histological classification previously proposed. Histologically, granulomas from calves lack a connective tissue capsule and have fewer multinucleated giant cells (MGCs) and more acid-fast bacilli (AFB) than the classic tuberculosis lesions found in cattle older than 1 year (adults); this suggests a deficient immune response against M. bovis infection in young animals. Therefore, we used IHC and digital pathology analysis to characterize the in situ immune response of granulomas from young and adult cattle. The immunolabeling quantification showed that granulomas from calves had more mycobacteria, CD3+ cells, IFN-γ, TNF-α, and inducible nitric oxide synthase (iNOS) than those of adult cattle. Furthermore, calf granulomas showed lower immunolabeling of MAC387+, CD79+, and WC1+ cells without connective tissue surrounding the lesion and were associated with less vimentin, Alpha Smooth Muscle Actin (α-SMA), and TGF-β compared with granulomas from adult cattle. Our results suggest that the immune responses in granulomas of cattle naturally infected with M. bovis may be age dependent. This implies that an exacerbated proinflammatory response may be associated with active tuberculosis, producing more necrosis and a lower microbicidal capacity in the granulomas of calves naturally infected with M. bovis.

Radiomics-based Unsupervised Clustering of Acute Multiple Sclerosis Lesions (P10-3.015)

<h3>Objective:</h3> To leverage radiomics and machine learning to identify clusters of focal acute MS lesions exhibiting similar spatial and/or textural patterns on conventional cross-sectional (pre- and post-contrast) T1-weighted, T2-weighted, PD-weighted and FLAIR brain MRIs. <h3>Background:</h3> Multiple sclerosis (MS) lesions exhibit substantial heterogeneity in terms of underlying pathology, anatomic location, and longitudinal evolution. Conventional MRI is sensitive to some aspects of lesion heterogeneity. Unsupervised clustering approaches may identify subtypes of acute MS lesions with specific pathologic features and help improve disease characterization and prognostication. <h3>Design/Methods:</h3> Brain MRIs from the ADVANCE trial (1,512 patients with relapsing-remitting MS, NCT00906399) were retrospectively analysed. For each scan, focal acute (gadolinium-enhancing and/or new or substantially enlarging) T2 lesions (N=3058) were identified in the white matter (WM). Each lesion was represented via its center of mass in standard ICBM-152 space and radiomics-based textural properties. Similar lesions were grouped together via k-means clustering, applied separately across the spatial and each sequence-specific textural domain. Cluster count was optimized based on the silhouette score, Davies-Bouldin index and Variance Ratio Criterion. <h3>Results:</h3> Optimal clustering quality resulted in 8 prototypical WM sites of lesion emergence, 3 prototypical textural patterns on each of post-contrast T1-, PD-weighted and FLAIR MRI and 5 patterns on each of pre-contrast T1- and T2-weighted MRI. Statistically significant cross-sectional associations were found between the occurrence of these lesion subtypes and patient age, sex, years since disease onset and EDSS score, via logistic regression analysis (p &lt; 0.05). <h3>Conclusions:</h3> Specific spatial and textural patterns of acute MS lesions were identified using unsupervised clustering. Further work will evaluate the clinical relevance of identified acute MS lesion patterns towards predicting clinical and MRI endpoints of disease progression. The longitudinal dynamics of each lesion pattern will be investigated via measurements of future lesion repair or transition towards chronic active/inactive lesion states. <b>Disclosure:</b> Mr. Caba has received personal compensation for serving as an employee of Therapanacea. Mr. Caba has received personal compensation for serving as an employee of Biogen. Mr. Caba has received personal compensation in the range of $50,000-$99,999 for serving as a Research Engineer with Therapanacea. Mr. Caba has received personal compensation in the range of $100,000-$499,999 for serving as a Scientist II, ML/AI with Biogen. Dr. Gafson has stock in Biogen. Dr. Ioannidou has received personal compensation for serving as an employee of Therapanacea. Xiaotong Jiang has nothing to disclose. Elizabeth Fisher has received personal compensation for serving as an employee of Biogen. Elizabeth Fisher has stock in Biogen. Elizabeth Fisher has received intellectual property interests from a discovery or technology relating to health care. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Celgene. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xfacto communications. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Arnold has stock in NeuroRx. Colm Elliott has received personal compensation for serving as an employee of NeuroRx Research. Nikos Paragios has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZeneca. Nikos Paragios has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Ipsen. Nikos Paragios has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for ArteDrone. Nikos Paragios has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Nikos Paragios has received intellectual property interests from a discovery or technology relating to health care. Nikos Paragios has received personal compensation in the range of $100,000-$499,999 for serving as a CEO with TheraPanacea. Dr. Belachew has received personal compensation for serving as an employee of Biogen Inc. Dr. Belachew has received stock or an ownership interest from Biogen Inc.

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral circulations (P11-5.022)

<h3>Objective:</h3> To determine the etiology spectrum and lesion distribution patterns of patients with acute multiple infarcts in multiple cerebral circulations (AMIMCC) and provide guidance for treatment and prevention. <h3>Background:</h3> The etiologies and mechanisms of AMIMCC were complicated deserving clinical attention. <h3>Design/Methods:</h3> Patients with acute ischemic stroke were consecutively included in this study between June 2012 and Apr 2022. AMIMCC was defined as noncontiguous focal lesions located at more than one cerebral circulation with acute neurological deficits. We retrospectively analyzed the clinical and imaging characteristics and etiology spectrums between patients with AMIMCC and non-AMIMCC. Infarct lesion patterns on DWI and its relevance with the etiology were further discussed. <h3>Results:</h3> A total of 1213 patients were enrolled, of whom 145(12%) were diagnosed as AMIMCC. Compared with non-AMIMCC, AMIMCC patients manifested as younger age(P=.016), more often female(P=.001), less common for conventional vascular risk factors(P&lt;.05). The constitution of TOAST classification was significantly different between patients with AMIMCC and non-AMIMCC(P=0.000), with higher proportion of stroke of other determined cause(67.6%vs12.4%). Regarding the detailed etiology of AMIMCC, autoimmune or hematologic diseases were the most common(27.6%), followed by peri-procedural infarcts(15.2%), cardioembolism(13.1%), malignant tumor(11.7%), large artery atherosclerosis (10.3%), sudden drop in blood pressure(8.3%). Hypercoagulability and systemic hypoperfusion were the common underlying mechanisms of AMIMCC. Distinctive lesion distribution patterns were associated with stroke etiologies and mechanisms in AMIMCC patients. Sixty-five percent of the 20 patients diagnosed with SLE/APS and 52.9% of the 17 patients with malignant tumor tended to manifest as supratentorial infarcts. However, 68.4% of cardioembolism presented with both supratentorial and infratentorial infarct lesions. More than half of patients with SOC and SUC had intracranial or extracranial artery stenosis. <h3>Conclusions:</h3> The etiologies and mechanism of AMIMCC were complicated compared to non-AMIMCC. The distribution characteristics of infarct lesions might have important implications for identification of etiology in AMIMCC patients, further guiding and optimizing clinical diagnosis strategy. <b>Disclosure:</b> Ms. Sha has nothing to disclose. Mr. Han has nothing to disclose. Ms. Hong has nothing to disclose. Dr. Wu has nothing to disclose. Dr. Tang has nothing to disclose. Lixin Zhou has nothing to disclose. Yi-Cheng Zhu has nothing to disclose. Jun Ni has nothing to disclose.

The longitudinal and regional analysis of bleomycin-induced pulmonary fibrosis in mice by microcomputed tomography

IntroductionMicrocomputed tomography (micro-CT) is powerful for assessment of the progression of lung fibrosis in animal model, but current whole lung analysis (WLA) methods are time-consuming. Here, a longitudinal and regional analysis (LRA) method was developed to assess fibrosis easily and quickly by micro-CT. MethodFirstly, we investigated the distribution pattern of lesions in BLM-induced pulmonary fibrosis mice. Then, the VOIs for LRA were selected based on the anatomical locations and we compared the robustness, accuracy, repeatability, analysis time of LRA to WLA. Additionally, LRA was applied to assess different stages of pulmonary fibrosis, and was validated with conventional endpoint measurements (such as lung hydroxyproline and histopathology). ResultsThe lesions of fibrosis in 66 bleomycin (BLM)-induced pulmonary fibrosis mice were mostly in the middle and upper parts of lungs. By applying LRA, the percentages of high-density voxels in selected volumes of interest (VOIs) were well correlated with that in WLA both at Day 7 and Day 21 after bleomycin induction (R2 = 0.8784 and 0.8464, respectively). The relative standard deviation (RSD) of the percentage of high-density voxels in the VOIs was lower than that of WLA (P < 0.05). The cost time of LRA was shorter than that of WLA (P < 0.05) and the accuracy of LRA was further confirmed by the histological analysis and biochemical quantification of hydroxyproline. ConclusionLRA is probably an easier and more time-saving method to assess fibrosis formation and evaluate treatment efficacy.

A new scoring system for differentiating malignant from benign “second-look” breast lesions detected by MRI in patients with known breast cancer

To propose a scoring system made of reproducible and objective criteria to aid in differentiating malignant from benign "second-look" breast lesions detected at magnetic resonance imaging (MRI). Data were collected retrospectively for "second-look" lesions identified on breast MRI studies performed at the University Hospitals of Leicester NHS Trust breast unit over a 2-year period (from January 2020 to January 2022). Ninety-five "second look" MRI-detected lesions were included in this retrospective study. Lesions were assessed according to margins, T2 signal, internal enhancement patterns, contrast kinetics, and diffusion-weighted imaging (DWI) patterns. Fifty-two per cent of the included lesions were confirmed at histopathology to be malignant. The most common contrast kinetics identified in malignant lesions was the plateau pattern followed by the washout pattern while the most common pattern in benign lesions was the progressive pattern. The apparent diffusion coefficient (ADC) cut-off value for separating benign and malignant lesions at the unit was found to be 1.1×10-3 mm2/s. Based on the MRI features described above, a scoring system is suggested to help differentiate benign from malignant "second-look" lesions. According to the present results, setting a score of 2 or more points as an indication for biopsy was 100% reliable in identifying malignant lesions and avoiding biopsies in >30% of lesions. The suggested scoring system could avoid biopsy of >30% of the "second-look" lesions detected by MRI without missing any malignant lesions.

Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide.

Over the years, several studies demonstrated the crucial role of knee menisci in joint biomechanics. As a result, save the meniscus has become the new imperative nowadays, and more and more studies addressed this topic. The huge amount of data on this topic may create confusion in those who want to approach this surgery. The aim of this review is to provide a practical guide for treatment of meniscus tears, including an overview of technical aspects, outcomes in the literature and personal tips. Taking inspiration from a famous movie directed by Sergio Leone in 1966, the authors classified meniscus tears in three categories: The good, the bad and the ugly lesions. The inclusion in each group was determined by the lesion pattern, its biomechanical effects on knee joint, the technical challenge, and prognosis. This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a reader-friendly narrative review of an otherwise difficult topic. Furthermore, the authors provide a concise premise to deal with some aspects of menisci phylogeny, anatomy and biomechanics.

Mathematical Model of Two-Dimensional Disease Progression and Categorization of Underlying Vector Fields with Machine Learning

A mathematical model was created for simulating disease progression in two-dimension, by specifying a vector field. It was equivalent to observing how a lesion pattern on the skin, could change its shape over time. This model had a parameter that might control the resolution and signal of the pattern. By specifying two different vector fields, we established two sets of subtly different image sets. And, three different supervised machine learning algorithms such as nearest neighbor, decision tree, and support vector machine were used for binary classification. This study was done with Python's numerical (numpy), plotting (matplotlib), and machine learning (sklearn) libraries on the Google Colab platform. All machine learning algorithms were able to distinguish subtle differences produced by different vector fields. Furthermore, the performance of the algorithms were improved by concatenating the beginning and end stages of the pattern and helping the algorithms to pick up the temporal changes. These results demonstrated how AI and machine learning could be adopted in medicine for accurately diagnosing underlying diseases from images.

The pseudohypopyon stage in adult-onset foveomacular vitelliform dystrophy.

To gain insight into the pathogenesis of adult-onset foveomacular vitelliform dystrophy (AFVD) via assessment of its pseudohypopyon stage (PHS). Retrospectively, data were collected in a tertiary center from established cohorts of a genetically evaluated AFVD and best vitelliform macular dystrophy (BVMD) eyes in the pseudohypopyon stage. Best-corrected visual acuity (BCVA, LogMAR), lesion characterization, including lesion dimensions, liquefaction areas and patterns (altitudinal or lateral), and ellipsoid zone integrity were analyzed from spectral-domain optical coherence tomography images. Out of 167 eyes of 90 AFVD patients and 56 eyes of 28 BVMD patients, 8 eyes of six AFVD patients and five eyes of four BVMD patients were at the PHS were included. The mean LogMAR BCVA ± SD was 0.21 ± 0.20 and 0.41 ± 0.10 in AFVD and BVMD diseases, respectively (p = 0.13). Seven AFVD eyes (87.5%) demonstrated lateral liquefaction, while all BVMD eyes demonstrated an altitudinal pattern (p = 0.005). Maximal horizontal lesion diameters were 1.41 ± 0.46mm and 2.64 ± 0.77mm in AFVD and BVMD, respectively (p = 0.02). AFVD patients were older (69 ± 14) than BVMD patients (22 ± 13; p = 0.009). The pseudohypopyon stage in AFVD is often characterized by a lateral liquefaction pattern, unlike the altitudinal pattern characterizing BVMD. Age, lesion size, or pathogenesis pathways may underline the different pseudohypopyon stage patterns in AFVD and BVMD.

A 10-year clinicopathological analysis of ovarian lesions in a tertiary hospital in Southern Nigeria.

Ovarian tumours are the most lethal of all gynaecological cancers and they are usually diagnosed in advanced stages when the prognosis is very poor. To determine the pattern of ovarian lesions, their frequency, presentation, and associated clinical symptoms in Uyo, Nigeria. A 10-year retrospective study of all ovarian specimens that were surgically removed and histologically diagnosed. The patients were between the ages of 5 and 73 years with median age of 34.1 years. Benign tumours occurred most commonly among the 20-39-year age group (31.3%) while malignant tumours were predominant among those aged 50-69 years (10.0%). Surface epithelial tumours (45.4%) were the most common neoplastic tumours while the mature cystic teratoma (33.2%) was the most common tumour overall. Surface epithelial malignancies accounted for 70.6% of all ovarian malignancies and the serous cyst adenocarcinoma (10.2%) was the most common surface epithelial tumour as well as the most common malignant tumour. There has been an increase in the number of malignant ovarian specimens in our centre. Though surface epithelial tumours were the most common category of ovarian tumours, overall, the mature cystic teratoma was the most common tumour. Serous cyst adenocarcinoma was the most common surface epithelial tumour and the most common malignant tumour.

Features of damage to the conductive structures of the nervous system in patients with vibration disease, burdened with diabetes mellitus and metabolic syndrome

Introduction. Of interest are the processes developing in vibration disease (VD) in combination with metabolic syndrome (MS) or diabetes mellitus (DM), combined forms of diseases worsen their course and prognosis.&#x0D; The study aims to assess the features of the state of central afferent conductive structures and peripheral nerves in patients with vibration disease, burdened with diabetes mellitus or metabolic syndrome.&#x0D; Materials and methods. The scientists have examined 155 workers with VD — group one with an established diagnosis of VD (86 people); group two — with VD combined with DM (30 people); group three — with VD burdened with MS (39 people). The authors have conducted the electroneuromyographic examination and registration of somatosensory evoked potentials, with stimulation of the median nerve in the wrist. Abduction points — Erb point, cervical spinal cord, from the scalp of the projection area of the precentral gyrus. The researchers have applied multivariate discriminant analysis from the STATISTICA — version 6 application software package of StatSoft Inc (USA).&#x0D; Results. With VD complicated by MS, changes were in the distal part of the motor axons, with VD burdened with DM, the amplitude of the motor component of the median and tibial nerves decreased, the speed of the pulse in the proximal part of the median nerve. Somatosensory evoked potentials in VD in combination with MS revealed an increase in latency of N13 and N20. The duration of N13-N18, N13-N20, latency N18, N20, N30 increased in the case of WB, burdened with DM.&#x0D; Limitations. The limitation of the study is the use of unrelated samples for statistical analysis. The study of the state of central and peripheral conductive structures in connected samples should be considered evidence-based: metabolic syndrome and further — diabetes mellitus.&#x0D; Conclusion. The patterns of peripheral nerve damage in VD associated with exposure to general and local vibration, burdened with DM or MS, were disorders of afferent axons of the upper and lower extremities, as well as changes in the distal parts of the motor component of the tibial and median nerves. The features of the peripheral nerve states in VD, burdened with DM, were the complex involvement of the motor component in the pathological process, characterized by changes in the amplitude, pulse transit time at the level of the terminal unmyelinated fibers of the median and tibial nerves and changes in the proximal part of the median nerve. In VD complicated by MS, pathological changes were characteristic of the distal part of the motor axons. The patterns of afferent conductive structures lesion in VD, burdened with DM or MS, consisted in a violation of the activity of neurons of the cervical spinal cord and the somatosensory cortex. The peculiarity of the state of the central afferent conducting structures in VD, burdened with DM, was the slowing down of the afferent excitation wave in the area of thalamic structures to the somatosensory zone of the cortex, a violation of the conduction from the trunk to the cortical projections of the somatosensory zone. In case of VD, complicated by MS — the time of the afferent excitation wave at the level of the cervical spine and the somatosensory cortex.&#x0D; Ethics. Conclusion of the MEC of the Federal State Budgetary Scientific Institution "East Siberian Institute of Medical and Environmental Research" No. 32 dated 09.10.2019.

PARENTAL KNOWLEDGE AND BEHAVIOUR ABOUT DENTAL AND ORAL HEALTH CARE WITH EARLY CHILDHOOD CARIES OF 3-5 YEARS

Early Childhood Caries (ECC) is caries with a unique pattern of lesions in infants, toddlers and preschoolers caused by prolonged administration of formula milk or other sweet liquids. knowledge and attitudes of parents play an important role in underlying the formation of behavior that supports or does not support the maintenance of children's dental health. Purpose: this study aims to analyze the relationship between parental knowledge and behavior regarding dental and oral health maintenance and ECC in children aged 3-5 years at the Occupational Health Regional General Hospital, West Java Province. Method: this research is an analytic descriptive study with a cross sectional design. Data was taken by accidental sampling technique on 52 children aged 3-5 years. The procedure for filling out knowledge and behavior questionnaires by parents and clinical examination of the child's oral cavity using def-s was then classified based on the severity of ECC. Results: Parents' knowledge about dental and oral health maintenance was 36.5% good criteria, 32.7% sufficient criteria and 30.8% poor criteria. Parental behavior with good criteria 48.1%, sufficient criteria 44.2% and 7.7% less criteria. There were 28.9% of children with mild-moderate ECC, 36.5% moderate-severe and 34.6% severe. The results of the Chi Square test show a relationship between parental knowledge and ECC p value = 0.000 and parental behavior has a relationship with ECC p value = 0.448. Conclusion: there is a significant relationship between parents' knowledge about maintaining oral health and ECC in children aged 3-5 years, while the behavior of parents has no relationship with ECC in children aged 3-5 years.

Profile of Dermatological Disorders among Construction Workers: A Cross-Sectional Study

Background: The construction industry is a growing industry worldwide, including India, employing a large population. Construction workers perform a variety of work including mixing concrete and carrying heavy objects. Occupational contact dermatitis is a significant occupational dermatosis, cement being the most important agent and is an occupational hazard. Objective: The objective of this study was to estimate the prevalence of occupational skin diseases among construction workers. Materials and Methods: This cross-sectional study was conducted in Manipal, Karnataka, among 300 construction workers. A detailed inquiry was made on demographic parameters such as age, sex, nature of work, duration of the job, chemicals exposed to, symptoms, and use of protective devices. They were examined to note the symptoms, clinical pattern, and distribution of lesions. Results: The majority of the workers belonged to the age group between 20 and 29 years. The common skin disorders noticed were callosities (17.33%), traumatic injuries (10%), dermatophyte infections (8.33%), and dermatitis (5.7%) along with few other dermatoses encountered due to increased exposure to heat and due to increased wet work in workers who did not wear protective devices. Conclusions: There is a lack of preemployment and periodic medical examinations for construction workers. Common dermatoses seen among the construction workers were mainly due to the lack of preventive measures. Hence, it is important to raise health awareness to recognize early signs and symptoms of various dermatoses and educate regarding the use of personal protective equipment.

P301 Diagnostic accuracy of Fine Needle Aspiration cytology of Breast masses, and Morphologic patterns of Breast lesions, Hawassa, Southern Ethiopia: A five year review

P301 Diagnostic accuracy of Fine Needle Aspiration cytology of Breast masses, and Morphologic patterns of Breast lesions, Hawassa, Southern Ethiopia: A five year review

Observational Study of Leprosy Presenting with Solitary Skin Lesion from a Tertiary Care Hospital in South India

Background: Leprosy presents with varied clinical morphology, and most often the morphological pattern and distribution of lesions denote a particular spectrum of leprosy; however, it may not be correct in all the cases which can lead to under treatment and dissemination of infection, particularly, in multibacillary leprosy presenting with single skin lesion. Objective: The objective of the study was to describe cases of leprosy presenting with solitary skin lesion and to establish the spectrum by slit-skin smear (SSS) and histopathological examination of skin biopsy. Materials and Methods: A prospective study involving thirty cases of leprosy presenting with single skin lesion to the department of dermatology of a tertiary care hospital spread over 2 years. Examination of skin lesion and nerves was carried out, and details were recorded. Routine hematological and biochemical investigations were done. SSS from the lesion, both ear lobes, right elbow, left middle finger, and right middle toe and lesional biopsy was done. Bacteriological index and morphological index were calculated in all cases, and the diagnosis was correlated by histopathology. Results: Of the thirty cases studied, twenty were males (66.7%) and ten (33.3%) were females with male-to-female ratio of 2:1. The most common age group afflicted was 21–40 years (70%). Hypopigmented patch was the most common presentation 19 (63.3%) in our study. The most common site of patch was forearm in 9 (30%). Of the thirty cases, 20 (66.7%) were diagnosed as borderline tuberculoid, 9 (30%) as tuberculoid tuberculosis, and 1 (3.3%) as indeterminate leprosy. Ulnar nerve was the most common nerve involved (80%). Ten patients (33.3%) were positive and twenty (66.7%) were negative for acid-fast bacilli on SSS examination. Out of the thirty clinically diagnosed leprosy cases, 19 (63.3%) showed positive histopathological correlation. Conclusions: The presentation of borderline lepromatous leprosy and lepromatous leprosy as single skin lesion reinforces the fact that certain aspects of the host cell-mediated response and pathophysiology of this disease are still not fully understood. It illustrates the importance of SSS and biopsy in these cases as such cases are undertreated.