Pattern Of Lesions Research Articles

Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature.

Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically.

Growth of nonexudative macular neovascularization in age-related macular degeneration: an indicator of biological lesion activity

PurposeTo investigate the growth of nonexudative macular neovascularization (MNV) in age-related macular degeneration (AMD) using swept-source optical coherence tomography angiography (SS-OCTA).MethodsPatients with treatment-naïve nonexudative AMD in one eye and exudative AMD in the fellow eye who underwent SS-OCTA imaging for at least 12 months were retrospectively reviewed. The MNV area measurement was quantified in eyes with treatment-naïve nonexudative MNV using ImageJ for analysing the correlation between MNV growth and the onset of exudation, as well as evaluating the consistency of the MNV growth rate during the subclinical and exudative stages. Kaplan-Meier survival analysis and logistic regression analyses were used.ResultsIn total, 45 eyes with treatment-naïve nonexudative AMD from 45 patients were enrolled. Treatment-naïve nonexudative MNV was identified in 21 eyes (46.67%) at baseline. The development of exudative findings was noted in eight eyes (17.78%), including six eyes with previously noted nonexudative MNV. Eyes with growing MNV (increase in area ≥50% within 12 months) had an increased risk of exudation and developed exudation earlier than eyes with stable MNV (13.60 [6.43–20.77] months versus 31.11 [26.61–35.62] months, P < 0.0001, Log-rank test). Consistent growth pattern of MNV lesions was further identified in eyes with growing MNV during anti-VEGF treatment.ConclusionSS-OCTA allows to qualitatively and quantitatively evaluate nonexudative MNV in AMD patients. Growing MNV involved higher probabilities and a faster onset of exudation compared to stable MNV. Identifying the growth of MNV on OCTA might be helpful for establishing treatment strategies and follow-up planning.

Cutaneous Manifestations in Patients With COVID-19 Treated at a University Hospital in Southern Brazil.

Objectives The aim of this study was toascertain whether pattern of cutaneous lesions, age, sex, ethnicity, long-term medication use, arterial oxygen saturation at the first examination, setting of care, and number of medications used to treat SARS-CoV-2 infection are associated with mortality in patients with a confirmed diagnosis of coronavirus disease 2019 (COVID-19) and cutaneous manifestations. In addition, to evaluate the occurrence of cutaneous manifestations in patients with a confirmed diagnosis of COVID-19 through a review of medical records and in-person evaluation by a dermatologist. Methods This investigation consisted of two components - (A) a cross-sectional study with a retrospective review of the medical records of all patients with a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 treated at Santa Casa de Misericórdia de Porto Alegre between March 2020 and November 2020, and (B) a prospective case series with in-person skin examination by an attending dermatologist of all patients admitted to COVID-19 wards between April 2021 and July 2021. The pattern of skin lesions and other variables were assessed. Results Information from 2968 individuals with COVID-19 was collected (2826 from the medical records and 142 from the in-person examination by a dermatologist). Of these, a total of 51 patients (1.71%) had COVID-19-related cutaneous lesions - 36 from the medical records group (1.27% of cutaneous manifestations) and 15 from the examinated group (10.56% of cutaneous manifestations). Of 51 patients, 15 (29.41%) died. There was no association between mortality and patterns of cutaneous manifestations. The variables male sex (p=0.021), intensive care unit (ICU) admission (p=0.001), and use of three or more antibiotics (p=0.041) were associated with higher mortality. Conclusions The risk factors, proven by our study, for mortality in patients with COVID-19 and cutaneous manifestations were male sex, ICU stays, and use of three or more antibiotics. Using the review of medical records as a tool for evaluating cutaneous manifestations related to COVID-19, there are about 10 times fewer occurrences when compared to in-person evaluation by a dermatologist.

Evaluation of histopathological spectrum of hepatic lesions in liver biopsies in a tertiary care hospital

Liver is vulnerable to a wide variety of metabolic, toxic, circulatory insults and is affected by a wide spectrum of various primary and secondary diseases. Liver biopsy contributes greatly to the understanding of liver diseases &amp; is considered gold standard for evaluating liver disorders, providing information regarding diagnosis, disease progression and response to therapy. Being an invasive procedure with certain unavoidable risks, with proper procedural precautions and careful selection of patients, complications and risks can be greatly minimized. To study histopathological features of liver biopsies in patients with liver disease. To document the pattern of various hepatic lesions. To document various types of lesions predominant in different age groups. A prospective study was conducted in Department of Pathology of tertiary care hospital of Ahmedabad over a period of two years which included 74 liver biopsies. Clinical, demographic and pathologic data was collected and analysed for each case. Out of total 74 liver biopsy specimen, 47.29% cases were males, 52.70% were females. Malignant lesions were most common finding (52/74), out of which 37(50%) were metastatic adenocarcinoma, 10 (13.51%) were hepatocellular carcinoma and 5 (6.75%) were cholangiocarcinoma. Non neoplastic lesions included 10 cases which were of hepatitis, cirrhosis, hemangioma, biliary atresia and hydatid cyst formation. In 12 cases (16.21%), there were no significant findings. Thehistopathological study of liver biopsy forms the cornerstone in the diagnosis and management of various hepatic diseases. Microscopic examination of liver biopsy yields range of pathological findings and helps in specific management.

Three-Time-Point PET Analysis of 68Ga-FAPI-46 in a Variety of Cancers.

A growing family of 68Ga-fibroblast activation protein inhibitor (FAPI) PET probes has shown promise in imaging a variety of medical conditions. 68Ga-FAPI-46, in particular, has emerged as unique for both its diagnostic and its theranostic applications; however, the optimal timing of PET remains unclear. Therefore, we evaluated uptake at 3 time points after 68Ga-FAPI-46 administration in a spectrum of tumor types. Methods: The cohort consisted of 43 patients with diverse cancer diagnoses undergoing 68Ga-FAPI-46 PET/CT at 3 time points (10 min, 1 h, and 3 h). We determined the tracer uptake based on SUVmean and SUVmax and on tumor-to-background-ratios (TBRs) (SUVmax/SUVmean). Results: There were 171 lesions in the 43 patients. Comparing all lesions at different time points, the mean SUVmax was maximal at 10 min (8.2) and declined slightly at 1 h (8.15) and 3 h (7.6) after tracer administration. Similarly, the mean SUVmax log still had a similar pattern in primary lesions at 10 min, 1 h, and 3 h (n = 30; 0.98, 1.01, and 0.98, respectively), lymph node metastases (n = 37; 0.82, 0.84, and 0.81, respectively), and distant metastases (n = 104; 0.81, 0.79, and 0.74, respectively). TBR also showed nonsignificant differences at the 3 times. Conclusion: 68Ga-FAPI-46 PET/CT imaging revealed remarkably stable tumor and background uptake as determined by SUV metrics and maintained high TBRs within 3 h of injection. Thus, it may be possible to scan with 68Ga-FAPI-46 within 10-20 min of injection, improving workflow and decreasing patient wait times. Confirmation of these findings in a larger cohort is under way.

Clinical-Pathological Correlation of Breast Non-mass Enhancing Lesions

Abstract Introduction/Objective MRI imaging of breast is mainly reserved for screening high-risk individuals with occasional application in women bearing moderate or average risk. Areas showing enhancement in MRI without space-occupying mass are defined as non-mass enhancement (NME). As biopsy of NME lesion is rare encounter in clinical practice, thorough clinical-pathological investigation is warranted. Methods/Case Report 289 patients who underwent core biopsy for NME lesion(s) in our institution between 2011 to 2021 were included in this retrospective study. Pathological diagnoses were lumped into 3 categories, namely benign, precursor lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ), and malignant lesions (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, and invasive carcinoma). The age distribution, MRI indications, and pathological diagnoses stratified by indications were studied. MRI patterns of NME lesions were compared between malignant versus benign lesions. Results (if a Case Study enter NA) Patient’s age ranges 25-79 yo (mean age 51.9 yo, median age 50 yo). Indications of MRI include high-risk screening (162 cases, 162/289, 56%), pre-operative staging (116 cases, 116/289, 40%), and problem-solving (11 cases, 11/289, 4%). There are 220 benign cases (220/289, 76%), 50 malignant cases (50/289, 17%), and 19 precursor lesions (19/289, 7%) in this study. There were 16 malignant cases identified in the high-risk group (16/162, 10%), 24 in the pre-operative staging group (24/116, 20.7%), and 2 in problem-solving group (2/11, 18.2%). Focal distribution is significantly associated with malignant lesions as compared to other patterns (linear, segmental, and regional) (Chi-square test, p&amp;lt;0.001). Conclusion High-risk screening is the major indication for biopsy NME lesions, followed by pre-operative staging, and problem-solving. Benign lesions are the predominant pathological findings of NME lesions, followed by malignant and then precursor lesions. Malignant lesions were mostly identified in high-risk group, followed by pre-operative staging and problem-solving group. Malignant lesions tend to assume the “focal distribution” than other MRI patterns.

Abstract 9865: Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE Cardiolink-3 Randomized Trial

Introduction: Our objective was to investigate the frequency and distribution of new ischemic brain lesions detected by diffusion-weighted imaging (DWI) on brain MRI after aortic arch surgery. Methods: This was an imaging sub-analysis of the ACE CardioLink-3 randomized controlled trial which compared the safety and efficacy of innominate vs axillary artery cannulation during elective proximal aortic arch surgery. All participants in the trial underwent pre- and post-operative MRI. New ischemic lesions were defined as lesions on post-operative DWI that were not visible on the pre-operative DWI. Results: Of 102 patients who underwent surgery, 71 (70%) had new ischemic lesions on DWI and the total lesion number across all participants was 391. The average lesion number in patients with at least one ischemic lesion was 5.5±4.9, and were similar in the right (3.3±2.7) or left (3.6±2.8) hemispheres (p=0.49). The most common lesion patterns were single or multiple cortical infarcts. Half of the lesions (n=183, 47%) were in the middle cerebral artery territory, while 24% were in the infratentorium. 42% of patients had lesions distributed in both anterior and posterior circulation, 21% in anterior circulation only, and 7% in posterior circulation only. Besides, 20% had lesions in watershed areas. There were no differences in distribution between patients in the innominate vs axillary artery cannulation groups. In multivariable regression models, more severe white matter hyperintensity on pre-operative MRI (odds ratio per 1-score increase of Fazekas scale 1.80; p=0.02) and lower nadir temperature during operation (odds ratio per 1°C decrease, 1.14; p=0.05) were associated with having any new ischemic lesion, while older age (risk ratio per 1-year increase 1.02; p=0.03) and lower nadir temperature (risk ratio per 1°C decrease, 1.06; p=0.06) were associated with higher lesion numbers. Conclusion: In patients who underwent elective proximal aortic arch surgery, new ischemic brain lesions were common, and mostly identified as scattered cortical infarcts in the middle cerebral artery territory. Advanced age, underlying small vessel disease, and lower nadir temperature during operation were risk factors of presence and burden of new ischemic lesions after surgery.

A Case Series With Acquired Dermal Melanocytosis: A Retrospective Study From 2001 to 2018.

Acquired dermal melanocytosis (ADM) is a pigmented lesion caused by melanocytes in the dermis, and it is most often observed on the face of young and middle-aged Asian women. ADM development may be associated with melanin synthesis alterations, but little evidence of its molecular and histological alteration has yet been reported. This study aimed to evaluate ADM in different body locations using different immunohistochemical and chemical staining techniques. This retrospective case series includes consecutive patients confirmed as ADM by biopsy between 2001 and 2018. Patient data and archival images were used to determine the pattern and duration of skin lesions, as confirmed by data analysis of immunohistopathological staining of skin biopsy specimens. A total of 22 ADM patients were included with mean age at diagnosis of 47 years, and 63.6% were female. The most common site was limbs (36.4%), followed by face (27.3%), trunk (22.7%), and scalp (13.6%). Melanin levels were highest in the face and upper extremities and lowest in the trunk. All participants had perivascular distribution of dermal melanocytes, particularly on the face and limbs. The perineural distribution of dermal melanocytes was observed in the lower limbs, with prominent inflammation and fibrosis on the scalp. Dermal melanocytes expressed most markers recognizing melanocytes except for CD117. Analysis of this ADM case series has confirmed that melanin is activated by dermal melanocytes that may aggregate along blood vessels. CD117 may be a useful biomarker by which to identify the migration of epidermal melanocytes.

Pattern of Uterine and Cervical Lesions Marked on Histopathological Examination of Hysterectomy Specimens

Background: In Gynecology, most of the knowledge circles around the female reproductive tract and uterus has been a vital organ playing central role in female reproductive life cycle both in terms of menstrual and ostereous cycles. Uterus is subjected to both mechanical and hormonal stresses so uterine pathologies and diseases are the most common pathologies marked in female reproductive systems. These pathologies range from benign uterine pathology to malignancy in many cases. Most of the uterine and cervical pathologies are diagnosed after hysterectomy on histopathological examination only. Objective: The study was carried out to see histopathological patterns of uterine and cervical lesions in hysterectomy specimens. Study Design: Histopathology department of Women Medical and Dental College, Abbottabad from August 2021 to August 2022. Materials and Methods: It was a retrospective study done on hysterectomy samples findings in histopathological examination of uterine and cervical area on 80 specimens over a 1 year period. SPSS latest version was used for DATA. Results: 80 patients were included based on histopathological reports of the post hysterectomy specimens. Age of patients lies &lt; 30 years to &gt; 60 years. Majority of the cases were between 41-50 years and 51-60 years of the age while patients between 41-50 years age group were 50 %,adenomyosis (09%), atrophied uterus (5%), Hyperplasia (10%), leiomyoma with adenomyosis (18.5%), Leiomyoma (55%) and leimyosarcoma (2.5%),while cervical pathologies show cervicitis, (62%), cervical dysplasia (21%), cervicitis (papillary) in 07 %, and 10% cases were normal. Different uterine lesions based on the age of the patients show that Leiomyoma is maximally found in patients between 46-60 years and above 60 years of patients and only two cases were marked below 30 Years. Conclusion: The commonest benign lesion was leiomyoma in uterus followed by adenomyosis combined with leiomyoma, while in cervical canal commonest finding was cervicitis in Hysterectomy specimen. Keywords: Adenomyosis, Histopathology, Hysterectomy, Leiomyoma, Cervicitis.

X-linked retinoschisis: OCT-angiography in two brothers from a four-generation family with a p.Arg197Cys pathogenic variant in the RS1 gene.

X-linked juvenile retinoschisis (XLRS) is a rare genetic disease causing retinal splitting. The aim of this work is to describe the optical coherence tomography angiography (OCTA) features in two brothers affected by an hemizygous c.589C>T (p.Arg197Cys) pathogenic variant in exon 6 of the RS1 gene. Each patient underwent a complete ophthalmological examination, including measurement of best corrected visual acuity, slit-lamp biomicroscopy, fundus color photographs, fundus autofluorescence and infrared imaging, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA). En Face SD-OCT and OCTA revealed the presence of two different pattern of cystic lesions, fusiform and oval, disposed on a petaloid or irregular manner in the perifoveolar area. A widening of the foveal avascular zone with interruption of the vascular arcades was clearly evident. Furthermore, a capillary drop-out was observed in the superficial plexus of the central retina, other than capillary ectasia in the deep capillary plexus. Straight gray lines were visible among the cysts. OCTA data herein described allow a detailed morphological evaluation of XLRS other than a quantitative assessment of retinal capillary flow in this disease. The retinal alterations that we have reported may be helpful to better understand this rare condition with OCTA being a sensitive technique to monitor the evolution of the disease and the response to potential future therapeutic approaches aimed to restore vision.

Histopathological pattern of Orbito-Ocular Lesions, a retrospective hospital-based study spanning 15 years.

Many previous studies on orbito-ocular lesions are skewed in favour of the neoplastic lesions in general and the malignant lesions in particular. This, therefore, creates a vacuum on the spectrum of these lesions, thus may result in problematic diagnostic bias by the ophthalmologist and pathologist. To give the spectrum and relative frequencies of orbito-ocular biopsies and by extension orbito-ocular lesions/diseases at the University of Benin Teaching Hospital (UBTH). A retrospective descriptive study of all cases of orbito-ocular biopsies with histopathologic diagnosis. There were 236 orbito-ocular biopsies. The male to female ratio was slightly in favour of the females. Orbito-ocular biopsies had a wide age range that spanned from the 1st to 10th decade, mean age in the 3rd decade (20-29years) and a peak age in the 1st decade (0-9 years). The neoplastic lesions were the prevalent indication for orbito-ocular biopsies (63.72%) while the conjunctiva (58.10%) was the most common site for orbito-ocular biopsies. This study noted a wide array of orbito-ocular lesions for which biopsies were done for histopathological diagnosis. This we hope will in no small measure increase the diagnostic precision of the ophthalmologist and the pathologists in our own environment.

Pattern of Endodontic Lesions of Maxillary and Mandibular Posterior Teeth: A Cone-Beam Computed Tomography Study.

The pattern of expansion of endodontic lesions in the jaws has been less commonly addressed in the literature. For this reason, the aim of this study is to assess the pattern of endodontic lesions of maxillary and mandibular posterior teeth using cone-beam computed tomography (CBCT). This cross-sectional study was conducted on 317 endodontic lesions of posterior teeth on CBCT scans retrieved from a radiology center in Qazvin, Iran, from 2020 to 2022. Endodontic lesions were assessed on sagittal, coronal, and axial sections by an endodontist and dental student using the Romexis software. The largest lesion diameter was measured occluso-apically, mesiodistally, and buccolingually. Lesion size was analyzed based on age, gender, jaw, tooth type, and presence/absence of root filling by independent samples t-tests and a one-way Analysis Of Variannce (ANOVA). The largest diameter of lesions in the maxilla and mandible was recorded in the occluso-apical dimension followed by buccolingual and mesiodistal dimensions (p > 0.05). The pattern of lesions was the same in teeth with and without endodontic treatment, but it was significantly different in maxillary and mandibular endodontically treated teeth in the occluso-apical and buccolingual dimensions (p < 0.05). No significant correlation was noted with tooth type or jaw except for maxillary and mandibular first molar lesions, which were significantly different in the occluso-apical dimension (p < 0.05). Lesion size in all three dimensions was significantly greater in males than females (p < 0.05), and was the highest in the occluso-apical dimension in both genders. In the maxilla, the mean lesion size significantly decreased in the mesiodistal dimension with age (p < 0.05). In conclusion, the largest lesion diameter in the maxilla and mandible was found in the occluso-apical dimension, indicating the role of bone density in the pattern of lesions.

Quantification and Proximal-to-Distal Distribution Pattern of Tibial Nerve Lesions in Relapsing-Remitting Multiple Sclerosis

PurposeRecent studies suggest an involvement of the peripheral nervous system (PNS) in multiple sclerosis (MS). Here, we characterize the proximal-to-distal distribution pattern of peripheral nerve lesions in relapsing-remitting MS (RRMS) by quantitative magnetic resonance neurography (MRN).MethodsA total of 35 patients with RRMS were prospectively included and underwent detailed neurologic and electrophysiologic examinations. Additionally, 30 age- and sex-matched healthy controls were recruited. 3T MRN with anatomical coverage from the proximal thigh down to the tibiotalar joint was conducted using dual-echo 2‑dimensional relaxometry sequences with spectral fat saturation. Quantification of PNS involvement was performed by evaluating microstructural (proton spin density (ρ), T2-relaxation time (T2app)), and morphometric (cross-sectional area, CSA) MRN markers in every axial slice.ResultsIn patients with RRMS, tibial nerve lesions at the thigh and the lower leg were characterized by a decrease in T2app and an increase in ρ compared to controls (T2app thigh: p < 0.0001, T2app lower leg: p = 0.0040; ρ thigh: p < 0.0001; ρ lower leg: p = 0.0098). An additional increase in nerve CSA was only detectable at the thigh, while the semi-quantitative marker T2w-signal was not altered in RRMS in both locations. A slight proximal-to-distal gradient was observed for T2app and T2-signal, but not for ρ.ConclusionPNS involvement in RRMS is characterized by a decrease in T2app and an increase in ρ, occurring with proximal predominance at the thigh and the lower leg. Our results indicate microstructural alterations in the extracellular matrix of peripheral nerves in RRMS and may contribute to a better understanding of the pathophysiologic relevance of PNS involvement.

Association between the patterns of large-vessel lesions and treatment outcomes in patients with large-vessel giant cell arteritis

We aimed to identify associations between patterns of large-vessel lesions of large-vessel giant cell arteritis (LV-GCA) and treatment outcomes. We extracted data on 68 newly-diagnosed patients with LV-GCA from a retrospective, multi-centric, nationwide registry of GCA patients treated with glucocorticoids between 2007 and 2014. Patients with aortic lesions were identified based on findings from contrast-enhanced computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT (group 2, n=49). Patients without aortic lesions were subdivided into LV-GCA with or without subclavian lesions defined as group 1 (n=9) or group 3 (n=10), respectively. Primary outcome evaluation was failure to achieve clinical remission by week 24 and/or relapse within 104 weeks. The mean age and proportion of patients with cranial lesions and polymyalgia rheumatica in group 2 was numerically lower than in the other two groups. Large-vessel lesions in group 3 included carotid, pulmonary, renal, hepatic or mesenteric lesions. The cumulative rate of poor treatment outcomes over two years was 11.1%, 55.3%, and 88.0% in groups 1, 2, and 3, respectively (by Kaplan-Meier analysis). The mean time to poor outcome was significantly different between the groups. Classification by subclavian and aortic lesions may be useful to determine treatment strategy.

Never stop wondering: When cells become PAP-art on the slides.

The project named Victoria's cells was created to train health care personnel, especially in low-income countries. This innovative approach is designed to associate benign and malignant cellular images and/or patterns with a range of shapes and color shades to evoke animals, common objects, and colorful aquariums. The project makes use of familiar images to capture the viewer's interest as an aid for cytological interpretation. Cervicovaginal cytology is processed with conventional and liquid-based cytology. The images are visually compelling to highlight the importance of studying cells and their diagnostic significance. Infectious diseases as well as malignant cells are thereby easily recognized. The pictures are organized into different sections, including Victoria's zoo, Victoria's fantasy, and malignant mockery. Branching mycelia resemble a starfish; squamous metaplasia recalls a sea turtle's shell. Among others, different patterns of endometrial, endocervical, and squamous cells can resemble fish tanks populated by cells with the shapes of pufferfish, anglerfish, whales, scorpions, and garfish. The sea transitions to the earth, with a sly cat, a little elephant, a dog, and a koala. Other cellular preparations resemble a gymnast, a geisha, and a plunging diver as well as hummingbirds, a heron, a water lily, and a peony. The malignant mockery section is composed of squamous intraepithelial lesion patterns that resemble monsters, eyes, a foul tongue, eagles, and feathers. In conclusion, the recognition of visual images can make the study of cytology simpler and more enjoyable and serve the final objectives of prevention and cure.

Regional differences in percutaneous coronary intervention outcomes in STEMI patients with diabetes: The Asia-Pacific evaluation of cardiovascular therapies (ASPECT) collaboration

BackgroundDiabetes is associated with poorer outcomes and increased complication rates in STEMI patients undergoing percutaneous coronary intervention (PCI). Data are notably lacking in the Asia-Pacific region. We report the overall association of Diabetes with clinical characteristics and outcomes in STEMI patients undergoing PCI across the Asia-Pacific, with a particular focus on regional differences. MethodologyThe Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration consists of data from various PCI registries across Australia, Hong Kong, Singapore, Malaysia, Indonesia and Vietnam. Clinical characteristics, lesion characteristics, and outcomes were provided for STEMI patients. Key outcomes included 30-day overall mortality and major adverse cardiovascular events (MACE). ResultsA total of 12,144 STEMI patients (mean(SD) age 59.3(12.3)) were included, of which 3912 (32.2%) had diabetes. Patients with diabetes were likely to have a higher baseline risk profile, poorer clinical presentation, and more complex lesion patterns (all p < 0.05). Across all regions, patients with diabetes had a higher rate of 30-day mortality and MACE (all p < 0.05). After multivariable adjustment, diabetes was significantly associated with both increased 30-day mortality (9.6%vs 5.5%, OR 1.79 [95% CI 1.40–2.30]) and MACE (13.3% vs 8.6%, R 1.73 [1.44–2.08]). The association between diabetes and 30-day MACE varied by region (pinteraction = 0.041), with the association (OR) ranging from 1.34 [1.08–1.67] in Malaysia, to 2.39 [1.66–3.45] in Singapore. ConclusionsDiabetes portends poorer clinical outcomes in STEMI patients undergoing PCI in the Asia-Pacific with regional variations noted. The development of effective preventative measures and interventional strategies targetted at this high-risk group is crucial.

Searching for underlying atrial fibrillation using artificial intelligence-assisted MRI images from ischemic stroke patients

Abstract Background Nearly 30% of ischemic strokes are attributed to atrial fibrillation (AF) related cardiac thromboembolism. This subset of strokes are associated with higher recurrence rate, morbidity and mortality. As a result, current recommendation suggests a cardiac monitoring of variable intensity and duration to search for unknown AF after a stroke so that optimal secondary prevention could be administered. Unfortunately, it is reported that 24h Holter ECG monitoring for underlying AF is completed routinely in only a minority of stroke centers, making a huge gap between AF detection rate in clinical practice and estimated actual data (2–3% vs 23–30%). So, it is obvious that paroxysmal AF remains undetected in a significant proportion of patients after a stroke and an early and effective identification approach of cardiac disturbances is needed. Purpose We aim to develop an innovative end-to-end artificial intelligence model to rapidly search for atrial fibrillation in post ischemic stroke patients using MRI imaging data. Methods 489 patients diagnosed with ischemic stroke, 174 of which had a prior known history of AF or new AF detected by intensive ECG monitoring poststroke, from January 2018 to October 2021 were enrolled in this study. The MRI images obtained after their admission in the stroke unit were meticulously evaluated and acute ischemic stroke lesions on DWI sequences were segmented and confirmed by two senior neuroradiologists independently. These processed images were randomly split into training (n=315) and testing set (n=174) for the implementation and validation of our AI screening model. And the algorithm was based on the combination of radiomic features and semantic features extracted from convolutional neural network (CNN). The model performance was evaluated by accuracy, recall, precision, F-Measure and AUC. Also, heatmaps which indicate the attention mechanism of the model were generated for interpreting underlying patterns. Results The AUC of our model (COM) reached 0.8 (Figure 1A). Also, the algorithm yielded values for the accuracy, recall, precision and F-Measure of 70%, 92.5%, 63.8% and 75.5%, respectively, which showed satisfactory classification results. As to the interpretability of the AI model, we found that more “attention” was paid to the main lesions (Figure 1B) and radiomic features which indicated the minimum gray level intensity and the sphericity of the lesions (Figure 1C, D) were crucial to the classifier. Conclusions Our work revealed a potential correlation between brain ischemic lesion pattern on DWI images and underlying etiology of AF. Moreover, the AI model we developed may serve as a rapid screening tool for AF in clinical practice of stroke units. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Syndesmotic Reduction Landmarks in Healthy Ankle Patients, Comparative Analysis of Weight- Bearing Computed Tomography

Category: Ankle Introduction/Purpose: Introduction: The diagnosis of low-energy syndesmotic injuries continues to be a challenge, and there is no standard for it. Being the dynamic exams, the ones with the best performance. With the development of Weight-Bearing computerized tomography (WBCT), the understanding of their lesion patterns has improved, however, there is high variability in the syndesmotic anatomy between different individuals, with asymmetry parameters in up to 89% of healthy syndesmosis. therefore the best element to evaluate them is the healthy contralateral ankle and compare these parameters. However, what are the normal values in our population, or the possible anatomical differences according to different age groups, in the morphology of the syndesmal notch of our patients, nor that there is a real symmetry between both ankles. Methods: Retrospective analysis of comparative bilateral ankle WBCT in healthy patients from March 2018 to July 2021 according to the parameters: anterior, posterior and central syndesmal distance, fibular rotation, sagittal translation and area. All patients with comparative bilateral ankle weight-bearing CT taken since January 2018 to August 2021, patients without history of ankle injuries, were included in the analysis. That have required a comparative bilateral WBCT to study another pathology. Patients with a history of acute or chronic ankle or syndesmal injuries, patients with degenerative ankle joint injuries, with severe misalignments &gt; 10° in varus or valgus, incomplete or non-comparative study were excluded. Results: 150 patients with comparative bilateral WBCT were evaluated. Among the ankles evaluated with WB CT in a comparative manner, it is established that there were no significant differences between both ankles of subjects with healthy ankles (Wilcoxon Test) in anterior syndesmal distance (SD), posterior SD, central SD, syndesmal area (p &gt; 0.05). While fibular rotation and sagittal translation showed significant differences between the measurements in healthy ankles, evaluated with comparative bilateral WB CT in independent evaluations (p &lt; 0.05). Regarding the differences by age range established for the different syndesmotic reduction parameters, for the different subgroups of patients under 40 years of age, 40 and 60 years of age and over 60 years of age, no significant differences were generated between them (Wilcoxon test). Conclusion: We have established normal ranges for measurements in the syndesmal anatomy in axial slices during weight bearing CT, as well as that there are no differences between the right and left ankle in healthy ankles in anterior, posterior and central syndesmal distance, or syndesmal area. Being these parameters, the most suitable as internal control for patients with suspected syndesmotic injury regardless of the age of the patients.

МСКТДИАГНОСТИКА ОСТЕОМИЕЛИТА ВЕРХНЕЙ ЧЕЛЮСТИ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. COVID-19 is widely known as a disease that causes respiratory dysfunction, however, it is also associated with a mass of extrapulmonary manifestations and complications, gastrointestinal, hepatocellular complications, neurological diseases, as well as complications in the maxillofacial region. Aim. The aim of this study was to diagnose osteomyelitis of the upper jaw in post COVID-19 patients using multispiral computed tomography. Material and methods. We retrospectively evaluated radiation imaging and clinical data of 37 patients, aged 28 to 52 years with osteomyelitis of the upper jaw, who underwent COVID-19. The male sex prevailed among the patients. Results and discussion. All patients had sinusitis and ophthalmic symptoms. The pattern of anatomical lesions of the upper jaw, nasal cavity, maxillary sinus, orbit, and lattice cells was consistently observed in all patients. Conclusion. Progressive and rapid course, involvement of the cavernous sinus, vascular structures, and further upward spread (intracranial) complications may be the usual evolution of rhinophthalmocerebral mucormycosis. Multiplanar tomographic imaging shows the localization, nature, as well as relationship of the surrounding structures, helping in turn to plan the operation. However, the prognosis remains difficult, despite radical surgery and, in particular, antifungal treatment.

Electroencephalogram and Neuroimaging Markers of Poor Prognosis in Hypoxic-Ischemic Brain Injury

Purpose:Hypoxic-ischemic brain injury (HIBI) can cause coma.Several factors may affect the outcome after HIBI and prediction of the prognosis is challenging in clinical practice.Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG) are two reliable tools to predict the possible outcome after brain damage.We aimed to test the utility of MRI and EEG in predicting the outcome by exploring specific lesion and electrophysiological patterns. &#x0D; Method:Patients who had admitted to the intensive care unit (ICU) due to hypoxic-ischemic brain injury between January 2017 and March 2020 were retrospectively reviewed.Patients over 18 years of age with a history of cardiac arrest or respiratory problems leading to hypoxic-ischemic brain injury were included in the study.Glasgow Coma Score (GCS) was used for the level of consciousness.All patients had a Glasgow Coma Score (GCS) of