Stalk Width Research Articles

Pituitary stalk thickening in pediatric patients: an underrecognized diagnosis?

Pituitary stalk thickening (PST) is a rare condition in pediatric patients. Data on PST in Latin American pediatric populations are scarce. The aim of this study was to characterize a comprehensive cohort of pediatric patients diagnosed with PST in Chile between 2020 and 2022. Retrospective review of medical records from 2020 to 2022 of patients under 18 years old diagnosed with PST, defined as a pituitary stalk width ≥ 3 mm at the pituitary insertion and/or ≥ 4 mm at the optic chiasm. A literature review was also performed to compare the identified cases with previously published ones. Nine patients with PST were identified. Their mean age at diagnosis was 10.36 years (range 2.4-17 years). The patients' main manifestations were polydipsia and polyuria (100%) and poor growth (77.8%). Eight patients had germ cell tumors, while one patient had Langerhans cell histiocytosis. At the time of diagnosis, all patients had arginine vasopressin (AVP) deficiency, along with a deficiency in at least one anterior pituitary hormone. Germ cell tumor markers were negative in all patients. A biopsy-confirmed diagnosis was obtained in all cases. Four patients required a second biopsy. The frequency of PST due to germ cell tumors was four patients/year during the study period, which is twice the expected frequency in Chile. This study, characterizing the largest cohort of pediatric patients with PST in Latin America, found germ cell tumors to be the main etiology of this condition. It is important to focus diagnostic procedures on obtaining a correct diagnosis and promptly initiating appropriate treatment in patients with PST. Regional cooperation is essential for gathering data from larger cohorts to enhance our understanding of pediatric PST and improve patient outcomes.

A Nomogram of MRI Features to Assess Muscle Invasion in VI-RADS 2 Tumors With Stalk.

Vesical Imaging-Reporting and Data System (VI-RADS) is widely used to assess the muscle-invasive status of bladder cancer. However, the current classification efficacy of VI-RASD 2 tumors of stalk is unsatisfactory. To develop a nomogram to assess muscle-invasive bladder cancer (MIBC) in VI-RADS 2 tumors with stalk. Retrospective. A total of 186 patients (age: 67.8 ± 12.7 years) with 15.1% females, divided randomly into a training cohort (N = 130) and validation cohort (N = 56). 3-T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (breathing-free spin-echo), and dynamic contrast-enhanced imaging (gradient-echo). Twenty-one MRI features of tumors and stalks were developed from training cohort. The mean apparent diffusion coefficient (ADC) values of the tumor, stalk, and psoas muscles were calculated from the three circular regions of interest. The normalized T . The normalized ST . Three readers assessed the morphology of tumors and stalks. The final features of nomogram were selected by univariable logistic and the least absolute shrinkage and selection operator (LASSO) regression. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis. In VI-RADS 2 tumors with stalk, tumor size over 3 cm, increased stalk width, stalk morphology, decreased normalized T value, and increased normalized ST value were selected as the risk factors for MIBC. The AUC, accuracy, sensitivity, and specificity of the nomogram to assess MIBC were 0.969 (95% CI: 0.941-0.997), 92.3%, 94.1%, and 92.0% in training cohort and 0.940 (95% CI: 0.859-1.000), 89.3%, 75.0%, and 91.7% in validation cohort. This study constructed a nomogram for preoperative assessment of MIBC and modifying the current VI-RADS. 3 TECHNICAL EFFICACY: Stage 2.

The Potential of Several Wild Invasive Fish Species as Fish-Based Organic Fertilizers on the Growth of Two Common Vegetables in Malaysia

Three common invasive fish species in Malaysia, Peacock Bass (Cichla ocellaris), Nile Tilapia (Oreochromis niloticus) and Algae Suckermouth Catfish (Hypostomus plecostomus) were assessed for their efficacy as potential fish powder fertilizers. These invasive fish species were known to disturb the stability of lentic and lotic aquatic ecosystems in Malaysia, especially O. niloticus and H. plecostomus, altering aquatic habitats and food webs to be unsuitable for survival of indigenous fish species, while C. ocellaris becoming active aggressive predators on indigenous fish species, overall reducing indigenous fish species diversity. Plant primary macronutrient traces showed that C. ocellaris fish powder fertilizer recorded the highest Nitrogen (N) element percentage (15.81 ± 0.43 N %w/w) and trace Potassium (K) element (28,909.15 ± 32.56 K mg/kg), while H. plecostomus fish powder fertilizer recorded the highest trace Phosphorus (P) element (30,562.09 ± 197.11 P mg/kg). Plant secondary macronutrient traces showed that C. ocellaris fish powder fertilizer recorded the highest trace Magnesium (Mg) element (1496.66 ± 3.99 Mg mg/kg), while H. plecostomus fish powder fertilizer recorded the highest trace Calcium (Ca) element (6984.48 ± 26.20 Ca mg/kg). Two vegetable species tested for their growths, the water spinach (Ipomoea aquatica) and the spinach (Spinacia oleracea), showed that C. ocellaris fish powder fertilizer recorded the highest heights (263.74 ± 12.29 mm, 166.35 ± 9.46 mm), the widest leaf width (14.82 ± 0.66 mm, 21.08 ± 1.53 mm), and the widest stalk width (3.06 ± 0.10 mm, 2.89 ± 0.17 mm), respectively, comparable to the NPK 15:15:15 compound fertilizer, followed by H. plecostomus and O. niloticus fish powder fertilizers. C. ocellaris as predatory invasive fish species with the highest Mg concentration and moderate Ca concentrations, was especially suitable for the growth of both semi-aquatic and terrestrial vegetables grown on low Mg concentration soils.

ASSESSMENT OF GROWTH AND YIELD PARAMETERS OF MUSHROOM SPECIES (Pleurotus Eryngii and Pleurotus Ostreatus) AS INFLUENCED BY DIFFERENT SUBSTRATES

This experiment was carried out to determine the influence of three substrates on the growth and yield of Pleurotus eryngii and Pleurotus ostreatus in 2022 at the laboratory of Faculty of Agriculture, COOU, Igbariam, Anambra State. This study was designed out as a 3×2 factorial experiment in a completely randomized design. The substrates (rice bran, corn chaff, groundnut cake) were the main factor while the mushroom species (P. eryngii and P. ostreatus) were the sub-factor. Data were collected on spawn run period, pinhead initiation, total number of fruiting bodies, maximum and minimum weight of fruiting bodies, length and width of stalk, diameter of mushroom cap, yield of first three flushes, total yield and biological efficiency. The data collected above were subjected to analysis of variance. Significant means were separated using Fisher’s Least Significant Difference. The results obtained indicated that rice bran substrate gave the highest yield (10.70g), and biological efficiency (6.20%). This was followed by corn chaff while, groundnut cake had the lowest growth and yield values. The results also showed that P. ostreatus specie produced highest or maximum weight of fruiting bodies (4.88g), better cap diameter (3.10cm), stalk length (3.70cm), stalk width (1.20cm) and yield (40.67g) followed by P. eryngii.

Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma

Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas. Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas. Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs( Z=-5.189, P<0.001), polyp blood flow signal(χ 2=33.630, P<0.001), vascular stalk width(Z=-7.366, P<0.001), polyp enhancement time(χ 2=22.487, P<0.001), enhancement intensity in arterial phase(χ 2=44.371, P<0.001), polyp vascular morphology(χ 2=53.814, P<0.001)and gallbladder wall integrity(χ 2=13.277, P=0.001).The sensitivity, specificity and accuracy of CEUS in distinguishing gallbladder adenomas from cholesterol polyps were 85.37%, 89.47% and 88.24%, respectively, and the area under the curve was 0.874. Conclusion CEUS can effectively distinguish gallbladder adenomas from cholesterol polyps and help patients with GPLs to select the appropriate treatment.

Endoscopic characteristics influencing postpolypectomy bleeding in 1147 consecutive pedunculated colonic polyps: a multicenter retrospective study

Postpolypectomy bleeding is the most common adverse event with pedunculated polyps. We clarified the endoscopic characteristics influencing postpolypectomy bleeding for pedunculated colonic polyps. We reviewed clinical data for 1147 pedunculated colonic polyps removed by polypectomy in 5 Japanese institutions. Pedunculated polyps were defined as polyps with a stalk length≥5mm. Analyzed clinical data were age, sex, polyp location/size, stalk length/width, prophylactic clipping or endoloop before polypectomy, injecting the stalk, closing the polypectomy site, antithrombotic agent use, and endoscopist experience. Postpolypectomy bleeding was classified as immediate bleeding or delayed bleeding. Immediate and delayed bleeding was observed in 8.5% (97/1147) and 2% (23/1147) of polypectomies, respectively. Comparing immediate bleeding with nonbleeding, multivariate analysis showed that stalk width≥6mm (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.4) was a significant risk factor for immediate bleeding. For polyp size≥15mm, prophylactic endoloop use (OR, .17; 95% CI, .04-.72) was a significant inhibiting factor. Comparing delayed bleeding with nonbleeding, multivariate analysis showed that prophylactic clipping before polypectomy (OR, 4.2; 95% CI, 1.3-13) and injecting the stalk (OR, 4.0; 95% CI, 1.4-12) were significant risk factors for delayed bleeding. The increased risk for delayed bleeding with injecting the stalk and prophylactic clipping before polypectomy suggests that simple resection with coagulation mode is a suitable strategy in endoscopic resection of pedunculated polyps. Moreover, prophylactic endoloop use was highly likely to inhibit immediate bleeding with polyp size≥15mm.

Contrast-enhanced ultrasound to assess gallbladder polyps

PurposeTo assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. MethodsA total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. ResultsThere were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. ConclusionVascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.

Recovery of hypothalamus-pituitary-gonadal dysfunction after the treatment of suprasellar germ cell tumors.

To investigate the incidence of hypothalamus-pituitary-gonadal (HPG) axis initiation/recovery after treatment and to identify predictive risk factors for noninitiation/recovery. A total of 127 consecutive suprasellar germ cell tumor (GCT) patients managed at Peking Union Medical College Hospital (2006-2019) were retrospectively analyzed. Prepubertal patients (followed up until 13 years of age for girls and 14 years of age for boys) and patients with HPG dysfunction (followed up for 2 years) were divided into the initiation/recovery and noninitiation/recovery groups. Of the 127 suprasellar GCT patients, 75 met the follow-up criteria, 28 (37.3%) of whom experienced HPG axis initiation/recovery. Compared to the noninitiation/recovery group, the initiation/recovery group included more males and had shorter delayed diagnosis times, smaller tumor sizes, lower panhypopituitarism rates, thinner pituitary stalk widths, lower visual deficit rates, and higher serum testosterone and estradiol levels. The cutoff values of pituitary stalk width, tumor size, and delayed diagnosis time used to predict noninitiation/recovery were 6.9 mm, 6.9 mm and 1.7 years, respectively. Tumor size ≥6.9 mm (odds ratio (OR) = 7.5, 95% CI: 2.2-25.8, P = 0.001), panhypopituitarism (OR = 5.0, 95% CI: 1.4-17.6, P = 0.013), and delayed diagnosis time ≥1.7 years (OR = 5.7, 95% CI: 1.5-20.7, P = 0.009) were risk factors for noninitiation/recovery. Among suprasellar GCT patients, nearly one-third of prepubertal patients and patients with HPG dysfunction experience HPG axis initiation/recovery after treatment. Tumor size ≥6.9 mm, panhypopituitarism, and delayed diagnosis time ≥1.7 years were identified as predictive risk factors for noninitiation/recovery.

Effects of combined application of organic fertilizer and microbial agents on tobacco soil and tobacco agronomic traits

Using the tobacco variety Yunyan87 as an example, we investigated the effects of the combined application of organic fertilizer and microbial agents on the physicochemical properties and enzyme activities of tobacco soil and on tobacco agronomic parameters. Compared with the control group, the contents of alkali-hydrolyzed nitrogen, available potassium, and available phosphorus in the soil treated with organic fertilizer and microbial agents increased by 27.7, 12.3, and 133.7%, respectively. The activities of soil urease, phosphatase, sucrase, and catalase increased by 86.3, 85.1, 46.6, and 33.5%, respectively, while the numbers of bacteria and actinobacteria increased by 89.9 and 183.4% respectively. In contrast, the numbers of fungi decreased by 64.8%. Plant height, effective leaf number, stem circumference, stalk width, cutting length, and cutting width increased by 8.1, 7.8, 12.1, 15.7, 20.5, and 11.5%, respectively. Based on our results, the application of organic fertilizer combined with microbial agents significantly improved soil properties, enzyme activities, microbial numbers, and tobacco agronomic parameters.

Variation in Maize Chlorophyll Biosynthesis Alters Plant Architecture.

Chlorophyll is a tetrapyrrole metabolite essential for photosynthesis in plants. The first committed step of chlorophyll biosynthesis is catalyzed by a multimeric enzyme, magnesium chelatase, the subunit I of which is encoded by the oil yellow1 (oy1) gene in maize (Zea mays). A range of chlorophyll contents and net CO2 assimilation rates can be achieved in maize by combining a semidominant mutant allele of oy1 (Oy1-N1989) and a cis-regulatory modifier named very oil yellow1 (vey1) that varies between different inbred lines. We previously demonstrated that these allelic interactions can delay reproductive maturity. In this study, we demonstrate that multiple gross morphological traits respond to a reduction in chlorophyll. We found that stalk width, number of lateral branches (tillers), and branching of the inflorescence decline with a decrease in chlorophyll level. Chlorophyll deficit suppressed tillering in multiple maize mutants, including teosinte branched1, Tillering1, and grassy tillers1 In contrast to these traits, plant height showed a nonlinear response to chlorophyll levels. Weak suppression of Oy1-N1989 by vey1 B73 resulted in a significant increase in mutant plant height. By contrast, enhancement of the severity of the Oy1-N1989 phenotype by the vey1 Mo17 allele resulted in reduced plant height. We demonstrate that the effects of reduced chlorophyll contents on plant growth and development are complex and depend on the trait being measured. We propose that the lack of chlorophyll exerts growth control via energy balance sensing, which is upstream of the known genetic networks for branching and architecture.

Benign gallbladder diseases: Imaging techniques and tips for differentiating with malignant gallbladder diseases.

Benign gallbladder diseases usually present with intraluminal lesions and localized or diffuse wall thickening. Intraluminal lesions of the gallbladder include gallstones, cholesterol polyps, adenomas, or sludge and polypoid type of gallbladder cancer must subsequently be excluded. Polyp size, stalk width, and enhancement intensity on contrast-enhanced ultrasound and degree of diffusion restriction may help differentiate cholesterol polyps and adenomas from gallbladder cancer. Localized gallbladder wall thickening is largely due to segmental or focal gallbladder adenomyomatosis, although infiltrative cancer may present similarly. Identification of Rokitansky-Aschoff sinuses is pivotal in diagnosing adenomyomatosis. The layered pattern, degree of enhancement, and integrity of the wall are imaging clues that help discriminate innocuous thickening from gallbladder cancer. High-resolution ultrasound is especially useful for analyzing the layering of gallbladder wall. A diffusely thickened wall is frequently seen in inflammatory processes of the gallbladder. Nevertheless, it is important to check for coexistent cancer in instances of acute cholecystitis. Ultrasound used alone is limited in evaluating complicated cholecystitis and often requires complementary computed tomography. In chronic cholecystitis, preservation of a two-layered wall and weak wall enhancement are diagnostic clues for excluding malignancy. Magnetic resonance imaging in conjunction with diffusion-weighted imaging helps to differentiate xathogranulomatous cholecystitis from gallbladder cancer by identifying the presence of fat and degree of diffusion restriction. Such distinctions require a familiarity with typical imaging features of various gallbladder diseases and an understanding of the roles that assorted imaging modalities play in gallbladder evaluations.

Karakterisasi Morfologidan Uji Daya Hasil 15 Genotipe Caisin (Brassica rapa L.Cv. Grup Caisin)

Characterization is the first stage in plant breeding that aims to reveal the morphological character and selection of the genotypes that adapt to low-altitude of area. To fulfill caisin consumption demands in Indonesia, extensification was needed from high altitude grounds which is the natural habitat of caisin to low-altitude. Randomize Complete Block Design (RCBD) is used and genotype as a single factor. 15 genotypes were used from collection of PKHT BRP 004, BRP 002, BRP 009, BRP 022, BRP 007, BRP 020, BRP 010, BRP 012, BRP 021, and those given the induction of mutations in BRP 004 R, BRP 002 R, BRP 009 R, BRP 003 R, and BRP 019 R. The data were analyzed by analysis of variance then Tukey test as the advanced test. BRP 010 genotype has the heaviest total harvest mass and harvest mass without the root, yet BRP 009 R genotype has the highest harvest index score which means it has the highest percentage of edible part. BRP 002 R, BRP 009 R, and BRP 019 R, are genotypes from the irradiation process that has color diversity. The result of analysis of variance showed that from 11 quantitative characters from 15 caisin genotypes, 3 characters was found not showing a true statistical difference, there are quantity of leaf, leaf width, and height ratio (NLP), and stalk width. BRP 022 Genotypes has the narrowest and the shortest leaf, the shortest leaf stalk, and the narrowest leaf diameter. BRP 002 has the highest plant height and Sri Tanjung genotype has the shortest plant height. BRP 010, BRP 004 R, BRP 002 R, BRP 019 R and BRP 009 R genotypes have potential to submitted for new varieties candidate that adaptive to low-altitude ground.

Pituitary Stalk Thickening in a Large Cohort: Toward More Accurate Predictors of Pituitary Dysfunction and Etiology

Objective: To summarize the characteristics of patients with pituitary stalk thickening, analyze the association between pituitary stalk width and hypopituitarism, and develop a diagnostic model to differentiate neoplastic and inflammatory origins. Methods: A total of 325 patients with pituitary stalk thickening in a tertiary teaching hospital between January 2012 and February 2018 were enrolled. Basic characteristics and hormonal status were evaluated. Indicators to predict etiology in patients with histologic diagnoses were analyzed. Results: Of the 325 patients, 62.5% were female. Deficiency in gonadotropin was most common, followed by corticotropin, growth hormone, and thyrotropin. The increase in pituitary stalk width was associated with a risk of central diabetes insipidus (odds ratio [OR], 3.57; P<.001) and with a combination of central diabetes insipidus and anterior pituitary deficiency (OR, 2.28; P = .029). The cut-off pituitary stalk width of 4.75 mm had a sensitivity of 69.2% and a specificity of 71.4% for the presence of central diabetes insipidus together with anterior pituitary deficiency. Six indicators (central diabetes insipidus, pattern of pituitary stalk thickening, pituitary stalk width, neutrophilic granulocyte percentage, serum sodium level, and gender) were used to develop a model having an accuracy of 95.7% to differentiate neoplastic from inflammatory causes. Conclusion: Pituitary stalk width could indicate the presence of anterior pituitary dysfunction, especially in central diabetes insipidus patients. With the use of a diagnostic model, the neoplastic and inflammatory causes of pituitary stalk thickening could be preliminarily differentiated. Abbreviations: APD = anterior pituitary dysfunction; AUC = area under the curve; CDI = central diabetes insipidus; GH = growth hormone; MRI = magnetic resonance imaging; OR = odd ratio; PHBS = posterior hypophyseal bright spots; PST = pituitary stalk thickening; PSW = pituitary stalk width.

MON-458 Radiological Alterations Of The Hypothalamic-pituitary Region After Craniospinal Irradiation For Medulloblastoma During Childhood.

Background Hypothalamic-pituitary (HP) dysfunction after craniospinal irradiation (CSI) is frequently observed in childhood brain tumor survivors (CBTS). The risk increases with higher dose and younger age at time of radiation exposure. Whether radiological alterations of the HP-region or alterations in brain volume are predictive of HP dysfunction remains unknown. Aim The aim of this (retrospective) study was to quantify radiological alterations of the HP-region in time in CBTS after CSI and to correlate these alterations to the occurrence of HP dysfunction. Methods Ninety survivors of childhood medulloblastoma (mean age at diagnosis: 8.3 years) from a previously reported nationwide cohort, treated with CSI between 2002-2012, were included. Sixty CBTS (67%) were diagnosed with HP dysfunction during follow-up (FU). All MRI scans were collected from time of diagnosis, post-neurosurgical intervention, post-radiation and 3 and 5 years of FU. Pituitary height (PH) and width (PW) were measured on mid-sagittal images. The pituitary stalk (PS) width was assessed by measuring the ratio of the PS to basilar artery (BA) on axial images on the same plane in the middle of the PS. Volume measurements of the PG (PGV) were performed. Observers were blinded for outcome of HP function. Separate analyses were performed for children < 6 years at time of CSI. All measurements were corrected for age and gender using Z-scores. Statistical analyses were performed by SPSS (General Linear Model repeated measures with Bonferroni correction). Results Mean PH (p<0.01, 95% CI [0.25, 1.27], PW (p<0.01, 95% CI [0.85-2.32], width of the PS (p<0.01, 95% CI [0.38-3.0] and PGV (p<0.05, 95% CI [0.12-1.29] declined during FU. No correlation was observed between radiological alterations in time and the presence of HP dysfunction. On a marginal trend level, an interaction effect was seen for PS/BA ratio and the presence of HP dysfunction (p= 0.097, F= 2.44). HP dysfunction occurred more frequently in CBTS treated with CSI < 6 years (71% vs 58%). Radiological alterations in this age group could also not be related to occurrence of HP dysfunction. Conclusion When compared to age and gender reference values, CBTS treated with CSI show radiological alterations of the HP region in time. Exposure to cranial irradiation in childhood seems to have a negative effect on PH, PW, width of PS and PGV. However, these effects cannot be related to the development of HP dysfunction or age at time of CRT. Prospective studies are needed to confirm these results, with systematic evaluation of the HP function in time.

The Value of Differentiation Diagnosis of Gallbladder Polyps Larger Than 1.0cm by CEUS: 7 Years Clinical Experiences

To assess the value of differentiation diagnosis of gallbladder polyp lesion (GPL) by contrast enhanced ultrasound (CEUS). A total of 988 consecutive cases of patients with GPL larger than 1.0cm were collected between June 2010 and May 2017 in our hospital. All patients underwent gray scale ultrasound and contrast enhanced ultrasound examinations before cholecystectomy. The patients' data and the features of GPL on gray scale ultrasound images were recorded, which include the size, color Doppler blood flow, number of GPL, echoic features of GPL and gallbladder stone. The CEUS features of GPL including enhancement intensity, enhancement homogeneous, stalk width, vascular type in arterial phase were recorded. All of the gray scale and CEUS images were analyzed by two doctors independently who have more than 10 years CEUS examinations experiences. According to the pathology findings, all the patients enrolled in this study were divided into cholesterol polyps and gallbladder adenoma groups. All the patients' data and image features between two groups were statistically compared. There were 856 cases of cholesterol polyp and 132 cases of gallbladder adenoma. There were differences in patient age, lesion size, echogenicity, gallbladder stone and vascularity of lesion between two groups (P<0.05). There were differences in stalk width, enhancement intensity and vascular types between two groups (P<0.05). Multiple logistic regression analysis proved that size of lesions, enhancement intensity, stalk of lesion, vascularity and vascular type were the independent risk factors related with GB adenoma (P<0.05). CEUS could offer useful information to distinguish adenoma from cholesterol polyp. The treatment algorithm for GPL would likely benefit from CEUS as a routine imaging investigation, especially in cases where the polyp is larger than 1cm.

Endoscopic resection using the Clutch Cutter and a detachable snare for large pedunculated colonic polyps.

Background and study aims Endoscopic snare polypectomy with prophylactic detachable snare of large pedunculated colonic polyps (PCPs) is technically demanding. To facilitate removal of such polyps, we developed endoscopic resection using the Clutch Cutter and a detachable snare (ERCCDS). This study aimed to evaluate the efficacy and safety of the procedure. Patients and methods From April 2010 to July 2015, 14 consecutive patients who had PCPs with head > 10 mm, stalk width > 5 mm, and stalk length > 10 mm were enrolled in this single-center prospective uncontrolled study. They were treated using ERCCDS by a single endoscopist. The efficacy and safety were assessed using a database prospectively formatted from the medical records. Results The Clutch Cutter was able to cut the distal side of the stalk an adequate distance from the detachable snare under good visual control. R0 resections were obtained in all lesions. There were no immediate or delayed complications. Conclusions ERCCDS appears to be a safe, easy, and technically efficient method for large PCPs, although larger studies are needed to compare ERCCDS and standard resection.

Morphometric Study of Several Species of the Genus &lt;i&gt;Jatropha&lt;/i&gt; Linn. (Euphorbiaceae)

Morphological parameters of several Jatropha species, namely Jatropha curcas L., Jatropha gossypifolia L., Jatropha podagrica Hook., Jatropha integerrima Jacq. and Jatropha multifida L. were subjected to quantitative analysis within the present study. Twelve traits of the leaves, fruits and seeds were analysed: leaf length, leaf width, leaf length/width ratio, petiole length, petiole width, fruit length, fruit width, fruit length/width ratio, seed length, seed width, fruit stalk length and fruit stalk width were subjected to Principal Component Analysis (PCA) and cluster analysis. Highly significant positive correlations have been noted, while negative correlation was observed between leaf width and leaf length/width ratio, fruit width and leaf length/width ratio. Traits such as leaf length, leaf width and leaf length/width ratio contributed significantly along with other traits to discriminate the studied Jatropha species. J. podagrica and J. integerrima were found to have more similarities, with a stronger coefficient of agglomeration (69.072) than J. curcas and J. podagrica with 315.028 coefficient of agglomeration respectively. The generated dendrogram showed the relationship between the studied Jatropha species, whereas great affinity was noted between J. podagrica and J. multifida as compared with J. gossypifolia and J. integerrima which are distantly related. The closeness observed between J. podagrica and J. multifida is in line with their current sub-generic grouping.

Morphometric Study of Several Species of the Genus &lt;i&gt;Jatropha&lt;/i&gt; Linn. (Euphorbiaceae)

Morphological parameters of several Jatropha species, namely Jatropha curcas L., Jatropha gossypifolia L., Jatropha podagrica Hook., Jatropha integerrima Jacq. and Jatropha multifida L. were subjected to quantitative analysis within the present study. Twelve traits of the leaves, fruits and seeds were analysed: leaf length, leaf width, leaf length/width ratio, petiole length, petiole width, fruit length, fruit width, fruit length/width ratio, seed length, seed width, fruit stalk length and fruit stalk width were subjected to Principal Component Analysis (PCA) and cluster analysis. Highly significant positive correlations have been noted, while negative correlation was observed between leaf width and leaf length/width ratio, fruit width and leaf length/width ratio. Traits such as leaf length, leaf width and leaf length/width ratio contributed significantly along with other traits to discriminate the studied Jatropha species.&nbsp; J. podagrica and J. integerrima were found to have more similarities, with a stronger coefficient of agglomeration (69.072) than J. curcas and J. podagrica with 315.028 coefficient of agglomeration respectively. The generated dendrogram showed the relationship between the studied Jatropha species, whereas great affinity was noted between J. podagrica and J. multifida as compared with J. gossypifolia and J. integerrima which are distantly related. The closeness observed between J. podagrica and J. multifida is in line with their current sub-generic grouping.

From Polyuria to Renal Mass: An Unexpected Link

From Polyuria to Renal Mass: An Unexpected Link

Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case–control study

The aim of this study was to find the independent risk factors related with gallbladder (GB) adenoma compared to cholesterol polyp by contrast-enhanced ultrasound (CEUS). Between January 2010 and September 2014, a total of 122 consecutive patients undergoing cholecystectomy for GB polypoid lesions were enrolled. Before cholecystectomy, each patient underwent conventional US and CEUS examination and all image features were documented. The patients were divided into adenoma group and cholesterol polyp group according to the pathological findings. All the image features between two groups were statistically compared. There were differences in patient age, lesion size, echogenicity, and vascularity of lesion between two groups (P<0.05). There were differences in stalk width and enhancement intensity between the two groups (P<0.05). Multiple logistic regression analysis proved that enhancement intensity, stalk of lesion, and vascularity were the independent risk factors related with GB adenoma (P<0.05). CEUS could offer useful information to distinguish adenoma from cholesterol polyp. The treatment algorithm for gallbladder polyp lesions would likely benefit from CEUS as a routine imaging investigation, especially in cases where the polyp is larger than 1cm.