Diagnostic Imaging Research Articles

Restoration of motion-blurred numeral image using a complex-amplitude diffractive processor.

We propose a complex-amplitude diffractive processor based on diffractive deep neural networks (D2NNs). By precisely controlling the propagation of an optical field, it can effectively remove the motion blur in numeral images and realize the restoration. Comparative analysis of phase-only, amplitude-only, and complex-amplitude diffractive processor reveals that the complex-amplitude network significantly enhances the performance of the processor and improves the peak signal-to-noise ratio (PSNR) of the images. Appropriate use of complex-amplitude networks contributes to reduce the number of network layers and alleviates alignment difficulties. Due to its fast processing speed and low power consumption, complex-amplitude diffractive processors hold potential applications in various fields including road monitoring, sports photography, satellite imaging, and medical diagnostics.

Comparative evaluation of gold nanoparticles as contrast agent in multimodality diagnostic imaging

A contrast agent is clinically employed to aid the visualization of organs and structures when imaged by radiation based diagnostic imaging modalities. Iodinated contrast agents have been used for decades, but they carry a heightened risk of adverse allergy reactions and contrast-induced nephropathy. This study investigated the contrast enhancement characteristics of gold nanoparticles (AuNPs) through diverse cancer diagnostic imaging modalities as a potential alternative to the iodine-based contrasts. Solutions of 1.9 nm and 15 nm AuNPs, ranging from 3 to 20 mM concentrations, were prepared, alongside a low osmolar non-ionic iodine contrast agent as a control. All samples were scanned and imaged using x-ray computed tomography scanner (CT-Scan), digital mammography, digital radiography, and fluoroscopy modalities. The contrast-to-noise ratio (CNR) was measured to study the relationship between the size, the concentrations, and the influence of the tube voltage over the image contrast enhancement efficacy of the agents. A lower concentration of AuNPs produced lower CNR values. In addition, the 1.9 nm size of AuNPs caused lower CNR than the 15 nm AuNPs when tested with the highest concentration of 20 mM. High CT's HU values for both sizes of AuNPs indicated substantial contrast enhancement compare to iodine. Although the 15 nm AuNPs might set off higher CNR, a better quality of image contrast enhancement was also observed compared to the 1.9 nm AuNPs. The findings also suggested that the contrast enhancement by AuNPs is highly dependent on the modalities' type and x-rays energy. In conclusion, AuNPs could be applied as a contrast agent in various diagnostic imaging modalities representing promising approach in cancer detection particularly in cases of patients having adverse reactions towards the iodine based contrast agents.

Nano-Bio Interfaces: Pioneering Targeted Approaches for Disease Treatment and Prevention

Nanotechnology has emerged as a pivotal force in biomedical research, offering groundbreaking solutions for disease treatment and prevention through the integration of nanoscience with biology. This review explores the multifaceted applications of nano-bio interfaces in revolutionizing therapeutic interventions and public health strategies. At the forefront of innovation, nanomaterial-based drug delivery systems demonstrate unparalleled precision and efficacy in targeted drug delivery, minimizing systemic toxicity and maximizing therapeutic outcomes. Furthermore, the development of multifunctional nanoparticles capable of simultaneous drug delivery and diagnostic imaging enables real-time monitoring of treatment responses, heralding a new era of personalized medicine. Nano-bio interfaces also play a crucial role in advancing vaccine development and immunotherapies, with nanoparticle-based vaccine platforms offering enhanced antigen delivery and immune stimulation for robust and durable immune responses against infectious diseases and cancer. In the realm of disease prevention, antimicrobial nanomaterials provide effective strategies for infection control, while nanovaccines and prophylactic drug delivery systems offer tailored solutions for mitigating the spread of infectious agents. Through a comprehensive exploration of these pioneering approaches, this review, we believe, highlights the transformative potential of nano-bio interfaces in reshaping the landscape of disease treatment and prevention.

Contrast-Enhanced Sonography of the Liver: How to Avoid Artifacts.

Contrast-enhanced sonography (CEUS) is a very important diagnostic imaging tool in clinical settings. However, it is associated with possible artifacts, such as B-mode US-related artifacts. Sufficient knowledge of US physics and these artifacts is indispensable to avoid the misinterpretation of CEUS images. This review aims to explain the basic physics of CEUS and the associated artifacts and to provide some examples to avoid them. This review includes problems related to the frame rate, scanning modes, and various artifacts encountered in daily CEUS examinations. Artifacts in CEUS can be divided into two groups: (1) B-mode US-related artifacts, which form the background of the CEUS image, and (2) artifacts that are specifically related to the CEUS method. The former includes refraction, reflection, reverberation (multiple reflections), attenuation, mirror image, and range-ambiguity artifacts. In the former case, the knowledge of B-mode US is sufficient to read the displayed artifactual image. Thus, in this group, the most useful artifact avoidance strategy is to use the reference B-mode image, which allows for a simultaneous comparison between the CEUS and B-mode images. In the latter case, CEUS-specific artifacts include microbubble destruction artifacts, prolonged heterogeneous accumulation artifacts, and CEUS-related posterior echo enhancement; these require an understanding of the mechanism of their appearance in CEUS images for correct image interpretation. Thus, in this group, the most useful artifact avoidance strategy is to confirm the phenomenon's instability by changing the examination conditions, including the frequency, depth, and other parameters.

Synergizing frequency domain and texture-aware implicit module for MRI arbitrary-scale super-resolution

Arbitrary-scale MR image super-resolution (SR) methods have emerged as a prominent research topic in medical imaging due to their ability to address the demand for continuous resolution in medical image analysis and diagnostics. Although several methods currently employ Implicit Neural Representations (INR) to achieve arbitrary-scale SR for MR images, they still face the following issues that constrain further enhancements in SR performance. (1) They solely perform feature extraction on MR images in the image domain, disregarding the frequency domain information in MR images, which results in aliasing artifacts and blurriness in the reconstructed SR images. (2) They utilize a standard multi-layer perceptron in INR, which tend to learn global structures (i.e., low-frequency components) and fail to capture and restore detailed texture information (i.e., high-frequency components) in MR images adequately. To address these issues, we propose a brand-new method called FTNet, which introduces the frequency domain information and employs the texture-aware implicit module for MR image arbitrary-scale SR. Specifically, we design an additional branch to extract the feature of MR images in the frequency domain to maximize removing aliasing artifacts. To further improve the quality of SR images, we introduce a texture extraction branch and a texture-aware implicit module to capture and restore detailed texture information within the MR images. Extensive experiments demonstrate the superiority of our network over state-of-the-art methods and its great potential for clinical practice.

Ultrasound-guided laparoscopy for conservative management of a massive degenerated uterine fibroid during pregnancy: A case report

ObjectiveTo outline the key steps in the management of a massive, degenerated fibroid during pregnancy. DesignA video article demonstrating diagnostic imaging, laparoscopic anatomy, and innovative surgical technique. SettingThis video demonstrates an unusual presentation of a uterine fibroid in pregnancy. Uterine fibroids are common, with an incidence of 40%–60% by the age of 35 with a possibility of growing in pregnancy and impacting the developing fetus. InterventionsThis case summarizes an innovative, safe, and efficient minimally invasive surgery approach to a patient with a 30-cm degenerated fibroid at 16 weeks gestational age of pregnancy, permitting ongoing development of the viable fetus. Review of imaging revealed a solid-cystic uterine mass, suspicious for degenerated fibroid, compressing the gestation into the right upper quadrant. The patient did not have a reported history of a uterine mass prior to pregnancy. Interdisciplinary care with maternal-fetal medicine and gynecologic oncology ensured thorough counselling and various treatment possibilities. The MIGS team performed ultrasound-guided laparoscopy involving drainage, biopsy, and insertion of a transient drain to prevent re-accumulation of fluid throughout the pregnancy. Pathology revealed fibroid degeneration with infarct-type necrosis. The patient continued successfully in pregnancy until undergoing a Cesarean section at 33 weeks after developing an abscess within the fibroid. Neonatal outcome was excellent. ConclusionOur case demonstrates degeneration with massive expansion of a fibroid, compromising the potential of the fetus. A solution was devised and implemented, allowing for pregnancy continuation until the third trimester.

Surgical management strategies for unstable sacral fractures: Case series and surgical guideline

IntroductionUnstable sacral fractures usually have posterior pelvic and spinopelvic instability, which usually be classified as AO type C. There are many controversial points concerning the management of these fractures due to their rarity. Herein, we retrospectively review cases of this injury and propose a surgical guideline. Case presentationA 37-year-old female experienced back pain after a motor vehicle accident. Diagnostic imaging revealed an AO type C1 sacral fracture, Isler subtype 2a (case No. 7). Preoperative CT scan and CT reconstruction images showed a longitudinal fracture with a simple intraarticular fracture of the left S1 superior facet. Although the patient sustains a lumbosacral facet joint injury, the lumbosacral motion seems preservable after healing. The triangular osteosynthesis was chosen because it provides both transverse plane and vertical plane stability. The patient was allowed to continue weight-bearing ambulation after the operation. To maintain lumbosacral motion, the spinopelvic rod was removed in the postoperative seventh month. DiscussionThe unstable sacral fracture might have instability in both the vertical and transverse planes. The fixation construct should provide both vertical and transverse stability. Regarding vertical fixation, it might cost a loss of lumbosacral motion, which the treating surgeon has to consider. The lumbosacral injury is sometimes trivial, and long-term lumbosacral motion is expectable. So, permanent spinopelvic fixation is not necessary. The patient's character is also an important factor. Whether the patient needs or does not need early progressive weight bearing after the operation determines the fixation method. ConclusionUnstable sacral fractures are rare conditions usually resulting from a high-energy injury. We have proposed a surgical management strategy for this group of fractures with an optimal fixation method based on three factors: 1) fracture morphology, 2) lumbosacral integrity, and 3) concomitant injury.

[Translated article] Diagnostic imaging in patients with vertebral compression fractures

Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are intravertebral fluid collection or fluid signal, other vertebral deformities without oedema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.

Hope and trust in diagnostic imaging contexts – Constituting technology and liminal patients

IntroductionThis study investigates patients’ experience of selected imaging examinations and how human experiences are transformed through technological mediation. MethodA qualitative study of patients' experiences during selected imaging examinations, centering on human-technology relations, was conducted.Data was gathered in two Danish hospitals, through semi-structured interviews and participant observations. The study included fifteen diagnostic imaging examination cases, distributed over three Computed Tomography (CT)-guided lung biopsy interventions, seven conventional CT examinations, and five Positron Emission Tomography CT examinations. The participating patients were undergoing investigation for cancer within Fast Track Cancer Referral Programs (FTCRP).The study has a philosophical approach to practice grounded in Postphenomenology and draws on anthropological studies of healthcare practice as its theoretical and analytical framework. ResultsDiagnostic imaging technologies were found to have existential implications creating hope and trust in patients. Patients demonstrated technological readiness, in their willingness to comply with examination criteria and the professional's instructions. The patient's primary concern was achieving a good examination result, for which they were prepared to push themselves beyond their usual limits.Participating in diagnostic imaging examinations may be viewed as a life crisis ritual, wherein patients are constituted as liminal beings, existing between healthy and sick. ConclusionsThe existential implications of an imaging examination were clear in terms of hope and trust. Hope is related to life and death in two temporal perspectives: A future hope of surviving cancer and a present hope of being cancer-free. Hope was linked to avoiding despair and rested on trusting oneself to technology, thus, forming a circle of interrelated concepts. Implications for practiceProfessionals need to recognize the patients’ liminal passings yet, unnoticed transformative and existential implications, to perform better patient-centered care.

(Invited) C60-Based Switchable Fluorescent Probes

Photodynamic therapy (PDT), an emerging non-invasive tumor treatment, requires suitable photosensitizer (PS) molecules that generate reactive oxygen species (ROSs) efficiently under long wavelength of light with deep tissue penetration, ideally activated in the diseased tissue. C60 is known as an excellent acceptor molecule in both electron- and energy-transfer reactions and exhibits biocompatibility and efficient ROS generation, rendering it a promising candidate as a PS for PDT.In this study, we developed a C60-based dual-functional molecular probe containing a water-soluble C60-peptide and a donor fluorophore connected with a ligand peptide specific for matrix metalloproteinases (MMP) (Figure 1). We expect that such a molecular probe can be used in both diagnostic imaging and concurrent treatment. The probe revealed increased fluorescence signal and 1O2 generation in the presence of MMP2/9 enzymes that are known to be overexpressed in tumor cells. Furthermore, in vitro cellular tests demonstrated the probe's abilities in imaging MMP activity and photocytotoxicity on MMP-expressing tumor cells. Figure 1

Strengthening the Chain: A Continuing Medical Education Program for Test Results Follow-up.

The Canadian Medical Protective Association (CMPA)'s Commitment to Change in Test-Results Follow-Up (CTC-TRFU) program aims to provide physicians with resources to enhance their test results follow-up systems for improved patient safety. Framed around the Transtheoretical Model, the program involves a 6-month multimodal educational intervention involving individual and group coaching sessions, action planning, and reflection surveys. This study evaluates the CTC-TRFU program's impact by analyzing survey responses and course documents, focusing on three main outcomes: physicians' perceived barriers and challenges, changes in their confidence and commitment, and implemented practice changes with perceived impact on patient safety. Participants were Canadian physicians who enrolled through the CMPA's open-access registration, with a particular emphasis on those facing challenges in test result follow-up. One hundred two physicians have enrolled in the program. Of these physicians, 34 (33.3%) have successfully completed the program and 28 (27.5%) are actively enrolled. Among the 34 physicians who successfully completed the program, an overwhelming majority of 97.1% (n = 33) expressed their belief that the improvements made to their test follow-up system significantly enhance patient safety within their practice. We observed a significant increase in confidence in the robustness of the physician's follow-up system from program registration to completion (P < .001). Physicians reported catching specific missed test results (55.9%, n = 19), including various laboratory reports and diagnostic imaging like abnormal mammograms or missing MRI/CT results. Physicians who participated in the CTC-TRFU program reported meaningful practice changes, which we believe underscores the value of comprehensive, longitudinal continuing patient safety CPD initiatives. These findings indicate the potential for future studies to explore the long-term impact of similar programs and their scalability.

Deep learning MR reconstruction in knees and ankles in children and young adults. Is it ready for clinical use?

To evaluate the diagnostic performance and image quality of accelerated Turbo Spin Echo sequences using deep-learning (DL) reconstructions compared to conventional sequences in knee and ankle MRIs of children and young adults. IRB-approved prospective study consisting of 49 MRIs from 48 subjects (10 males, mean age 16.4years, range 7-29years), with each MRI consisting of both conventional and DL sequences. Sequences were evaluated blindly to determine predictive values, sensitivity, and specificity of DL sequences using conventional sequences and knee arthroscopy (if available) as references.Physeal patency and appearance were evaluated. Qualitative parameters were compared. Presence of undesired image alterations was assessed. The prevalence of abnormal findings in the knees and ankles were 11.7% (75/640), and 11.5% (19/165), respectively. Using conventional sequences as reference, sensitivity and specificity of DL sequences in knees were 90.7% and 99.3%, and in ankles were 100.0% and 100.0%. Using arthroscopy as reference, sensitivity and specificity of DL sequences were 80.0% and 95.8%, and of conventional sequences were 80.0% and 97.9%. Agreement of physeal status was 100.0%. DL sequences were qualitatively "same-or-better" compared to conventional (p < 0.032), except for pixelation artifact for the PDFS sequence (p = 0.233). No discrete image alteration was identified in the knee DL sequences. In the ankle, we identified one DL artifact involving a tendon (0.8%, 1/125). DL sequences were faster than conventional sequences by a factor of 2 (p < 0.001). In knee and ankle MRIs, DL sequences provided similar diagnostic performance and "same-or-better" image quality than conventional sequences at half the acquisition time.

Measurement of Cardiothoracic Ratio on Chest X-rays Using Artificial Intelligence-A Systematic Review and Meta-Analysis.

Background: Chest X-rays (CXRs) are pivotal in clinical diagnostics, particularly in assessing cardiomegaly through the cardiothoracic ratio (CTR). This systematic review and meta-analysis evaluate the efficacy of artificial intelligence (AI) in automating CTR determination to enhance patient care and streamline diagnostic processes. They are concentrated on comparing the performance of AI models in determining the CTR against human assessments, identifying the most effective models for potential clinical implementation. This study was registered with PROSPERO (no. CRD42023437459). No funding was received. Methods: A comprehensive search of medical databases was conducted in June 2023. The search strategy adhered to the PICO framework. Inclusion criteria encompassed original articles from the last decade focusing on AI-assisted CTR assessment from standing-position CXRs. Exclusion criteria included systematic reviews, meta-analyses, conference abstracts, paediatric studies, non-original articles, and studies using imaging techniques other than X-rays. After initial screening, 117 articles were reviewed, with 14 studies meeting the final inclusion criteria. Data extraction was performed by three independent investigators, and quality assessment followed PRISMA 2020 guidelines, using tools such as the JBI Checklist, AMSTAR 2, and CASP Diagnostic Study Checklist. Risk of bias was assessed according to the Cochrane Handbook guidelines. Results: Fourteen studies, comprising a total of 70,472 CXR images, met the inclusion criteria. Various AI models were evaluated, with differences in dataset characteristics and AI technology used. Common preprocessing techniques included resizing and normalization. The pooled AUC for cardiomegaly detection was 0.959 (95% CI 0.944-0.975). The pooled standardized mean difference for CTR measurement was 0.0353 (95% CI 0.147-0.0760). Significant heterogeneity was found between studies (I2 89.97%, p < 0.0001), with no publication bias detected. Conclusions: Standardizing methodologies is crucial to avoid interpretational errors and advance AI in medical imaging diagnostics. Uniform reporting standards are essential for the further development of AI in CTR measurement and broader medical imaging applications.

Importance and implementation of radiological modalities in the diagnostics of soft tissue tumors

Malignant soft tissue tumors, in particular, require amultimodal treatment concept involving interdisciplinary cooperation between radiologists, pathologists, surgeons and oncologists at special tumor centers. The foundations of the treatment decision are the imaging diagnostics and the diagnosis confirmation based on tissue samples. The (local) extent and growth behavior of atumor are among the most important findings of imaging as they have adirect influence on the surgical procedure. The most important diagnostic procedure here is magnetic resonance imaging (MRI). The T1-weighted and fat-suppressed sequences after i.v. contrast administration are used to visualize the extent of the tumor. In synopsis with diffusion-weighted and T2-weighted sequences, adifferentiation between vital tumor tissue and tumor necrosis is additionally possible. This also enables targeted sampling from vital tumor parts so that the patient can be assigned to the appropriate treatment concept as quickly as possible.

Deep learning ensemble approach with explainable AI for lung and colon cancer classification using advanced hyperparameter tuning

Lung and colon cancers are leading contributors to cancer-related fatalities globally, distinguished by unique histopathological traits discernible through medical imaging. Effective classification of these cancers is critical for accurate diagnosis and treatment. This study addresses critical challenges in the diagnostic imaging of lung and colon cancers, which are among the leading causes of cancer-related deaths worldwide. Recognizing the limitations of existing diagnostic methods, which often suffer from overfitting and poor generalizability, our research introduces a novel deep learning framework that synergistically combines the Xception and MobileNet architectures. This innovative ensemble model aims to enhance feature extraction, improve model robustness, and reduce overfitting.Our methodology involves training the hybrid model on a comprehensive dataset of histopathological images, followed by validation against a balanced test set. The results demonstrate an impressive classification accuracy of 99.44%, with perfect precision and recall in identifying certain cancerous and non-cancerous tissues, marking a significant improvement over traditional approach.The practical implications of these findings are profound. By integrating Gradient-weighted Class Activation Mapping (Grad-CAM), the model offers enhanced interpretability, allowing clinicians to visualize the diagnostic reasoning process. This transparency is vital for clinical acceptance and enables more personalized, accurate treatment planning. Our study not only pushes the boundaries of medical imaging technology but also sets the stage for future research aimed at expanding these techniques to other types of cancer diagnostics.

The Translational Medicine of 2030: Bedside to Biosphere.

For over two decades, translational medicine has accelerated basic science discovery into clinical application using a bench-to-bedside framework. Given that climate change represents the single greatest health threat facing humanity, the authors propose extending this framework to now include bedside to the biosphere. Several potential opportunities in clinical operations, research, and advocacy using this framework are provided. In addition, we propose that technology assessment studies of diagnostic imaging measure planetary outcomes alongside patient outcomes.

Osteochondritis Dissecans of the Knee: A Case Report

Osteochondritis dissecans (OCD) is a focal, idiopathic alteration of subchondral bone with the potential for instability and disruption of adjacent articular cartilage causing pain or discomfort in the knee and, if left untreated, may cause increasing disability and progressive arthritic change of the joint. This article presents a case study of a 16-year-old female who presented with intermittent right lateral knee pain for several years with no acute traumatic injury. Diagnostic imaging demonstrated subchondral changes of the lateral femoral condyle consistent with osteochondritis dissecans. The patient was diagnosed with an unstable OCD of the right knee and underwent surgical treatment. Following treatment, the patient attended formal physical therapy two times per week and began a gradual return to sport protocol at 4 months post-operatively. This case study will demonstrate the complexities surrounding the clinical presentation, diagnostic workup, and treatment options for this challenging diagnosis. The importance of accurate imaging and aggressive treatment of unstable OCD lesions will be highlighted.

Primary extraskeletal osteosarcomas of the pleura: A clinicopathological, immunohistochemical, and molecular analysis of 4 cases

Four primary extraskeletal osteosarcomas of the pleura are presented. The patients were men between the ages of 63 and 78 years (average: 70.5 years) who presented with symptoms of chest pain, cough, and shortness of breath. Diagnostic imaging showed variably calcified, pleural-based masses and/or diffuse pleural thickening, clinically mimicking mesothelioma. Thoracoscopic surgical material was obtained for histopathological diagnosis. Histological findings showed the presence of a neoplastic spindle cell proliferation composed of fusiform cells with scant cytoplasm, elongated nuclei and inconspicuous nucleoli. Mitotic activity was easily identified. Additionally, all tumors showed extensive osseous differentiation in the form of osteoid matrix production; one tumor demonstrated additional chondrosarcomatous elements and another showed focal myxoid changes. Immunohistochemical analysis revealed that the tumor cells were uniformly negative for a wide variety of antibodies, including keratin AE1/AE3, keratin 5/6, D2-40, EMA, calretinin, WT-1, BerEP4, and HEG1; BAP1 was retained in all cases. In addition, fluorescence in situ hybridization for CDKN2A (p16) was negative for homozygous deletion in all tumors. Clinical follow-up showed that one patient had died 8 months after diagnosis and one had remained alive with short post-diagnostic follow-up. The tumors herein described highlight a challenging issue in the separation of mesothelioma with heterologous elements from true osteosarcomas of pleural origin. We propose that a diagnosis of extraskeletal osteosarcoma of the pleura is rendered for tumors with malignant osseous and/or cartilaginous differentiation in which comprehensive immunohistochemical studies and FISH analysis have failed to provide support for a diagnosis of mesothelioma with heterologous elements.

Pattern of venous thromboembolism in childhood idiopathic nephrotic syndrome

ABSTRACT Introduction Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. Thromboembolic (TE) events are among the most serious complications of NS in children, with a reported prevalence of 1.8–5%. Venous thromboembolism (VTE) is the predominant type. Most cases of TE are clinically symptomatic, but some may be subclinical, thus, their true incidence may be underestimated. Studies on TE in childhood onset NS are few and varied, this prompted us to conduct the present study. Objective To study the pattern of thromboembolism in childhood INS. Patients and Methods This descriptive retrospective study included 225 pediatric patients with idiopathic NS (11 with TE events and 214 with no TE events) regularly following up in Alexandria University Children’s Hospital, Egypt from 2013 to 2023. Diagnosis of thromboembolism was based on clinical diagnosis and appropriate diagnostic imaging. Results The frequency of TE among our cohort was 4.9%.The median age of onset of the first TE event was 5.5 years. Most of the TE events (63.6%) occurred during the 1st 6 months of NS diagnosis. The total number of TE events was 15 events, and the most common site was cerebral sino-venous thrombosis (CSVT). The triglyceride levels were significantly higher in the TE event group. The median urinary protein/creatinine ratio was slightly higher in the TE event group. In the TE event group, 4 patients (36.4%) were steroid-resistant and only one of the 11 patients died. Conclusion In conclusion, TE events are not uncommon among INS children and most of the events occurred early during the disease. There was no significant relationship between the degree of proteinuria, serum albumin level, and the occurrence of TE events, while the level of triglycerides was significantly higher in patients who developed TE events.

Chronic osteoarthritis caused by Propionibacterium australiense infection in a captive sand gazelle.

Osteoarthritis is a common cause of morbidity and mortality in geriatric gazelles. Propionibacterium australiense has been reported as a cause of systemic granulomas in cattle, but there are no descriptions of this bacteria infecting other species nor causing osteoarthritis, to our knowledge. An 8-y-old, castrated male, sand gazelle (Gazella leptoceros leptoceros) was managed for chronic, intermittent, progressive osteoarthritis of the right tarsus. Serial biopsies revealed pyogranulomatous dermatitis with intralesional bacteria. Serial diagnostic imaging identified osseous and soft tissue proliferation with draining tracts. Treatments over 1 y included broad-spectrum antibiotics, anti-inflammatories, joint debridement, and infusion with platelet-rich plasma and stem cells. Despite therapy, lameness persisted, azotemia developed, and subsequently, the animal was euthanized. On postmortem examination, the periarticular tissue of the right tarsus was markedly expanded by pyogranulomas and fibrosis. Histologically, the synovium, joint capsule, and overlying soft tissues were markedly expanded by pyogranulomas and numerous gram-positive and acid-fast-negative filamentous bacteria surrounded by Splendore-Hoeppli material. Within the joint, there was regionally extensive cartilage ulceration, osteonecrosis, osteolysis, and pannus formation. PCR assay of affected formalin-fixed, paraffin-embedded tissue amplified segments of 16S rRNA and β subunit of bacterial RNA polymerase (rpoB) genes with 99.7% and 95.6% identity to P. australiense. This bacterium should be considered a differential for chronic pyogranulomatous osteoarthritis in gazelles.