Types Of Lesions Research Articles

Hybrid operating room for the multidisciplinary treatment of a juvenile nasoangiofibroma at the “Dr. Eduardo Liceaga” general hospital of Mexico: case report and literature review

Nasoangiofibroma or juvenile nasopharyngeal angiofibroma is a highly vascularized benign neoplasm, which mainly affects men between the first and second decade of life. The incidence of this type of lesion is extremely rare and occurs in a 0.05 to 0.5% of all head and neck neoplasm, in which surgical treatment is considered the best treatment option. Treatment of this pathology in a hybrid operating room is considered a novel tool, to carry out an effective multidisciplinary intervention, granting better control of the procedure and hemostasis. The purpose of this publication is to describe the advantages of performing surgery in a hybrid operating room, as well as to conduct a literature review on this condition. Two cases are reported, a 14 and 16-years old male, both with a probable diagnosis of juvenile nasoangiofibroma. The surgical treatment was carried out in the hybrid operating room of the General Hospital of Mexico “Dr. Eduardo Liceaga” by the otorhinolaryngology and the oral and maxillofacial surgery department after embolization by the interventional radiology team.

Investigation of the abasic sites induced by hydrogen peroxide and methyl methanesulfonate in calf thymus DNA and BEAS-2B cells

The primary goals of this study were to investigate the formation of abasic sites (AP sites) induced by methyl methanesulfonate (MMS) and hydrogen peroxide (H2O2), and to characterize specific types of these pro-mutagenic DNA lesions in calf thymus DNA (CT-DNA), and BEAS-2B human lung normal cell line. Furthermore, these profiles were compared with those observed in leukocytes derived from healthy controls (HC), breast cancer patients (BCP) before treatment, and 5-year survivors. Results indicated that both H2O2 and MMS induced the concentration- and time-dependent formation of AP sites in CT-DNA. To characterize the specific types of AP sites induced by H2O2 or MMS, we performed AP site cleavage assay using putrescine, T7 exonuclease (T7 Exo), and exonuclease III (Exo III). Results showed that the AP sites induced by H2O2 in CT-DNA were predominantly 5’-and 3’-nicked AP sites and no intact AP sites were detected. By contrast, the majority of AP sites generated by MMS in CT-DNA are not excisable and are classified as residual and intact AP sites. Similar approaches were performed in human BEAS-2B cells and comparable observations were confirmed in the cell-based model. Further investigation indicated that the profile of the AP sites observed in Taiwanese HC is identical to that of BEAS-2B cells treated with H2O2 whereas the pattern of AP sites detected in BCP is similar to that of CT-DNA exposed to H2O2, suggesting that these AP sites were produced primarily through reactive oxygen species (ROS) generation. More than 70 % of the AP sites in leukocytes derived from BCP were 5’-nicked and residual AP sites. Furthermore, the characteristics of the AP sites detected in 5-year survivors are comparable with the ones in HC by using putrescine cleavage assay. Overall, we speculate that deficiency in the DNA repair cascade may play a role in mediating the formation of specific types of AP sites detected in BCP.

Ischemic Stroke in Adults With Congenital Heart Disease: Cumulative Incidence and Associated Factors.

When more patients with congenital heart disease reach adult age, increased incidence of long-term complications, including ischemic stroke, are expected. The aim of this study was to analyze cumulative incidence of ischemic stroke, associated factors, and case fatality in adult congenital heart disease. The study is based on Swedish national registers on congenital heart disease and stroke. Patients with congenital heart disease were followed between 2001 and 2018 for first-ever ischemic stroke events (ischemic stroke due to patent foramen ovale excluded). Factors possibly associated with ischemic stroke were analyzed using Cox regression models. Out of 8914 adult patients with congenital heart disease, 108 suffered ischemic stroke over a mean period of 7.6±4.7 years. The mean age at ischemic stroke was 53.8 years, and the cumulative incidence was 0.15% at 1 year, 0.5% at 5 years, and 1.5% at 10 years. In multivariable analysis, age (hazard ratio [HR], 1.04 [95% CI, 1.03-1.06]), diabetes (HR, 2.9 [95% CI, 1.3-6.4]), ejection fraction <50% (HR, 1.9 [95% CI, 1.1-3.4]), atrial septal defect (HR, 3.0 [95% CI, 1.03-8.5]), and aortic valve lesions (HR, 4.8 [95% CI, 1.6-14.1]) were associated with increased risk. Among those with ischemic stroke, approximately half were on antithrombotic treatment (anticoagulants or antiplatelets) before admission. Case fatality was 6.5%. The cumulative incidence of ischemic stroke was 1.5% after 10 years. In adult congenital heart disease, the type of heart lesion, diabetes, ejection fraction <50%, and age were important factors associated with ischemic stroke. Despite a relatively young age, mortality is a significant threat. At time of the ischemic stroke event, approximately half of the patients were on antithrombotic treatment.

First report of Rhizoctonia blight caused by Rhizoctonia solani on Chinese cabbage (Brassica rapa subsp. chinensis) in India.

During January and February 2021, foliar blight symptoms were observed on the leaves of Chinese cabbage (Pak choi) at Lembucherra research farm, College of Agriculture, Tripura, India. The incidence of disease symptoms ranged from 5 to 10% of the plants observed in the field. The symptomatic leaves showed grayish colored water-soaked lesions with an irreguar shape and size. A total of 10 symptomatic leaves (1 leaf per plant) from Chinese cabbage infected plant were sampled, surface decontaminated with 1% NaOCl, washed twice in sterile water, plated on 2% water agar, and incubated at 25 ± 2°C. Hyphal tips from mycelium of 7-day old culture (2 isolates from two different plants) with right-angled branching were transferred to potato dextrose agar (PDA) media (SRL, India). Cream or light brown hyphae that branched at right angles, with septa near the point of the origin of hyphae, and a slight constriction at the base of the branch) were visible under a microscope. Olive-brown sclerotia were observed after 5 days of incubation. Multiple nuclei per cell were visible after staining with 4', 6-diamidino-2-phenylindole (Estandarte et al. 2016). Based on morphological characteristics (Parmeter et al. 1970) the isolates TP36 and TP37 were identified as Rhizoctonia solani. The internal transcribed spacer (ITS) region and glyceraldehyde-3-phosphate dehydrogenase gene (GAPDH) were amplified with ITS1& ITS4 (White et al. 1990) and (GAPDH F-5'- CAAGGAGAACCCAGGTGTTAAG-3' and GAPDH R- 5'-GGCGTCGAAGATAGAAGAGTGT-3') respectively for both isolates and sequenced (accession #. PP458158, PP458159, PP425343, PP425344). BLASTn analysis showed 99.26%( 668/673 nt) to 99.46% (659/664 nt) identity with R. solani sequences (GenBank MG397062.1 and KX674524.1) for ITS and 98.42% (552/562 nt) to 100% 540/540 nt)identity with R. solani sequences (GenBank HQ425709.1 and CP102644.1) for GAPDH. Isolates TP36 and TP37 were deposited in the Indian Type Culture Collection (ITCC), New Delhi as R. solani (nos. 9154 and 9319, respectively). Both isolates were amplified using (anastomosis group) AG1 subgroup specific primers (Matsumoto 2002; Prashantha et al. 2021) to identify their AG. The presence of a 265 bp amplicon for both isolates suggested that they belong to AG1-IA. A multilocus analysis of R. solani isolates from different host plants with concatenated sequences ITS and GAPH showed that TP36 and TP37 are closely related to rice isolate RS107. A pathogenicity test on five plants per treatment was conducted and repeated twice on one month old Chinese cabbage plants (hybrid, TOKITA, India) grown under glasshouse conditions in a sterilized mixture of soil and sand (3:1) at 27-28oC during January 2024 at ICAR-IARI, New Delhi. R. solani isolates TP36 and TP37 were grown on PDA and plants were inoculated by placing single sclerotia of 10-day old colony on different plant parts and covering it with moist cotton. After 7 day, typical lesions of R. solani infection were visible. No symptoms were observed on the control plants. The fungus was reisolated from the inoculated plants and identified as R. solani based on morphology. R. solani has previously been reported to cause disease on some members of Brassicaceae in different countries (Budge et al. 2009; Hua et al. 2014). Based on literature available this is the first report of R. solani infecting Chinese cabbage in India.

Prevalence of Radiolucent and Radiopaque Jawbone Lesions Using Panoramic Radiographic Analysis in Hail, Saudi Arabia: A Retrospective, Cross-Sectional, Observational Study.

Background Oral diseases are among the most prevalent public health issues worldwide, underscoring the importance of early diagnosis and effective prevention programs. Determining the prevalence of jawbone lesions is crucial for developing targeted interventions and ensuring timely treatment. Panoramic radiography, also known as orthopantomogram, has become a cornerstone in radiographic examinations, offering a comprehensive view of the dental and maxillofacial regions. Its accessibility and ability to detect a wide range of pathologies make it an invaluable diagnostic tool. This study aimed to assess the prevalence and distribution of radiolucent and radiopaque jawbone lesions in the population of Hail, Saudi Arabia, using panoramic radiographic analysis. Methodology A retrospective, cross-sectional study was conducted using pre-existing panoramic radiographs of individuals aged 18 years and older in Hail, Saudi Arabia. The radiographs were analyzed for the presence of jawbone lesions, classified as radiolucent, radiopaque, or mixed, and their anatomical distribution was recorded. Statistical analysis was performed using the chi-square test, with a significance level set at p-values <0.05. Results A total of 389 jawbone lesions were identified in 177 subjects, representing a prevalence of 45.5%. Radiolucent lesions were the most common, observed in 153 (39.3%) subjects, while radiopaque lesions were found in 18 (4.6%) subjects, and mixed lesions in six (1.5%) subjects. The mandible was more frequently affected than the maxilla, with 104 (59%) lesions occurring in the mandible and 52 (29%) lesions in the maxilla. The posterior region of the jaw was the most commonly involved site, accounting for 124 (31.9%) cases. Gender and age did not significantly influence the prevalence or type of lesions, although a higher incidence was noted in the 31-45-year age group. Conclusions This study revealed a significant prevalence of jawbone lesions in the Hail population, with radiolucent lesions being the most common type, predominantly affecting theposterior region of the mandible. The findings highlight the importance of early detection and targeted dental health initiatives in this region. Further research, particularly longitudinal studies, is recommended to explore the natural history of these lesions and their impact on oral health over time.

Early Disease-Modifying Treatments for Presymptomatic Multiple Sclerosis.

Radiologically isolated syndrome (RIS) is the earliest stage in the disease continuum of multiple sclerosis (MS). RIS is discovered incidentally in individuals who are asymptomatic but have typical lesions in the brain and/or spinal cord suggestive of demyelination. The2009 and revised 2023 RIS criteria weredeveloped for diagnosis.Presymptomatic individuals who fulfill the 2009 RIS criteria by having 3-4 of 4 dissemination in spaceMcDonald 2005 MS criteria are still diagnosed with RIS using therevised 2023 RIS criteria.Inpresymptomatic individuals who do not fulfill the 2009 RIS criteria, the revised 2023 RIS criteria target to secure an accurate and timely diagnosis: In addition to (a) having one lesion in two of four locations (periventricular, juxtacortical/cortical, infratentorial, spinal cord), (b) two of three features (spinal cord lesion, cerebrospinal fluid (CSF)-restricted oligoclonal bands, and new T2 or gadolinium-enhancing lesion) should be fulfilled. Among laboratory biomarkers,CSF kappa-free light chain can also increase diagnostic accuracy. Once the diagnosis is confirmed, the established risk factors, including demographics, imaging, and laboratory biomarkers, should be evaluated for symptomatic MS transition and prognosis. Younger age, male sex, increased neurofilament-light chain, CSF abnormality, and the presence of infratentorial, spinal cord, or gadolinium-enhancing lesions on imaging are the main risk factors for transition to symptomatic MS. Two randomized clinical trials showed significant efficacy of disease-modifying treatments in delaying or preventing the development of the first clinical event in RIS. However, because some individuals remain as RIS, it is crucial to identify the individuals with a higher number of risk factors to optimize disease outcomes by early intervention while minimizing adverse events. Discussing each RIS case with an expert MS team is recommended because there is still a lack of clinical guidelines to improve care, counseling, and surveillance.

Correlation of Endoscopic and Histopathological Diagnoses in Upper Gastrointestinal Tract Lesions: A Cross-Sectional Study.

Introduction Gastrointestinal tract (GIT) endoscopy with biopsy is essential for diagnosing and managing various GIT diseases, including malignancies and inflammatory conditions. This study aimed to analyze the spectrum of histopathological lesions in the GIT and their correlation with the endoscopic findings. Methodology This retrospective observational study was conducted at a tertiary medical college involving 114 patients who underwent GIT endoscopy between June 2023 and June 2024. This study focused on lesion types across different GIT sites (esophagus, stomach, and duodenum) and the agreement between endoscopic and histological diagnoses. Results Lesions were most prevalent in the stomach (52.6% of cases, n=60), followed by the duodenum (35.1%, n=40) and esophagus (12.3%, n=14). Significant correlations were found between endoscopic and histological diagnoses in the esophagus (concordance for esophagitis was 100%) and stomach (concordance for gastritis was 95%). In the duodenum, the concordance was high for duodenitis (100%) but lower for other lesions such as neuroendocrine tumors (71.43%). However, Cohen's kappa values indicated poor overall agreement across all sites (κ=0.49), reflecting variability in diagnostic accuracy. Conclusion This study highlights the reliability of endoscopic procedures for diagnosing upper GIT lesions, particularly in the esophagus and stomach, while emphasizing the challenges in diagnosing duodenal lesions. These findings support the need for targeted screening and further research to enhance diagnostic accuracy and patient outcomes in GIT diseases.

Mucopolysaccharidosis Type I (Hurler – Scheie Syndrome): Case Report

Background. Mucopolysaccharidosis type I (MPS I) is an inherited disease caused by pathogenic variants in the IDUA gene, which encodes the lysosomal enzyme alpha-L-iduronidase. This clinical case demonstrates the importance of diagnosing rare diseases when patients have phenotypic features indicating hereditary pathology presence. Phenotype changes can be so-called “red flag” that helps specialists suspect and diagnose lysosomal storage diseases. Clinical case description. The patient was observed with delayed psychomotor development; she also had hepatomegaly and on auscultation of the heart there was a functional systolic murmur above the apex and in the Botkin–Erb point on heart auscultation. Coarse “garholoid” facial features attracted attention at external examination: large nose, wide sunken nose bridge, macroglossia, thick lips, synophrysis, scaphocephaly, wide chest, and flat-valgus feet. Echocardiography has revealed mitral valve insufficiency and hardened valve leaflets. Ophthalmologist examination: hypermetropic astigmatism. Psychiatrist examination: mental and speech development delay. Enzymatic diagnostics: significant decrease in alpha-Liduronidase activity. No further examinations were carried out due to the onset of the COVID-19 epidemic and parents' doubts about the diagnosis. The patient was readmitted to the hospital at the age of 6 years due to aggravation of her condition. A molecular genetic study has revealed two pathogenic variants in the IDUA gene. Diagnosis of MPS I was established according to the clinical data, results of biochemical and molecular genetic studies. Conclusion. This clinical case demonstrates the classic course of MPS I with typical phenotypic signs and lesions in various organs and systems. The presented case demonstrates the importance of professional vigilance among doctors of various specialties regarding orphan diseases.

Clinical characteristics of pyoderma gangrenosum: Case series and literature review.

Pyoderma gangrenosum (PG) is a neutrophilic skin disease characterized by recurrent painful cutaneous ulcers, often accompanied by inflammatory bowel disease, joint pain, and other systemic damage. This disease is relatively rare in clinical practice and its diagnosis and treatment are often delayed, leading to secondary infections in the skin lesions, prolonged disease course, and increased disease burden on patients. This study retrospectively analyzed the clinical characteristics and treatment strategies of patients with PG admitted to our hospital and conducted a literature review, in order to improve the understanding of the disease among clinical doctors, enable patients to receive better diagnosis and treatment, and ultimately improve patient prognosis. Clinical data of patients diagnosed with PG and hospitalized in Beijing Chaoyang Hospital, Capital Medical University from January 2014 to December 2022 were retrospectively collected. The clinical manifestations, treatment strategies, efficacy, and disease outcomes were analyzed. A total of 14 patients, including 8 males and 6 females, aged 14 to 66 years, were included. Skin lesion types: 13 cases were ulcer-type, 1 case was pustule combined with ulcer-type, and the lower limbs were the most commonly affected areas. All the 14 patients presented with comorbidities. All patients were treated with glucocorticoids, with a daily dose equivalent to 20 to 100 mg prednisone and a median dose of 40 mg. Among them, 3 patients were treated with minocycline in combination, 1 patient was treated with mycophenolate mofetil 0.5 twice daily in combination, 1 patient was treated with cyclophosphamide 0.1 once daily in combination, and 1 patient was treated with thalidomide 0.1 every night in combination. PG is a relatively rare immune-related skin disease. Our small sample data analysis found that male PG is not uncommon in the Chinese population. Systemic glucocorticoids can quickly control the symptoms of PG in most patients with PG. In patients with poor efficacy or limited use of glucocorticoids, immunosuppressive drugs or novel targeted drugs such as biologics or small-molecule drugs should be used in combination as early as possible. Skin lesion care focuses on preventing infection, avoiding surgical debridement, and emphasizing pain management and the symptomatic treatment of comorbidities.

Perceptions, attitudes, and clinical experiences of Brazilian dental practitioners towards molar incisor hypomineralisation: a cross-sectional study.

To evaluate perceptions, attitudes, and clinical experience of Brazilian dental practitioners regarding molar incisor hypomineralisation (MIH). An online survey with 27 questions, covering professional profile data, perceptions, and knowledge on clinical management of MIH, was employed. Descriptive analyses, chi-square, Fisher's exact, and Cramer's V tests were used. Sample comprised 100 participants, equally distributed between those working in private or public sectors. Most private sector practitioners had 21-30years of clinical experience (28%) and master's degree (50%), while most public sector practitioners had 11-20years of clinical experience (32%) and a PhD degree (32%). Most participants (86%) recognized MIH in their practice. Statistically significant differences were observed in frequency (p = 0.001), incidence (p = 0.039), and lesion type (p = 0.043) between practitioners from both sectors. Uncertainly in management was reported by 49%, mainly in public sector. For mild MIH in incisors, no treatment was chosen (43%), and the treatment longevity was the only significant factor reported (p = 0.012). In cases of mild MIH in first permanent molars (FPMs), 51% of respondents opted to keep the affected tissue and apply fissure sealant. Glass ionomer (GI) restoration was commonly indicated for FPMs with severe MIH with moderate loss of structure and sensitivity (38%). In cases with substantial structural loss and pulpal involvement, the most chosen treatment was endodontic intervention combined with preformed crowns. Brazilian dental practitioners face MIH in clinical practice. Although, public sector professionals are less confident in diagnosis and treatment, no significant differences in treatment preferences between public and private sector dental practitioners were identified.

Diabetic Retinopathy Lesion Types and Distribution on Ultrawide Field Imaging and the Risk of Disease Worsening Over Time.

To evaluate the effect of diabetic retinopathy (DR) lesion type [hemorrhages and/or microaneurysms (H/Ma), intraretinal microvascular abnormalities (IRMA), new vessels elsewhere (NVE), venous beading], severity and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study (ETDRS)-Diabetic Retinopathy Severity Scale (DRSS). Post-hoc analysis of a multi-center observational study of 544 eyes with nonproliferative DR and an ETDRS-DRSS score of Level 35-53. Disease worsening was defined as ETDRS-DRSS worsening by ≥2 steps from baseline or receipt of DR treatment over 4 years. DR lesions were evaluated based on the entire visible area in the ultrawide field color (UWF-color) and UWF-fluorescein angiography (UWF-FA) images. A significantly greater risk of disease worsening was associated with the presence of more severe lesion grades outside the ETDRS fields for H/Ma (HR:1.74 [95% CI:1.28-2.36]) on UWF-color; and for H/Ma (1.90 [1.38-2.61]), IRMA (1.68 [1.13-2.49]), and NVE (1.99 [1.36-2.93]) on UWF-FA. These results suggest that features on UWF-color and UWF-FA may provide additional prognostic value in determining the risk of disease worsening. The use of UWF-FA improves identification of DR lesions and disease progression. However, the optimal method of disease risk assessment on UWF imaging still needs to be determined.

High-Risk HPV Detection in Paraffin-Embedded Tissue from Cervical Lesions.

Human papillomavirus (HPV), a leading cause of cervical cancer, is present in most cases of the disease and ranks as the fourth most common cancer in women globally. Among the HPV types, fourteen (HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68) are recognized as high-risk (hrHPV), each with varying levels of oncogenic potential. Detecting and genotyping these hrHPV types in cervical lesions is crucial, requiring the development of new diagnostic methods. This study focuses on a retrospective analysis conducted on 44 women from the Cova da Beira Local Health Unit. We used the Anyplex™ II hrHPV Detection kit for hrHPV genotyping from paraffin-embedded cervical tissue samples. hrHPV types were identified in 38 out of the 44 women. Genotyping revealed HPV-16 (55.3%), HPV-18/39/56/58/59 (5.3%), HPV-31 (21.1%), HPV-35 (7.9%), HPV-51/66 (2.6%), and HPV-52 (10.5%). This study demonstrates that the Anyplex™ II hrHPV Detection kit, originally designed for cervical cancer screening, is also effective for hrHPV genotyping in histological analyses. This methodology offers a simpler and more cost-effective approach for cervical cancer risk stratification. Its implementation in clinical practice could enhance the detection of hrHPV in cervical lesions, thereby contributing to more precise diagnoses and potentially more informed treatment strategies.

Opticopathies in the differential diagnosis of retinal diseases - part 2

Due to the close anatomical, functional and trophic relationships between the optic nerve and retina, a wide variety of diseases affecting both structures have reciprocal effects on each other, which must be considered in the differential diagnosis to avoid misdiagnosis. Therefore, it is essential to assess pathological changes in both structures in context to differentiate the type and location of the primary lesion from its consequences, as well as to correctly classify coincidences and disease-specific lesion patterns in both organ components.This article highlights the typical symptom constellations and lesion patterns of optic neuropathies and retinopathies. An attempt is made to identify the reciprocal characteristic relationships of the respective lesions in both structures in various disease groups, as well as to present their respective roles in the differential diagnosis.In this second part, acquired optic neuropathies in the context of vascular and systemic diseases and possible accompanying retinal findings, as well as symptom constellations and courses, are differentiated, discussing arteritic and non-arteritic (anterior) optic neuropathies, their causes and differential diagnosis. The combined involvement of the optic nerve and retina in the context of posterior infectious and non-infectious uveitis is also shown. Finally, various dysgenetic optic neuropathies, their differentiation and possible retinal sequelae are presented.It is demonstrated and exemplified how important it is in general, but also specifically in regard to the disease groups discussed in this article, to have a careful and targeted diagnostic approach in each case, considering both the retinal and optic nerve findings, in order to avoid misdiagnosis.

Opticopathies in the differential diagnosis of retinal diseases - part 1

Due to the close anatomical, functional and trophic relationships between the optic nerve and retina, a wide variety of diseases affecting both structures have reciprocal effects on each other, which must be considered in the differential diagnosis to avoid misdiagnosis. Therefore, it is essential to assess pathological changes in both structures in context to differentiate the type and location of the primary lesion from its consequences, as well as to correctly classify coincidences and disease-specific lesion patterns in both organ components.This article highlights the typical symptom constellations and lesion patterns of optic neuropathies and retinopathies. An attempt is made to identify the reciprocal characteristic relationships of the respective lesions in both structures in various disease groups, as well as to present their respective roles in the differential diagnosis.In the first part of the article, typical optic neuropathies in the context of various syndromic and non-syndromic retinal dystrophies are initially examined. Subsequently, the relationships between different hereditary and acquired mitochondriopathic optic neuropathies and possible accompanying retinal changes are analysed, and their pathogenesis and relevant differential diagnoses are discussed.It is demonstrated and exemplified how important it is in general, but also specifically in regard to the disease groups discussed in this article, to have a careful and targeted diagnostic approach in each case, considering both the retinal and optic nerve findings, in order to avoid misdiagnosis.

Understanding the Malignancy Potential of Cutaneous/Subcutaneous Lesions: Insight from 9,202 Day-Surgery Procedures

Abstract Objectives: Cutaneous and subcutaneous lesions often go unnoticed or disregarded, yet they can harbor malignant potential. These seemingly innocuous bumps and lumps vary in size and nature, necessitating thorough evaluation by health care professionals. In this study encompassing 9,202 day-surgery procedures, we sought to elucidate the malignancy risk associated with cutaneous/subcutaneous lesions. Materials and Methods: Conducted as a descriptive case-control investigation, our study enrolled patients undergoing excision for such lesions from 2009 to 2018. Patients were stratified into study (malignancy confirmed by histopathology) and control groups. Comprehensive data collection included demographic profiles, pathology reports, surgical details, and follow-up outcomes. Results: Analysis of 9,202 excision procedures involving 8,962 patients revealed epidermal/tricholemmal cyst as the most prevalent lesion type (34.5%), followed by lipomas (21.8%). Malignancies were identified in 1.1% of cases, predominantly affecting older individuals (mean age: 60.3 ± 16.2 years). While malignancy incidence correlated with advancing age, no significant gender disparity was observed (p &lt; 0.001 and p = 0.353, respectively). Conclusion: Our findings underscore the imperative of vigilance toward cutaneous and subcutaneous lesions, as they may harbor malignancy. Timely assessment by health care providers is paramount to promptly identify and manage potentially malignant lesions. With malignancy detected in over 1% of cases, our study emphasizes the necessity for meticulous evaluation and appropriate intervention strategies to mitigate associated risks effectively.

Variation in Craniodental Pathologies Among Cercopithecoid Primates.

Pathologies of the skull and teeth are well documented for many human populations, but there are fewer studies of other primates. We contrast lesion prevalence and patterning among cercopithecoid primates and map variation onto socioecological variables. We compare craniodental lesions in six species: Nasalis larvatus (n = 54), Colobus polykomos (n = 64), Cercopithecus mitis (n = 65), Macaca fascicularis (n = 109), Theropithecus gelada (n = 13), and Papio anubis (n = 76). One of us (C.A.K.) evaluated each adult skull for multiple lesion types using standard criteria. We also tested for a relationship between lesion prevalence and cranial suture fusion (age proxy). We used nonparametric tests for sex and species differences as well as pathology co-occurrence in SPSS. Socioecological data come from previous studies. Sex differences in lesion prevalence were only detected in P. anubis. Within taxa, some lesion types co-occurred. In Macaca, the presence of caries was associated with several other lesion types. Pulp cavity exposure co-occurred with TMJ osteoarthritis in multiple taxa. Among taxa, male P. anubis had higher lesion prevalences, particularly related to the anterior dentition and facial trauma. Because we did not detect a relationship between suture fusion and lesion prevalence, we propose that craniodental lesions may also be influenced by socioecological variables such as group composition and ratio of fruit to leaves in the diet. Our findings suggest that pain from pulp cavity exposure and related dental infections may alter chewing biomechanics and contribute to onset of TMJ osteoarthritis in nonhuman primates, as seen in humans. Further, we suggest that higher lesion prevalence in male baboons is likely related to male-male competition. Skeletal lesion analysis provides useful insight into primate socioecology, particularly for rare or difficult-to-observe phenomena, and provides additional biological context for our own species.

Clinical outcomes and coronary artery lesion characteristics of young patients with ST elevation myocardial infarction and no standard modifiable risk factors.

Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear. Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used. Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24-4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06-6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001). Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.

Endoscopic submucosal dissection and endoscopic mucosal resection for Barrett’s-associated neoplasia: a systematic review and meta-analysis of the published literature

Abstract Background The role of endoscopic submucosal dissection (ESD) in the treatment of Barrett esophagus-associated neoplasia (BEN) has been evolving. We examined the efficacy and safety of ESD and endoscopic mucosal resection (EMR) for BEN. Methods A database search was performed for studies reporting efficacy and safety outcomes of ESD and EMR for BEN. Pooled proportional and comparative meta-analyses were performed. Results 47 studies (23 ESD, 19 EMR, 5 comparative) were included. The mean lesion sizes for ESD and EMR were 22.5 mm and 15.8 mm, respectively; most lesions were Paris type IIa. For ESD, pooled analysis showed rates of en bloc, R0, and curative resection, and local recurrence of 98%, 78%, 65%, and 2%, respectively. Complete eradication of dysplasia and intestinal metaplasia were achieved in 94% and 59% of cases, respectively. Pooled rates of perforation, intraprocedural bleeding, delayed bleeding, and stricture were 1%, 1%, 2%, and 10%, respectively. For EMR, pooled analysis showed rates of en bloc, R0, and curative resection, and local recurrence of 37%, 67%, 62%, and 6%, respectively. Complete eradication of dysplasia and intestinal metaplasia were achieved in 94% and 75% of cases. Pooled rates of perforation, intraprocedural bleeding, delayed bleeding, and stricture were 0.1%, 1%, 0.4%, and 8%, respectively. The mean procedure times for ESD and EMR were 113 and 22 minutes, respectively. Comparative analysis showed higher en bloc and R0 resection rates with ESD compared with EMR, with comparable adverse events. Conclusion ESD and EMR can both be employed to treat BEN depending on lesion type and size, and center expertise.

Solitary medial proximal tibial osteochondromas cause pes anserinus syndrome in adolescents.

Osteochondromas are common bone tumors with hyaline cartilage-covered heads, arising from cortical and medullary bone. Solitary medial proximal tibial osteochondromas (MPTOs) can cause pes anserinus syndrome via compression. However, the literature lacks comprehensive studies on MPTO-related pes anserinus syndrome and its surgical outcomes. The study reviewed 227 patients diagnosed with osteochondroma between January 2018 and January 2022, with 21 patients meeting inclusion criteria: under 19 years, MPTO, surgical excision, histological diagnosis, ≥1-year follow-up. Cases with irregular follow-ups and multiple hereditary exostoses were excluded. Different surgical techniques were employed based on lesion characteristics. Postoperative weight bearing was allowed, and follow-ups involved postoperative complications assessment, clinical data collection, imaging, and functional evaluations using the International Knee Documentation Committee (IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale scoring systems. The study involved 21 adolescents (15 ± 2 years). Lesion types were predominantly pedunculated (86%) and surgical interventions involved pes anserinus split (76%) or tenoplasty (24%). No significant correlations were observed between lesion dimensions and IKDC scores. Split intervention led to a significant improvement in IKDC scores (p < 0.01), while tenoplasty showed similar results (p < 0.05). Athlete status did not affect IKDC scores significantly, but both athletes and non-athletes demonstrated improvements (p < 0.05). The negative impact of MPTOs causing pes anserinus tendinitis on the patient's quality of life and activity can be completely corrected with surgical treatment. Complete pes anserinus tendon cutting and subsequent repair are recommended if they facilitate surgery. The study underscores the importance of surgical management for MPTO-related pes anserinus syndrome and provides insights into the effectiveness of different surgical techniques.

Interobserver agreement on line-field confocal optical coherence tomography image markers in keratinocyte carcinomas and precursor lesions

Line-field confocal optical coherence tomography (LC-OCT) is a new technology for skin cancer diagnostics. However, the interobserver agreement (IOA) of known image markers of keratinocyte carcinomas (KC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), as well as precursors, SCC in situ (CIS) and actinic keratosis (AK), remains unexplored. This study determined IOA on the presence or absence of 10 key LC-OCT image markers of KC and precursors, among evaluators new to LC-OCT with different levels of dermatologic imaging experience. Secondly, the frequency and association between reported image markers and lesion types, was determined. Six evaluators blinded to histopathologic diagnoses, assessed 75 LC-OCT images of KC (21 SCC; 21 BCC), CIS (12), and AK (21). For each image, evaluators independently reported the presence or absence of 10 predefined key image markers of KCs and precursors described in an LC-OCT literature review. Evaluators were stratified by experience-level as experienced (3) or novices (3) based on previous OCT and reflectance confocal microscopy usage. IOA was tested for all groups, using Conger’s kappa coefficient (κ). The frequency of reported image marker and their association with lesion-types, were calculated as proportions and odds ratios (OR), respectively. Overall IOA was highest for the image markers lobules (κ = 0.68, 95% confidence interval (CI) 0.57;0.78) and clefting (κ = 0.63, CI 0.52;0.74), typically seen in BCC (94%;OR 143.2 and 158.7, respectively, p < 0.001), followed by severe dysplasia (κ = 0.42, CI 0.31;0.53), observed primarily in CIS (79%;OR 7.1, p < 0.001). The remaining seven image-markers had lower IOA (κ = 0.06–0.32) and were more evenly observed across lesion types. The lowest IOA was noted for a well-defined (κ = 0.07, CI 0;0.15) and interrupted dermal-epidermal junction (DEJ) (κ = 0.06, CI -0.002;0.13). IOA was higher for all image markers among experienced evaluators versus novices. This study shows varying IOA for 10 key image markers of KC and precursors in LC-OCT images among evaluators new to the technology. IOA was highest for the assessments of lobules, clefting, and severe dysplasia while lowest for the assessment of the DEJ integrity.