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Background: The discrimination between multiple sclerosis (MS) and other white matter lesions in adults is still problematic as multiple diseases have similar clinical and radiological findings, especially at the disease onset. This case–control study aimed to evaluate the efficacy of diffusion tensor imaging (DTI) and brain morphometry in the differentiation between adult MS and its magnetic resonance imaging (MRI) mimics. Methods: Fifty-eight patients (49 women and 9 men; mean age 35.74 ± 11.86 years, range 18–50 years) with clinically suspected MS and age- and sex-matched fifteen healthy subjects were included. All study subjects underwent MRI using 3D FLAIR, 3D T1 MPRAGE, axial T2WI fast spin echo, and DTI sequences. The included patients were classified into MS and mimics groups according to MC Donald's criteria 2017. Image post-processing using the region of interest (ROI) analysis for DTI parameters and automated voxel brain morphometry and segmentation was done for all study groups. Statistical comparison between the two patient groups and between them and the control group was performed regarding DTI indices (fractional anisotropy [FA], mean diffusivity [MD], and relative anisotropy [RA]) and brain morphometry parameters (including white matter volume (WMV), grey matter volume (GMV), cerebrospinal fluid volume (CSFV), T2 lesion load and deep grey matter volume). Results: A statistically significant difference was observed between the MD, FA, and RA values of the patients and control groups. The MD values were significantly higher in the MS than in its mimics with a cut-off value of > 1.058 × 10−3 mm2/s (p < 0.001). Compared to the mimics group, the MS patients showed significantly lower WMV (33.31 ± 4.40 versus 35.71 ± 4.58; p = 0.047) and higher CSFV (16.38 ± 5.93 versus 13.06 ± 3.09; p = 0.012) with no significant difference regarding the GMV. Conclusions: MD analysis of DTI, WMV, and CSFV are useful quantitative measurements in confirming the diagnosis of MS and differentiating it from its imaging mimics. [ABSTRACT FROM AUTHOR]

Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona , commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status. [ABSTRACT FROM AUTHOR]

Kaposi sarcoma (KS) is a human herpes virus-8 (HHV8) – associated vasoformative lesion affecting the skin, mucosae, and viscera. Conventional cutaneous KS manifests with patch, plaque, or nodular lesions, with each subtype exhibiting distinctive histomorphology. Recent decades, however, have revealed a broader histological spectrum of KS in the skin. Recognition of the wide range of microscopic variants of KS and their individual mimics is essential for correct diagnosis. This is enhanced by careful clinico-pathological correlation and the utilisation of appropriate ancillary investigations. The demonstration of nuclear staining for HHV8 latency associated nuclear antigen by immunohistochemistry enables confirmation of a given KS variant. Conversely, negative immunoreactivity for HHV8 is a unifying feature among the numerous dermatoses and/or neoplasms that constitute the differential diagnosis of a given KS subtype. [ABSTRACT FROM AUTHOR]

Proximal muscle weakness in children, as well as adults, can be the presenting feature of a wide range of diseases including but not limited to the idiopathic inflammatory myopathies, muscle dystrophies, metabolic, endocrine, and drug-induced myopathies. Certain diagnostic clues such as selective muscle involvement in inherited dystrophies, cramping on exertion in metabolic myopathies, diffuse muscular pain in endocrinal myopathies, and relevant drug history along with a lack of appropriate treatment response to steroids should be considered. Awareness of other possibilities and a keen eye to identify the mimics may avoid diagnostic delays and allow timely treatment. In this review, we cover some of the salient features of the various myositis mimics and the pertinent investigation findings as well as gray areas which may confound recognition of the underlying etiology. Later, we discuss key features of certain mimics while providing an overview of the differential diagnosis and clinical management for treating clinicians. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the accuracy and efficiency of the 3-dimensional dynamic navigation system (DNS) compared with the freehand technique (FH) when removing fiber posts from root canal–treated teeth. Twenty-six maxillary teeth were included. Teeth were root canal treated and restored with Parapost Taper Lux (Coltene/Whaledent, Altstätten, Switzerland) luted with RelyX Unicem (3M ESPE, St Paul, MN). A core buildup was then performed using Paracore (Coltene/Whaledent). Teeth were mounted in tissue-denuded cadaver maxillae. Teeth were divided into 2 groups: the DNS group (n = 13) and the FH group (n = 13). Cone-beam computed tomographic scans were taken pre- and postoperatively. The drilling path and depth were planned virtually using X-guide software (X-Nav Technologies, Lansdale, PA) in both groups. For the DNS group, drilling was guided with X-Nav software and the FH group under a dental operating microscope. Global coronal and apical deviations, angular deflection, operation time, and the number of mishaps were compared between the groups to determine the accuracy and efficiency. The 3-dimensional volume (mm3) of all teeth was calculated before and after post removal using the Mimics Innovation Suite (Materialise NV, Leuven, Belgium). The Shapiro-Wilk, 1-way analysis of variance, and Fisher exact tests were used (P <.05). The DNS group showed significantly less global coronal and apical deviations and angular deflection than the FH group (P <.05). DNS required less operation time than FH. Moreover, the DNS technique had significantly less volumetric loss of tooth structure than the FH technique (P <.05). The DNS was more accurate and efficient in removing fiber posts from root canal–treated teeth than the FH technique. [ABSTRACT FROM AUTHOR]

• Adjust window settings, look at multiple planes, and review prior imaging. • Mimics of SDH - Pathologic, Iatrogenic, Anatomic/Physiologic, Artifactual. • Not all SDH results from accidental trauma (exclude child abuse and other causes). Subdural hemorrhage (SDH), the accumulation of blood between the dura and arachnoid mater, is one of the most commonly encountered traumatic findings in emergency radiology setting. The purpose of this essay is to review the pitfalls in the diagnosis of SDH including a) mimics on CT imaging and b) etiology other than accidental trauma. We describe several entities that closely mimic SDH on non-contrast CT scans. A knowledge of these mimics is essential in the emergency setting since overdiagnosis of SDH can lead to unnecessary hospital admissions, potentially invasive procedures, or even delay in necessary treatment. The mimics of SDH on non-contrast head CT include: PATHOLOGIC ENTITIES 1. Cerebral venous thrombosis 2. Dural based benign masses 3. Dural based malignant neoplasms 4. Epidural hematoma 5. Hemorrhage in arachnoid cyst 6. Intracranial hypotension 7. Subdural hygroma 8. Subdural empyema IATROGENIC MIMICS 1. Enhancement of chronic subdural collection after contrast administration 2. Temporalis muscle entrapment under craniotomy flap ANATOMIC/PHYSIOLOGIC MIMICS 1. Cortical veins 2. Dural calcification/thickening 3. Dural enhancement 4. Hyperdense dural venous sinuses ARTIFACTUAL MIMICS 1. Cerebral edema 2. Streak and motion artifact We also briefly review non-accidental and non-traumatic causes of SDH. Although, the most common cause of SDH is accidental trauma, other routinely encountered causes of SDH include coagulopathy, non-accidental trauma, cranial surgery, vascular malformations etc. Clinicians dealing with SDH in the emergency setting should consider SDH mimics and less common etiologies of SDH in order to facilitate appropriate patient management. [ABSTRACT FROM AUTHOR]

With the development of recent technology, radiographs can be saved digitally, and angular measurements can be processed using various software packages. We developed an innovative computer-aided design method with Materialize Interactive Medical Image Control System software to measure hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA) and assessed its concordance with traditional X-ray imaging methods. All measurements were carried out on 42 feet from 26 adult patients diagnosed with hallux valgus who were prospectively selected from July 2016 to April 2018. Standing X-ray radiograph and weightbearing computed tomography scans were conducted on all patients, and HVA, IMA, and DMAA were generated using both a traditional X-ray method and our innovative method. Two different observers assessed measurements for each patient. Finally, statistical analyses were conducted to assess the reliability of the measurements. Both X-ray imaging and our innovative method had strong interobserver and test-retest reliability. The ICC of X-ray imaging was 0.945, p <.001, and the ICC of the innovative method was 0.915, p <.001. There was no statistical difference between the 2 methods for HVA and IMA measurements (p >.05); however, a difference was detected for DMAA (p <.05). Bland-Altman analyses demonstrated a high degree of agreement between the 2 methods for HVA and IMA, but a significant difference for DMAA. From the results, we concluded that our innovative computer-aided design method is a feasible, reliable way to quantitatively assess HVA, IMA, and DMAA, and it is likely more accurate for measuring DMAA. [ABSTRACT FROM AUTHOR]

A challenge in the diagnosis of prostate pathology is the numerous benign mimics of prostatic adenocarcinoma. Most of these lesions have no clinical significance but may be misinterpreted as cancer in biopsy specimens. In this review we describe the features of some of the more common benign mimics and discuss how they can be distinguished from carcinoma. The diagnostic entities most commonly associated with a false positive diagnosis of cancer are the atrophic group of lesions that include simple atrophy, partial atrophy and post-atrophic hyperplasia. Benign proliferations exhibit architectural atypia, often with closely packed small glands, but with no or little nuclear atypia. The most common diagnostic pitfall of this group is adenosis, which may have an even more atypical architecture than some cancers. A common denominator of atrophy and benign proliferations is that they consist of small glands that may have a patchy or absent basal cell layer, which adds to the diagnostic difficulties. Amongst hyperplastic and metaplastic lesions, basal cell hyperplasia may be misinterpreted as cancer because of its dark basophilic glands that sometimes display a certain degree of nuclear atypia and occasionally exhibit a pseudoinfiltrative pattern. The most important extraprostatic anatomical structure causing diagnostic difficulties is the seminal vesicle. The closely clustered small glands and often strikingly atypical nuclei of seminal vesicle epithelium may be misinterpreted as cancer. Awareness of these mimics is of paramount importance for the practicing pathologist as a false positive diagnosis of prostate cancer may lead to unnecessary radical therapy. [ABSTRACT FROM AUTHOR]

• Cavernous malformations are angiographically occult vascular malformations. • Cavernous malformations are discrete tiny lesions with mixed-signal characteristics. • Hemorrhagic tumors frequently mimic cavernous malformations. • Mimics often have greater lesion enhancement on MRI and persistent edema. • Distinguishing cavernous malformations from mimics may influence care strategies. Cavernous malformations (CM) are angiographically occult vascular malformations. CM appear as discrete, small lesions with mixed-signal characteristics on T2 reflecting the underlying pathology. However, the appearance is not pathognomonic. Distinguishing true CM from hemorrhagic tumors can be difficult. We report 5 cases of tumors mimicking CMs. We compared clinical, initial radiologic features, and MRI evolution between 5 tumor mimics and 51 true hemorrhagic, sporadic, brain CM. Compared to true CM, mimic patients were older (47.0 vs. 38.3 years; p = 0.076) and more likely to have a history of primary neoplasm (60% vs 12%; p = 0.0267). Radiologically, the CM mimics demonstrated a higher likelihood of lesion enhancement on the initial diagnostic MRI (60% vs. 16.7%%; p = 0.0609). On follow-up MRI (<1 year after baseline), CM mimics typically had persistent edema (100.0% vs. 6.25%, p = 0.0003) and demonstrated mixed density on ADC (100% vs. 32.1%; p = 0.0199) as well as increased likelihood of enhancement (100% vs 25.8, p = 0.0852). CM mimics were less likely to evolve to Type 2 or 3 lesions (25.0% vs. 84.4%, p = 0.0278). Clinical and radiologic factors may distinguish tumor metastases from true hemorrhagic CM. CM mimics should be suspected in older patients with a history of neoplasm and contrast enhancement on initial MRI. A repeat MRI within 90 days post-initial hemorrhage should be considered to confirm CM diagnosis. Persistent edema without rebleed, lesion enhancement, mixed signal on apparent diffusion co-efficient, and persistence of a Type 1 lesion should raise suspicion of a metastatic tumor. [ABSTRACT FROM AUTHOR]

Type A cricothyroid joint (CTJ) leads to a higher elongation of the vocal folds than Type B/C CTJ. Therefore, the determination for the CTJ type is important whether to perform a cricoid-thyroid approximation for a pitch elevation in transwomen with gender dysphoria. This study aimed to develop a tool for clinicians and radiologists for distinguishing between Type A (cricoid cartilage protuberance) and Type B/C (flat surface with/without cartilage of the cricoid) CTJs on high-resolution computed tomography (HRCT). This was a prospective study. Analysis of 60 male HRCTs and 60 female HRCTs of the larynx/CTJs. Three-dimensional reconstruction of the laryngeal cartilages, based on visualization of the CTJ in HRCT scans. The intercartilaginous distances (nearest distance between the inner side of the Thyroid and outer side of the cricoid of the CTJ) were measured to compare different types of CTJs. In all HRCT scans, three-dimensional reconstructions of the CTJ were feasible. All Type A CTJs showed the typical cricoid cartilage protuberance (like a volcano) in biplanar images and three-dimensional reconstructions. All Type B/C CTJs showed a flat cricoid joint cartilage in biplanar images and three-dimensional reconstructions. The type distribution was Type A: 61% in male and female larynges; Type B/C: 39% in male and female larynges. The intercartilaginous distances were Type A: 0.71 mm [0.42–0.98] in male larynges and 0.75 mm [0.44–1.40] in female larynges; Type B/C: 1.13 mm [0.36–1.24] in male larynges and 1.32 mm [0.76–2.47] in female larynges. In HRCT scans, the Type A CTJ showed an intercartilaginous space less than 1 mm. In contrast, the Type B/C CTJ showed an intercartilaginous distance exceeded 1 mm. [ABSTRACT FROM AUTHOR]

Medialization thyroplasty (MT) has become a prominent method for treating glottal insufficiency. This study aimed to visualize the biomechanical influence of a medialization implant on arytenoid cartilage, particularly on the length and level of paralyzation in the vocal fold, in patients with unilateral vocal fold paralysis. Prospective study. We recruited 15 patients (10 men, 5 women) with unilateral vocal fold paralysis that underwent MT with a Montgomery® thyroplasty implant. We performed high-resolution computed tomography of the arytenoid cartilage before and after MT and analyzed the three-dimensional images. To visualize the movement of the arytenoid and to measure the lengthening of the vocal fold, we superimposed pre- and postoperative 3D images with MIMICS software. On the affected side, the implant pushed the arytenoid backwards. In addition, the vocal process of the arytenoid was inwardly rotated. These movements resulted in an elongated, augmented vocal fold on the affected side. MT led to an elongated, medialized vocal fold on the treated side. After the intervention, the vocal folds on both sides were the same length in the phonatory position. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy. [ABSTRACT FROM AUTHOR]

Background Glenoid component loosening after total shoulder arthroplasty (TSA) may occur if retroversion is not corrected to <10°. However, accurately measuring postoperative glenoid component version has been difficult without postoperative computed tomography (CT), adding cost and radiation exposure outside of the standard radiographic follow-up. We present a new method to assess glenoid component version after TSA using only routine preoperative CT and postoperative radiographs (x-rays). Methods Preoperative glenoid version was measured using established methods with an axillary x-ray, 2-dimensional CT, and Glenosys software (Imascap, Plouzané, France). Postoperative glenoid component version and inclination were measured for 61 TSA patients using Mimics software (Materialise, Leuven, Belgium) with preoperative CT and postoperative x-rays. Four patients also had postoperative CTs. Glenoid implantation and imaging were performed on 14 cadavers, allowing validation of results against the gold standard postoperative CT glenoid retroversion measurement. Results Compared with the gold standard, retroversion and inclination measurement error was 2° ± 1° and 2° ± 1°, respectively. Average postoperative version correction was 6° ± 7°, with 35 of 61 patients (57%) corrected to <10° of retroversion. Correlation between preoperative version measurement methods was good to very good, except on the axillary x-ray. Patients not corrected to <10° of retroversion had significantly higher preoperative retroversion (14° ± 6°) than those corrected to <10° (6° ± 7°; P  < .00001). Conclusions Glenoid component retroversion after TSA can be accurately measured with a method using only routine preoperative CT and postoperative x-rays, validated to within 1.9° of the gold standard postoperative CT measurement. Future studies using this method may correlate glenoid retroversion correction with glenoid component longevity to help optimize shoulder arthroplasty outcomes. [ABSTRACT FROM AUTHOR]

The spine is a complex structure composed of different tissues with a wide range of clinical pathologies. There are multiple imaging modalities available at our disposal to image the spine. This article will present several common pathologies and how different imaging modalities have their respective roles in clinching the right diagnosis and aiding subsequent management. [ABSTRACT FROM AUTHOR]

Systemic sclerosis is a rare autoimmune connective tissue disorder characterised typically by tightening and tethering of skin. However, several other disorders are also characterised by hardening and thickening of skin. These mimics can be potentially confused with systemic sclerosis, leading to a misdiagnosis. This review describes the aetiopathogenesis, clinical features and treatment of Morphea (localised scleroderma), Scleredema, Scleromyxoedema, Eosinophilic fasciitis, Nephrogenic Systemic Fibrosis, Diabetic Cheiroarthropathy, chronic GVHD, POEMS syndrome and drug induced scleroderma like illness. A careful and thorough clinical assessment is essential in order to differentiate these mimics from each other and from systemic sclerosis, establish the diagnosis, and initiate appropriate treatment. [ABSTRACT FROM AUTHOR]

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Giant cell tumour (GCT) of flat bones of pelvis is extremely rare. GCT of the ilium and ischium represent less than 0.05% of all GCT. Iliac bone GCT has been treated traditionally by intra-lesion curettage with bone grafting, wide resection with or without reconstruction and hemi-pelvectomy in very aggressive tumours. None of the above treatments were without morbidities. Reconstruction using bone grafts and bone cement has also been inadequate. In GCT, where life expectancy is not decreased significantly, surgical treatment should be aimed at giving optimum functional outcome. We are reporting here a rare case of giant cell tumour of ilium bone in a 25-year-old female and its unique treatment approach. We designed a computed tomography (CT) based customized iliac prosthesis using Materialise Mimics and 3-Matic software. 3D model of pelvis was generated from the CT. After deciding the extent of resection on affected side, we virtually mirrored an identical portion of opposite ilium to the affected side. Connecting plates were made over the mirrored part and merged with it. Multiple relevant holes were made to attach various muscles to the prosthesis. Prosthesis was made in medical grade titanium by using Computerized Numerical Control (CNC) machine. The method is called as computer based subtractive manufacturing. Wide resection was done and the prosthesis was placed using multiple 3.5 millimetres screws through the connecting plates. Muscles were stitched to relevant holes using ethibond suture. Post-operative course was unremarkable. Patient was made to walk with full weight bearing after 5 weeks. Powers of abductors at 6 months is 4/5 and patient walks normally without a limp. [ABSTRACT FROM AUTHOR]

• The clinical evaluation of a new diagnosis of MS typically includes serologic testing for mimics. • There are few studies evaluating the utility of such testing. • In our study of new patient referrals for MS, serologic testing did not change any diagnosis or management. • Instead, serologic testing results resulted in unnecessary additional testing and diagnostic delay. • Serologic testing in the assessment for routine MS may not be necessary. The clinical evaluation of a new diagnosis of MS typically includes serologic testing to evaluate for its many mimics, yet there is little data to guide approaches to such testing. To evaluate for the frequency and clinical significance of serologic testing for MS diagnostic evaluations. In a single MS subspeciality center retrospective study, new patient evaluations for MS over the course of a year were identified, and the results of serologic testing and diagnostic evaluation extracted. Retrospective longitudinal diagnostic assessment was performed to confirm the accuracy of initial serological testing assessments. 150 patients had 823 serologic tests. 40 (5%) tests were positive, and resulted in 117 additional serologic tests, 10 radiographs, and 2 biopsies. 77 (51%) patients were diagnosed with a non-demyelinating disorder. Serologic testing results did not change any diagnosis, yet in some patients, it resulted in unnecessary additional testing and diagnostic delay. Serologic testing in the clinical assessment for routine MS resulted in unnecessary diagnostic delay, additional testing, and considerable healthcare cost. [ABSTRACT FROM AUTHOR]

Given the considerable overlap between the clinical, endoscopic, and histologic features of infectious colitides and inflammatory bowel disease (IBD), correct classification of chronic colitis requires thorough clinical and pathologic evaluation of affected patients. Herein, we discuss a pattern-based approach to colitis, classification of IBD, and infectious mimics of IBD. Infectious mimics of IBD include bacterial pathogens ( Shigella , Campylobacter , Salmonella , shiga toxin-producing Escherichia coli , Yersinia , Aeromonas ), tuberculous and non-tuberculous mycobacterial infections, sexually transmitted proctocolitis (syphilis, lymphogranuloma venereum), amoebiasis, and the recently described cord colitis syndrome. The histologic finding of chronic active colitis should be considered infectious until proven otherwise in order to detect treatable, curable conditions and prevent exacerbation by inappropriate immunomodulatory therapy. Family and medical histories, signs and symptoms, radiologic and endoscopic features (especially disease distribution), and serologic/ancillary studies for markers of infection are invaluable tools that aid in the distinction between infectious colitis and IBD. [ABSTRACT FROM AUTHOR]

Introduction The purpose of this study was to observe and evaluate 3-dimensional pulp cavity changes during orthodontic treatment. Methods Eighty-seven patients formed the study sample and were divided into an experimental group (48 patients) and a control group (39 patients). Cone-beam computed tomographic (CBCT) records were obtained before the start of the treatment (T0) and after space closure for the experimental group, whereas for the control group CBCT images were obtained approximately 17–18 months (T1) after obtaining the first image (T0). CBCT data were reconstructed with surface and volume rendering software (Mimics; Materialise, Leuven, Belgium), and the volumetric images were modified to display the teeth from various orientations. Six anterior teeth were segmented and their pulps isolated. Paired t test was used to check for statistical significance. Results The difference in the pulp volume was statistically significant at P < .05 for all the anterior teeth in the experimental group and at P < .05 for the right canine, P < .05 for the right and left lateral incisors, and P < .05 for the left central in the control group. Conclusions Orthodontic treatment in the experimental group produced a significant decrease in the size of the pulp, which was statistically significant. [ABSTRACT FROM AUTHOR]

As small volumes of prostate cancer are being detected with ever-increasing frequency, the pathologist is challenged to make more diagnostically out of less. This photoessay explores ten diagnostic problems that are noted with regularity by a provider of second opinions in prostate biopsy interpretation. These include: suboptimal submission of prostate cores, atypia with small size of the focus of concern, cytologic ambiguity of the focus of concern, issues with ordering and interpreting immunostains, atypia arising with high-grade prostatic intraepithelial neoplasia, benign mimics of cancer, omitting mention of extraprostatic tumor extension or of Gleason pattern 5, not recognizing intraductal carcinoma, and the differential diagnosis of cancer of urothelial versus prostatic origin. [ABSTRACT FROM AUTHOR]

Our bodies have the amazing ability to self-trigger tissue regeneration when required to repair or renew tissues. Adult stem cells emerge from their niche and are instructed by local environmental factors to differentiate into the needed specific phenotypes once they have migrated to the target sites. For example, the complex weaving of collagen filaments composing the tissue framework not only offers nanoscaled topographical cues to cells but also its stiffness may influence their differentiation. Specific biomolecules, secreted by glands or other cells and transported by body fluids, also provide instructive indications to cells. In this sense, combinations of various physical and chemical stimuli at the micro- and nanoscale are crucial in regenerating tissues. [ABSTRACT FROM AUTHOR]

Objectives: Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness. A spectrum of non-Kaposi's sarcoma clinical and histopathological mimickers contributes to the potential over- or underdiagnosis of Kaposi's sarcoma. The aim of this audit was to investigate the clinical diagnostic accuracy of Kaposi's sarcoma and to find out whether or not knowledge of the human immunodeficiency virus (HIV) serostatus influenced the clinical diagnostic accuracy. Design: Cross-sectional study of 511 mucocutaneous biopsies. Settings and subjects: All the biopsies were from African patients from the Limpopo province. The HIV seropositive status was known in 327 cases (64.2%). The clinical diagnosis, provided in 369 cases (72.2%) was compared with the biopsy. A Kaposi's sarcoma herpesvirus-positive immunophenotype on biopsy served as the diagnostic gold standard. Outcome measure: Concordance or discordance between the clinical provisional diagnosis and the histopathological gold standard. Results: The rate of provisional clinical diagnosis of non- Kaposi's sarcoma in biopsy-proven Kaposi's sarcoma was 18.1% in HIV-positive, and 39.5% in HIV unknown, serostatus (chi-square 11.8, p-value = 0.0006). The concordance between the clinical diagnosis and biopsy was 76.5% in the HIV-positive, and 49.9% in the HIV-unknown, cases (chi-square 16.9, p-value < 0.0001). Conclusion: Knowledge of the patient's serostatus significantly improved the clinical diagnostic accuracy of Kaposi's sarcoma. Biopsy remains the diagnostic gold standard. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the most important cause of death and illness in the western world. Atherosclerosis constitutes the single most important contributor to CVD. miRNAs are small ribonucleic acids (RNAs) that negatively regulate gene expression on the post-transcriptional level by inhibiting mRNA translation or promoting mRNA degradation. Several studies demonstrated that miRNAs dysregulation have a key role in the disease process and, focus-ing on atherosclerotic disease, in every step of plaque formation and destabilization. These data suggest a possible therapeutic application of miRNA modulation, in particular dysregulated miRNAs can be mod-ulated in disease process antagonizing miRNAs up-regulated and increasing miRNAs down-regulated. In this review we summarize the miRNA therapeutic techniques (antimiR, mimics, sponges, masking, and erasers) underlining their therapeutic advantages and evaluating their risks and challenges. In particular, the use of miRNA modulators as a therapeutic approach opens a novel and fascinating area of intervention in the therapy of ischemic heart disease. [ABSTRACT FROM AUTHOR]

Abstract: Facial nerve paralysis is one of several possible complications following conservative parotidectomy. To assess three-dimensional facial movements non-invasively in patients with unilateral facial palsy following parotidectomy for benign tumours, the three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded in 32 patients (21 HB I, 5 HB II, 6 HB III-IV; 3 months post-surgery follow-up), and 40 control subjects, during the performance of facial movements (smile, ‘surprise’, eye closure, single eye closure). For all symmetric animations, control subjects had larger total mobility than patients; mobility progressively decreased in patients with larger clinical grades. For asymmetric eye closures, HB I patients and control subjects had similar total movements, while HB II patients had smaller movements, especially for the paretic side eye closure; smaller total movements were found in HB III-IV patients. The method allowed the quantitative detection of alterations in facial movements. Significant differences between patients and control subjects in the magnitude and asymmetry of movements were found. [Copyright &y& Elsevier]

Summary: Objectives/Hypothesis: Laryngeal electromyography (LEMG) is an important tool for the assessment of laryngeal nerve and muscle functioning. The purpose of the study was to determine electrode insertion angle and insertion depth for the various laryngeal muscles. Methods: Twenty-three cadaver larynges were examined with magnetic resonance tomography (MRT) and Materialize Interactive Medical Image Control System (Leuven, Belgium) 3-dimensional (3D) imaging software. Geometrical analysis was used to calculate the electrode insertion angles. Results: All laryngeal muscles could be identified and 3D visualized on MRT scans. Although the insertion angles were the same in male and female larynges, the insertion depth was significantly larger in male than in female larynges (P <0.05). Of particular clinical importance is the fact that the electrode has to be directed lateral and upward for the thyroarytenoid muscle but lateral and downward for the lateral cricoarytenoid muscle (insertion point=midline lower border of the thyroid). Conclusions: This is the first study that analyzes electrode insertion angles and insertion depths for each laryngeal muscle using 3D imaging. We hope that the information gained from this study will help clinicians performing LEMG to localize the individual laryngeal muscles. [Copyright &y& Elsevier]

Summary: Objectives/Hypothesis: Cricothyroid approximation (CTA) surgery aims at raising the voice pitch in male-to-female transsexuals. However, 30% of the patients are not satisfied with the result. The purpose of our study was to examine the cricothyroid joint (CTJ) biomechanics and to analyze if (and how) the CTJ anatomy influences the movement of the cricoid and, consequently, the elongation of the vocal fold and the voice pitch after CTA. Methods: Twenty-four cadaver larynges were examined with high-resolution computerized tomography and MIMICS three-dimensional imaging software (Materialise Interactive Medical Image Control System, Leuven, Belgium). After superimposing the two scans taken in “neutral” and in “CTA” positions, vector geometrical analysis was used to determine the effective rotation axis of the CTJ and to calculate the elongation of the vocal folds after CTA. Results: Our results showed that the cricoid rotates around an axis, the position of which depends on the anatomical structure of the CTJ. Based on the location of this effective rotation axis, we could distinguish three groups. In group I (N=13), the rotation axis was located in the lower third; in group II (N=5), it was located in the middle third; and in group III (N=6), it was located in the upper third of the cricoid. The elongations of the vocal fold were 12%, 8%, and 3%, in groups I, II, and III, respectively. Conclusions: The anatomical structure of the CTJ influences directly (1) the position of the effective rotation axis and (2) the elongation of the vocal folds. [Copyright &y& Elsevier]

Summary: Background: The submental flap, based on a large branch of the facial artery, is an excellent flap option which is most commonly used for head and neck reconstruction. The purpose of this report is to clarify aspects of the anatomy of the submental flap in order to improve the utility of this flap. Methods: Ten cadavers were injected with a modified lead oxide–gelatin mixture. Four cadavers were selected for three-dimensional reconstruction using a spiral computed tomography scanner and specialised volume-rendering software. Dissection, angiography and photography of each layer were performed to outline the course of every perforator in the neck. The area of the vascular territory supplied by each source vessel was calculated. Surface areas were measured using Scion Image software. Results: The skin and muscles on the anterior neck and mandible are nourished by several arterial perforators: facial artery, superior thyroid artery, mental artery, lingual artery and the submental artery. The diameter of the submental artery was 1.7±0.4mm at its origin from the facial artery. It sends 1.8±0.6 perforators to the skin on its course towards the chin. The average size of the territory supplied was 45±10.2cm2. Its largest perforating branch arises from behind the medial border of the anterior belly of the digastric muscle. There were multiple anastomoses between perforators from the submental artery, facial artery and sublingual artery. Conclusions: This study clarifies the anatomy of the submental flap and provides a three-dimensional understanding to this important head and neck donor site. [ABSTRACT FROM AUTHOR]

Abstract: To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20–50 years) performed seven standardized facial movements (maximum smile; free smile; “surprise” with closed mouth; “surprise” with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p >0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p >0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student''s t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p <0.05; mouth, up to 30%, p <0.05 only in the 20–30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women. [Copyright &y& Elsevier]

Summary: To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; “surprise” with closed mouth; “surprise” with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p <0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p >0.01), with a significant effect of movement (p <0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the “surprise with mouth open” movement had the largest landmark displacements (p <0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults. [Copyright &y& Elsevier]

During the nineteenth century, the problem of significant gestures became a scientific issue for physicians, psychologists, artists… The physician Duchenne de Boulogne invented a method to study the relations between the muscles of the face and the emotions. He created artificial mimics by stimulating the face with an with an electric device. By this way he established what he called an 'alphabet' of the emotions. Darwin highly praised Duchnne's works, discussed his ideas and used his photographs. However, it was discussed whether these artificial expressions could have a real signification. Simulation was another issue, and Diderot's Paradoxe sur le comedien was often referred to. Some authors emphasized how artificial mimics or gestures, or intentional simulations can provoke a real emotion. Others, among the artists, thought that to be understood, emotions must be exaggerated. The body-mind problem was at stake in these debates. [ABSTRACT FROM AUTHOR]

Background and Purpose: Mimics comprise a third of patients presenting with an acute stroke. There is limited information on their natural history.Methods: We evaluate long term major cardiovascular events (MACE) in stroke mimics in a prospective database from Qatar.Results: Between Feb 2014 and Jan 2019, 481 patients (male: 238; female: 243) mean age 57.5 years (±18.0), with 399 (83%) medical mimics and 82 (17%) functional mimics were evaluated. Imaging revealed previous old stroke in 26.6% and small vessel disease in 5%. MACE occurred in 57 (11.9%) and there were 31 deaths (6.4%) with majority of deaths (5.6%) from cardiovascular causes. MACE was significantly higher in patients with previous stroke, p < 0.0001), coronary artery disease, p = 0.002), diabetic, p = 0.01), and hypertensive on admission, p < 0.0001. MACE were also significantly higher in patients where imaging showed a previous stroke, p = 0.006).Conclusion: The occurrence of MACE during follow-up suggests that patients with existing vascular disease require aggressive management of vascular risk factors. [ABSTRACT FROM AUTHOR]

Summary Objectives/Hypothesis Biplanar imaging technique is not sufficient for an exact visualization and evaluation of the laryngeal biomechanics during speaking or singing. The aim of this pilot study was to test a 3D-visualization software MIMICS ( Materialize Interactive Medical Image Control System , Materialize, Leuven, Belgium) for visualizing laryngeal cartilages and resonance space of living humans during singing based on high-resolution computed tomography (HRCT) and analyzing the biomechanics thereof. Study Design This is a prospective pilot study. Methods A total of 10 professional female singers (five sopranos and five altos) was scanned with HRCT in three singing positions fundamental frequency (ƒo), first octave (ƒo+1 8va) and second octave (ƒo+2 8va). Results All relevant laryngeal structures and resonance space could be 3D visualized. Superimposing the different HRCT scans showed an inward rotation and rocking of the arytenoid cartilages from ƒo+1 8va to ƒo+2 8va and a backward tilting of the cricoid cartilage from ƒo+1 8va to ƒo+2 8va. Moreover, we could demonstrate a vocal fold elongation of 13% from ƒo to ƒo+1 8va and an additional elongation from ƒo+1 8va to ƒo+2 8va of 10% in type A cricothyroid joints (CTJ) A and 4% in CTJ's type B/C. There were no significant differences between sopranos and altos in all parameters (length of the glottis, subglottic diameter, distance between anterior commissure and cervical spine, and CTJ distribution). Conclusions This noninvasive 3D-visualization technique with MIMICS allows the anatomical structures and landmarks of the larynx to be analyzed. We believe that this pilot study will serve as a basis for further biomechanical studies on speakers' and singers' larynges. [ABSTRACT FROM AUTHOR]