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Anatomic total shoulder arthroplasty (TSA) is an effective surgical option for the treatment of primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. While an intact rotator cuff is essential to the success of TSA, little is known about how preoperative rotator cuff muscle quality may impact clinical outcomes. In this study, we sought to determine the effects of rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on clinical outcomes following TSA. A retrospective review of a prospectively maintained, single-surgeon registry was used to identify patients undergoing TSA for GHOA between April 2015 and March 2020. Patients were included if they had preoperative magnetic resonance imaging available, an intact rotator cuff, and complete preoperative and minimum 2-year postoperative patient-reported outcome measures (PROMs) and active range of motion (ROM) measurements. Preoperative MA and FI of the rotator cuff were assessed on magnetic resonance imaging by measuring muscle cross-sectional area and using the Goutallier classification system, respectively. Pearson's correlation was used to determine any relationship between MA and clinical outcomes. Univariate analysis was used to compare clinical outcomes of patients with moderate-to-severe FI to those with minimal-to-mild FI. There were 163 shoulders from 154 patients with a mean age of 62.5 (standard deviation = 7.4) and a mean follow-up of 2.9 years (standard deviation 1.2) that met inclusion criteria. Rotator cuff muscle area was not correlated with any preoperative or postoperative ROM or PROMs (P >.05). However, the ratio of infraspinatus and teres minor (posterior cuff) to subscapularis muscle area was minimally negatively correlated with change in Single Assessment Numerical Evaluation (r = −0.171, P =.029) and change in internal rotation (r = −0.207, P =.008), although the clinical relevance is unclear. No significant differences in preoperative ROM or PROMs were found between patients with minimal-to-mild and moderate-to-severe FI (P >.05). Preoperative rotator cuff muscle volume and FI do not impact clinical outcomes following TSA in patients with GHOA and intact rotator cuffs. TSA remains a viable surgical treatment for individuals with GHOA and an intact rotator cuff, provided the MA and FI are not so severe that a patient may be indicated for another type of treatment. [ABSTRACT FROM AUTHOR]

The article "Utility of Biorbitofrontal Craniotomy in the Transsphenoidal Era—A 30-Year Single-Surgeon Experience" published in the Journal of Neurological Surgery. Part B. Skull Base discusses the continued relevance and strengths of the biorbitofrontal (BOF) craniotomy technique in skull base surgery. The study evaluated outcomes and complications in patients who underwent BOF by a single surgeon over 30 years, highlighting the technique's exceptional visibility of anatomy, controlled dissection, and reduced risk of brain injury. The results showed successful gross total resection in 84% of patients across various pathologies, with postoperative complications including meningitis, CSF leaks, and strokes. The study concludes that the BOF approach remains valuable in treating anterior skull base pathology in the era of minimally invasive surgery. [Extracted from the article]

Objective: To investigate gender disparities in applications and admissions to the medical residency programs in Peru, focusing on differences in application and admission proportions between male and female. Methods: We conducted a cross-sectional study to assess the proportions of female applicants and admissions to medical residency programs in Peru from 2016 to 2023. Bayesian multilevel linear models were employed, incorporating random intercepts and slopes by specialty to account for variability across specialties. This approach provided initial proportions of female in 2016 (intercepts) and annual percentage changes (beta coefficients) for each specialty. A multilevel Poisson regression model with robust variance was used to determine if being female was associated with higher admission frequency. Results: Of the 48,013 applicants, 48% were considered female applicants. Most specialties exhibited an increasing trend in female applicants (+0.2% to +2% annually), except for Family Medicine, Hematology, Pediatric Neurology, and Pathological Anatomy (-0.6%, -0.6%, -0.7%, and -0.9% annually, respectively). The specialties with the highest proportions of female admissions were in Physical Medicine and Rehabilitation (71.9%), Dermatology (71.2%), and Pathological Anatomy (71.2%). In contrast, the lowest proportions were observed in Neurosurgery (18.9%), Thoracic and Cardiovascular Surgery (17.7%), and Urology (15.6%). Declining trends in female admissions were noted in Family Medicine, Hematology, and Pathological Anatomy (-0.6%, -0.6%, and -0.8% annually, respectively). In addition, being female was associated with an 18% lower probability of admission to the medical residency program (prevalence ratio: 0.82; 95% CI: 0.78–0.85; p-value: <0.001). Conclusion: This study identified persistent gender disparities in medical residency programs in Peru, with female applicants facing reduced probabilities of admission and exhibiting specialty-specific trends from 2016 to 2023. [ABSTRACT FROM AUTHOR]

BACKGROUND: Millions worldwide are exposed to elevated levels of arsenic that significantly increase their risk of developing atherosclerosis, a pathology primarily driven by immune cells. While the impact of arsenic on immune cell populations in atherosclerotic plaques has been broadly characterized, cellular heterogeneity is a substantial barrier to in-depth examinations of the cellular dynamics for varying immune cell populations. OBJECTIVES: This study aimed to conduct single-cell multi-omics profiling of atherosclerotic plaques in apolipoprotein E knockout (ApoE–/– ) mice to elucidate transcriptomic and epigenetic changes in immune cells induced by arsenic exposure. METHODS: The ApoE–/– mice were fed a high-fat diet and were exposed to either 200 ppb arsenic in drinking water or a tap water control, and single-cell multi-omics profiling was performed on atherosclerotic plaque-resident immune cells. Transcriptomic and epigenetic changes in immune cells were analyzed within the same cell to understand the effects of arsenic exposure. RESULTS: Our data revealed that the transcriptional profile of macrophages from arsenic-exposed mice were significantly different from that of control mice and that differences were subtype specific and associated with cell–cell interaction and cell fates. Additionally, our data suggest that differences in arsenic-mediated changes in chromosome accessibility in arsenic-exposed mice were statistically more likely to be due to factors other than random variation compared to their effects on the transcriptome, revealing markers of arsenic exposure and potential targets for intervention. DISCUSSION: These findings in mice provide insights into how arsenic exposure impacts immune cell types in atherosclerosis, highlighting the importance of considering cellular heterogeneity in studying such effects. The identification of subtype-specific differences and potential intervention targets underscores the significance of understanding the molecular mechanisms underlying arsenic-induced atherosclerosis. Further research is warranted to validate these findings and explore therapeutic interventions targeting immune cell dysfunction in arsenic-exposed individuals. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of the study is to measure anatomical and dosimetric changes experienced by patients with head and neck cancer undergoing intensity-modulated radiation therapy and evaluate the need for adaptive radiotherapy using predefined relative thresholds as benchmarks. Methods: This study involved 31 consecutive patients. Two computed tomography (CT) scans were utilized for initial treatment planning and a midpoint assessment. The study employed rigid registration and contour transfer techniques to apply primary dose calculation to midpoint CT, generating a hybrid plan, and an adaptive plan was generated on the midpoint CT. Results: The results revealed statistically significant volume reductions mainly in PTV70, PTV60 and PTV54 volumes. The volume of the parotid glands exhibited volumetric reductions in most of the patients. Hybrid plans demonstrated inferior dose coverage of the tumour regions, and comparisons between hybrid and adaptive plans showed significant variations in the maximum doses. Conclusions: Anatomical deviations necessitating a repeat CT scan, along with the application of a new immobilization mask, emerged as a primary rationale for replanning. Indicators that could potentially encompass a breach of 95% dose coverage for 95% of the tumour volume, maximum doses surpassing 50 Gy in the spinal cord and 59 Gy in the brainstem<>, as well as lateral neck displacement exceeding 1cm from the initial position act as benchmarks before implementing a replan. [ABSTRACT FROM AUTHOR]

Gaëtan Gatian de Clérambault (1872–1934) submitted his thesis for his medical degree in 1899. This thesis testifies for the visionary nature of its author in the field of psychiatry. In our study, we present the very rare work entitled " Contribution to the study of the othematoma. Pathogenesis, pathological anatomy and treatment". We then analyze this work before attempting to understand the choice of this thesis topic, which may seem strange for a psychiatrist. We put forward three hypotheses. The study of Clérambault's thesis hardly unveils the mystery of this great psychiatrist who committed suicide in 1934, thus putting an end to a brilliant career. [ABSTRACT FROM AUTHOR]

This research project aims to automate the identification, labeling, and counting of teeth, as well as the classification of abnormalities and detection of caries in dental X-rays, specifically orthopantomograms (OPGs). It involves several deep neural networks and learning algorithms. The first module uses semantic segmentation with a U-net model to create masks for tooth detection, which are then refined with the YOLOv3 detector, achieving 80% accuracy. Canonical correlation analysis (CCA) helps find tooth midpoints and count the total number of teeth. The second module classifies abnormalities and pathologies using transfer learning with the Inceptionv3 model, yielding moderate accuracy. Caries detection is performed with thresholding and segmentation. The third module detects three treated pathologies—root canal treatments, crowns, and implants—using Faster RCNN and Inceptionv3, showing fair accuracy. Overall, the automated approach demonstrates promising results for enhancing X-ray image interpretation and diagnosing oral diseases. [ABSTRACT FROM AUTHOR]

Simple Summary: Biphenotypic sinonasal sarcoma is a rare low-grade tumor arising from the mucosa of the upper respiratory tract characterized by aggressive biological behavior and a high tendency to invade the skull base and the orbit. The main presenting symptoms and signs include nasal obstruction, facial discomfort, epistaxis and ocular impairment. Surgical resection represents the gold standard of treatment, allowing for the resolution of clinical manifestations and gross total tumor resection in most cases; the role of adjuvant treatments is unclear. The local recurrence rate after treatment is 26%. Tumor-related mortality is very rare. Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients' sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon's experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity. [ABSTRACT FROM AUTHOR]

Background: Schwannomas of C1 are rare tumors. Because of the wide variation in their anatomy, and presentation and their rarity, there is no proper understanding of their pathological anatomy nor their optimal management. Methods: A retrospective study of the C1 schwannomas operated by the author between 2000 and 2020 and a PubMed-based search of English literature were done to analyze data on the location and extent of the lesions, surgical approaches used, and operative outcomes. Using this data, a classification system was created indicating the location and extent of these lesions, depending on whether they were extradural (E) or intradural (I); with further subdivisions based on their relation to the vertebral artery, and cervicomedullary junction (CMJ). Results: Six patients with C1 schwannoma were operated by the author in the said period. Literature search yielded 44 cases in 16 publications. The details of location and extent of tumor were available in 22 patients including six of this article. Most of the tumors were intradural (13/22), with six in intradural and extradural compartments. Specific growth patterns were identified and a theory for this is proposed. Different surgical approaches were used; the far lateral and the posterolateral in 9 patients each, and the posterior midline in 7 of 25 patients. Using the available data, preferred surgical approaches are also presented. Conclusions: C1 schwannomas are a rare and complex group of tumors. The classification presented will help in understanding the growth pattern and pathological anatomy and choose the preferred surgical approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: To determine the precise frequency of main pancreatic duct (MPD) dilatation within the remnant pancreas at 1 year after pancreatoduodenectomy (PD) and its clinical implications, a prospective multicenter cohort study was performed in patients without MPD dilatation before PD (registry number: UMIN000029662). STUDY DESIGN: Between October 2017 and July 2020, patients with an MPD diameter less than 3 mm who were planned to undergo PD for periampullary lesions at 21 hospitals were enrolled. The primary endpoints were frequency of MPD dilatation at 1 year after PD, and the relationship between MPD dilatation and pancreatic endo- and exocrine function, nutritional status, and fatty liver. Secondary endpoints were risk factors for MPD dilatation at 1 year after PD and time-course change in MPD diameter. RESULTS: Of 200 registered patients, 161 patients were finally analyzed. Pancreatic fistula was the most frequent complication (76; 47.2%). MPD dilatation (MPD > 3 mm) at 1 year after PD was seen in 35 patients (21.7%). Pancreatic exocrine function, assessed by steatorrhea, was significantly impaired in patients with MPD dilatation. However, endocrine function, nutrition status, and fatty liver development were comparable between the 2 groups. In multivariate analysis, the serum total protein level 7.3 g/dL or more was an independent predictor for MPD dilatation at 1 year after PD (odds ratio 3.12, 95% CI 1.31 to 7.15). A mean MPD diameter significantly increased at 6 months after PD and kept plateau thereafter. CONCLUSIONS: MPD dilatation at 1 year after PD was seen in 21.7% of patients and significantly associated with exocrine function impairment but not with endocrine function, nutrition status, or development of fatty liver. [ABSTRACT FROM AUTHOR]

Simple Summary: Numerous studies have examined the accessory ligament of the deep digital flexor tendon (AL-DDFT), focusing on both its normal and pathological anatomy. However, limited information is available regarding the precise relationship between the AL-DDFT and its surrounding structures. Clinically, this ligament is often implicated in desmitis and the formation of adhesions, yet the mechanisms driving these pathological changes are not fully understood. While previous investigations have suggested potential contributing factors, detailed descriptive studies are still necessary. In this study, macroscopic, microscopic, and morphometric analyses of the AL-DDFT were carried out. Through dissection and examination of E12 plastinated sections, we provide novel insights into the structural organization and interactions of the AL-DDFT with adjacent tissues. These findings enhance the current understanding of the anatomical and clinical aspects of the AL-DDFT, building upon and integrating previous research. The accessory ligament of the deep digital flexor tendon (AL-DDFT) plays a crucial role in the stay apparatus of the horse. This study aimed to investigate the anatomical relationship between the AL-DDFT, the superficial digital flexor tendon (SDFT), and other structures in the metacarpal region. Sixteen distal forelimbs from eight horses, aged 1 to 6 years, were evaluated through macroscopic, microscopic, and morphometric analyses, utilizing detailed dissection, E12 plastinated sections, and histological analysis. During lateral dissection, a connection was observed between the AL-DDFT and the SDFT. Histological evaluation revealed that this connection was a fibrous band (FB), extending the common synovial sheath (CSS) to the SDFT, along with associated collagen fibrils of the epiligament and peritenon. Additionally, two distinct forms of the AL-DDFT were identified, Type I and Type II, with Type II showing a greater cross-sectional area (CSA) than Type I. While numerous morphological and morphometric studies have explored the AL-DDFT and related structures, research incorporating plastination-based morphological and histological evaluations remains scarce. The findings provide valuable insights for both the morphological and clinical assessment of structures within the metacarpal region. [ABSTRACT FROM AUTHOR]

The increasing use of imaging has led to incidental findings in the liver. The Western experience of managing focal intrahepatic duct dilatation (FIDD) is not well recorded. We present our experience based on a large prospectively maintained database at a tertiary hepatobiliary surgical unit. We identified patients with liver resection for focal incidental duct dilatation from January 2003 to December 2019 from the liver unit database. We recorded the demographics, symptomatology, blood test results, imaging, type of liver resection, morbidity, mortality and histology of resected specimens. Nine patients had focal intrahepatic duct dilatation among 994 liver resections performed (0.9%). Six patients were asymptomatic, 2 upper abdominal pain and 1 recurrent gram-negative sepsis. Liver function tests were normal in all patients. Two patients had cholangiocarcinoma (CCA), 4 intrahepatic stones, 1 intraductal papillary neoplasm of bile duct (IPN-B) and 2 benign strictures. Focal incidental duct dilatation is rare in the Western population. Most patients are asymptomatic with an incidental finding of intrahepatic duct dilatation on cross-sectional imaging. Differentiating benign and malignant pathology is difficult warranting liver resection, in fit patients, to resolve the diagnosis. Liver resection is safe and can be potentially curative in patients with a neoplasm, which can occur in 30% of patients with focal intrahepatic duct dilatation. [ABSTRACT FROM AUTHOR]

AIM: To avoid the problem of retinal dissection in guinea pig large eyeball tissue sections, different methods were used to optimize the fixation effect of the posterior pole of the eyeball.METHODS: A total of 75 normal guinea pigs(2 weeks old)were randomly divided into 5 large groups. Group A(1-3 small groups), the entire eyeball was fixed with FAS, Davidson fixative 1(D1), and Davidson fixative 2(D2)for 24 h; group B(4-6 small groups), the entire eyeball was fixed with FAS, D1, and D2 for 1 h, then cut the cornea and fix it in their respective fixatives for 2 h; group C(7-9 small groups), the eyeball was fixed in FAS, D1, and D2 for 1 h, divided into left and right halves along the direction of the optic nerve, and then placed them in their respective fixation solutions for 2 h; group D(10-12 small groups), after fixation for 3 h in FAS, D1, and D2, the eyeball was divided into left and right halves along the optic nerve direction; group E(13-15 small groups), the cornea was cut after fixation for 3 h in FAS, D1, and D2. Hematoxylin-eosin(HE)staining was used to compare the fixation effect on posterior eyeball in each group.RESULTS: After fixation, the surface of the eyeballs in groups, 1-6 and 11-15 was smooth and round, with a transparent and bright color. In groups 7-10, the eyeballs were sunken, wrinkled, and deformed. The HE staining showed that the eyeball morphology of groups 1, 5, 6, 14, and 15 was significantly better than the other groups, with a regular internal tissue structure. The eyeballs of the other groups were sunken and wrinkled, and the internal tissue was curled and tangled, with severe retinal detachment. In groups 1, 5, 6, 14, and 15, the retina, choroid, and sclera tissues of group 14 were closely connected, without obvious retinal detachment, rupture, or curling. The tissue structure was clear and visible, and the cells were arranged neatly.CONCLUSION: The fixation effect of cutting the cornea after fixing guinea pig eyeball with D1 fixative for 3 h is the most ideal, and this operation method is simple and suitable for studying the related structures of the posterior pole of the eye.

Introduction: Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap—yet little research has explored this topic. The goal of the current study was to explore specialty‐specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1)why, how and when do doctors choose to pursue AP trainingand (2) what can be learned from this for recruitment to AP and other specialties? Methods: A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're‐storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP. Results: Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die‐hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non‐pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die‐hards made this decision during medical school. Conclusions: Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die‐hard, negotiator and migrant traits. Use of this framework could enhance current specialty‐specific recruitment approaches, particularly in fields challenged by workforce shortages. Want to know more about doctors' decision‐making processes when choosing a specialty? Check out this article! [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the most common neurodegenerative disease after Alzheimer's disease. PD causes degenerative changes in the cerebellum. It is known that the cerebellum does not have a symmetrical anatomy and some pathological disorders may cause asymmetric changes in the cerebellum. In this study, our aim is evaluate whether or not cases with PD show age and gender dependent cerebellar changes and cerebellar asymmetry comparing with healthy subjects. We also aimed to depict the probable cortical thickness differences in cases with PD by using a stereological technique. The study evaluated the volumetric assesment of each cortical cerebellar hemisphere and total cerebellum by applying a stereological technique on magnetic resonance images. The age and gender-matched study was composed of 47 adult cases with PD and 47 healthy subjets as control. In the PD group, right and left cerebellar hemisphere volume, total cerebellum volume, and cortical thickness of the right and left cerebellar hemispheres were significantly lower than the control group (p<0.01). Although there was significant cerebellar atrophy and asymmetry in PD cases with age between 40-71, the study showed no statistically significant cerebellar asymmetry in cases over 70 years of age. However, no significant difference was detected depending on gender. Our findings suggest that in PD, cerebellum's cortical thickness and volume decreases. The decrease in the volume and cortical thickness of the cerebellum increases with age, regardless of gender, compared to healthy individuals. However, this difference begins to close with age. [ABSTRACT FROM AUTHOR]

Purpose: Alagille syndrome (ALGS) is a multisystem autosomal dominant disorder with highly variable expression. Intracranial arterial and venous anomalies have a reported prevalence of 30–40% and can increase the risk of stroke by 16%. Few reports document the frequency and evolution of cerebrovascular abnormalities (CVAs) in children with ALGS. We aimed to define the spectrum, frequency, and evolution of CVAs in a series of children with ALGS using magnetic resonance angiography (MRA). Methods: We conducted a single-center, retrospective study in a large tertiary pediatric hospital. CVAs were grouped into 4 categories: 1) Stenosis or narrowing; 2) Aneurysms and ectasias; 3) Tortuosity; and 4) Vascular anomalies and anatomical variants. Results: Thirty-two children met the inclusion criteria. The median age at initial diagnosis was 6 (3.8–10.3) years. Thirteen (40%) had follow-up MRI at a mean of 55 (31.5–66) months. Eighteen (56%) had CVAs; the most frequent fell into group 1 (n = 12, 37.5%). CVAs were stable over time, except for one patient with Moyamoya arteriopathy (MMA). One patient developed a transient ischemic attack secondary to an embolic event. Three (9.3%) had microhemorrhages at the initial diagnosis secondary to Tetralogy of Fallot. Another patient had recurrent subdural hematomas of unknown cause. Conclusion: CVAs were stable except in the presence of MMA. Vascular strokes, which are reported in older patients with ALGS, were not a common feature in children under 16 years of age, either at presentation or over the 31.5–66 month follow-up period. [ABSTRACT FROM AUTHOR]

The intricate relationship between tubular injury and glomerular dysfunction in kidney diseases has been a subject of extensive research. While the impact of glomerular injury on downstream tubules has been well-studied, the reverse influence of tubular injury on the glomerulus remains less explored. This paper provides a comprehensive review of recent advances in the field, focusing on key pathways and players implicated in the pathogenesis of tubular injury on glomerular dysfunction. Anatomical and physiological evidence supports the possibility of crosstalk from the tubule to the glomerulus, whereby various mechanisms contribute to glomerular injury following tubular injury. These mechanisms include tubular backleak, dysfunctional tubuloglomerular feedback, capillary rarefaction, atubular glomeruli, and the secretion of factors from damaged tubular epithelial cells. Clinical evidence further supports the association between even mild or recovered acute kidney injury and an increased risk of chronic kidney disease, including glomerular diseases. We also discuss potential therapeutic interventions aimed at mitigating acute tubular injury, thereby reducing the detrimental effects on glomerular function. By unraveling the complex interplay from tubular injury to glomerular dysfunction, we aim to provide insights that can enhance clinical management strategies and improve outcomes for patients with kidney disease. [ABSTRACT FROM AUTHOR]

Background and Objectives: Anorectal and pharyngeal infections with Neisseria gonorrhoeae (NG) are common in men who have sex with men (MSM). However, they are often asymptomatic and found in the absence of reported risk behavior and concurrent genital infection. These serve as a hidden reservoir for ongoing transmission and may cause complications. Additionally, they drive the transmission of other sexually transmitted infections (STIs) including HIV and may contribute to the development of antimicrobial resistance. The current study was undertaken to study the anatomic site distribution of gonococcal infection in MSM as limited data are available from India. Materials and Methods: A total of 127 MSM patients attending the STI clinic Dermatology Outpatient Department of AIIMS were included in the study. A duplex polymerase chain reaction (PCR) targeting opa and porA psuedogene targets using in-house primers was standardized and used for testing. In addition, all samples were processed by conventional methods, i.e., microscopy and culture. Results: A total of 26 patients were found to be positive for NG by PCR with a prevalence rate of 20%. The prevalence rate for urethral, rectal, and pharyngeal gonorrhea was 8.7%, 9.4%, and 4.7% respectively. Out of the 26 positives, 15 patients, i.e., 57.7%, had only extragenital infections and none were positive at all three sites. On the other hand, only three patients were culture positive at the urethral site. Discussion: We would have missed approximately 60% of the infections if the testing was restricted to genital sites only. Conclusion: An expanded testing including extragenital sites for screening of gonococcal infection in MSM will have clinical and public health benefits. [ABSTRACT FROM AUTHOR]

Background: Pancreatic duct (PD) dilation could be presented in both benign and malignant diseases. Endoscopic ultrasonography (EUS) is a sensitive modality that provides both structural assessment and tissue sampling. This study aims to explore the importance of PD dilation as a potential indicator related to various pancreatobiliary pathologies identified via EUS. Methods: Among 3109 subjects who underwent EUS, 599 had evidence of dilated PD and met the inclusion criteria of this retrospective study. Also, the patients underwent EUS fine needle aspiration (EUS-FNA) to evaluate the etiology when required. All data were extracted from patients' medical records to perform statistical analysis. Results: The study sample revealed 64% being male with a median age was 65-years. Pancreatic adenocarcinoma was the most common etiology diagnosed in 236 patients (39.4%), followed by sphincter of Oddi dysfunction (SOD) in 13% of subjects. Ampullary carcinoma, common bile duct stone, and cholangiocarcinoma were found at 9.5%, 8.8%, and 6.8%, respectively. Abdominal pain was the most common symptom seen in 440 (73.4%) patients. Opium consumption was reported in 170 (28.4%) subjects. Opium consumption was significantly more prevalent in patients with SOD (P < 0.05). Conclusion: We suggest that PD dilation could be associated with a wide range of pancreaticobiliary pathologies, especially pancreatic neoplasms. In this regard, PD dilation should be considered as a crucial indicator of pancreatic neoplasm despite it may be associated with no clear etiologies. [ABSTRACT FROM AUTHOR]

Background: Augusto Bonome (1857–1922), professor at the University of Padua until 1922, was involved in a study about a particular kind of pulmonary leprosy, being the first to testify the lepromatous alterations also in the deepest parts of the respiratory tract, even though the same Gerhard Hansen (1841–1912) had denied the possibility that lungs could host Mycobacterium leprae. Objectives: It is necessary to reevaluate the research done by Bonome to also demonstrate how it can still be relevant today in further comprehension of leprosy. Methods: Bonome's advances in leprosy studies are testified by some specimens from the Morgagni Museum of Pathological Anatomy of the University of Padua. Among the specimens, there is a peculiar case of advanced tuberous leprosy in an adolescent, who died in 1908, of which the face, the larynx, the hands and genitals are still preserved today in the Museum. Results: Through autoptic and histological analysis of this specimen, Bonome succeeded in identifying a peculiar case of bone toxoid‐infectious dystrophy besides characteristic leprous laryngitis, which caused the death of the young leprosy patient. Conclusions: The results confirmed the innovative research carried on by Bonome during his medical career, being among the first to offer an important contribution to improving and revolutionary knowledge on leprosy which could still be useful today. [ABSTRACT FROM AUTHOR]

The thyroid in Graves' disease undergoes a considerable divergence in size and position from the normal anatomy. However, knowledge of the pathological anatomy related to the change, which is required before planned surgical or local intervention, or diagnosis, is neglected. To investigate Graves' disease, we established a model of mice that successfully mimicked all the signs presented in the clinic. Under a long-term immunization (35 weeks), the animals displayed large heterogeneity in thyroid size, such as the cases of natural occurrence. These thyroids in the model were sized into various phases and registered. A blend of the registered thyroids and the thyroid and tracheal cartilage landmarks led to the production of site-dependent incidence graphs of thyroid in the front view and on the section for each phase. The merger of the incidence graphs of all the phases resulted in thyroid phase-dependent topography. The depicted graphs illustrate the fine localization of the thyroid in various sizes and their dynamic changes during enlargement, which may facilitate currently used fine-needle aspiration biopsy and ultrasonography-guided biopsy techniques. Familiarity with this knowledge might avoid misclassifying an abnormality as normal, or vice versa, and be helpful for imaging diagnosis and local surgery therapy in Graves' disease. [ABSTRACT FROM AUTHOR]

Background: Coronary artery ectasia (CAE), while being considered a variant of atherosclerosis, harbors distinct features that significantly differ from atherosclerosis in terms of pathophysiological mechanisms. On the other hand, headache appears to be the most common side effect of nitrates that have been used traditionally for decades. In this context, we aimed to compare the frequency and temporal characteristics of nitrate-induced headache (NIH) between subjects with sole coronary artery disease (CAD) and subjects with CAD and coexisting CAE. Materials and Methods: Two hundred and forty-four patients who had undergone coronary angiogram (CAG) and received a single dose of sublingual isosorbide dinitrate during the procedure comprised in this retrospective study population. CAG is performed in the indications due to guidelines. All patients who had undergone CAG were held under close supervision, at least, for 6 h following CAG (and administration of sublingual nitrate); duration and emergence time of NIH were recorded for all patients. Of these 244 patients, 225 patients having sole CAD were assigned to Group I, whereas 19 patients having both CAD and CAE were assigned to Group II. Results: NIH was observed in 19 out of 225 patients (8%) with sole CAD and in 9 out of 19 patients (56%) with CAD and CAE (P = 0.003). The mean interval between the administration of sublingual isosorbide dinitrate and NIH onset was significantly lower in Group II in comparison to Group I (44 ± 14 min vs. 87 ± 63 min, respectively, P = 0.018). However, the duration of NIH was comparable between the two groups (Group I: 203 ± 53 min vs. Group II: 173 ± 61 min, P = 0.24); logistic regression analysis revealed an independent association between NIH and CAE (odds ratio: 11.5, 95% confidential interval: 3.9–33.8, P < 0.001). Conclusion: We have demonstrated that sublingual nitrates might induce NIH more frequently in subjects with CAE and CAD in comparison to those with sole CAD. Furthermore, NIH has been demonstrated to be independently associated with CAE. [ABSTRACT FROM AUTHOR]

Pulsatile tinnitus is a rhythmic type of tinnitus. Most cases are caused by vascular disorders and present as synchronous with the patient's heartbeat. A dilated mastoid emissary vein may cause pulsatile tinnitus. Here, we report the first case of bilateral pulsatile tinnitus caused by dilated bilateral mastoid emissary vein. The patient suffered from bilateral pulsatile tinnitus for 2 years. His bilateral tinnitus disappeared temporarily when the bilateral mastoid processes were compressed. Temporal bone computed tomographic (CT) showed the bilateral dilated mastoid emissary canals. Cranial Magnetic resonance venograms (MRV) showed the bilateral dilated mastoid emissary veins. We explained the risk of surgery to the patient. Because the patient could tolerate his tinnitus and did not have a hemangioma or tumor, he did not choose to undergo surgery. [ABSTRACT FROM AUTHOR]

* Context.--To provide high-quality, safe training during the COVID-19 pandemic, our anatomic pathology fellowship program implemented a hybrid virtual/in-person training model with supplemental digital material. Objective.--To evaluate the impact of this model. Design.--We examined Accreditation Council for Graduate Medical Education survey results and board pass rates for fellows before the pandemic (group 1); during the pandemic peak (group 2); and early and late after the pandemic peak (groups 3 and 4). Additionally, we distributed an online survey, including questions related to performance as attending physicians and fellowship experience, to recent graduates. Results.--Information loss during handover, supervision and teaching by faculty, and having at least 4 free days a month exhibited the greatest score declines between group 1 and groups 2, 3, and 4 on the Accreditation Council for Graduate Medical Education surveys. No differences were seen in board passing rates between groups. The groups did not differ in responses regarding preparation for role as attending, confidence in role as attending, or overall impression of the fellowship program. The pandemic-affected groups responded more positively on the perceived utility of supplemental digital material, impact of digital pathology on quality of education, and impact of supplemental digital material on familiarity with digital pathology. The difference was particularly large between group 1 and combined groups 3 and 4. Conclusions.--Despite the limitations noted, the hybrid training model was effective and successfully prepared fellows for their role as attending physicians. Similar studies can be informative for the implementation of similar programs or for the meaningful integration of digital pathology into training curricula. [ABSTRACT FROM AUTHOR]

Objective: The videolaryngostroboscopy parameters form (VLSP form) is a diagnostic tool for the collection of videolaryngostroboscopic basic findings through the evaluation of 12 parameters. The aim of the present study is to preliminarily investigate intra- and inter-rater reliability, validity and responsiveness of the VLSP form. Methods: A study on a total amount of 160 forms for the evaluation of VLS basic findings was carried out. 80 forms were scored through the VLSP form and 80 with the Voice Vibratory Assessment with Laryngeal Imaging (VALI) form Stroboscopy (S) by four expert phoniatricians, that blindly scored the VLS recordings of 5 subjects without voice disorders and 5 patients with organic voice disorder before and after successful phonosurgery. Intra-rater and inter-rater analysis have been performed for both forms. The scores obtained through VLSP form and VALI form S have been compared to analyse concurrent validity, while VLSP scores before and after phonosurgery have been compared to analyse responsiveness. Finally, each rater annotated the "difficulty" in rating every parameter and its "importance" for the diagnosis. Results: The VLSP form showed good inter- and intra-rater reliability. It showed a good accuracy for the documentation of changes of laryngeal anatomy and function after phonosurgery, similarly to the VALI form S. The 12 parameters of the VLSP form were judged "Slightly Important" in 28.3% of the samples, "Very Important" in 64.8% of the samples, "Not Difficult" in 73.1% of the samples. Conclusions: The results of the present study suggest that the VLSP form is comparable to the VALI form S for the evaluation of videolaryngostroboscopic parameters and is a valid, reliable and reproducible diagnostic tool. It can help voice clinicians in the evaluation of VLS examinations and it allows for a punctual assessment of modifications in laryngeal anatomy and function in pathological conditions and after phonosurgery. [ABSTRACT FROM AUTHOR]

Objective: To summarize the scientific evidence on the prevalence of maxillary sinus hypoplasia (MSH) and associated anatomical variations as assessed by computed tomography scans. Study design: This PROSPERO-registered systematic review followed the recommendations of the PRISMA guidelines. Search algorithms were constructed for each of the six databases and gray literature. After screening the references (Rayyan®), the extracted data were meta-analyzed according to a random-effects model. The joanna briggs critical appraisal tool assessed the methodological quality of the included studies. The GRADE approach was used to estimate the certainty of the evidence. Results: From a total of 2781 studies screened, 22 were considered for four meta-analysis. The prevalence of MSH in 7358 patients was 5.65% (CI95% = 4.07–7.47%) with significant heterogeneity between studies (p < 0.001, I2 = 89.30%). MSH was identified in 295 patients, of whom 82.38% (CI95% = 75.82–88.09%) had unilateral hypoplasia and 17.62% (CI95% = 11.91–24.18%) bilateral hypoplasia with moderate heterogeneity between studies (p < 0.0503, I2 = 42.87%). The prevalence of MSH in 9998 maxillary sinuses was 3.77% (95% CI = 2.44–5.38%), with significant heterogeneity between studies (p < 0.001, I2 = 92.84%). Hypoplastic/aplastic uncinate process, concha bullosa and paradoxical concha were the most reported anatomical variations. The studies presented a low-moderate methodological quality. The certainty of the evidence was very low to moderate. Conclusion: The prevalence of maxillary sinus hypoplasia observed was 5.65%, with most cases being unilateral. [ABSTRACT FROM AUTHOR]

This article discusses the case of a patient with melanoma-associated leptomeningeal disease (LMD) who was successfully treated with concurrent intrathecal (IT) nivolumab and targeted therapy (TT). LMD is a challenging condition associated with poor prognosis, and treatment options have been limited. However, recent data suggests that IT injection of anti-PD1 antibodies, such as nivolumab, may be a promising approach. In this case, the patient showed a clinical and radiological response to the treatment, with relief of neurological symptoms and no disease progression. This approach may offer a potential alternative for patients with LMD. [Extracted from the article]

Introduction: Retrorectal tumors constitute a rare and heterogeneous group of neoplasms, which are characterized by being located in the so-called retrorectal space. In most cases these are benign lesions. The main imaging test for its characterization and planning its therapy is magnetic resonance imaging. Surgery is generally the treatment of choice, often without preoperative anatomopathological studies, given the potential risk of malignancy of these tumors and the appearance of compressive symptoms during the course. Clinical case: The clinical case of a 34-year-old patient is reported, who consulted for a history of pain in the dorso-lumbar region of months of evolution, accompanied by rectal pain. Magnetic resonance imaging of the abdomen and pelvis was requested, which revealed a retrorectal tumor with imaging characteristics suggestive of teratoma. The resolution was a surgical procedure through a perineal approach, with the diagnosis being confirmed by deferred pathological anatomy. Conclusion: Retrorectal tumors are rare lesions in adults that represent a diagnostic and therapeutic challenge. The surgical approach depends above all on the tumor size and the relationship with the S3 sacral vertebra. In the case presented, a mature retrorectal teratoma, the perineal approach is a valid therapeutic option that allowed correct exposure and tumor resection. [ABSTRACT FROM AUTHOR]

Breast cancer is the most diagnosed cancer worldwide and represents the fifth cause of cancer mortality globally. It is a highly heterogeneous disease, that comprises various molecular subtypes, often diagnosed by immunohistochemistry. This technique is widely employed in basic, translational and pathological anatomy research, where it can support the oncological diagnosis, therapeutic decisions and biomarker discovery. Nevertheless, its evaluation is often qualitative, raising the need for accurate quantitation methodologies. We present the software BreastAnalyser, a valuable and reliable tool to automatically measure the area of 3,3'-diaminobenzidine tetrahydrocholoride (DAB)-brown-stained proteins detected by immunohistochemistry. BreastAnalyser also automatically counts cell nuclei and classifies them according to their DAB-brown-staining level. This is performed using sophisticated segmentation algorithms that consider intrinsic image variability and save image normalization time. BreastAnalyser has a clean, friendly and intuitive interface that allows to supervise the quantitations performed by the user, to annotate images and to unify the experts' criteria. BreastAnalyser was validated in representative human breast cancer immunohistochemistry images detecting various antigens. According to the automatic processing, the DAB-brown area was almost perfectly recognized, being the average difference between true and computer DAB-brown percentage lower than 0.7 points for all sets. The detection of nuclei allowed proper cell density relativization of the brown signal for comparison purposes between the different patients. BreastAnalyser obtained a score of 85.5 using the system usability scale questionnaire, which means that the tool is perceived as excellent by the experts. In the biomedical context, the connexin43 (Cx43) protein was found to be significantly downregulated in human core needle invasive breast cancer samples when compared to normal breast, with a trend to decrease as the subtype malignancy increased. Higher Cx43 protein levels were significantly associated to lower cancer recurrence risk in Oncotype DX-tested luminal B HER2- breast cancer tissues. BreastAnalyser and the annotated images are publically available https://citius.usc.es/transferencia/software/breastanalyser for research purposes. [ABSTRACT FROM AUTHOR]

Breast cancer is the most diagnosed cancer worldwide and represents the fifth cause of cancer mortality globally. It is a highly heterogeneous disease, that comprises various molecular subtypes, often diagnosed by immunohistochemistry. This technique is widely employed in basic, translational and pathological anatomy research, where it can support the oncological diagnosis, therapeutic decisions and biomarker discovery. Nevertheless, its evaluation is often qualitative, raising the need for accurate quantitation methodologies. We present the software BreastAnalyser, a valuable and reliable tool to automatically measure the area of 3,3'-diaminobenzidine tetrahydrocholoride (DAB)-brown-stained proteins detected by immunohistochemistry. BreastAnalyser also automatically counts cell nuclei and classifies them according to their DAB-brown-staining level. This is performed using sophisticated segmentation algorithms that consider intrinsic image variability and save image normalization time. BreastAnalyser has a clean, friendly and intuitive interface that allows to supervise the quantitations performed by the user, to annotate images and to unify the experts' criteria. BreastAnalyser was validated in representative human breast cancer immunohistochemistry images detecting various antigens. According to the automatic processing, the DAB-brown area was almost perfectly recognized, being the average difference between true and computer DAB-brown percentage lower than 0.7 points for all sets. The detection of nuclei allowed proper cell density relativization of the brown signal for comparison purposes between the different patients. BreastAnalyser obtained a score of 85.5 using the system usability scale questionnaire, which means that the tool is perceived as excellent by the experts. In the biomedical context, the connexin43 (Cx43) protein was found to be significantly downregulated in human core needle invasive breast cancer samples when compared to normal breast, with a trend to decrease as the subtype malignancy increased. Higher Cx43 protein levels were significantly associated to lower cancer recurrence risk in Oncotype DX-tested luminal B HER2- breast cancer tissues. BreastAnalyser and the annotated images are publically available https://citius.usc.es/transferencia/software/breastanalyser for research purposes. [ABSTRACT FROM AUTHOR]

Introduction: Aberrant right subclavian artery (ARSA) is the most common of the aortic arch anomalies, occurring in.5% to 1% of the population. There is no standardized follow up protocol, especially in the asymptomatic cases. The purpose of the present study was to evaluate the natural history of ARSA and the role of serial CT scans. Methods: This is a single-center retrospective study of patients with ARSA depicted on chest computed tomography (CT) scans between February 2013 and July 2022. Data were collected from their medical records. Measurements of the aorta at different segments including the aortic diameter at the orifice of ARSA, and ARSA at ostium followed by 1 cm intervals were collected, as well as for follow-up CT scans. Results: 65 patients were diagnosed with ARSA, 70.8% of whom were women. The average age for the cohort was 58.569 ± 16.99 years. The median follow up time was 4 years (range 0-10 years), KM estimated survival after ARSA diagnosis at 1 and 5 years as 97% and 93%, respectively. Nineteen patients had a second CT scan and were included in the morphological CT dynamic analysis, on average of 29 ± 27 months apart (range 7-108). The mean ARSA diameter at origin was larger in the second scan 16.91 ± 4.31 mm compared to the initial scan 16.31 ± 4.96 mm, (P =.04).The mean aortic arch diameter in the first and second CT were 28.54 ± 4.24 and 29.64 ± 5.14 (P =.10), respectively. All other measurements did not disclose any significant enlargement over time. Conclusions: Our cohort demonstrate a benign natural history of ARSA with slow growth rates. However, due to our small sample size we can't draw a clinically sound recommendation on the need for imaging follow up, and further larger cohort with longer follow up interval are required. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) may show a variety of scrotal and penile pathologic finding, but is usually not used as a first-line imaging due to its limited soft tissue contrast. Nonetheless, there are three main scenarios for imaging of the scrotum and penis with CT. Pathologies may be found incidentally in patients undergoing abdominal and pelvic CT scanning for different reasons. In emergency settings, CT is frequently performed, and the recognition of scrotal and penile pathologies by the reporting radiologist is crucial to ensure optimal patient treatment and outcome. If MRI scanning cannot be performed due to contraindications or is unavailable in resource, limited CT may be used for the further characterization of scrotal and penile pathology found on ultrasound. This pictorial review wants to familiarize general and emergency radiologists with the anatomy and possible pathological findings of the scrotum and penis on CT. [ABSTRACT FROM AUTHOR]

Aims Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes. Methods and results Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707). Conclusion Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD. [ABSTRACT FROM AUTHOR]

Long-term follow-up after surgical correction of patients with radial polydactyly might reveal unexpected or undesired outcomes that are accentuated by growth. It should be stressed that assessment of outcomes differs considerably by the system used. Preoperative examination can elucidate the underlying pathological anatomy of these anomalies and consequently, these anatomical differences should be corrected as much as possible during the first operation to prevent worse outcomes at long-term follow-up. In various long-term studies, the reoperation rate was in the range of 7%–28%, with the most common reasons being deviation, instability, nail deformity and suboptimal appearance. Most unfavourable results occur during growth and are frequently revealed only at longer-term follow-up. Concentration of care to a few centres is advised since these malformations occur in small numbers and experienced surgeons tend to have better results. Consensus on the used assessment system and multicentred studies are essential in future to better understand how we can prevent reoperations. [ABSTRACT FROM AUTHOR]

The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed. [ABSTRACT FROM AUTHOR]

Absent pulmonary valve syndrome (APVS) is a rare congenital anomaly characterized by rudimentary PV tissue with variable degrees of PV stenosis and regurgitant pulmonary blood flow. In most cases, it is associated with tetralogy of Fallot. In a minority of APVS cases, with an unknown frequency, intact ventricular septum (IVS), patent ductus arteriosus, and possible tricuspid atresia are present. This condition is known as non-Fallot type APVS. We describe a case of an antenatal diagnosis of APVS with IVS, a large patent ductus arteriosus, and ascending aorta dilatation. The mother was referred to our center at 32 weeks of gestation due to cardiomegaly on sonography. Fetal echocardiography revealed cardiomegaly, right atrial and ventricular enlargement, aneurysmal dilatation of the main pulmonary artery, and mild dilatation of the pulmonary artery branches. Also observed were IVS, rudimentary PV tissue with severe to-and-fro turbulence across the PV, a widely open ductus arteriosus, ascending aorta dilatation, and levorotation of the heart. After childbirth, our diagnosis was confirmed by echocardiography and surgery. The baby experienced severe respiratory distress. At 15 days of life, surgical intervention in the form of pulmonary artery arterioplasty was performed, resulting in good outcomes. The patient underwent follow-up for 6 months and showed reasonable health. [ABSTRACT FROM AUTHOR]

This article presents a case study of a rare and aggressive neoplastic disease called primary diffuse leptomeningeal melanomatosis (PDLM) in a pediatric patient. The patient exhibited nonspecific symptoms and imaging studies revealed inflammation in the brain. The diagnosis was confirmed through a biopsy, although no pigmented areas were observed during surgery. Unfortunately, the patient's condition was advanced and palliative care was provided. The article emphasizes the challenges in diagnosing PDLM and the lack of curative treatment options, highlighting the need for further research to improve therapeutic options and prolong survival. [Extracted from the article]

Radical sternectomy with sternal reconstruction using synthetic mesh or titanium plates has been described before with excellent results. However, radical removal of the sternum without reconstruction is a rare surgical treatment for complicated deep sternal wound infections (DSWI). The long-term outcome following this radical operation is not well-known due to the limited number of cases in the literature. We report on a patient 10 years after a radical sternectomy for DSWI who presented with shortness of breath. We highlight some of the anatomical and physiological changes the chest cavity may undergo and the fact that this patient had a near normal quality of life in the 10 years following the sternectomy. [ABSTRACT FROM AUTHOR]

Background Pericoronary adipose tissue (PCAT) may influence plaque development through inflammatory mechanisms. We assessed PCAT density, as a measure of pericoronary inflammation, in relationship to coronary plaque among people with human immunodeficiency virus (HIV [PWH]) and to a matched control population. Methods In this baseline analysis of 727 participants of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Mechanistic Substudy, we related computed tomography–derived PCAT density to presence and extent (Leaman score) of coronary artery disease (CAD), noncalcified plaque, coronary artery calcium (CAC), and vulnerable plaque features using multivariable logistic regression analyses. We further compared the PCAT density between PWH and age, sex, body mass index, CAC score, and statin use–matched controls from the community-based Framingham Heart Study (N = 464), adjusting for relevant clinical covariates. Results Among 727 REPRIEVE participants (age 50.8 ± 5.8 years; 83.6% [608/727] male), PCAT density was higher in those with (vs without) coronary plaque, noncalcified plaque, CAC >0, vulnerable plaque, and high CAD burden (Leaman score >5) (P <.001 for each comparison). PCAT density related to prevalent coronary plaque (adjusted odds ratio [per 10 HU]: 1.44; 95% confidence interval, 1.22–1.70; P <.001), adjusted for clinical cardiovascular risk factors, body mass index, and systemic immune/inflammatory biomarkers. Similarly, PCAT density related to CAC >0, noncalcified plaque, vulnerable plaque, and Leaman score >5 (all P ≤.002). PCAT density was greater among REPRIEVE participants versus Framingham Heart Study (−88.2 ± 0.5 HU versus −90.6 ± 0.4 HU; P <.001). Conclusions Among PWH in REPRIEVE, a large primary cardiovascular disease prevention cohort, increased PCAT density independently associated with prevalence and severity of coronary plaque, linking increased coronary inflammation to CAD in PWH. [ABSTRACT FROM AUTHOR]

Background: Mucoepidermoid carcinoma starts in the salivary glands and accounts for 5%-10% of all salivary gland tumours. Its intraosseous occurrence is rare and only accounts for 2%-3% of all mucoepidermoid carcinomas. This neoplasm often follows a long and indolent course. Also, given its ambiguous presentation and similarities to other dental pathologies, it often has a late diagnosis. In this instance, we present the case of a patient with an asymptomatic mandibular lesion, who underwent mandibular resection and reconstruction with fibula free flap. Case report: A 32-year-old male patient reported discomfort when chewing, which was attributable to a self-detected mass localised in proximity to teeth 47 and 48. The lesion presented as a slight swelling without clear expression in the oral cavity mucosa. The rest of the physical examination revealed no abnormalities. Both the panoramic radiograph and computed tomography of the maxillary bones revealed lytic lesions in proximity to teeth 47 and 48, close to the mandibular angle. An incisional biopsy was performed, for which the pathological anatomy showed low-grade mucoepidermoid carcinoma. A resection was then performed, which involved a right hemimandibulectomy with ipsilateral cervical lymphadenectomy. The reconstruction was performed with a right fibulafree flap. Upon histological evaluation of the surgical specimen, an intermediate-grade mucoepidermoid carcinoma was found. The patient presented good post-operative evolution. Following a multidisciplinary assessment, the use of adjuvant radiation therapy was deemed necessary. The patient currently presents good evolution and has regular check-ups. Conclusion: Intraosseous mucoepidermoid carcinoma is a rare salivary gland tumour. Given its low frequency, there are no studies that accurately describe its biological behaviour and prognosis. [ABSTRACT FROM AUTHOR]

During catheter ablation (CA) of tachycardia, conventional point‐by‐point mapping may be hindered due to hemodynamic instability. We performed open‐window mapping (CARTO, Biosense Webster, USA) in a patient who developed hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT) and unwarranted induction of AVRT during attempts to map accessory pathway (AP) with ventricular pacing. With over 11,000 points acquired rapidly, the system accurately identified AP at the mitral valve (MV) annulus where the application of single radiofrequency (RF) lesion promptly eliminated AP's conduction. Our case illustrates the utility of open‐window mapping for the ablation of AVRT. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses articles within the issue on topics including application of diagnostic immunohistochemistry (IHC) in undifferentiated neoplasm/tumor of uncertain primary site on fine-needle aspiration, IHC markers for salivary glands, and IHC markers in the diagnosis and differential diagnosis of both benign and neoplastic lesions in genitourinary organs.

This paper describes the scientific practices of the anatomists from the Société Anatomique de Paris (1803–1873) who were collecting anatomical and pathological specimens in Nineteenth-Century Paris and which led to the building of the anatomy and pathology Musée Dupuytren (1835–2016). The framework introduced by Robert Kohler to describe collecting sciences (2007) is useful as a tool to identify the set of diverse practices within pathological anatomy in nineteenth-century Paris. However, I will argue that anatomy and pathology collecting had specific features compared to most collecting sciences. Two main collecting practices could be distinguished: first, "finding" anatomical specimens and second, keeping these specimens. The first kind of practices were at least rhetorically and explicitly motivated by Auguste Comte's positive philosophy. But "finding" an anatomy or pathology specimen could not be completely compared to finding an object or making a simple observation, as dissecting as well as some experimental practices were also involved. Heterogeneous practices thus coexisted within collecting in anatomy and pathology. Epistemological as well as pragmatic tensions arose. On top of Kohler's framework, I introduce Sabina Leonelli's concept of "data journey" to offer a narrative of the diversity of collecting practices involved in the Société Anatomique de Paris and the Musée Dupuytren. I use the concept to analyse how this diversity of practices impacted knowledge production. [ABSTRACT FROM AUTHOR]

Coronary plaque stability is a key pathological mechanism of coronary heart disease (CHD). Inflammation is recognized as a key factor of coronary plaque stability. The dietary inflammatory index (DII) is calculated from 21 dietary nutrients to predict the inflammation potential of an individual's diet. We hypothesized that high DII may be associated with decreased coronary plaque stability in CHD patients; therefore, this study aimed to evaluate the association between DII and plaque stability in patients with CHD. This cross-sectional study included 314 patients with CHD. DII was calculated based on food frequency questionnaires. Plaque stability was measured with optical coherence tomography. The DII ranged from –1.41 to 3.04. After adjusting for confounding factors, higher DII scores were associated with unstable plaque characteristics including thin-capped fibroatheroma (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.78–7.29), macrophage infiltration (OR, 2.16; 95% CI, 1.01–4.61), and plaque rupture (OR, 3.55; 95% CI, 1.73–7.29). Mediation analyses revealed that DII was important mediator of the relationship between plaque stability and food intake including soybeans and nuts, fish and shrimp, eggs (P <.05). The present study confirmed that higher DII is significantly associated with decreased plaque stability in CHD patients, suggesting an important protective role of anti-inflammatory diets in the pathogenesis of CHD. High dietary inflammatory index (DII) is significantly associated with decreased plaque stability in coronary heart disease (CHD) patients, suggesting that a pro-inflammatory diet increases systemic inflammation, which leads to unstable plaque progression. It is suggested that patients with CHD should change their dietary structure and increase their anti-inflammatory diet intake to delay the development of CHD. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Herein, we present a rare case of the successful ablation of an accessory pathway (AP) involving the Marshall Bundle (MB) and coronary sinus musculature (CSM) in a 40‐year‐old man with Wolff−Parkinson−White syndrome. Methods and Results: An orthodromic reciprocating tachycardia (ORT) was inducible with the earliest atrial activation site located at the posterolateral mitral annulus. The local conduction and the cycle length of ORT was prolonged by peri‐mitral ablation; however, it failed to block the AP. The atrial insertion of the AP was identified by remapping during ORT at the left atrial ridge, which was away from the mitral annulus, where ablation was successful. Together with the electrophysiological findings in CSM potentials, we conclude that the epicardial MB‐CSM connection functioned as the AP in this patient. Conclusion: The novel variant form of AP comprised of MB and CSM should be noted. The atrial insertion of the MB may be the target of catheter ablation. [ABSTRACT FROM AUTHOR]

The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by "bumping" during right‐heart catheterization. In the era of cardiac electrophysiology, catheter‐induced RBB block (CI‐RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre‐existing RBBB, the transient nature of CI‐RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI‐RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self‐limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI‐RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His‐Purkinje‐System, such as fasciculo‐ventricular pathways, bundle branch reentry, and right‐Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI‐RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates. [ABSTRACT FROM AUTHOR]

Objective: We investigated the anatomical and dental factors associated with unilateral maxillary sinus fungal ball (MSFB). Also, we evaluated the effect of combinations of those factors on the incidence of MSFB. Methods: Three hundred patients were divided into MSFB, normal, and chronic rhinosinusitis (CRS) groups. We reviewed paranasal computed tomography scans for the presence of deviated nasal septum, concha bullosa (CB), Haller cells, and various dental factors. Also, we measured the ethmoid infundibulum, maxillary natural ostium, and CB. Results: Maxillary sinus fungal ball showed a more significant association with CB compared to the other 2 groups (37%, P <.05). The MSFB group had a lower rate of Haller cells than the normal group (10% vs 22%, respectively; P <.05). Also, the MSFB group had a wider maxillary sinus ostium than the normal group (7.07 ± 1.8 vs 5.48 ± 1.3 mm; P <.01). Moreover, the combination of CB and Haller cells was significantly associated with a decreased rate of the fungal ball (P =.047, odds ratio = 0.694). The dental factors were more prevalent in the MSFB and CRS groups (73% and 75%, respectively) than in the normal group (32%, P <.001). Conclusions: Maxillary sinus fungal ball is significantly associated with CB, Haller cells, an increased maxillary sinus ostium size, and dental factors. [ABSTRACT FROM AUTHOR]