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Tidal marshes play a globally critical role in carbon and hydrologic cycles by sequestering carbon dioxide from the atmosphere and exporting dissolved organic carbon to connected estuaries. These ecosystems provide critical habitat to a variety of fauna and also reduce coastal flood impacts. Accurate characterization of tidal marsh inundation dynamics is crucial for understanding these processes and ecosystem services. In this study, we developed remote sensing-based inundation classifications over a range of tidal stages for marshes of the Mid-Atlantic and Gulf of Mexico regions of the United States. Inundation products were derived from C-band and L-band synthetic aperture radar (SAR) imagery using backscatter thresholding and temporal change detection approaches. Inundation products were validated with in situ water level observations and radiometric modeling. The Michigan Microwave Canopy Scattering (MIMICS) radiometric model was used to simulate radar backscatter response for tidal marshes across a range of vegetation parameterizations and simulated hydrologic states. Our findings demonstrate that inundation classifications based on L-band SAR—developed using backscatter thresholding applied to single-date imagery—were comparable in accuracy to the best performing C-band SAR inundation classifications that required change detection approaches applied to time-series imagery (90.0% vs. 88.8% accuracy, respectively). L-band SAR backscatter threshold inundation products were also compared to polarimetric decompositions from quad-polarimetric Phased Array L-band Synthetic Aperture Radar 2 (PALSAR-2) and L-band Uninhabited Aerial Vehicle Synthetic Aperture Radar (UAVSAR) imagery. Polarimetric decomposition analysis showed a relative shift from volume and single-bounce scattering to double-bounce scattering in response to increasing tidal stage and associated increases in classified inundated area. MIMICS modeling similarly showed a relative shift to double-bounce scattering and a decrease in total backscatter in response to inundation. These findings have relevance to the upcoming NASA-ISRO Synthetic Aperture Radar (NISAR) mission, as threshold-based classifications of wetland inundation dynamics will be employed to verify that NISAR datasets satisfy associated mission science requirements to map wetland inundation with classification accuracies better than 80% at 1 hectare spatial scales. [ABSTRACT FROM AUTHOR]

Lymphovascular space invasion (LVSI) is an important prognostic parameter in endometrial carcinoma (EC) and has gained increasing interest in recent years due to an expanding body of evidence of its independent prognostic value, especially when the presence of LVSI is quantified. A key strength of LVSI as a prognostic factor is that it can be detected on routine microscopic examination, without ancillary tests, and thus can be used in low‐resource settings. A weakness, however, is the lack of uniformly applied criteria for assessment and quantification of LVSI, resulting in interobserver variation in diagnosis. This is confounded by artefacts and other morphological features that may mimic LVSI (commonly referred to as pseudo‐LVSI). Despite these issues, multiple studies have shown that LVSI is strongly associated with lymph node (LN) metastasis and is an independent risk factor for LN recurrence and distant metastasis. Consequently, the presence of substantial/extensive LVSI has become an important consideration in formulating adjuvant treatment recommendations in patients with EC, and this has been incorporated in the recent International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system. Herein, we review the current literature on LVSI in EC and discuss its role as a prognostic marker, the reproducibility of LVSI assessment and distinction between LVSI and its mimics. We provide illustrations of key diagnostic features and discuss the two‐tiered (none/focal versus substantial) system of LVSI classification. This work is intended to provide guidance to practising pathologists and unify the approach towards LVSI assessment in EC. [ABSTRACT FROM AUTHOR]

An alarming increase in hypertension is a hazard to global health that poses severe implications for the body’s vital organs. To prevent serious repercussions, hypertension should be monitored continuously for early detection. It is well known that physiological signals, such as the photoplethysmogram (PPG) and electrocardiogram (ECG), carry essential information about the vitals of the human body. Considering this, numerous machine learning-based models based on ECG-PPG have been proposed for monitoring hypertension; however, such models are “non-explainable” and lack clinical interpretation. This work proposes a formal method-based runtime verification approach for hypertension monitoring using ECG and PPG sensing, which is explainable. The pulse arrival time (PAT) feature extracted using both signals is employed to implement a decision tree to infer hypertension patterns/policies defined in PAT, based on which a runtime monitor is synthesized to classify hypertension. Using the MIMIC II dataset, the proposed scheme’s performance is assessed, and the accuracy, sensitivity, and specificity are determined to be 95.7%, 93.9%, and 97.6%, respectively. [ABSTRACT FROM AUTHOR]

With the increasing use of next generation sequencing in soft tissue pathology, particularly in neoplasms not fitting any World Health Organization (WHO) category, the spectrum of EWSR1 fusion-associated soft tissue neoplasms has been expanding significantly. Although recurrent EWSR1::ATF1 fusions were initially limited to a triad of mesenchymal neoplasms including clear cell sarcoma of soft tissue, angiomatoid fibrous histiocytoma and malignant gastrointestinal neuroectodermal tumor (MGNET), this family has been expanding. We herein describe 4 unclassified extra-abdominal soft tissue (n = 3) and bone (n = 1) neoplasms displaying epithelioid and round cell morphology and carrying an EWSR1::ATF1 fusion. Affected were 3 males and 1 female aged 20–56 years. All primary tumors were extra-abdominal and deep-seated (chest wall, mediastinum, deltoid, and parapharyngeal soft tissue). Their size ranged 4.4–7.5 cm (median, 6.2). One patient presented with constitutional symptoms. Surgery with (2) or without (1) neo/adjuvant therapy was the treatment. At last follow-up (8–21 months), 2 patients developed progressive disease (1 recurrence; 1 distant metastasis). The immunophenotype of these tumors is potentially misleading with variable expression of EMA (2 of 3), pankeratin (2 of 4), synaptophysin (2 of 3), MUC4 (1 of 3), and ALK (1 of 3). All tumors were negative for S100 and SOX10. These observations point to the existence of heretofore under-recognized group of epithelioid and round cell neoplasms of soft tissue and bone, driven by EWSR1::ATF1 fusions, but distinct from established EWSR1::ATF1-associated soft tissue entities. Their overall morphology and immunophenotype recapitulate that of the emerging EWSR1/FUS::CREB fusion associated intra-abdominal epithelioid/round cell neoplasms. Our cases point to a potentially aggressive clinical behavior. Recognizing this tumor type is mandatory to delineate any inherent biological and/or therapeutic distinctness from other, better-known sarcomas in the differential diagnosis including sclerosing epithelioid fibrosarcoma. [ABSTRACT FROM AUTHOR]

Imaging evaluation for lower extremity infections can be complicated, especially in the setting of underlying conditions and with atypical infections. Predisposing conditions are discussed, including diabetes mellitus, peripheral arterial disease, neuropathic arthropathy, and intravenous drug abuse, as well as differentiating features of infectious versus non-infectious disease. Atypical infections such as viral, mycobacterial, fungal, and parasitic infections and their imaging features are also reviewed. Potential mimics of lower extremity infection including chronic nonbacterial osteomyelitis, foreign body granuloma, gout, inflammatory arthropathies, lymphedema, and Morel-Lavallée lesions, and their differentiating features are also explored.

Objectives: Meningiomas are the most common non-glial central nervous system (CNS) tumors, typically presenting as well-defined extra-axial masses with distinct computed tomography (CT) and magnetic resonance imaging (MRI) features. Despite their characteristic appearance, some meningiomas exhibit atypical features that can be diagnostically challenging. This study aims to analyze the imaging findings of meningiomas in a series of 82 cases, covering both common and uncommon locations, and exploring their typical as well as atypical/malignant features. Material and Methods: A retrospective review was conducted on 82 patients with pathologically confirmed meningiomas who underwent both CT and diffusion-weighted MRI (1.5 T) at our institution. The imaging data were analyzed to assess various parameters, including age incidence, sex distribution, tumor location, T1- and T2-weighted sequences, contrast enhancement patterns, and the presence of calcifications, cysts, peritumoral edema, hemorrhage, and magnetic resonance spectroscopy findings. Results: The analysis revealed a spectrum of imaging characteristics across the 82 meningioma cases. While many tumors exhibited typical imaging features, such as well-circumscribed margins and homogeneous contrast enhancement, others presented with atypical or malignant features, including heterogeneous signal intensity, irregular borders, and evidence of invasion into adjacent structures. The study also identified a range of tumor locations, with both common (e.g., convexity and parasagittal) and uncommon (e.g., intraventricular and skull base) sites represented. Peritumoral edema, calcifications, cystic changes, and hemorrhage were noted in varying frequencies across the cases, providing insights into the diverse radiological presentations of meningiomas. Conclusion: Meningiomas are the most common non-glial primary neoplasms of the CNS, and their diagnosis is generally straightforward when located in typical regions with characteristic imaging features. However, it is crucial for radiologists to recognize that meningiomas can present in atypical locations and with misleading or atypical imaging characteristics. A broad understanding of these variations is essential for accurate diagnosis and appropriate management of meningiomas, especially in cases where the imaging findings are not straightforward. [ABSTRACT FROM AUTHOR]

Imaging evaluation for lower extremity infections can be complicated, especially in the setting of underlying conditions and with atypical infections. Predisposing conditions are discussed, including diabetes mellitus, peripheral arterial disease, neuropathic arthropathy, and intravenous drug abuse, as well as differentiating features of infectious versus non-infectious disease. Atypical infections such as viral, mycobacterial, fungal, and parasitic infections and their imaging features are also reviewed. Potential mimics of lower extremity infection including chronic nonbacterial osteomyelitis, foreign body granuloma, gout, inflammatory arthropathies, lymphedema, and Morel-Lavallée lesions, and their differentiating features are also explored. [ABSTRACT FROM AUTHOR]

Objective: Three‐dimensional (3D) reconstructed models have been shown to improve visualization in complex female pelvic tumors. Cinematic rendering (CR) is a 3D imaging technique for computed tomography (CT) images, which creates more realistic images with the ability to enhance imaging of anatomical features for diagnosis. This study was set up to compare two types of 3D models and to validate the use of 3D anatomical techniques for the diagnosis of complex female pelvic tumors. Methods: The preclinical, randomized, two‐sequence crossover investigation was performed from December 2022 to January 2023 at First Affiliated Hospital of Chongqing Medical University. Sixteen residents and 10 attending surgeons assessed the cases of 23 patients with two types of 3D model images. The surgeons were randomly assigned to two assessment sequences (CR‐3D model group and CT‐3D model group). For each case, participants selected one question that probed fundamental questions about the tumor's genesis throughout each assessment period. Following a 4‐week washout period, case assessments were transferred to the other image modality. Results: The main result assessment was the accuracy of the answers. The time to answer the questions and the case assessment questionnaire was added as a secondary outcome. The mean scores in the CR‐3D models (19.35 ± 1.87) varied significantly from those in the CT‐CR group (16.77 ± 1.8) (P < 0.001), and solving the questions in the CT‐3D model sequence (41.96 ± 6.31 s) varied significantly from that in the CR‐3D model sequence (52.88 ± 5.95 s) (P < 0.001). Subgroup analysis revealed that there were statistically significant variations in the scores of female reproductive tumors, pelvic tumors other than the reproductive system, and retroperitoneal tumors (P = 0.005). Analysis of the assessment questionnaire showed that more surgeons choose CR 3D reconstruction (8.31 ± 0.76 vs 7.15 ± 1.19, P < 0.001). Conclusions: The results suggest that each 3D reconstruction method has its own advantages. Surgeons feel that CR reconstruction models are a useful technique that can improve their comprehension of complex pelvic tumors, while traditional 3D models have an advantage in terms of speed to diagnosis. Synopsis: The results suggest that cinematic rendering reconstruction models are a useful technique that can improve the surgeon's understanding of complex pelvic tumors. [ABSTRACT FROM AUTHOR]

Traditionally, Malignant Small Round Cell Tumors (MSRCT) of the CNS are synonymous with Medulloblastomas. Histologically they are characterised by cellular blue tumor and pose diagnostic problems. There is no broad category of MSRCT in WHO classification. Though now we know many tumor of diverse histogenesis that can be included in this group. Overall, brain tumors amount to <2% of all malignant neoplasm's and thus constitute a small fraction of the overall human cancer burden. As a clinical perspective, incidence of brain tumors is approximately 2.8/100000 children per year2 of which about 2-4% are MSRCT. The need for studying and subcategorizing MSRCT is due to the fact that MSRCT includes a diverse group of tumors like Embryonal tumors, Pineal Parenchyma Tumors, Neuroblastic Tumors, Germ Cell Tumors, lymphomas, metastatic tumors and rare ones like Atypical teratoid/rhabdoid tumor, Medulloepitheliomas etc. Mimics of MSRCT diagnostic problems. This is a prospective study as well as retrospective study of MALIGNANT SMALL ROUND CELL TUMOR of the Central Nervous System at our Grant medical college over a period of 10 years. To evaluate the feasibility of sub-characterizing the broad category of Malignant Small Round Cell Tumors of the CNS by judicious use of histological parameters. To establish that to date routine histopathology still remains the gold standard for the diagnosis. To use stringent morphological criteria to diagnose, subcategorize and reduce the intra and inter observer variation in our cases. To categorize and study the mimics of MSRCT'S. [ABSTRACT FROM AUTHOR]

Background and Objectives: Ectodermal dysplasia (ED)—a genetic disorder—is characterized by severe tooth deficiency. We compared the mandibular volume and the sagittal and horizontal mandibular widths between patients with ED (ED group) and individuals without tooth deficiency (control group) using three-dimensional modeling. We hypothesized that the mandibular volume differs in ED cases owing to congenital tooth deficiency. Materials and Methods: We used previously obtained cone-beam computed tomography (CBCT) images of 13 patients with ED. The control group data comprised retrospective CBCT images of patients of similar age and sex with a skeletal relationship of class 1. Further, using the three-dimensional image analysis software, the tooth crowns were separated from the mandible, the mandible was reconstructed and the gonion-to-gonion distance in the mandible was marked, the distance to the menton point was measured, and the distance between the two condyles was measured and compared with the control group. Results: Overall, 46.2% and 53.8% of the participants were men and women, respectively. In the ED group, the mean age of the participants was 15.46 (range, 6–24) years, and the mean number of mandibular teeth was 4.62. Notably, the edentulous mandible volume of the ED group (27.020 mm3) was statistically significantly smaller than that of the control group (49.213 mm3) (p < 0.001). There was no difference between the two groups in terms of the marked points. For data analysis, the Shapiro–Wilk test, independent samples t-test, and Mann–Whitney U test were used. Conclusions: It has been considered that mandible volume does not develop in ED cases because of missing teeth. Modern practices, such as the CBCT technique and three-dimensional software, may be effective in identifying the true morphologic features, especially in patients with genetic syndromes affecting the maxillofacial structure. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a severe and life-threatening condition triggered by a dysregulated response to infection, leading to organ failure and, often, death. The syndrome is expensive to treat, with survivors frequently experiencing reduced quality of life and enduring various long-term disabilities. The increasing understanding of RNA, RNA biology, and therapeutic potential offers an unprecedented opportunity to develop innovative therapy. Objective: This study is a scoping review focusing on pre-clinical studies of microRNA (miRNA)-based therapies for sepsis. Methodology: A scoping review. The search strategy identified papers published in PubMed until 15 October 2023, using the keywords (microRNA) AND (sepsis) AND (animal model). Inclusion criteria included papers that used either gain- or loss-of-function approaches, excluding papers that did not focus on microRNAs as therapy targets, did not include animal models, did not show organ failure-specific assessments, and focused on microRNAs as biomarkers. The PRISMA-ScR guideline was used in this study. Results: A total of 199 articles were identified that featured the terms “microRNA/miRNA/miR”, “Sepsis”, and “animal model”. Of these, 51 articles (25.6%) employed miRNA-based therapeutic interventions in animal models of sepsis. Of these, 15 studies extended their inquiry to include or reference human clinical data. Key microRNAs of interest and their putative mechanisms of action in sepsis are highlighted. Conclusions: The body of work examined herein predominantly addresses various dimensions of sepsis-induced organ dysfunction, supporting the emerging role of miRNAs as potential therapeutic candidates. However, nearly 5% of papers on miR-based therapy have been retracted over the past 5 years, raising important concerns regarding the quality and complexity of the biology and models for assessing therapeutic potential.

Abstract 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

Abstract Background Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group. Methods Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (

Background. One of the important conditions for the final victory over tuberculosis is not only the prevention of its development and early detection, but also the provision of high-quality personalized medical care to the patient. Additive technologies and virtualization technologies are ways to fully reveal this principle in phthisiatric practice. Aim. Demonstrate the possibilities and evaluate the labor costs (time spent on virtualization and the size of the final digital files of models) while working with the Mimics inPrint 2.0.0.159 and Mimics Medical 21.0.0.406 software systems in the aspect of virtual reconstruction of the lungs of a patient with a destructive form of tuberculosis. Materials and methods. A comparative analysis of methods for creating virtual three-dimensional models of the lungs from CT images was carried out at the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary. The study involved one patient with a destructive form of tuberculosis of the upper lobe of the left lung. Virtual three-dimensional models were made according to a specially developed algorithm. The time spent for the formation of virtual lung models was analyzed using the built-in function in the "Log" software. The analysis of the size of the obtained virtual lung models in the STL format was carried out using the operating system function from the Windows family "Properties", section "General", subsection "Size". Results. The most practical software package for virtual lung reconstructions turned out to be Mimics inPrint 2.0.0.159 with the result of the time spent on creating a model of 2 minutes (Mimics Medical 21.0.0.406 7 minutes 17 seconds) and a model size of 125 megabytes (Mimics Medical 21.0.0.406 26.1 megabyte). The technical nuances and algorithms of lung reconstruction covered in the article using the Mimics inPrint 2.0.0.159 and Mimics Medical 21.0.0.406 software packages will allow the interested person not to make a mistake in realizing their scientific and practical interests in the process of providing personalized care to the patient. The article focuses on the main advantages of the Mimics inPrint 2.0.0.159 software package in comparison with Mimics Medical 21.0.0.406. A brief description of similar programs is given. Conclusion. The studied software systems successfully coped with the goal assigned to them, which concerned the demonstration of their capabilities and the assessment of labor costs for virtualization. Mimics inPrint 2.0.0.159 turned out to be the most understandable and promising software and application complex for use in everyday clinical practice.

Objective: Our review aims to summarize the current literature on skull base infections (SBIs) and retrospectively analyze any such cases encountered at our institution. Design: A literature search was conducted using online databases PubMed, MEDLINE, and ResearchGate with the terms "skull base osteomyelitis," "temporal bone osteomyelitis," "skull base infections," "necrotizing otitis media," and "SBO". References from the resulting manuscripts were reviewed for relevant articles. A search of our electronic health records using the same key terms was also performed to identify patients with a tissue biopsy-confirmed diagnosis of skull base infections. Patients with an indeterminate diagnosis or inaccessible/poor imaging were excluded. Setting: A level one trauma and major tertiary academic medical center. Participants: All patients treated at the University of California Davis Health System with a confirmed diagnosis of skull base infections from January 2005 to November 2020. Main Outcome Measures: Imaging results, symptoms, treatment, morbidity, and mortality. Results: Our literature search yielded 59 articles ranging from 1982 to 2021. A retrospective search of our electronic health records identified two cases of skull base infections. Conclusion: Skull base infections have no pathognomonic findings. A multimodal approach with computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine is necessary to characterize the disease process in addition to a biopsy for definitive diagnosis. Other diagnoses can mimic SBI on imaging, such as nasopharyngeal carcinoma and inflammatory pseudotumor. Culture-guided antimicrobial treatment and surgery are mainstay therapies. Other adjuvant strategies currently lack the robust evidence necessary to characterize their risks and benefits. [ABSTRACT FROM AUTHOR]

Tuberculosis is known as one of "the great masqueraders" due to unusual and nonspecific symptoms it presents, which causes a challenge in diagnosis. There are rare radiological pulmonary patterns described in some case reports such as lung mass and bilateral pulmonary nodules similar to primary lung cancer or pulmonary metastases. We present a case of a 42-year-old man who was admitted to the emergency room due to pain and increased testicular volume. His chest tomography revealed a right lung mass and bilateral pulmonary nodules with a diffuse distribution. Therefore, based on clinical and radiological results, we suspected malignancy. His testicular fluid drainage resulted in a positive Ziehl Neelsen staining. The patient received anti-tuberculosis treatment for 1 month showing clinical and tomographic improvement. Pulmonary tuberculosis can present unusual radiological patterns. Therefore, we suggest that it should be considered in the differential diagnosis of patients with clinical and radiological characteristics of metastatic or primary lung disease. Diagnosis should be aided by invasive interventions. [ABSTRACT FROM AUTHOR]

Vasculitis conditions are often serious and sometimes fatal diseases, therefore it is paramount to diagnose correctly and treat appropriately. Mimics of primary vasculitis can include either non-inflammatory syndromes or secondary vasculitis where the underlying etiology of the vasculitis is being driven by infection, malignancy, drug-effect or other. This review comprises six individual cases of vasculitis mimics. Each case is presented and the clinical, radiographic, and histological features that distinguish the case from primary vasculitis are highlighted. Key mimics in large, medium and small vessel vasculitis are outlined. The diagnosis of vasculitis requires a comprehensive assessment of clinical, radiographic, and histologic features. Clinicians should be familiar with mimics of primary vasculitis conditions. In the case of non-inflammatory mimics, it is important to differentiate from primary vasculitides in order to avoid unnecessary and potentially harmful immunosuppression. For cases of secondary vasculitis, identification of the correct etiologic cause is critical because treatment of the underlying stimulus is necessary for successful management and outcomes. [ABSTRACT FROM AUTHOR]

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]

Key Clinical Message: Mycosis fungoides is a diagnostic challenge. Herein, we report a case with marked lichenoid features in pathology assessments. After several biopsies and clinicopathologic correlation, the diagnosis of lichenoid mycosis fungoides was made. Mycosis fungoides (MF) is a great imitator and mimicks other dermatoses clinically and histopathologically. We report a 61‐year‐old patient with 5‐year history of generalized violaceous patches and plaques. His biopsy revealed a marked lichenoid band‐like infiltrate of inflammatory cells along the basal layer with basal layer vacuolar changes; the diagnosis of lichen planus was first made histopathologically. Several biopsy specimens, clinicopathologic correlation, and immunohistochemistry findings confirmed the diagnosis of lichenoid MF. Awareness of peculiar histopathologic findings of MF is essential to avoid a potential misdiagnosis. When in doubt, multiple biopsies with other diagnostic methods should be employed. [ABSTRACT FROM AUTHOR]

Endometrial Stromal Tumour (EST) mimics other neoplasms and is difficult to diagnose due to its wide range of morphologies. This is a clinicopathological study of seven cases of EST, which includes Endometrial Stromal Nodule (ESN), Low-grade Endometrial Stromal Sarcoma (LGESS), and High-grade Endometrial Stromal Sarcoma (HGESS). The age ranges from 34 to 75 years. Five out of seven cases presented with abnormal uterine bleeding, abdominal pain, and were radiologically suspected to be leiomyomas. After histopathological and Immunohistochemical (IHC) examination, one was diagnosed as ESN, three as LGESS, and the remaining three cases as HGESS. One case was initially diagnosed as a cellular leiomyoma and experienced multiple recurrences, eventually being diagnosed as HGESS with a fatal outcome within 36 months of the onset of the first symptoms. ESN and LGESS should be differentiated from leiomyoma and leiomyosarcoma. IHC plays an important role in distinguishing these tumours from the more common smooth muscle counterparts.

Background: Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group. Methods: Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (< 60 years) and old (≥ 60 years). Logistic regression analyses were performed with mimics vs. stroke as dependent variable to identify predictors of mimics. Results: Of the 1091 patients included in the trial, 211 patients (19.3%) were under the age of 60 years. Out of the 1091 patients, 434 (39.8%) were female, median age 77 years (18–99 years), and median NIHSS was 4. Sixty-nine patients (32.7%) out of the 211 patients under the age of 60 were diagnosed as mimic. Mimics were significantly more frequent among the young (OR = 3.3, 32.7% vs. 12.8%, p = < 0.001). The most frequent mimics diagnoses among patients under 60 years of age were migraine (11.8%), no definite diagnosis (11.4%) and peripheral vertigo (3.3%). Mimics were independently associated with age < 50 years (OR = 4.97, p = < 0.001), not currently working/studying (OR = 3.38, p = 0.002) and not having aphasia on admission (OR = 2.95, p = 0.025). None of the mimics under the age of 60 years had symptomatic or asymptomatic intracerebral hemorrhage as a complication to thrombolysis. Conclusion: We found significantly more mimics in the young, of which migraine was the most predominant diagnosis. Thrombolysis with alteplase or tenecteplase did not cause ICH in any mimics under 60 years. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Three‑dimensional evaluation of maxillary sinus volume using VR mesh and correlate it with the volume of maxillary canine, lateral incisor, and dentoalveolar and skeletal dimensions in both impacted and non‑impacted sites. MATERIALS AND METHODS: In a retrospective cross‑sectional study, cone beam computed tomography scans of 100 patients with unilateral palatally impacted maxillary canine were analyzed. Canine, lateral incisor, and maxillary sinus volumes on the impaction and non‑impaction sides were measured using DICOM files, with three‑dimensional softwares (MIMICS) and VR mesh to accomplish this assessment. RESULTS: There were no significant differences in canine and lateral incisors volumes between male and female patients in the impacted side at (p > 0.05) while the maxillary sinuses volume revealed a statistical difference (P = 0.022) between male (12642 ± 810) and female (12481 ± 650) patients in the impacted side. A strong positive correlation was found between canine and lateral incisor volume for male patients in the non‑impacted (r = 0.420**, P = 0.008) and impacted sides (r = 0.334*, P = 0.038). CONCLUSIONS: There were no significant differences in the canine volume, the height of the anterior alveolar ridge (AARHMLI), and anterior dentoalveolar (ADAHMLI) of maxillary lateral incisors in the impacted/non‑impacted side, but it showed a statistically significant difference for the lateral incisors volume in the impacted and non‑impacted sides for male and female patients. The maxillary sinus volumes revealed a statistical difference between males and females in impacted and non‑impacted sides. [ABSTRACT FROM AUTHOR]

Background: Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various mimics and the anatomy of recurrent laryngeal nerve. Objectives are to know the signs and underlying causes leading to VCP and various mimics which may lead to the false positive diagnosis of VCP. Methods: A retrospective cross-sectional pilot study comprising 54 patients with vocal cord palsy proven by IDL was conducted. 3 groups were identified. The first group comprised missed VCP on cross-sectional imaging. The second group was, of missed cause of VCP in patients with clinical diagnoses. The third group was patients with mimics of the palsy. Results:Thirteen (76.5%) patients had missed diagnosis due to lack of knowledge of signs and 23.5% due to lack of time, overwork and tiredness. A vigilant search for the cause was not done in 31.6% of patients and in 68.4% of patients, the cause was identified but not correlated. A total of 8 patients had false positive diagnoses due to failure to differentiate from mimics. Conclusion: There is an increasing trend of missed diagnosis of vocal cord palsy on cross-sectional imaging in patients with established clinical diagnosis due to a lack of knowledge of VCP signs and missed causes along the course of recurrent laryngeal nerve. [ABSTRACT FROM AUTHOR]

microRNA mimics are synthetic RNA molecules that imitate the mature miRNA duplexes and their functions. These mimics have shown promise in treating cancers. Nucleotide chemical modifications of microRNA mimics have been investigated and have improved the stability of miRNA mimics. However, the potential therapeutic benefit of mimic analogs based on sequence modifications has not been explored. miR-506-3p was identified as a differentiation-inducing microRNA in neuroblastoma cells, suggesting the potential of applying the miR-506-3p mimic in neuroblastoma differentiation therapy. In this study, we explored the possibility of developing shortened miR-506-3p analogs that can maintain differentiation-inducing activities comparable to the wild-type miR-506-3p mimic. We found that deleting up to two nucleotides at either the 3′ end or within the middle region of the miR-506-3p sequence fully maintained the differentiation-inducing activity when compared to the wild-type mimic. Deleting up to four nucleotides from the 3′ end or deleting three nucleotides in the middle positions diminished the differentiation-inducing activity, but the analogs still maintained differentiation-inducing activities that were significantly higher than the negative control oligo. The shortened analog designs potentially benefit patients from two perspectives: (1) the reduced cost of manufacturing shortened analogs, and (2) the reduced non-specific toxicity due to their smaller molecular sizes. [ABSTRACT FROM AUTHOR]

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Background: Ischemic stroke and gliomas are pathologies with poor prognosis. Aside from different characteristics and incidences, 10% of ischemic stroke patients will develop glioblastoma in the post-ischemic period. The aim of this study is to present the interplay between cerebral ischemic stroke and glioblastoma in one patient and to review literature data. Case Description: A 61-year-old patient got sick and became confused and inadequate, incorrectly replacing words and syllables. He complained of a severe headache the whole day. The patient was transported to the Emergency Department of UMHAT "DrGeorgiStranski", and after a neurological examination and a native CT examination of the brain, the patient was admitted to the Neurology clinic with a diagnosis of MCA ischemic stroke. The neurological examination showed a central lesion of the right VIIth and XIIth cranial nerves, Babinski sign (+) on the right side, sensory loss of the right arm and sensory aphasia. Glasgow-Liege Scale (GLS) =18. National Institutes of Health Stroke Scale (NIHSS) = 6. After 4 days of active medical treatment, the patient was discharged from the clinic with improvement. In 2 months and 10 days, the patient was admitted to the ED again with worsening of the clinical signs. An MRI (with contrast) of the head diagnosed the patient with a brain tumor (glioma), and he was admitted to the Neurosurgery clinic for operative treatment. Conclusion: Ischemic stroke as an early manifestation of brain cancer is rare. Approximately 10% of patients with ischemic stroke may develop glioblastoma. Exact diagnosis and specific treatment of stroke or glioma is always challenging and requires appropriate MRI or CT protocols to make timely and accurate differentiation.

Endometrial Stromal Tumour (EST) mimics other neoplasms and is difficult to diagnose due to its wide range of morphologies. This is a clinicopathological study of seven cases of EST, which includes Endometrial Stromal Nodule (ESN), Low-grade Endometrial Stromal Sarcoma (LGESS), and High-grade Endometrial Stromal Sarcoma (HGESS). The age ranges from 34 to 75 years. Five out of seven cases presented with abnormal uterine bleeding, abdominal pain, and were radiologically suspected to be leiomyomas. After histopathological and Immunohistochemical (IHC) examination, one was diagnosed as ESN, three as LGESS, and the remaining three cases as HGESS. One case was initially diagnosed as a cellular leiomyoma and experienced multiple recurrences, eventually being diagnosed as HGESS with a fatal outcome within 36 months of the onset of the first symptoms. ESN and LGESS should be differentiated from leiomyoma and leiomyosarcoma. IHC plays an important role in distinguishing these tumours from the more common smooth muscle counterparts. [ABSTRACT FROM AUTHOR]

Purpose of Review: Neurosarcoidosis is a rare manifestation of sarcoidosis that is challenging to diagnose. Biopsy confirmation of granulomas is not sufficient, as other granulomatous diseases can present similarly. This review is intended to guide the clinician in identifying key conditions to exclude prior to concluding a diagnosis of neurosarcoidosis. Recent Findings: Although new biomarkers are being studied, there are no reliable tests for neurosarcoidosis. Advances in serum testing and imaging have improved the diagnosis for key mimics of neurosarcoidosis in certain clinical scenarios, but biopsy remains an important method of differentiation. Summary: Key mimics of neurosarcoidosis in all cases include infections (tuberculosis, fungal), autoimmune disease (vasculitis, IgG4-related disease), and lymphoma. As neurosarcoidosis can affect any part of the nervous system, patients should have a unique differential diagnosis tailored to their clinical presentation. Although biopsy can assist with excluding mimics, diagnosis is ultimately clinical. [ABSTRACT FROM AUTHOR]

BACKGROUND: A novel one-hole split endoscope technique has been used in the treatment of lumbar spondylolisthesis, but there is no literature on the safety, feasibility and effectiveness of this technique. OBJECTIVE: The relationship between bone markers and L4, L5 nerves and intervertebral space position is observed by lumbar CT three-dimensional reconstruction to evaluate the safety of intervertebral fusion with one-hole split endoscopic L4/5 spondylolisthesis. METHODS: Totally 26 patients with grade I L4/5 spondylolisthesis (spondylolisthesis group) and 26 volunteers (normal group) underwent lumbar CT scanning. Data were input into Mimics 17.0 software to measure the following parameters: (1) vertical distance. a, b: The intersection of the medial edge of the articular surface at the coronal position of the upper endplate of L5 and the upper articular process of L5 (N) to the highest point of the posterior edge of the mastoid process (R) and the tip of the superior articular process of L5 (S); c: point of intersection between L4 inferior articular process tip (X) and N on sagittal plane and L4 inferior endplate (M). (2) Horizontal distance. d: intersection point between R and N and lower edge of L4 outlet nerve root (N1); e: intersection point of transverse section from R to M with lower edge of L4 outlet nerve root (M1); f: intersection point of N to N cross section and lateral edge of nerve tissue (N2); g: N1 to N2; h: M1 to M2; i: N2 to M1; j: Posterior edge of articular surface (R1) in sagittal position of superior articular process from M1 to L5. (3) Nine patients underwent a one-hole split splinterbody endoscopic interbody fusion with bone grafting. The outcomes were evaluated by visual analogue scale for lumbar and leg pain, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index, and 36-item Short-Form scale. RESULTS AND CONCLUSION: (1) There was no significant difference between b and c in the spondylolission group (P > 0.05), indicating that only equal amounts of upper and lower articular processes and/or laminae were removed to expose the L4/5 disc. (2) There were statistically significant differences in d and e between the two groups (P < 0.05), so surgery should be planned according to pathological changes. (3) There were no significant differences in f, g and i between the two groups (P > 0.05), indicating that the degenerative spondylolisthesis did not change the position relationship between walking and outlet nerve, and it was safe to implant the fusion device in the constant transverse workspace of both groups. (4) Visual analogue scale score, Japanese Orthopaedic Association Evaluation score, Oswestry Disability Index and 36-item Short-Form scale score of nine patients with lumbar spondylolisthesis were significantly improved at the last follow-up compared with the data before operation and 6 months after operation (P < 0.05). (5) Safe fenestrating range: S down (11.78±2.34) mm to N, X up to L4 lower endplate to expose the upper and lower margins of the intervertebral disc. Opening the window outward to M1 would not damage L4 nerve; decompress inwards to prevent damage to N and its adjacent L5 nerves. Understanding the technical features of the novel one-hole split endoscope technique can help improve surgical safety and efficacy. [ABSTRACT FROM AUTHOR]

Background and purpose: Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics. Methods: We conducted a retrospective study of all the consultations in our Ochsner Health's TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/ transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiveroperating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis. Results: Eight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749-- 0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3--2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis. Conclusion: We report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Ectodermal dysplasia (ED)—a genetic disorder—is characterized by severe tooth deficiency. We compared the mandibular volume and the sagittal and horizontal mandibular widths between patients with ED (ED group) and individuals without tooth deficiency (control group) using three-dimensional modeling. We hypothesized that the mandibular volume differs in ED cases owing to congenital tooth deficiency. Materials and Methods: We used previously obtained cone-beam computed tomography (CBCT) images of 13 patients with ED. The control group data comprised retrospective CBCT images of patients of similar age and sex with a skeletal relationship of class 1. Further, using the three-dimensional image analysis software, the tooth crowns were separated from the mandible, the mandible was reconstructed and the gonion-to-gonion distance in the mandible was marked, the distance to the menton point was measured, and the distance between the two condyles was measured and compared with the control group. Results: Overall, 46.2% and 53.8% of the participants were men and women, respectively. In the ED group, the mean age of the participants was 15.46 (range, 6–24) years, and the mean number of mandibular teeth was 4.62. Notably, the edentulous mandible volume of the ED group (27.020 mm3) was statistically significantly smaller than that of the control group (49.213 mm3) (p < 0.001). There was no difference between the two groups in terms of the marked points. For data analysis, the Shapiro–Wilk test, independent samples t-test, and Mann–Whitney U test were used. Conclusions: It has been considered that mandible volume does not develop in ED cases because of missing teeth. Modern practices, such as the CBCT technique and three-dimensional software, may be effective in identifying the true morphologic features, especially in patients with genetic syndromes affecting the maxillofacial structure.

Hend Abdel Ghany,1 Ahmed Karam-Allah,1 Ramy Edward,2 Maged Abdel Naseer,1 Mohamed I Hegazy1 1Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Radiology Department, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Mohamed I Hegazy, Neurology Department, Cairo University, 108 Al Manial street, Degla, Maadi, Cairo, 11435, Egypt, Tel +20 1223130686, Email mhegazy@kasralainy.edu.egPurpose: Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics.Patients and Methods: Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2&ast;-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients’ clinical presentation. The MS consultant made the final diagnosis without reviewing the T2&ast;-weighted gradient-echo sequence or the CVS analysis results.Results: Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919– 1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017).Conclusion: The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%.Keywords: multiple sclerosis, central vein, mimics, cutoff, gradient-echo

Abstract Lymphovascular invasion is a hallmark of malignant neoplasms, however the presence of benign epithelium within vessels has been reported in benign processes, albeit infrequently. The proposed mechanism to explain this phenomenon entails mechanical displacement of benign epithelium into the vascular spaces during surgical manipulation or diagnostic interventions. We report a case of numerous benign epithelial vascular emboli in a cholecystectomy specimen. A 29-year-old male presented with acute calculous cholecystitis. Surgery was delayed for several weeks due to COVID-19 infection. Histologic examination of the gallbladder showed subacute cholecystitis, widespread vascular epithelial emboli with associated fibrin deposition and bile embolism supporting an in vivo process. The epithelial emboli were localized in small veins and arterioles with D2–40−/CD31+/CD34+ endothelium. The displaced epithelium showed benign cytologic features, was negative for p53 expression, and had a Ki-67 labelling index like the benign background mucosa, supporting a benign process. There was no evidence of dysplasia or malignancy in the specimen after thorough sampling. Persistent inflammation, mucosal ulceration, transmural mucosal herniation (Rokitansky-Aschoff sinuses), and protracted surgical manipulation secondary to adhesive disease are favored to be the underlying causes of this unusual histologic finding. Although we presume an uneventful outcome, clinical follow up was recommended. COVID-19 infection likely contributed to this phenomenon by causing a delay in the surgical management.

In the fields of environmental research, developing innovative catalytic cascade systems (CCS) to simulate multiple enzyme-driven biological catalytic cascades (ME-DBCC) processes in vitro is often required for identifying pollutants. Nanozymes are recently employed in the creation of biomimetic cascade nanoreactors (BCNR) owing to their high catalytic kinetics. BCNR powered by nanozymes has improved cascade catalytic activity and great stability, leading to enhanced biosensing of environmental pollutants. This article covers relevant research on the involvement of inorganic enzymes in regulating the performance of biomimetic catalytic systems (BCSs). The significance of enzyme mimics and the need to tune their catalysis will be discussed first. Followed by the most recent breakthroughs in comprehending the cascade catalytic mechanism of nanozyme-engineered biomimetic cascade catalytic nanoreactors (nanozymes-BCCNR), as well as their evolving utilization in biosensing of environmental pollutants and biomedical applications, are extensively discussed in this publication. In the final section of this manuscript, the major crucial difficulties, and possibilities, as well as the prospects, are highlighted.

Background and purposeTelestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics.MethodsWe conducted a retrospective study of all the consultations in our Ochsner Health’s TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis.ResultsEight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR− were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749–0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3–2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis.ConclusionWe report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.

(1) Background: Accurate diagnosis and treatment plans in orthodontics were facilitated by novel technologies. The prediction of occlusal problems is of utmost importance for clinicians. This present study aimed to find any possible correlation between unilateral and bilateral palatally impacted maxillary canine, palatal dimensions, and maxillary arch perimeter using digital measurements and determine the factors that could be used as predictors for maxillary palatal canine impaction. (2) Method: A cross-sectional study was conducted on cone-beam computed tomography images of orthodontic patients aged 15 to 25. Palatal dimensions and maxillary arch perimeter were digitally measured using Materialize Interactive Medical Image Control System. (3) Results: A significant difference was found between the case and the study groups regarding palatal depth, length, and arch perimeter, except for the palatal width. A weak correlation was reported in palatal depth and length with canine impaction, whereas the correlation was moderate concerning the arch perimeter. They can be used as predictors for palatal canine impaction. (4) Conclusion: Palatal dimensions and dental arch perimeter affect maxillary palatal canine impaction. Deficient arch perimeter, palatal depth, and length could be helpful in the prediction of maxillary palatal canine impaction. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In a resource‐limited setting such as Sudan, where diagnostic and surveillance capacities are limited and several dermal diseases with similar clinical presentation are endemic, further precautious must taking into account. Cutaneous tuberculosis (CTB) is a rare infection caused by Mycobacterium tuberculosis. Atypical clinical presentations of CTB may resemble other skin neglected diseases. For definitive diagnosis, we require a holistic diagnostic approach including clinical examination and deployment of laboratory investigations including microbial culture, histopathological, and molecular examinations of the proper samples per test. In this communication, we report a case of CTB that was initially misidentified clinically as mycetoma. [ABSTRACT FROM AUTHOR]

Pregnancy is a remarkable time of pronounced growth and development of the fetus. Benign pathologies outside of the uterus, including those containing hormonally responsive tissue which undergo physiologic changes and other incidentally identified lesions, may mimic malignancy on clinical evaluation and imaging. A detailed history and physical exam, ultrasound and non-contrast magnetic resonance imaging features and comparison with prior imaging if available may help to narrow the list of potential differential diagnoses. Follow-up imaging in the postpartum period is often vital to confirm benignity and, in some cases, sampling to confirm the diagnosis is necessary. This review will cover the clinical, pathological and multimodality imaging features of numerous potential mimickers of cancer in the setting of pregnancy organized by organ systems. The goal is to better equip abdominal radiologists to accurately identify benign disease and help guide further imaging or follow-up recommendations to avoid unnecessarily aggressive intervention and improve patient care. [ABSTRACT FROM AUTHOR]

Background: Histopathologic features of interface dermatitis can occasionally be seen in mycosis fungoides (MF), particularly in early patch-stage disease. Materials and Methods: We identified six patients with MF whose early biopsy specimens showed such prominent interface dermatitis that a benign diagnosis was favored. All subsequent specimens were reviewed for these patients, and the histopathologic evolution of disease was documented. Immunohistochemistry (IHC) for CD2, CD3, CD4, CD5, CD7, CD8, CD30, and CD123 was performed retrospectively. Educational archives were reviewed to assess the incidence of interface dermatitis in biopsies otherwise diagnostic of MF. Results: A spectrum of vacuolar and lichenoid patterns of interface change was observed in this series of six patients eventually diagnosed as having MF, and was seen as a recurring pattern in multiple specimens over time. In retrospect, findings described in early MF such as lining up of lymphocytes along the dermal--epidermal junction within the basal layer, papillary dermal fibrosis, and intraepidermal lymphocyte atypia could be appreciated to varying degrees in the confounding specimens. CD123 was negative in all cases, putatively excluding a connective tissue disease (CTD). None of the early biopsies showed loss of pan-T antigens CD2, CD5, and CD7. Forty-six of 164 cases (28%) of MF in an archival study set showed varying degrees of interface dermatitis in the setting of otherwise diagnostic changes of MF. Conclusions: Early MF can show prominent interface change and mimic inflammatory dermatoses. Histopathologic clues suggestive of MF should be carefully assessed, and IHC for CD123 may be helpful in distinguishing MF from CTD. Repeat biopsies over time may be necessary to arrive at a definitive diagnosis, in conjunction with ancillary studies and strong clinicopathologic correlation. [ABSTRACT FROM AUTHOR]

Purpose of Review: This article aims to review the challenges in axial spondyloarthritis diagnosis and identify the possible contributing factors. Recent Findings: The inability to reach an accurate diagnosis in a timely fashion can lead to treatment delays and worse disease outcomes. The lack of validated diagnostic criteria and the misuse of the currently available classification criteria could be contributing. There is also significant inter-reader variability in interpreting images, and the radiologic definitions of axial spondyloarthritis continue to be re-defined to improve their positive predictive value. The role of inflammatory back pain features, serologic biomarkers, genetics, and their diagnostic contribution to axial spondyloarthritis continues to be investigated. Summary: There is still a significant amount of delay in the diagnosis of axial spondyloarthritis. Appreciating the factors that contribute to this delay is of utmost importance to close the gap. It is similarly important to recognize other conditions that may present with symptoms that mimic axial spondyloarthritis so that misdiagnosis and wrong treatment can be avoided. [ABSTRACT FROM AUTHOR]

Abstract Background Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The term JIA encompasses a heterogenous group of diseases. The variability in phenotype of patients affected by the disease means it is not uncommon for mimics of JIA to be misdiagnosed. Case presentation We present four cases who were treated in single tertiary rheumatology centre for JIA who were subsequently diagnosed with a rare monogenic disease. All four patients shared the unifying features of presenting in early childhood and subsequently suffered with refractory disease, not amenable to usual standards of treatment. Multicentric Carpotarsal Osteolysis Syndrome and Camptodactyly-arthropathy-coxa vara-pericarditis syndrome are non-inflammatory conditions and patients typically present with arthropathy, normal inflammatory markers and atypical radiological features. Blau syndrome is an autosomal dominant condition and patients will typically have symmetrical joint involvement with a strong family history of arthritis, signifying the genetic aetiology. Conclusions We share our learning from these cases to add to the growing portfolio of JIA mimics and to highlight when to consider an alternative diagnosis. In cases of refractory disease and diagnostic uncertainty further imaging and genetic testing can play a crucial role in establishing the aetiology. In all of these cases the correct diagnosis was made due to careful, longitudinal clinical phenotyping and a close working relationship between rheumatology, radiology and clinical genetics; highlighting the importance of the multidisciplinary team in managing complex patients.

Objective: This study aimed to evaluate the pattern of presentation of infectious lesions mimicking malignancy. This will serve to heighten clinical indices of suspicion and prevent unwarranted aggressive management. Methods: This is a 19-year (1999-2017) audit review of all morphologically diagnosed infection-related lesions in which malignancy was primarily clinically suspected. Results: Fifty-six cases of infection-related mimics of malignancy were diagnosed in the study period: schistosomiasis related, 22 (39.2%); actinomycosis, 21(37.5%); tuberculosis-related, 10 (17.9%); fungi-related, 3(5.4%). Twenty-one cases of actinomycosis of the lower limbs and oropharynx were mistaken for melanoma, squamous cell carcinoma, sarcoma, and oropharyngeal carcinoma. The mean age was 33±17years.The 10 patients with atypical Mycobacterium tuberculosis-mimicking malignancy had mean age of 37±14 years and included three in the testes, testicular cases, one from the jaw, and two cases each from ovary, breast, and uterus. Of the three fungal lesions, there was a case each from the brain, skin, and bone. All were males with mean age of 21±7 years. Conclusion: For accurate diagnosis of infection-related mimics of malignancy, a high index of clinical suspicion, knowledge of and attention to characteristic radiological signs, and obtaining representative tissues for histopathologic and cytopathologic diagnoses are paramount.

ObjectiveThe purposes of this article are to review a variety of pitfalls in liver imaging that can lead to the inaccurate diagnosis of focal hepatic lesions in cirrhosis, to describe the pathophysiologic processes of these pitfalls, and to provide specific clues for achieving the correct diagnoses.ConclusionCirrhosis complicates liver imaging. The distortion and replacement of normal liver parenchyma by fibrous and regenerative tissue can change the typical appearance of many benign lesions, causing them to be misinterpreted as malignancy. In addition, the high incidence and prevalence of hepatocellular carcinoma among patients with cirrhosis put radiologists on high alert for any suspicious findings, especially because not all hepatocellular carcinomas have a typical imaging appearance.

BACKGROUND: There are few articles on the treatment of lumbar spinal stenosis by unilateral two-channel endoscopic contralateral approach, and there is no in-depth analysis of the endoscopic location, decompression scope and adjacent relationship of various structures of this approach. OBJECTIVE: To observe the bony structure, nerve tissue, intervertebral space, attachment of ligamentum flavum and position of lumbar isthmus in lateral recess and foraminal area through three-dimensional CT imaging. METHODS: Totally 34 patients with lumbar spinal stenosis admitted to the Affiliated Hospital of Binzhou Medical College from June 2019 to July 2021 were enrolled. Lumbar CT myelography was performed before surgery, and the images were imported into Mimics 21.0 software to reconstruct lumbar threedimensional CT model. Relevant parameters of L4/5 and L5S1 segments were measured: (1) The vertical distance from the intersection of the lumbar spinous process and the lower edge of the lamina (Q) to the lower edge of the contralateral same lumbar pedicle (a), the upper edge of the contralateral pedicle of the lower lumbar spine (b), the lower endplate of same lumbar (c), the upper endplate of lower lumbar vertebrae (d); (2) The vertical distance from superior articular process to the upper edge of same lumbar pedicle (e), the lower endplate of upper lumbar vertebrae (f); (3) The vertical distance from the lower endplate of lumbar vertebrae to the lower edge of the contralateral lumbar pedicle (g); (4) The vertical distance from the upper endplate of lumbar vertebrae to the upper edge of the same lumbar pedicle (h); (5) The vertical distance from the lower edge of the nerve root origin to the lower edge of the upper lumbar pedicle (i), the upper edge of the lower lumbar spine pedicle (j); (6) A 3 mm diameter guide rod was established through point Q and the lower edge of the contralateral same lumbar pedicle to measure the abduction angle of guide rod (k). Seven patients underwent unilateral biportal endoscopic lumbar decompression through the contralateral approach. The effect of surgery was verified by visual analog scale score, Oswestry disability index, and short form-36 health survey. RESULTS AND CONCLUSION: (1) The Q points and the upper margin of ligamentum flavum could be used as important localization markers under the endoscopy. The upper margin of the ligamentum flavum was used to locate the exiting nerve root, the upper edge of the foramina, the lumbar isthmus and the inferior articular process. The level of 1/3 of the contralateral foramen of L4/5 and the vicinity of L4 inferior endplate could be reached by Q point perpendicular to the posterior midline of spinous process, and then decompress the lateral recess at the level of the disc. (2) The lower edge of L5 nerve root origin was mostly projected at the level of L4/5 lower 1/3 of the foramen, and it was consistent with the L4/5 intervertebral projection, suggesting that the L5 walking nerve roots were mostly compressed near the level of the L4/5 disc. (3) The Q point, the lower edge of S1 nerve root origin and the L5 the exiting nerve root all corresponded to the level of the upper 1/3 of the L5S1 intervertebral foramen, and the corresponding lateral recess with dense nerve tissue in this area should be prudently decompressed. (4) The intervertebral spaces of L4/5 and L5S1 were projected near the level of the lower 1/3 of the same segment intervertebral foramen and under the Q point. The operation channel should be decompressed through Q point level with moderate tail tilt. (5) When removing the hyperplastic superior facet osteophytes of L4/5 and L5S1, the superior facet should be retained at approximately normal height to avoid affecting the stability of lumbar spine. (6) All seven patients with contralateral approach surgery successfully completed the operation, and the follow-up time was 6-12 months. With the prolongation of postoperative rehabilitation time, the visual analog scale score and Oswestry disability index were significantly lower than those before surgery, and the score of short form-36 health survey was significantly improved than that before surgery. (7) It is suggested that the results of this study can guide unilateral biportal endoscopy for lumbar spinal stenosis through contralateral approach. [ABSTRACT FROM AUTHOR]

Multiple system atrophy (MSA) is a sporadic and progressive neurodegenerative disorder with a complex differential diagnosis. A range of disorders— also of nondegenerative etiology— can mimic MSA, expanding its differential diagnosis. Both misdiagnosis and diagnostic delays are relatively common in clinical practice. A correct diagnosis is vital for daily clinical practice, in order to facilitate proper counselling and to timely install therapies in treatable disorders that mimic MSA. A correct diagnosis is also essential for including properly classified individuals into research studies that aim to better understand the pathophysiology of MSA, to develop specific biomarkers or to evaluate novel symptomatic or disease-modifying therapies. Here, we offer some practical guidance to support the diagnostic process, by highlighting conditions that may be considered as MSA lookalikes, by emphasizing some key clinical aspects of these mimics, and by discussing several useful ancillary diagnostic tests. [ABSTRACT FROM AUTHOR]

Precise blood pressure (BP) estimation is vital for diagnosing arterial hypertension and other cardiovascular ailments. The photoplethysmogram (PPG)-based cuff-less BP measurement is an alternative to the traditional cuff-based systems. The morphological, temporal, and frequency-domain-based features have been used for BP estimation in the PPG-based BP measurement systems. However, dealing with varying signal morphology and feature dependency on the fiducial points in PPG contours remains challenging and limits the performance of the existing BP estimation algorithms, especially in wearable devices. This work presents a novel approach that considers the nonlinear features of PPG signals evaluated using higher order derivatives. In particular, the PPG signal’s third and fourth derivative contours are used to extract features, such as fractal dimension, bubble entropy (BE), Lyapunov exponent, and moving slope. Machine learning algorithms such as random forest (RF), extreme gradient boosting (XGBoost), and support vector regression (SVR) models are used for BP estimation using the nonlinear features of PPG signals. The estimated BP values are further categorized based on five broad classes based on the BP stratification criteria such as hypotension, normal, prehypertension, stage-I, and stage-II hypertension, respectively. The performance of the suggested approach is evaluated using PPG signals from three publicly available databases (multiparameter intelligent monitoring in intensive care (MIMIC)-I, II, and III). The proposed estimation approach has outperformed the recent existing algorithms and achieved a minimum value of mean absolute error (MAE) ± standard deviation (STD) in (systolic BP (SBP) and diastolic BP (DBP) values) as ${0}.{74}\pm {2}.{42}$ and ${0}.{35} \pm {1}.{06}$ , respectively, for the MIMIC-I database. The suggested approach has also achieved grade-A on the British Hypertension Society (BHS) standard. [ABSTRACT FROM AUTHOR]

Cryptococcoid Sweet syndrome is a rare histologic variant of the neutrophilic dermatosis presenting clinically with skin lesions typical of classical Sweet syndrome but with yeast-like structures suggestive of C ryptococcus on histopathology. Histochemical stains for fungus and cultures are negative whereas staining for myeloperoxidase is positive. We present 2 cases of cryptococcoid Sweet syndrome with atypical skin manifestations, including hemorrhagic bullae and plaques, and provide a brief review of the literature. Clinicians should be aware that this variant of Sweet syndrome can present with uncommon clinical findings and has histopathologic findings suggestive of Cryptococcus species. [ABSTRACT FROM AUTHOR]