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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]

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]

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]

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]

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]

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]

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]

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.

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]

Non-negative tensor factorization has been shown a practical solution to automatically discover phenotypes from the electronic health records (EHR) with minimal human supervision. Such methods generally require an input tensor describing the inter-modal interactions to be pre-established; however, the correspondence between different modalities (e.g., correspondence between medications and diagnoses) can often be missing in practice. Although heuristic methods can be applied to estimate them, they inevitably introduce errors, and leads to sub-optimal phenotype quality. This is particularly important for patients with complex health conditions (e.g., in critical care) as multiple diagnoses and medications are simultaneously present in the records. To alleviate this problem and discover phenotypes from EHR with unobserved inter-modal correspondence, we propose the collective hidden interaction tensor factorization (cHITF) to infer the correspondence between multiple modalities jointly with the phenotype discovery. We assume that the observed matrix for each modality is marginalization of the unobserved inter-modal correspondence, which are reconstructed by maximizing the likelihood of the observed matrices. Extensive experiments conducted on the real-world MIMIC-III dataset demonstrate that cHITF effectively infers clinically meaningful inter-modal correspondence, discovers phenotypes that are more clinically relevant and diverse, and achieves better predictive performance compared with a number of state-of-the-art computational phenotyping models. [ABSTRACT FROM AUTHOR]

Purpose: 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*-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*-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%. [ABSTRACT FROM AUTHOR]

Nasal tip mechanical stability is important for functional and cosmetic nasal airway surgery. Palpation of the nasal tip provides information on tip strength to the surgeon, though it is a purely subjective assessment. Providing a means to simulate nasal tip deformation with a validated model can offer a more objective approach in understanding the mechanics and nuances of the nasal tip support and eventual nasal mechanics as a whole. Herein we present validation of a finite element (FE) model of the nose using physical measurements recorded using an ABS plastic-silicone nasal phantom. Three-dimensional photogrammetry was used to capture the geometry of the phantom at rest and while under steady state load. The silicone used to make the phantom was mechanically tested and characterized using a linear elastic constitutive model. Surface point clouds of the silicone and FE model were compared for both the loaded and unloaded state. The average Hausdorff distance between actual measurements and FE simulations across the nose were 0.39 ± 1.04 mm and deviated up to 2 mm at the outermost boundaries of the model. FE simulation and measurements were in near complete agreement in the immediate vicinity of the nasal tip with millimeter accuracy. We have demonstrated validation of a two-component nasal FE model, which could be used to model more complex modes of deformation where direct measurement may be challenging. This is the first step in developing a nasal model to simulate nasal mechanics and ultimately the interaction between geometry and airflow.

Abstract SARS‐CoV‐2 viral infection led to the devastating COVID‐19 pandemic, where illness stemmed from interactions between virions and recipient host cells resulting in multi‐layered pathological consequences. The role of the infection portal is now understood to be the cellular angiotensin converting enzyme‐2 (ACE2) receptor, which binds to viral spike (S) protein initiating virion internalisation process. Since SARS‐CoV‐2 virions bear some resemblance to endogenously produced small extracellular vesicles (sEVs) we reasoned that EVs engineered to express S protein (viral mimics) may interfere with viral infection. Here, we report generation of HEK293T cells producing sEVs enriched for transmembrane S‐protein tagged with green fluorescent protein (S/GFP). Strikingly, S protein drove the GFP tag to the membrane of sEVs, while GFP alone was not efficiently included in the sEV cargo. High‐throughput quantitative proteomics revealed that S/GFP sEVs contained over 1000 proteins including canonical components of the exosomal pathway such as ALIX, syntenin‐1, and tetraspanins (CD81, CD9), but depleted for calnexin and cytochrome c. We found that 84 sEV proteins were significantly altered by the presence of S/GFP. S protein expressing EVs efficiently adhered to target cells in an ACE2‐dependent manner, but they were poorly internalised. Importantly, prolonged administration of S/GFP EV to K18‐hACE2 mice provided a significant protection against SARS‐CoV‐2 infection. Thus, the generation of sEV containing S protein can be considered as a novel therapeutic approach in reducing the transmission of SARS‐CoV‐2.

Abstract Batesian mimicry may result in remarkable cases of phenotypic convergence that represent classic examples of evolution through natural selection. The existence of mimicry systems among coral snakes, however, remains controversial because of contradictions between the predictions of mimetic theory and the empirical patterns of co-occurrence and species abundance. Here, we analyze the geographic distribution of coral snake species of the genus Micrurus and populations of the false coral snake Atractus latifrons in Amazonia, and perform ecological niche modeling (ENM) analyzes to generate potential geographic distributions of species of Micrurus and A. latifrons, identify patterns of co-occurrence and assess whether the distribution of A. latifrons coincides with the distribution of Micrurus species, which could suggest the existence of a possible mimetic relationship between the species. We identified six Micrurus species that may represent mimetic models for A. latifrons. The results of the co-occurrence analysis corroborates the results from ENM, indicating that chromatic patterns of A. latifrons and their respective model species are aggregated. Our study suggests that all color patterns of A. latifrons – including the tricolor monads, and the more common tricolor dyads and tricolor tetrads – may benefit from the resemblance with other Micrurus species as perfect and imperfect mimics.

Objectives: COVID-19 is a transmissible illness triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its onset in late 2019 in Wuhan city of China, it continues to spread universally, leading to an ongoing pandemic that shattered all efforts to restrain it. On the other hand, in Africa, the COVID-19 infection may be influenced by malaria coinfection. Hence, in this review article, we aimed to give a comprehensive account of the similarities between COVID-19 and malaria in terms of symptoms, clinical, immunological, and molecular perspectives. Methodology: In this article, we reviewed over 50 research papers to highlight the multilayered similarities between COVID-19 and malaria infections that might influence the ontology of COVID-19. Results: Despite the poor health and fragile medical system of many sub-Saharan African countries, they persisted with a statistically significantly low number of COVID-19 cases. This was attributed to many factors such as the young population age, the warm weather, the lack of proper diagnosis, previous infection with malaria, the use of antimalarial drugs, etc. Additionally, population genetics appears to play a significant role in shaping the COVID-19 dynamics. This is evident as recent genomic screening analyses of the angiotensin-converting enzyme 2 (ACE2) and malaria-associatedvariants identified 6 candidate genes that might play a role in malaria and COVID-19 incidence and severity. Moreover, the clinical and pathological resemblances between the two diseases have made considerable confusion in the diagnosis and thereafter curb the disease in Africa. Therefore, possible similarities between the diseases in regards to the clinical, pathological, immunological, and genetical ascription were discussed. Conclusion: Understanding the dynamics of COVID-19 infection in Sub-Saharan Africa and how it is shaped by another endemic disease like malaria can provide insights into how to tailor a successful diagnostic, intervention, and control plans that lower both disease morbidity and mortality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ObjectivesCOVID-19 is a transmissible illness triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its onset in late 2019 in Wuhan city of China, it continues to spread universally, leading to an ongoing pandemic that shattered all efforts to restrain it. On the other hand, in Africa, the COVID-19 infection may be influenced by malaria coinfection. Hence, in this review article, we aimed to give a comprehensive account of the similarities between COVID-19 and malaria in terms of symptoms, clinical, immunological, and molecular perspectives.MethodologyIn this article, we reviewed over 50 research papers to highlight the multilayered similarities between COVID-19 and malaria infections that might influence the ontology of COVID-19.ResultsDespite the poor health and fragile medical system of many sub-Saharan African countries, they persisted with a statistically significantly low number of COVID-19 cases. This was attributed to many factors such as the young population age, the warm weather, the lack of proper diagnosis, previous infection with malaria, the use of antimalarial drugs, etc. Additionally, population genetics appears to play a significant role in shaping the COVID-19 dynamics. This is evident as recent genomic screening analyses of the angiotensin-converting enzyme 2 (ACE2) and malaria-associated-variants identified 6 candidate genes that might play a role in malaria and COVID-19 incidence and severity. Moreover, the clinical and pathological resemblances between the two diseases have made considerable confusion in the diagnosis and thereafter curb the disease in Africa. Therefore, possible similarities between the diseases in regards to the clinical, pathological, immunological, and genetical ascription were discussed.ConclusionUnderstanding the dynamics of COVID-19 infection in Sub-Saharan Africa and how it is shaped by another endemic disease like malaria can provide insights into how to tailor a successful diagnostic, intervention, and control plans that lower both disease morbidity and mortality.

AbstractMimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

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

Aim and Objective : Our study was an observational and evolutional to analyze the significance of orbital volume calculation in predicting the probability or tendency of developing late enopthalmous on patients with unilateral orbital fracture with or without associated midface injury reported to our hospital. Materials and Methods: The subjects in our study included fifteen patients between18 and 60years. They were treated surgically and conservatively. Patients were exposed to series of examination from the day of injury or reporting for a consecutive period of up to six months following injury. CT was taken prior to treatment following management to evaluate the volume change in orbit. Its correlation and significance to treatment outcome were analyzed using MIMICS software by Materialise by comparing injured orbit to opposite side normal eye. Result: Conclusive of clinical examination and summary of statistical analysis patients were categorized into three groups: Low (with volume change of less than 2%), Medium (volume change between 2 to 20%) and High (volume change more than 20%) by comparing fractured orbit to uninjured orbit and a statistically significant mean value of 27.7 ± 2.6 cu.mm for fractures eye and 25.9 ± 2.6 cu.mm for normal eye was found ( P ≤≤ 0.05). Conclusion: Orbital volume can be considered as useful criteria in evaluation of patients with orbital fracture. Evaluation and follow up in correlation with resultant volume assessment provide a better indicator for assessment of prognosis and enopthalmous. Unlike other methods for volume assessment MIMICS software by Materialise provide a better method and it can be incorporated to working station in hospital. Every CT assessment in orbital trauma should include orbital volume as a parameter and this software is easy and user-friendly software that does not require its technical knowledge for application. [ABSTRACT FROM AUTHOR]

Abstract It was critical for the clinician to be aware of the neuroimaging and early‐onset symptoms of this fatal neurodegenerative disease, and avoid initiating inappropriate therapy. Neuroimaging plays a key role in differentiating it from other mimics.

Objective To assess whether the computed tomography (CT)‐based method of three‐dimensional (3D) analysis (Mimics) was accurate and reliable for spine surgical anatomical measurements. Methods A total of 40 lumbar segments and 32 inter‐vertebral discs from eigth adult male cadavers without fractures or deformities fixed with the classical formaldehyde method were included in this research on 5 June 2017. CT scans including seven dimensions: anterior height of the vertebral body (VBHa), middle height of the vertebral body (VBHm), posterior height of the vertebral body (VBHp), width of the upper endplate (EPWu), depth of the upper endplate (EPDu), anterior height of the inter‐vertebral disc in the median sagittal plane (IDHa), and posterior height of the inter‐vertebral disc in the median sagittal plane (IDHp). They were performed based on uniform conditions (slice thickness: 0.625 mm) using a CT scanner on 8 June 2017. Afterwards, the surgical anatomical measurements were conducted with a Vernier caliper on 12 June 2017. The computer‐aided anatomical measurements were conducted by three investigators using Mimics 16.0 to perform 3D reconstructions of CT bone on 16 June 2017. Finally, the length and angle were measured with associated measurement tools, yielding a verified accuracy of 0.01 mm and 0.01°, respectively. Each measurement was repeated three times, and all anatomical data was analyzed using the statistical software and P‐value 0.05) for lumbar vertebra measurements, and the absolute difference between surgical and computer‐aided data were all less than 1.0 mm (for the VBHa, VBHm, VBHp, EPWu, and EPDu were 0.12, 0.03, 0.03, 0.31, and 0.03 mm, respectively). Moreover, although the absolute differences of discs was larger than those of lumbar vertebras, no significant differences were detected between the computer‐aided and surgical anatomical measurements for the IDHa, as well as IDHp in the vast majority of measurements (P = 0.543, 0.079 or 0.052 for IDHa, and P = 0.212, 0.133 or 0.042 for IDHp). In addition, excellent reliability correlation was observed between the measurements of each investigator, and the reliability coefficients in the intra‐groups were all greater than 0.9 except for IDHp (reliability coefficient = 0.892). Additionally, the reliability coefficients were greater than 0.9 for the all between‐group correlations, and a significant correlation was also observed. Furthermore, no statistically significant difference for three anatomical values was found in the computer‐assisted measurements of the lumbar bone structure (P > 0.05). Similarly, we did not observe a statistical difference in the anatomical data of the lumbar discs from the three measures (P > 0.05). Conclusions Computer‐aided anatomical measurement for spine based on CT scans presents the high accuracy and reliability for improving spinal surgical procedures.

Abstract Background Stroke mimics account for up to one-third of acute stroke admissions and are a heterogeneous entity which pose diagnostic challenges. Diagnosing such patients is however crucial to avoid delays in treatment and potentially harmful medication prescription. We aimed at describing the magnitude, clinical characteristics and short-term outcomes of stroke mimics in patients clinically diagnosed with a stroke. Methods This prospective study enrolled patients admitted with a World Health Organization clinical criteria for stroke at a tertiary hospital in Tanzania. Baseline data was collected and the simplified version of the FABS scale was used to determine its usefulness in predicting stroke mimics. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess for admission stroke severity and outcomes respectively. Results Among 363 patients with suspected stroke on admission, the final diagnosis was stroke mimics in 24 (6.6%) who had a mean age of 65.8 ± 15 years. Patients with stroke mimics were less likely to have cardiovascular risk factors for stroke including premorbid hypertension (7 (29.2%) vs 263 (77.6%), p

Abstract The human PXR (pregnane X receptor), a master regulator of drug metabolism, has essential roles in intestinal homeostasis and abrogating inflammation. Existing PXR ligands have substantial off‐target toxicity. Based on prior work that established microbial (indole) metabolites as PXR ligands, we proposed microbial metabolite mimicry as a novel strategy for drug discovery that allows exploiting previously unexplored parts of chemical space. Here, we report functionalized indole derivatives as first‐in‐class non‐cytotoxic PXR agonists as a proof of concept for microbial metabolite mimicry. The lead compound, FKK6 (Felix Kopp Kortagere 6), binds directly to PXR protein in solution, induces PXR‐specific target gene expression in cells, human organoids, and mice. FKK6 significantly represses pro‐inflammatory cytokine production cells and abrogates inflammation in mice expressing the human PXR gene. The development of FKK6 demonstrates for the first time that microbial metabolite mimicry is a viable strategy for drug discovery and opens the door to underexploited regions of chemical space.

ABSTRACT Mitochondria are dynamic organelles vital for energy production with now appreciated roles in immune defense. During microbial infection, mitochondria serve as signaling hubs to induce immune responses to counteract invading pathogens like viruses. Mitochondrial functions are central to a variety of antiviral responses including apoptosis and type I interferon signaling (IFN-I). While apoptosis and IFN-I mediated by mitochondrial antiviral signaling (MAVS) are well-established defenses, new dimensions of mitochondrial biology are emerging as battlefronts during viral infection. Increasingly, it has become apparent that mitochondria serve as reservoirs for distinct cues that trigger immune responses and that alterations in mitochondrial morphology may also tip infection outcomes. Furthermore, new data are foreshadowing pivotal roles for classic, homeostatic facets of this organelle as host-virus interfaces, namely, the tricarboxylic acid (TCA) cycle and electron transport chain (ETC) complexes like respiratory supercomplexes. Underscoring the importance of “housekeeping” mitochondrial activities in viral infection is the growing list of viral-encoded inhibitors including mimics derived from cellular genes that antagonize these functions. For example, virologs for ETC factors and several enzymes from the TCA cycle have been recently identified in DNA virus genomes and serve to pinpoint new vulnerabilities during infection. Here, we highlight recent advances for known antiviral functions associated with mitochondria as well as where the next battlegrounds may be based on viral effectors. Collectively, new methodology and mechanistic insights over the coming years will strengthen our understanding of how an ancient molecular truce continues to defend cells against viruses.

Lymphomas of the central nervous system (CNS) are broadly classified into primary CNS lymphoma (PCNSL) and secondary CNS lymphoma (SCNSL). PCNSL refers to lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes without evidence of it outside the CNS at primary diagnosis, while SCNSL refers to secondary CNS involvement by systemic lymphoma. The brain is the most common site of involvement and intracranial CNS lymphoma has a highly variable imaging appearance and varies according to the patient’s clinical profile and immunity. This pictorial essay aims to illustrate the different facets of intracranial CNS lymphomas on neuroimaging. This enables radiologists to be familiarized with their key diagnostic features and differentiate from their differential diagnoses, leading to early diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

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

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention. [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.

Urinary catheters often become contaminated with biofilms, resulting in catheter-associated urinary tract infections (CAUTIs) that adversely affect patient outcomes. Histotripsy is a noninvasive focused ultrasound therapy previously developed for the noninvasive ablation of cancerous tumors and soft tissues. Histotripsy has also previously shown the ability to treat biofilms on glass slides and surgical meshes. Here, we investigate the potential of histotripsy for the treatment of CAUTIs for the first time in vitro. Clinically relevant catheter materials (Tygon, Silicone, and latex catheter mimics) and commonly used clinical catheters were tested to determine the feasibility of producing luminal histotripsy bubble clouds. A Pseudomonas aeruginosa (strain PA14) biofilm model was developed and tested to produce luminal biofilms in an in vitro Tygon catheter mimic. This model was treated with histotripsy to determine the ability to remove a luminal biofilm. Finally, the bactericidal effects of histotripsy were tested by treating PA14 suspended inside the Tygon catheter mimic. Results showed that histotripsy produced precise luminal cavitation within all tested catheter mimics and clinical catheters. Histotripsy treatment of a PA14 biofilm with histotripsy reduced luminal biofilm OD590 signal down to background levels. Further, the treatment of suspended PA14 in Luria–Bertani (LB) showed a 3.45 ± 0.11 log10 reduction in CFU/mL after six histotripsy scans across the catheter mimics. Overall, the results of this study demonstrate the potential of histotripsy to provide a new modality for removing bacterial biofilms from catheter-based medical devices and suggest that additional work is warranted to investigate histotripsy for the treatment of CAUTIs and other biomaterial-associated infections. [ABSTRACT FROM AUTHOR]