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Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.

Inflammatory syndromes, including those caused by infection, are a major cause of hospital admissions among children and are often misdiagnosed because of a lack of advanced molecular diagnostic tools. In this study, we explored the utility of circulating cell-free RNA (cfRNA) in plasma as an analyte for the differential diagnosis and characterization of pediatric inflammatory syndromes. We profiled cfRNA in 370 plasma samples from pediatric patients with a range of inflammatory conditions, including Kawasaki disease (KD), multisystem inflammatory syndrome in children (MIS-C), viral infections, and bacterial infections. We developed machine learning models based on these cfRNA profiles, which effectively differentiated KD from MIS-C-two conditions presenting with overlapping symptoms-with high performance [test area under the curve = 0.98]. We further extended this methodology into a multiclass machine learning framework that achieved 80% accuracy in distinguishing among KD, MIS-C, viral, and bacterial infections. We further demonstrated that cfRNA profiles can be used to quantify injury to specific tissues and organs, including the liver, heart, endothelium, nervous system, and the upper respiratory tract. Overall, this study identified cfRNA as a versatile analyte for the differential diagnosis and characterization of a wide range of pediatric inflammatory syndromes.

Miliary tuberculosis is a form of disseminated tuberculosis that can be difficult to detect when the classic pattern is absent on chest radiograph and advanced cross-sectional imaging is not readily available. While the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol for extrapulmonary tuberculosis emphasizes easy-to-teach findings, experienced sonographers may detect additional, subtler signs that can aid in diagnosis. We report a case of a 20-year-old man with miliary tuberculosis diagnosed on computed tomography of the chest. We describe subtle sonographic signs of disseminated tuberculosis including subpleural irregularities and comet-tail artifacts, a bright liver pattern, peritoneal nodules, and a nonspecific sponge spleen pattern. We then discuss important differential diagnoses for each finding. Knowledge of subtle sonographic signs outside of the FASH protocol can aid clinicians in detecting disseminated tuberculosis, including the miliary form, when advanced imaging may not be available.

This study aimed to determine whether choroid plexus volume (CPV) could differentiate multiple sclerosis (MS) from its mimics. A secondary analysis of two previously enrolled studies, 50 participants with MS and 64 with alternative diagnoses were included. CPV was automatically segmented from 3T magnetic resonance imaging (MRI), followed by manual review to remove misclassified tissue. Mean normalized choroid plexus volume (nCPV) to intracranial volume demonstrated relatively high specificity for MS participants in each cohort (0.80 and 0.76) with an area under the receiver-operator characteristic curve of 0.71 (95% confidence interval (CI) = 0.55-0.87) and 0.65 (95% CI = 0.52-0.77). In this preliminary study, nCPV differentiated MS from its mimics.

BackgroundS100A8 is a melanoma biomarker expressed in the melanoma-associated epidermal keratinocytes, but its diagnostic utility has not been compared with other biomarkers, including PRAME.ObjectivesTo compare the utility of S100A8 and PRAME immunohistochemistry (IHC) in the differential diagnosis of melanoma and naevi in a case-control study.MethodsA previously described cohort of 209 melanomas (case samples) and naevi (control samples) dual-immunostained for S100A8 and PRAME were included. For S100A8, previously reported scores indicating the proportion of tumour-associated epidermis stained (0 = indeterminate; 1 = 0-4%; 2 = 5-25%; 3 = 26-50%; 4 = 51-75%; 5 = > 75%) were utilized. PRAME IHC was reviewed by at least two reviewers and a consensus score assigned, with score indicating the proportion of tumour stained (0 = indeterminate; 1 = 0%; 2 = 1-50%; 3 = > 50%). A positive test was defined as > 50% staining.ResultsThe area under the receiver operating characteristic curves for S100A8 (0.833) and PRAME (0.874) were not significantly different from each other (P = 0.22). The diagnostic sensitivity and specificity were 42.4% [95% confidence interval (CI) 32.6-52.8%] and 98.2% (95% CI 93.6-99.8%) for S100A8, and 79.8% (95% CI 70.5-87.2%) and 87.3% (95% CI 79.6-92.9%) for PRAME, respectively. A combined test requiring both S100A8 and PRAME IHC positivity had a sensitivity of 39.4% (95% CI 29.7-49.7%) and specificity of 99.1% (95% CI 95.0-100.0%).ConclusionsS100A8 and PRAME have utility in the diagnostic workup of melanoma, with S100A8 being more specific and PRAME being more sensitive when using this threshold. Our findings suggest that these two immunohistochemical markers may favourably complement one another to improve the detection of melanoma.

BACKGROUND AND OBJECTIVE: Parkinsonian disorders, including Parkinsons disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS), exhibit overlapping early-stage symptoms, complicating definitive diagnosis despite heterogeneous cellular and regional pathophysiology. Additionally, the progression and the eventual conversion of prodromal conditions such as REM behavior disorder (RBD) to PD, MSA, or DLB remain challenging to predict. Extracellular vesicles (EVs) are small, membrane-enclosed structures released by cells, playing a vital role in communicating cell-state-specific messages. Due to their ability to cross the blood-brain barrier into the peripheral circulation, measuring biomarkers in blood-isolated speculative CNS enriched EVs has become a popular diagnostic approach. However, replication and independent validation remain challenging in this field. Here, we aimed to evaluate the diagnostic accuracy of speculative CNS-enriched EVs for parkinsonian disorders. METHODS: We conducted a PRISMA-guided systematic review and meta-analysis, covering 18 studies with a total of 1695 patients with PD, 253 with MSA, 21 with DLB, 172 with PSP, 152 with CBS, 189 with RBD, and 1288 HCs, employing either hierarchical bivariate models or univariate models based on study size. RESULTS: Diagnostic accuracy was moderate for differentiating patients with PD from HCs, but revealed high heterogeneity and significant publication bias, suggesting an inflation of the perceived diagnostic effectiveness. The bias observed indicates that studies with non-significant or lower effect sizes were less likely to be published. Although results for differentiating patients with PD from those with MSA or PSP and CBS appeared promising, their validity is limited due to the small number of involved studies coming from the same research group. Despite initial reports, our analyses suggest that using speculative CNS-enriched EV biomarkers may not reliably differentiate patients with MSA from HCs or patients with RBD from HCs, due to their lesser accuracy and substantial variability among the studies, further complicated by substantial publication bias. CONCLUSION: Our findings underscore the moderate, yet unreliable diagnostic accuracy of biomarkers in speculative CNS-enriched EVs in differentiating parkinsonian disorders, highlighting the presence of substantial heterogeneity and significant publication bias. These observations reinforce the need for larger, more standardized, and unbiased studies to validate the utility of these biomarkers but also call for the development of better biomarkers for parkinsonian disorders.

Objective: To describe and evaluate the current knowledge of MRI characteristics of osteitis condensans ilii (OCI) in the diagnostics and differentiation of OCI from other conditions. Materials and methods: The databases PubMed, EMBASE, Scopus, and Web of Science were searched from their inception to March 2024 using the search terms "Magnetic Resonance Imaging" (MESH term in PubMed) and "osteitis condensans ilii" and limited to English language. Two reviewers independently screened titles, abstracts, and full-text eligibility and assessed the risk of bias according to Quality Assessment of Diagnostic Accuracy Studies, QUADAS-2. Results: The search identified 53 records. Case reports, letters/notes, and conference abstracts were excluded, resulting in 24 reports assessed by full-text, 9 research articles, 14 reviews, and a book chapter. Five retrospective research studies were found eligible for the review. Detailed MRI features of OCI were only described in two studies of patients with pain where they encompassed manifest subchondral iliac sclerosis often accompanied by bone marrow edema (BME) located peripheral to the sclerosis and displaying a continuous distribution and frequently accompanied by sacral BME. Erosions were rare and ankylosis did not occur. Fat deposition in the bone marrow was frequent and similar to BME often located to anterior strain-related joint areas. The QUADAS-2 assessments revealed risks of bias in all studies analyzed, especially regarding general applicability of the MRI features. Conclusion: There is a lack of valid data describing characteristic MRI features in general groups of OCI patients with and without pain. [ABSTRACT FROM AUTHOR]

Background: Spinal bulbar muscular atrophy (SBMA) and amyotrophic lateral sclerosis (ALS) are motor neuron disorders that demonstrate overlapping clinical features, especially in the early stage. Therefore, the aim of this study was to investigate the utility of chest tomography (CT) imaging in distinguishing between SBMA and ALS. Methods: This was a retrospective study reviewing CT images from patients with SBMA and sporadic ALS and those in the control group. The CT images were assessed to measure the diameter and morphology of glandular tissue associated with gynecomastia. We compared CT-measured gynecomastia between the SBMA, ALS, and control groups. Additionally, correlation analyses were performed between the quantitative measurements of gynecomastia obtained from CT scans and various clinical/laboratory parameter in the SBMA group. Results: 15 chest CT images were collected from SBMA, 41 from ALS, and 29 from control group. No statistical differences were observed in BMI, functional scales, or age at the time of CT scans between the SBMA and ALS groups. Despite similar functional scales and age in both groups, the mean glandular tissue diameter of breast tissue observed in chest CT imaging differed significantly between SBMA, ALS, and controls: 32.22 ± 12.57 mm, 15.91 ± 4.81 mm, and 15.76 ± 7.26 mm, respectively. This disparity allowed for the differentiation of SBMA from ALS and controls with statistical significance. Clinical gynecomastia was 80%, while radiological gynecomastia was 93.3% in SBMA. A significantly higher prevalence of diffuse glandular morphology pattern in SBMA (50%) was observed, contrasting with the predominance of nodular morphology in ALS and controls (9.1% and 20%). Correlative analysis between glandular tissue diameter and other clinical/laboratory parameters within the SBMA group showed no specific finding. Conclusion: CT-based radiological gynecomastia effectively differentiated SBMA from ALS. These findings support the usefulness of radiological gynecomastia as a potential differential diagnostic marker for SBMA, especially in the early stages. [ABSTRACT FROM AUTHOR]

Introduction. Tuberculosis (TB) continues to be a global health problem, with various manifestations affecting different organs and organ systems. Tuberculous lymphadenitis (TBL), also known as scrofula or lymph node (LN) TB, is a manifestation of Mycobacterium tuberculosis infection primarily affecting the LNs. Our region has a low annual incidence rate of TB, which is why the expected prevalence of TBL is also low. Case report. We present two cases of TBL diagnosed three months apart. Both presented patients had the disease localized in the LNs of the neck. These were young people without chronic diseases and previously in good health condition. The diagnosis was confirmed by surgical biopsy of the LNs in the first patient and fine needle aspiration biopsy in the second patient. Both patients were treated with standard protocols for TBL, with favorable outcomes and without significant complications and side effects. Conclusion. Presented cases highlight the importance of considering TBL in the differential diagnosis of neck masses, even in regions with a low prevalence of TB. Timely diagnosis and treatment are essential for preventing complications and ensuring a successful outcome. [ABSTRACT FROM AUTHOR]

Introduction. Immunotherapy is associated with a wide range of adverse events. A drug-induced sarcoidosis-like reaction is a systemic granulomatous reaction that is no different from sarcoidosis and occurs in a certain temporal relationship with the initiation of the drug. Case report. The f irst p resented p atient w as a 6 1-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant nivolumab therapy. After four cycles of therapy, enlarged mediastinal lymph nodes were confirmed using computed tomography. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy showed chronic granulomatous inflammation. After 12 cycles, grouped brownish-red papules and plaques covered with whitish scales were observed in the skin of both knees, and a histopathology finding indicated a sarcoidosis-like reaction. He was treated with oral prednisone, 60 mg daily in decreasing doses, and after 16 months, the enlarged mediastinal lymph nodes and skin lesions disappeared completely. The second presented patient was a 45-year-old male with stage IIIC BRAF-positive melanoma treated with adjuvant pembrolizumab therapy. After four cycles, enlarged mediastinal lymph nodes were observed. Bronchoscopy with bronchoalveolar lavage revealed granulomatous inflammation, and transbronchial biopsy confirmed sarcoidosis. Therapy with oral prednisone 40 mg daily in decreasing doses was performed in the next three months, and immunotherapy was continued. The enlarged mediastinal lymph nodes resolved after completion of adjuvant therapy. Conclusion. In most cases, a diagnosis of a sarcoidosis-like reaction requires a biopsy of the suspected lesions. It is not usually necessary to s top immunotherapy, but sometimes standard corticosteroid therapy is indicated. An interdisciplinary approach is important to distinguish true disease progression from adverse drug reaction. [ABSTRACT FROM AUTHOR]

This pilot study investigated a new simplified OSA screening tool that could be used in primary care/GP settings – the "GPSS" tool – "General Practice Sleep Scale" and compared against common existing OSA screening tools. A convenience sample of patients attending the respiratory and sleep clinic in the Northern Territory of Australia were included if they completed the GPSS prior to undergoing a diagnostic polysomnography. The GPSS contained 9 questions to provide information on: sex, age, body mass index, neck circumference, snoring, witnessed apnoeas, morning tiredness, daytime sleepiness and presence of hypertension/diabetes/heart disease/depression. Presence of OSA was defined as an apnoea-hypopnoea index of ≥15/hour. The GPSS scoring was developed via log odds of regression predictions for each GPSS question upon OSA. 159 patients (65 % male, median age 45 years) were enrolled. A minimum score of 1 was assigned to GPSS questions, up to 5 for the strongest predictor (neck circumference). The median total GPSS score was 13 (IQR 9, 16) (maximum 22) and correlated strongly with OSA (AUC 0.812 (95 % CI 0.744, 0.881)). Categorised into low (0–7), moderate (8–13) or high risk (>13), a moderate or severe score had sensitivity 100, specificity 34.9 %. The GPSS significantly outperformed the Epworth Sleepiness Scale, Berlin questionnaire and OSA-50, and was comparable but slightly improved against the STOP-Bang. The proposed GPSS tool could be of use in general practice settings. Further prospective research is warranted to test the applicability and adaptability of the GPSS tool in wider population settings. • General practitioners play a critical role in identifying at risk patients with OSA. • Underdiagnosis of OSA continues in General Practice due to competing priorities. • A simplified OSA screening tool (GPSS) for use in General practice was developed. • This proposed OSA screening tool outperformed most existing OSA screening tools. • Further research is warranted to test the GPSS utility in wider populations. [ABSTRACT FROM AUTHOR]

Yang Tao,&ast; Wen-Tao Zhang,&ast; Can Ding, Bin-Jie Fu, Fa-Jin Lv, Zhi-Gang Chu Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fa-Jin Lv; Zhi-Gang Chu, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1&num; Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, People’s Republic of China, 400016, Tel +86 18723032809, Fax +86 23 68811487, Email cyscitg@hospital.cqmu.edu.cn; chuzg0815@163.comPurpose: To determine the significance of lesion–pleura relationship in differentiating peripheral inflammatory lesions (PILs) and peripheral lung cancers (PLCs).Patients and Methods: From January 2017 to April 2022, a total of 743 patients with 501 PLCs and 292 PILs (≥ 1.5 cm) were retrospectively enrolled. The patients’ clinical characteristics and CT features of lesions in these two groups were analyzed and compared, and the impact of the lesion–pleura relationship (broad or narrow basement and distance between lesion and pleura) on differentiation was specifically assessed.Results: Lesions attached to pleura were more frequent in PILs (188, 64.4%) than in PLCs (244, 48.7%) (P < 0.001), and those with broad basement-to-pleura were also more common in PILs (133, 70.7%) than in PLCs (47, 19.3%) (P < 0.001). Among the 296 lesions with a lesion-pleura distance ≤ 16 mm, the optimal cutoff value of distance was ≤ 8.9 mm (area under curve [AUC], 0.733; sensitivity: 0.770; specificity: 0.623; P < 0.001) for predicting PLCs. Regarding the 728 lesions attached to pleura or with a lesion-pleura distance ≤ 16 mm, the AUC of the model based on the clinical and CT features for predicting PLCs significantly increased from 0.812 to 0.879 after including lesion-pleura relationship (narrow basement or lesion-pleura distance ≤ 8.9 mm) (P < 0.001). Additionally, the lesion–pleura relationship was one of independent indicators for differentiation (odds ratio, 9.433; P < 0.001).Conclusion: When differentiating peripheral lesions (≥ 1.5 cm), it is crucial to consider the basement-to-pleura and lesion-pleura distance besides patients’ clinical characteristics, laboratory parameters and morphological features.Keywords: lung neoplasms, diagnosis, differential, tomography, X-ray computed

This case report discusses a diagnosis of uterine torsion in an 84-year-old woman who presented with five days of right lower quadrant abdominal pain, nausea, vomiting, constipation, and poor intake. Computed tomography (CT) imaging demonstrated a whorled configuration at the junction of the cervix and lower uterine segment, with the left gonadal vein crossing midline, and two previously known right leiomyomas now appearing on the left. These findings were consistent with the diagnosis of uterine torsion. She then underwent an urgent exploratory laparotomy, and the uterus was found to be dextroverted 270 degrees, with dark mottled purple tissue and engorged vessels. A supracervical hysterectomy and bilateral salpingo-oopherectomy were performed. Final pathology demonstrated extensive necrosis. This case reviews the classic presentation and imaging findings for the rare diagnosis of uterine torsion and options for management of both non-gravid and gravid patients.

Objective To investigate the value of 18F⁃FDG PET in the diagnosis and differential diagnosis of Parkinson's disease (PD) and multiple system atrophy with parkinsonism⁃predominant (MSA⁃P). Methods Total 96 patients with PD and 52 patients with MSA ⁃ P from The First Hospital of Jilin University from May 2019 to December 2022 were included, and 18F⁃FDG PET data were collected from all patients and 18F⁃FDG PET data was analyzed using CortexID Suite software. The diagnostic and differential diagnostic efficacy of PD and MSA⁃P of 18F⁃FDG PET was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). The Z ⁃ scores of 26 brain regions were obtained, and the brain glucose metabolism patterns of patients with PD and MSA⁃P were finally obtained by comparing with the normal control database. The consistency between 18F⁃FDG PET and "gold standard" diagnosis was evaluated using the Kappa test. Results 1) Metabolic pattern: compared with the normal control database, the PD group showed significantly hypermetabolism in pons (t = 2.851, P = 0.005), cerebellum (t = 2.295, P = 0.024) and mesial temporal (t = 5.850, P = 0.000), and significantly hypometabolism in lateral occipital (t = ⁃ 7.116, P = 0.000), superior parietal (t = ⁃ 13.466, P = 0.000), inferior parietal (t = ⁃ 21.838, P = 0.000), precuneus (t = ⁃ 7.121, P = 0.000), sensorimotor (t = ⁃ 6.931, P = 0.000) and lateral prefrontal (t = ⁃ 6.778, P = 0.000); while the MSA⁃P group showed significant hypometabolism in pons (t = ⁃ 8.364, P = 0.000), cerebellum (t = ⁃ 9.900, P = 0.000), superior parietal (t = ⁃ 4.830, P = 0.000) and inferior parietal (t = ⁃ 11.287, P = 0.000), and hypermetabolism in the primary visual (t = 5.579, P = 0.000). 2) Diagnosis and differential diagnosis: compared with the MSA⁃P group, the PD group had lower Z⁃score in sensorimotor (t = ⁃ 0.646, P = 0.008), precuneus (t = ⁃ 4.516, P = 0.000), superior parietal (t = ⁃ 4.611, P = 0.000), inferior parietal (t = ⁃ 5.903, P = 0.000), lateral occipital (t = ⁃ 5.088, P = 0.000) and primary visual (t = ⁃ 3.218, P = 0.002), while the Z⁃scores in mesial temporal (t = 3.718, P = 0.002), cerebellum (t = 9.880, P = 0.000) and pons (t = 9.520, P = 0.000) were higher. The ROC curve was drew for the differential diagnostic efficacy of 18F⁃FDG PET through the six brain regions with statistical difference and P = 0.000 between the 2 groups, the result showed that the AUC of cerebellum (Z = 3.595, P = 0.000; Z = 2.942, P = 0.003; Z = 2.942, P = 0.003; Z = 3.519, P = 0.000), pons (Z = 3.363, P = 0.001; Z = 3.237, P = 0.000; Z = 2.376, P = 0.018; Z = 3.012, P = 0.003) and the combination of the six brain regions (Z = 4.354, P = 0.000; Z = 4.242, P = 0.000; Z = 3.711, P = 0.000; Z = 4.233, P = 0.000) were bigger than the AUC of precuneus, superior parietal, inferior parietal and lateral occipital; the AUC of the combination of the six brain regions was bigger than pons (Z = 1.986, P = 0.047). Kappa test indicated that the diagnosis of the 18F⁃FDG PET had good agreement with the diagnosis of the "gold standard" in the two diseases (κ = 0.678, P = 0.000, for all). Conclusions The characteristic brain glucose metabolism patterns of PD and MSA⁃P can be obtained by 18F⁃FDG PET. 18F⁃FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA⁃P.

Objective: To establish lactate and glucose differences between affected and non-affected limbs in cats with feline arterial thromboembolism (FATE). To evaluate the correlation between these values and survival to discharge as well as congestive heart failure (CHF). Methods: Blood glucose and lactate concentrations were prospectively obtained on admission from client-owned FATE cats and client-owned cats presented for other conditions. The glucose and lactate concentrations of the front limbs (or non-affected) and the hind limbs (or affected) were measured. Lactate (Δlactate) and glucose (Δglucose) differences between the two limbs were calculated. Results: The FATE group and control groups included 18 and 41 cats, respectively. The median age of the cats within the FATE group and control groups was 9.5 years and 5 years, respectively. The median Δlactate was significantly higher in the FATE group than in the control group (7.2 mmol/L versus 0.1 mmol/L, respectively; p ≤ 0.01). The median Δglucose was significantly higher in the FATE group than in the control group (155 mg/dL versus 3 mg/dL, respectively; p ≤ 0.01). A diagnosis of FATE was made using a ∆lactate cutoff of 2.2 mmol/L (100% sensitivity and 95% specificity) or a ∆glucose cutoff of 41 mg/dL (100% sensitivity and specificity). There was no correlation between Δlactate and Δglucose and survival to discharge. A higher ∆glucose was significantly associated with concurrent CHF (p = 0.01). Conclusion: Both Δlactate and Δglucose were accurate diagnostic tools for cats with FATE. Neither were correlated with survival to discharge. Higher Δglucose values were significantly associated with the presence of CHF. [ABSTRACT FROM AUTHOR]

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Objective To investigate the value of 18F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease (PD) and multiple system atrophy with parkinsonism-predominant (MSA-P). Methods Total 96 patients with PD and 52 patients with MSA-P from The First Hospital of Jilin University from May 2019 to December 2022 were included, and 18F-FDG PET data were collected from all patients and 18F-FDG PET data was analyzed using CortexID Suite software. The diagnostic and differential diagnostic efficacy of PD and MSA-P of 18F-FDG PET was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). The Z-scores of 26 brain regions were obtained, and the brain glucose metabolism patterns of patients with PD and MSA-P were finally obtained by comparing with the normal control database. The consistency between 18F-FDG PET and "gold standard" diagnosis was evaluated using the Kappa test. Results 1) Metabolic pattern: compared with the normal control database, the PD group showed significantly hypermetabolism in pons (t = 2.851, P = 0.005), cerebellum (t = 2.295, P = 0.024) and mesial temporal (t = 5.850, P = 0.000), and significantly hypometabolism in lateral occipital (t = - 7.116, P = 0.000), superior parietal (t = - 13.466, P = 0.000), inferior parietal (t = - 21.838, P = 0.000), precuneus (t = - 7.121, P = 0.000), sensorimotor (t = - 6.931, P = 0.000) and lateral prefrontal (t = - 6.778, P = 0.000); while the MSA-P group showed significant hypometabolism in pons (t = - 8.364, P = 0.000), cerebellum (t = - 9.900, P = 0.000), superior parietal (t = - 4.830, P = 0.000) and inferior parietal (t = - 11.287, P = 0.000), and hypermetabolism in the primary visual (t = 5.579, P = 0.000). 2) Diagnosis and differential diagnosis: compared with the MSA-P group, the PD group had lower Z-score in sensorimotor (t = - 0.646, P = 0.008), precuneus (t = - 4.516, P = 0.000), superior parietal (t = - 4.611, P = 0.000), inferior parietal (t = - 5.903, P = 0.000), lateral occipital (t = - 5.088, P = 0.000) and primary visual (t = - 3.218, P = 0.002), while the Z-scores in mesial temporal (t = 3.718, P = 0.002), cerebellum (t = 9.880, P = 0.000) and pons (t = 9.520, P = 0.000) were higher. The ROC curve was drew for the differential diagnostic efficacy of 18F-FDG PET through the six brain regions with statistical difference and P = 0.000 between the 2 groups, the result showed that the AUC of cerebellum (Z = 3.595, P = 0.000; Z = 2.942, P = 0.003; Z = 2.942, P = 0.003; Z = 3.519, P = 0.000), pons (Z = 3.363, P = 0.001; Z = 3.237, P = 0.000; Z = 2.376, P = 0.018; Z = 3.012, P = 0.003) and the combination of the six brain regions (Z = 4.354, P = 0.000; Z = 4.242, P = 0.000; Z = 3.711, P = 0.000; Z = 4.233, P = 0.000) were bigger than the AUC of precuneus, superior parietal, inferior parietal and lateral occipital; the AUC of the combination of the six brain regions was bigger than pons (Z = 1.986, P = 0.047). Kappa test indicated that the diagnosis of the 18F-FDG PET had good agreement with the diagnosis of the "gold standard" in the two diseases (κ = 0.678, P = 0.000, for all). Conclusions The characteristic brain glucose metabolism patterns of PD and MSA-P can be obtained by 18F-FDG PET. 18F-FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA-P. [ABSTRACT FROM AUTHOR]

Background/Aim. Serum tumor markers (TMs) are commonly combined with imaging examinations to differentiate benign and malignant breast nodules (BNs), but there are still limitations. The aim of the study was to determine the value of real-time tissue elastography (RTE) diffusion quantitative analysis combined with serum TMs for the differential diagnosis of benign and malignant BNs. Methods. A total of 149 patients with BNs were included in this study. They were assigned to the benign BN group (n = 87) and malignant BN group (n = 62). All patients were examined using RTE diffusion quantitative analysis. Venous blood was collected to detect the levels of TMs carcinoembryonic antigen-CAE, cancer antigen (CA) 153, and CA 199. The value of RTE diffusion quantitative analysis parameters, TMs, and their combination for the differentiation of benign and malignant BNs was analyzed using the receiver operating characteristic-ROC curve. Results. Among all the above indicators, the area ratio of the blue region (AREA%) had the highest differential value, with an area under the curve (AUC) of 0.916 [95% confidence interval (CI): 0.812-0.967], while sensitivity and specificity were 88.90% and 86.79%, respectively (p < 0.05). Compared to RTE diffusion quantitative analysis parameters or TMs alone, the combination of the two showed the highest value for the differentiation of benign and malignant BNs, with an AUC of 0.957 (95% CI: 0.834-0.982), while sensitivity and specificity were 95.50% and 94.33%, respectively (p < 0.05). Conclusion. RTE diffusion quantitative analysis combined with TMs has a high value for the differentiation of benign and malignant BNs. [ABSTRACT FROM AUTHOR]

Diagnosing subcentimeter solid pulmonary nodules (SSPNs) remains challenging in clinical practice. Deep learning may perform better than conventional methods in differentiating benign and malignant pulmonary nodules. This study aimed to develop and validate a model for differentiating malignant and benign SSPNs using CT images. This retrospective study included consecutive patients with SSPNs detected between January 2015 and October 2021 as an internal dataset. Malignancy was confirmed pathologically; benignity was confirmed pathologically or via follow-up evaluations. The SSPNs were segmented manually. A self-supervision pre-training-based fine-grained network was developed for predicting SSPN malignancy. The pre-trained model was established using data from the National Lung Screening Trial, Lung Nodule Analysis 2016, and a database of 5478 pulmonary nodules from the previous study, with subsequent fine-tuning using the internal dataset. The model's efficacy was investigated using an external cohort from another center, and its accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were determined. Overall, 1276 patients (mean age, 56 ± 10 years; 497 males) with 1389 SSPNs (mean diameter, 7.5 ± 2.0 mm; 625 benign) were enrolled. The internal dataset was specifically enriched for malignancy. The model's performance in the internal testing set (316 SSPNs) was: AUC, 0.964 (95% confidence interval (95%CI): 0.942–0.986); accuracy, 0.934; sensitivity, 0.965; and specificity, 0.908. The model's performance in the external test set (202 SSPNs) was: AUC, 0.945 (95% CI: 0.910–0.979); accuracy, 0.911; sensitivity, 0.977; and specificity, 0.860. This deep learning model was robust and exhibited good performance in predicting the malignancy of SSPNs, which could help optimize patient management. [ABSTRACT FROM AUTHOR]

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Background and Aims: Plain film radiography is the first imaging modality in the detection of most foreign bodies. However, it is not sensitive for detection of radiolucent objects such as organic material including plant thorns. Case report: Herein, we present the case of a 19-year-old male patient, presenting with an 8-month history of right knee pain and laxity, whose radiographic appearance mimicked that of pigmented villonodular synovitis (PVNS) but was found to have a retained neglected plant thorn in his knee. Upon ultrasound evaluation for image-guided biopsy to confirm the provisional diagnosis of PVNS, he was found to have a retained neglected plant thorn in his knee. Discussion: Plant thorn injuries can present as knee synovitis, as in our case, and should be kept in the differential diagnosis. An ultrasound-guided removal is possible and is a useful minimally invasive procedure. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of quantitative magnetic resonance (MR) imaging biomarkers in distinguishing between inflammatory pancreatic masses (IPM) and pancreatic cancer (PC). Methods: A literature search was conducted using PubMed, Embase, the Cochrane Library, and Web of Science through August 2023. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to evaluate the risk of bias and applicability of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated using the DerSimonian-Laird method. Univariate meta-regression analysis was used to identify the potential factors of heterogeneity. Results: Twenty-four studies were included in this meta-analysis. The two main types of IPM, mass-forming pancreatitis (MFP) and autoimmune pancreatitis (AIP), differ in their apparent diffusion coefficient (ADC) values. Compared with PC, the ADC value was higher in MFP but lower in AIP. The pooled sensitivity/specificity of ADC were 0.80/0.85 for distinguishing MFP from PC and 0.82/0.84 for distinguishing AIP from PC. The pooled sensitivity/specificity for the maximal diameter of the upstream main pancreatic duct (dMPD) was 0.86/0.74, with a cutoff of dMPD ≤ 4 mm, and 0.97/0.52, with a cutoff of dMPD ≤ 5 mm. The pooled sensitivity/specificity for perfusion fraction (f) was 0.82/0.68, and 0.82/0.77 for mass stiffness values. Conclusions: Quantitative MR imaging biomarkers are useful in distinguishing between IPM and PC. ADC values differ between MFP and AIP, and they should be separated for consideration in future studies. Clinical relevance statement: Quantitative MR parameters could serve as non-invasive imaging biomarkers for differentiating malignant pancreatic neoplasms from inflammatory masses of the pancreas, and hence help to avoid unnecessary surgery. Key Points: • Several quantitative MR imaging biomarkers performed well in differential diagnosis between inflammatory pancreatic mass and pancreatic cancer. • The ADC value could discern pancreatic cancer from mass-forming pancreatitis or autoimmune pancreatitis, if the two inflammatory mass types are not combined. • The diameter of main pancreatic duct had the highest specificity for differentiating autoimmune pancreatitis from pancreatic cancer. [ABSTRACT FROM AUTHOR]

In teaching and in practice, little attention is given to a low anion gap. This oversight can result in a missed opportunity to diagnose acute or chronic disorders requiring treatment. In this article, we review the constituents of the anion gap, build a differential diagnosis for a low anion gap using case examples, and provide a stepwise approach to diagnostic testing to evaluate this abnormal finding.

A 49-year-old woman with a history of right breast cancer status post radiation therapy presented to our ED with increasing chest pain, exertional dyspnea, fatigue, and dizziness for several weeks. She denied syncope or near-syncope, and she had no personal or family history of cardiac disease. Her outpatient medications included tamoxifen and venlafaxine.

This study aimed to evaluate the contrast-enhanced ultrasound (CEUS) features of ureteral tuberculosis (UTB) and ureteral malignant tumour and to explore its application value in the differentiation of UTB from ureteral tumour. The ultrasound (US) and CEUS imaging features of 33 and 12 cases of pathologically confirmed UTB and ureteral malignant tumour, respectively, were retrospectively evaluated, and echo of the ureteral wall, abnormal echo of the lumen, degree of ureteral dilation and CEUS patterns of the two diseases were statistically analysed. The results revealed that the lumen echo of UTB was hyperechoic or anechoic, whereas that of ureteral tumour lesions was hypoechoic (χ2 = 28.22, P < 0.001). The wall echo of the obstruction site differed between the two diseases; in UTB, the ureteral wall was thickened but the outer wall remained intact, whereas in ureteral tumour, both the malignant tumour wall and outer wall were irregular (χ2 = 30.25, P < 0.001). CEUS of UTB revealed nonenhancement or heterogeneous enhancement in the lumen, whereas that of ureteral tumours revealed significant homogeneous enhancement (χ2 = 30.25, P < 0.001). Thus, CEUS can reveal lesion microcirculation and be used to evaluate blood supply characteristics in the lesion, indicating that it has high potential for differentiating the two diseases.

A series of conditions can mimic musculoskeletal infections on imaging, complicating their diagnosis and affecting the treatment. Depending on the anatomical location, different conditions can manifest with clinical and imaging findings that mimic infections. Herein we present a wide spectrum of the musculoskeletal disorders of the axial skeleton, long bones, peripheral joints, and soft tissue that may manifest as infectious processes, and we focus on the potential mimics of osteomyelitis, septic arthritis, and infectious spondylodiscitis that are common in clinical practice. We present the typical imaging characteristics of each musculoskeletal infection, followed by mimicking conditions. [ABSTRACT FROM AUTHOR]

In order to predict the sealing quality of the differential assembly of forestry timber tranpsort vehicle trucks beforehand and improve the quality of its products and the assembly qualification rate, a prediction model based on grey correlation analysis algorithm combined with particle swarm (PSO) optimized BP neural network is proposed. The key assembly process parameters affecting the sealing quality of differential assembly screened out by the grey correlation analysis algorithm are taken as input variables, and the leakage value of differential assembly is taken as output variable to create a prediction model based on particle swarm algorithm optimized BP neural network, and the results show that the PSO-BP prediction method simplified by the grey correlation analysis obtains the smallest average relative error of 1. 18%. On this basis, PyQt5 GUI library is applied to develop a differential assembly leakage value prediction system. The results of the study can provide a theoretical basis for the prediction of differential assembly sealing quality. [ABSTRACT FROM AUTHOR]

Objective To investigate the imaging diagnosis and differential diagnosis methods for common tumors in the posterior fossa of children, and to propose a flow chart for the diagnosis of common tumors in the posterior fossa of children based on the limited diffusion of DWI according to the idea localization diagnosis followed by qualitative diagnosis. Methods A total of 118 pediatric patients with posterior fossa tumors who underwent surgical resection in Huashan Hospital, Fudan University from January 2021 to January 2024 were enrolled, and all of them underwent head CT and MRI examinations, and preoperative localization diagnosis and qualitative diagnosis were carried out accordingly. Then, based on whether DWI was diffusion limited, a flow chart for the diagnosis of common tumors in the posterior fossa of children was proposed. Results A total of 118 children with posterior fossa tumors were localization and qualitatively diagnosed, including 41 cases of fourth ventricular tumors, including medulloblastoma (27 cases), pilocytic astrocytoma (7 cases), ependymoma (5 cases), choroid plexus papilloma (one case), and rosette-forming glioneuronal tumor (RGNT, one case). There were 38 cases of brainstem tumors, including 24 cases of diffuse midline glioma, H3 K27 - altered, 5 cases of pilocytic astrocytoma, 3 cases of cavernous hemangioma, 2 cases of pediatric-type diffuse high-grade glioma (prone to diffuse midline glioma, H3 wild type), 2 cases of ganglio glioma, one case of atypical teratoid/rhabdoid tumor (AT/RT), and one case of pediatric - type diffuse low - grade glioma. There were 9 cases of cerebellopontine angle (CPA) tumors, including 3 cases of pilocytic astrocytoma, 2 cases of cholesteatoma, one case of medulloblastoma, one case of diffuse midline glioma, H3 K27-altered, one case of pilomyxoid astrocytoma, and one case of Ewing sarcoma. There were 30 cases of cerebellar tumors, including 15 cases of pilocytic astrocytoma, 7 cases of medulloblastoma, 2 cases of cavernous hemangioma, one case of ependymoma, one case of pediatric-type diffuse low-grade glioma, one case of pediatric-type diffuse high- grade glioma (prone to diffuse midline glioma, H3 wild type), one case of dysembryoplastic neuroepithelial tumor (DNT), one case of hamartoma, and one case of extrarenal rhabdomyomatoid tumor cerebellar metastases. Localization diagnosis, the accuracy of preoperative CT was 93.22% (110/118), while the accuracy of preoperative MRI was 100% (118/118). Qualitative diagnosis, 74 cases (62.71%) had accurate qualitative diagnosis, 23 cases (19.49%) had general diagnosis, and 21 cases (17.80%) had wrong diagnosis. The imaging differential diagnosis of posterior fossa tumors in children focuses on medulloblastoma, pilocytic astrocytoma, ependymoma, and diffuse midline glioma, H3 K27-altered. The incidence of limited diffusion of DWI in medulloblastoma, pilocytic astrocytoma and ependymoma outside the brainstem was 100% (35/35), 4% (1/25) and 5/6, and the difference among the three tumors was statistically significant (Z = - 5.601, P = 0.000). The incidence of limited diffusion of DWI in diffuse midline glioma, H3 K27- altered and pilocytic astrocytoma in the brainstem was 79.17% (19/24) and 1/5, and the difference between the two tumors was also statistically significant (Fisher's exact possibility: P = 0.038). Conclusions The early diagnosis of posterior fossa tumors in children is difficult, and DWI is an important basis for differential diagnosis. [ABSTRACT FROM AUTHOR]

Let G=(V,E) be a graph of order n. A Roman dominating function of G is a function f: V→{0,1,2} such that every vertex v for which f(v)=0 has a neighbor u with f(u)=2. The weight of a Roman dominating function is 𝑤(𝑓) = Σ𝑣∈𝑉 𝑓(𝑣). The Roman domination number of a graph G, denoted by 𝛾𝑅 (𝐺), is the minimum weight of all possible Roman dominating functions. Let B(S) be the set of vertices in V\S that have a neighbor in the vertex set S. The differential of a vertex set S is defined as ∂(S)=|B(S)|-|S| and the maximum value of ∂(S) for any subset S of V is the differential of G. A set D⊆V(G) is said to be a dominating set if every vertex in V\D is adjacent to a vertex in D. Let 𝐺 ̄ be the complement of a graph 𝐺. The complementary prism 𝐺𝐺 ̄ of 𝐺 is the graph formed from the disjoint union of 𝐺 and 𝐺 ̄ by adding the edges of a perfect matching between the corresponding vertices of 𝐺 and 𝐺 ̄. This paper is devoted to the computation of Roman domination in complementary prism graphs 𝐺𝐺 ̄ by the use of the proven Gallai-type result 𝛾𝑅 (𝐺)=n-∂(G). A graph 𝐺 is a Roman graph if 𝛾𝑅 (𝐺)=2γ(G). Particular attention is given to the complementary prims of special types of graphs and Roman complementary prisms are recognized. [ABSTRACT FROM AUTHOR]

To counter adversarial facial accessory presentation attacks (PAs), a detection method based on local face differential is proposed in this article. It extracts the local face differential features from a suspected face image and a reference face image, and then adaptively fuses the differential features of different local face regions to detect adversarial facial accessory PAs. Meanwhile, the principle of the proposed method is explained by theoretically investigating the local facial differences between a bona fide presentation and an adversarial facial accessory PA when they are compared with a reference face image. To evaluate the proposed method, this article builds a database with different adversarial examples (AEs), presentation attack instruments (PAIs), illumination conditions, and cameras. The experimental results show that it can effectively distinguish between adversarial facial accessory PAs and bona fide presentations, and it has good generalization ability to unseen AEs, PAIs, illumination conditions, and cameras. Moreover, it outperforms the existing AE detection and presentation attack detection methods in detecting adversarial facial accessory PAs. [ABSTRACT FROM AUTHOR]

ObjectiveTo establish lactate and glucose differences between affected and non-affected limbs in cats with feline arterial thromboembolism (FATE). To evaluate the correlation between these values and survival to discharge as well as congestive heart failure (CHF).MethodsBlood glucose and lactate concentrations were prospectively obtained on admission from client-owned FATE cats and client-owned cats presented for other conditions. The glucose and lactate concentrations of the front limbs (or non-affected) and the hind limbs (or affected) were measured. Lactate (Δlactate) and glucose (Δglucose) differences between the two limbs were calculated.ResultsThe FATE group and control groups included 18 and 41 cats, respectively. The median age of the cats within the FATE group and control groups was 9.5 years and 5 years, respectively. The median Δlactate was significantly higher in the FATE group than in the control group (7.2 mmol/L versus 0.1 mmol/L, respectively; p ≤ 0.01). The median Δglucose was significantly higher in the FATE group than in the control group (155 mg/dL versus 3 mg/dL, respectively; p ≤ 0.01). A diagnosis of FATE was made using a ∆lactate cutoff of 2.2 mmol/L (100% sensitivity and 95% specificity) or a ∆glucose cutoff of 41 mg/dL (100% sensitivity and specificity). There was no correlation between Δlactate and Δglucose and survival to discharge. A higher ∆glucose was significantly associated with concurrent CHF (p = 0.01).ConclusionBoth Δlactate and Δglucose were accurate diagnostic tools for cats with FATE. Neither were correlated with survival to discharge. Higher Δglucose values were significantly associated with the presence of CHF.

Background: the aim of this study is to understand the diagnostic process undertaken by psychiatrists and psychologists regarding adjustment disorder (AD) in their clinical practice and how they differentiate it from major depressive episode (MDE).Methods: A hermeneutic study using grounded theory techniques was carried out. Semi-structured interviews were conducted with twelve psychiatrists and eight psychologists in Colombia, and transcribed verbatim. Initial line-by-line coding was performed, followed by focused and axial coding to construct categories explaining the professionals’ reasoning process.Results: The clinical reasoning of professionals regarding AD was understood through four major categories. (1) Difficulty in addressing the experience of stressful events, as there is a risk of pathologizing and medicalizing them. (2) Mental health diagnoses are necessary but not apodictic. (3) The diagnostic category of AD allows for the description of a fluctuating depressive and anxious syndrome occurring in reaction to a stressful event, whose abnormality criteria are based on intersubjective knowledge of the patient's life history and consequential reasoning regarding the need for professional support. (4) The AD label could potentially protect against overdiagnosis of MDE and overuse of antidepressants. Many clinicians in their practice thus subordinate the diagnosis of MDE to ensuring it is not AD, contrary to what is outlined in diagnostic manuals.Conclusion: This study allowed us to understand the clinical reasoning of psychiatrists and psychologists about AD as a diagnosis that inherently indicates the need to work on coping and intervene in the stressor and should be considered as a diagnostic possibility in the same hierarchy as MDE in reactive syndromes, rather than a residual category.

Dynamic contrast-enhanced MRI (DCE-MRI) is routinely included in the prostate MRI protocol for a long time; its role has been questioned. It provides rich spatial and temporal information. However, the contained information cannot be fully extracted in radiologists' visual evaluation. More sophisticated computer algorithms are needed to extract the higher-order information. The purpose of this study was to apply a new deep learning algorithm, the bi-directional convolutional long short-term memory (CLSTM) network, and the radiomics analysis for differential diagnosis of PCa and benign prostatic hyperplasia (BPH). To systematically investigate the optimal amount of peritumoral tissue for improving diagnosis, a total of 9 ROIs were delineated by using 3 different methods. The results showed that bi-directional CLSTM with ± 20% region growing peritumoral ROI achieved the mean AUC of 0.89, better than the mean AUC of 0.84 by using the tumor alone without any peritumoral tissue (p = 0.25, not significant). For all 9 ROIs, deep learning had higher AUC than radiomics, but only reaching the significant difference for ± 20% region growing peritumoral ROI (0.89 vs. 0.79, p = 0.04). In conclusion, the kinetic information extracted from DCE-MRI using bi-directional CLSTM may provide helpful supplementary information for diagnosis of PCa.

BACKGROUND/OBJECTIVES: Diagnostic criteria for atopic dermatitis (AD) are limited in their performance and/or usability. The American Academy of Dermatology (AAD) consensus criteria include hierarchical categories of disease features to improve these metrics but have not been validated. Our objective was to create and validate a checkbox form of the AAD consensus criteria in the pediatric population. METHODS: We performed a cross-sectional study of 100 pediatric patients with AD (n = 58) and diseases in the differential diagnosis of AD (n = 42). RESULTS: Having three or more Essential, ≥2 Important, ≥1 Associated features of the AAD criteria was optimal for the diagnosis of AD in children. This combination was 91.4% (95% CI, 84.2%-98.6%) sensitive and 95.2% (88.8%-100%) specific. The UK working party criteria and the Hanifin-Rajka criteria had sensitivities of 96.6% (95% CI 91.9%-100%) and 98.3% (95% CI 94.9%-100%) and specificities of 83.3% (95% CI 72.1%-94.6%) and 71.4% (95% CI 57.8%-85.1%), respectively. The AAD criteria had significantly greater specificity than the Hanifin-Rajka criteria (p = .002). CONCLUSIONS: This study represents an important step in validating the AAD consensus criteria and formulating a useable checkbox form for diagnosing AD in the pediatric population.

Abstract Purpose To investigate the computed tomography (CT) characteristics of air-containing space and its specific patterns in neoplastic and non-neoplastic ground glass nodules (GGNs) for clarifying their significance in differential diagnosis. Materials and methods From January 2015 to October 2022, 1328 patients with 1,350 neoplastic GGNs and 462 patients with 465 non-neoplastic GGNs were retrospectively enrolled. Their clinical and CT data were analyzed and compared with emphasis on revealing the differences of air-containing space and its specific patterns (air bronchogram and bubble-like lucency [BLL]) between neoplastic and non-neoplastic GGNs and their significance in differentiating them. Results Compared with patients with non-neoplastic GGNs, female was more common (P

Objective: Challenging differential diagnosis Background: Acute epiploic appendagitis is an uncommon cause of acute abdominal pain characterized by pain in the left or right lower quadrants of the abdomen. It is caused by torsion or spontaneous venous thrombosis of one of the epiploic appendages, which are found along the colon, most commonly in the sigmoid colon. The literature consistently compares the presenting symptoms and clinical picture of acute epiploic appendagitis to acute diverticulitis and acute appendicitis. However, ovarian torsion is not reported as a differential diagnosis for this pathology in the literature. Case Report: This case report demonstrates a female patient in her late 30s presenting with acute left iliac fossa pain associated with vomiting, in the context of a negative beta-hCG blood test. The history of severe unilateral intermittent pelvic pain progressing to constant pain associated with vomiting led to a working differential diagnosis of ovarian torsion. A bimanual vaginal examination was positive for tenderness in the left iliac fossa with no palpable adnexal masses or cervical motion tenderness. Therefore, the patient underwent an emergency diagnostic laparoscopy and was found to have normal ovaries, with torsion of an epiploic appendage identified. A diagnosis of acute epiploic appendagitis was made. Conclusions: This case report demonstrates the importance of considering acute epiploic appendagitis as a rare differential diagnosis for ovarian torsion in female patients. With the management of this pathology being non-operative, identification of this condition on ultrasound or computed tomography is essential in avoiding unnecessary surgery for patients with this pathology. [ABSTRACT FROM AUTHOR]

The term 'hyperkeratotic flexural erythema' (HFE) has been used synonymously with granular parakeratosis (GP), to describe a scaly, typically intertriginous rash associated with contact factors such as benzalkonium chloride. However, clinical HFE can occur without the classical GP histological pattern. We reviewed skin biopsies from 10 patients with clinically diagnosed HFE. A progression of histopathological features is suggested. The absence of histological GP should not exclude the clinical diagnosis of HFE when there is a high index of suspicion. [ABSTRACT FROM AUTHOR]

This paper introduces an analog differential optoelectronic receiver (ADOR) integrated with digital slicers for short-range LiDAR systems, consisting of a spatially modulated P+/N-well on-chip avalanche photodiode (APD), a cross-coupled differential transimpedance amplifier (CCD-TIA) with cross-coupled active loads, a continuous-time linear equalizer (CTLE), a limiting amplifier (LA), and dual digital slicers. A key feature is the integration of an additional on-chip dummy APD at the differential input node, which enables the proposed ADOR to outperform a traditional single-ended TIA in terms of common-mode noise rejection ratio. Also, the CCD-TIA utilizes cross-coupled PMOS-NMOS active loads not only to generate the symmetric output waveforms with maximized voltage swings, but also to provide wide bandwidth characteristics. The following CTLE extends the receiver bandwidth further, allowing the dual digital slicers to operate efficiently even at high sampling rates. The LA boosts the output amplitudes to suitable levels for the following slicers. Then, the inverter-based slicers with low power consumption and a small chip area produce digital outputs. The fabricated ADOR chip using a 180 nm CMOS process demonstrates a 20 dB dynamic range from 100 μApp to 1 mApp, 2 Gb/s data rate with a 490 fF APD capacitance, and 22.7 mW power consumption from a 1.8 V supply.

An 18-y-old female tufted deer (Elaphodus cephalophus) had a short history of chronic diarrhea, progressive weight loss, and hindlimb instability. Given the poor prognosis, the deer was euthanized and submitted for postmortem examination. The most significant gross finding was segmental and multinodular mural thickening of the proximal colon. On cut surface of the affected colonic segments, 0.5-2-cm diameter, intramural, multiloculated, cystic structures containing gray, translucent, gelatinous material elevated the edematous mucosa. Microscopically, the intramural cystic structures were filled with mucinous matrix admixed with foamy macrophages, and lined by discontinuous segments of well-differentiated columnar, pancytokeratin-positive epithelium with basilar nuclei. Multifocally, transition was observed from hyperplastic mucosal crypt epithelium to dysplastic or neoplastic columnar and flattened epithelium lining submucosal and serosal cysts. Cyst lumina were irregularly disrupted by polypoid ingrowths of collagenous tissue covered by attenuated epithelium. Based on these findings, we diagnosed a well-differentiated mucinous adenocarcinoma. Although intestinal adenocarcinomas have been described in humans and animals, they are considered uncommon in most domestic species, except for sheep, for which genetic and environmental factors appear to influence occurrence. Our report addresses the knowledge gap regarding intestinal adenocarcinomas affecting cervids and specifically the tufted deer, a less-studied, near-threatened Asian cervid.