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Background/Aim. The cause of eosinophilia often remains unelucidated. The aim of the study was to analyze causes and treatment approaches in children with eosinophilia in pediatric tertiary care hospital. Methods. The medical records of children investigated for eosinophilia (based on the International Classification of Diseases code D72.1) were retrospectively reviewed in the University Children's Hospital, Belgrade, Serbia, from December 2011 to December 2022. A total of 105 children (62 boys; male:female ratio was 1:4) aged one month to 16.5 years (median 7.7 years) were diagnosed with eosinophilia. After excluding 15 of them due to incorrectly assigned diagnosis based on relative eosinophil number only, the remaining 90 children were grouped according to the severity of eosinophilia (mild, moderate or severe). Results. Serological analysis confirmed toxocariasis in six (6.7%) patients, while two (2.2%) had a confirmed nematode infestation (Ascaris lumbricoides and Enterobius vermicularis, respectively). Thirty-two (35.6%) children with eosinophilia and three with no true eosinophilia were diagnosed with helminthiasis ex juvantibus. Eosinophilia was ultimately explained by allergic/atopic conditions [19 (21.1%)], drug reactions [four (4.4%)], bacterial infections [nine (8.9%)], hematological problems [five (5.5%)], autoimmune disorders [three (3.3%)], unrelated congenital disorders (one), or as an isolated finding [seven (7.8%)]. In addition, one of the children without an increased absolute eosinophil number was diagnosed with eosinophilic esophagitis. A total of 56 (53.3%) children received anthelminthic treatment: 9 (90.0%) with severe eosinophilia, 19 (51.4%) with moderate, 23 (53.5%) with mild, and 5 (33.3%) children with no true eosinophilia. Most (42) of the children were given mebendazole only, while the remaining 14 (eight with severe, three with moderate, and three with mild) were also initially treated with mebendazole but subsequently shifted to albendazole due to the persistence of eosinophilia. In all treated children, eosinophilia and other relevant findings (if any) subsided in a matter of a few days to a few weeks after initializing treatment. Conclusion. Our results support the recommendation that unexplained eosinophilia of all levels of severity requires a standardized diagnostic approach. The results also provide some support for a potential rational basis for ex juvantibus administration of anthelminthic drugs in a fraction of children with eosinophilia without an obvious etiological explanation. [ABSTRACT FROM AUTHOR]

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Objective To explore the value of computerized tomography (CT) and magnetic resonance imaging (MRI) imaging features in differential diagnosis of giant cell tumors with prominent aneurysmal bone cysts (GABCs) in the extremities and primary aneurysmal bone cysts (PABCs). Methods In this study, the CT and MRI imaging features of 20 patients with GABCs in the extremities and 21 patients with PABCs were retrospectively analyzed, and the age and sex of patients were collected. The differences in different indicators between the two groups were compared. The diagnostic sensitivity and specificity for GABCs and PABCs were calculated based on the age, transverse/longitudinal diameter ratio of the mass, subchondral bone involvement, deep edge lobulation of the lesion, and vascular shadow around the mass. Results There were significant differences in the age and transverse/longitudinal diameter ratio of the mass between the two groups (t=-3.956,-2.985,P

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 of 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.

Objective To investigate the clinical effect of arytenoid cartilage reposition with a suspension laryngoscope under general anesthesia in the treatment of cricoarytenoid joint dislocation. Methods Ten patients with cricoarytenoid joint dislocation who were admitted to our department from December 2012 to December 2020 were enrolled and underwent arytenoid cartilage reposition with a suspension laryngoscope under general anesthesia, and the patients were analyzed in terms of etiology, surgical timing, and treatment outcome. Results Among the ten patients, eight achieved successful reposition in a single attempt, one improved after two attempts, and one showed no response. Conclusion Arytenoid cartilage reposition with a suspension laryngoscope is an effective method for the treatment of cricoarytenoid joint dislocation, and the earlier the treatment, the better the treatment outcome.

Objective To investigate the value of CT enterography (CTE) in the diagnosis and differential diagnosis of small intestinal tumors and tumor-like lesions. Methods A retrospective analysis was performed for the imaging data of 74 patients who underwent CTE in our hospital from January 2015 to December 2022 and were diagnosed with small intestinal tumors and tumor-like lesions based on pathological examination, and according to the nature of lesions, they were divided into malignant tumor group with 54 patients and non-malignant+tumor-like lesion group with 20 patients. The two groups were compared in terms of major axis of tumor, intestinal residual rate, and CT values during plain scan phase, arterial phase, and venous phase. Results Compared with the non-malignant+tumor-like lesion group, the malignant tumor group had significantly higher major axis of tumor and CT value during plain scan phase (Z=-3.512,-3.214,P0.05). In the malignant tumor group, compared with the patients with adenocarcinoma, the patients with lymphoma had significantly higher major axis of tumor and intestinal residual rate (Z=-3.161,-4.853,P0.05). Conclusion CTE can fully display the features of small intestinal tumor and tumor-like lesions and thus provide a basis for the diagnosis and differential diagnosis of these diseases.

Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose. [ABSTRACT FROM AUTHOR]

Acantholytic squamous cell carcinoma (ASCC) is a rare histological variant of squamous cell carcinoma, with vulvar ASCC being an uncommon and atypical tissue variant characterized by acantholysis and unique morphological features. Its specific pathogenesis and etiology remain unclear. Given its low incidence, gynecologists generally lack understanding of it, raising the risk of misdiagnosis or missed diagnosis. We report the data of a 79-year-old patient with primary vulvar ASCC, who was admitted to our hospital due to self-reported vulvar pruritus for 5 years. Examination revealed an 8 cm×4 cm red and swollen ulcer on the left vulva with partial white change, and the pathological biopsy showed ASCC. Following 25 times of radical radiotherapy, close follow-up is recommended. And now three months post-radiotherapy, there is no evidence of tumor recurrence or metastasis. There are few research reports on vulvar ASCC both domestically and internationally. This article presents a case of vulvar ASCC in an elderly woman, analyzing its clinical characteristics, pathogenesis, pathogenic factors, differential diagnosis, treatment, and prognosis, in order to provide reference for the clinical diagnosis and treatment of ASCC. [ABSTRACT FROM AUTHOR]

Cryptococcosis occurs primarily in immunocompromised patients. It is difficult to suspect in an immunocompetent patient presenting with a headache. The clinical manifestations of cryptococcosis can be subtle in a patient whose immune system is responding, but inadequate. This is the report of a case of fatal cryptococcosis initially misdiagnosed as a sinus headache on the basis of a telephone call, and then misdiagnosed as aseptic meningitis on the basis of mild findings and negative cerebrospinal fluid cultures. Autopsy revealed unsuspected severe cryptococcal meningoencephalitis. Cerebrospinal fluid nuclear acid amplification (NAA) panels including Cryptococcus should enable the diagnosis of unsuspected cryptococcal meningitis in most cases, but can be false positive, which could be adjudicated by cryptococcal antigen and culture. It will remain important to test for cryptococcal antigen and to maintain a broad differential diagnosis for all patients with meningitis.

Pancreatic hamartoma is a rare benign lesion of the pancreas characterized by a lack of typical clinical symptoms and imaging features, which leads to the difficulty in diagnosis before surgery. Since surgical intervention is often performed due to the inability to exclude the risk of malignant tumor, it may cause damage to normal pancreatic tissue. In addition, the presence of gastric mucosal tissue in pancreatic hamartoma has not been reported in the literature. This article reviews the articles on pancreatic hamartoma in China and globally and summarizes its clinical and imaging features, so as to provide help for preoperative diagnosis. [ABSTRACT FROM AUTHOR]

Background The diagnosis of Hansen disease (HD) can be difficult when acid-fast bacilli are not detected in the patient's skin sample.

Narcolepsy and attention deficit hyperactivity disorder (ADHD) are distinct neurobiological conditions characterized by overlapping symptoms, including excessive daytime sleepiness and cognitive dysfunction. Despite their differences in etiology and pathophysiology, recent studies have highlighted a potential association between the two disorders, with a significant prevalence of ADHD symptoms observed in narcolepsy patients. This narrative review explores the similarities and differences between narcolepsy and ADHD, focusing on their shared symptomatology, neurobiological mechanisms, challenges in diagnosis, and treatment implications. While both disorders exhibit disruptions in dopaminergic and noradrenergic neurotransmitter systems, differential diagnosis remains challenging due to overlapping clinical presentations. Polysomnography findings, such as appearance of sleep onset rapid eye movements in narcolepsy patients, provide important distinctions that enable accurate diagnosis. Treatment strategies often involve stimulant medications for symptom management; however, nonpharmacological interventions, such as cognitive behavioral therapy, have been shown to have the potential to improve patient outcomes. Clinicians must consider the possibility of coexisting narcolepsy in ADHD patients and vice versa to ensure appropriate treatment selection and optimal patient care. Further research is needed to refine diagnostic criteria, elucidate the complex interplay between the two disorders, and develop personalized therapeutic approaches. A multidisciplinary approach involving sleep specialists, neurologists, psychiatrists, and psychologists is essential to address the diverse biopsychosocial needs of patients with concurrent narcolepsy and ADHD.

Background The diagnosis of Parkinson disease (PD) is mainly based on clinical symptoms, and there is a lack of objective methods for correct diagnosis. At present, there have been studies on retinal structural changes as a biomark for early diagnosis of PD, but machine learning based on retinal structural changes for predicting early PD has not yet been studied. Objective To construct a machine learning model based on the characteristics of retinal structural changes, explore its value in early PD diagnosis, and the accuracy of different machine learning algorithms for early PD diagnosis. Methods From October 2021 to September 2022, 49 PD patients aged 40 to 70 years old (PD group) who attended outpatient clinics and were hospitalized in the department of neurology of Henan Provincial People's Hospital (PD group) and 39 healthy people with matching age and sex (healthy control group) who came to the hospital for physical examination were collected. All study subjects underwent swept-source optical coherence tomography and swept-source optical coherence tomography angiography, the thickness and vessel density of the macular retina were also quantitatively analyzed. The 88 subjects were randomly divided into the 62 training sets and 26 validation set according to the ratio of 7∶3. Variables with significant differences between the PD group and healthy control group were selected as the characteristic variables for inclusion in the machine learning model, and Logistic regression (LR) , K-nearest neighbor algorithm (KNN) , decision tree (DT) , random forest (RF) and extreme gradient boosting (XGboost) models were constructed in the training set. The area under the curve (AUC) , accuracy, sensitivity and specificity of the receiver operating characteristic (ROC) curve were used to evaluate the predictive value of the machine learning model based on retinal structural changes for early PD. Results Compared with the healthy control group, the density of the upper outer ring (A6) , the outer temporal outer ring (A7) , the lower outer ring (A8) and the outer nasal ring (A9) of the superficial capillaries in the PD group were reduced, the thickness of the upper inner ring (A2) , the inner temporal inner ring (A3) , the inferior inner ring (A4) , the inner ring of the nasal side (A5) of the retinal layer, A6, A7, A8 and A9, the thickness of A6 of the ganglion cell complex layer, the thickness of A7 of the nerve fiber layer, A2 and A4, A5, A6, A7, A8, A9 became thinner (P

Intrahepatic cholangiocarcinoma (iCCA) is one of the primary liver cancers and presents with tumor heterogeneity. About 50% of iCCAs comprise actionable mutations, which completely change patient management. In addition, the precise diagnosis of iCCA, including subtype, has become crucial, and pathologists play an important role in this regard. This review focuses on iCCA heterogeneity; looking at different perspectives to guide diagnosis and optimal treatment choice.

ABSTRACTPulmonary lophomoniasis is a rare and life-threatening disease, most commonly reported across Asian and Latin American countries. Here, we have reported two cases of pulmonary lophomoniasis presenting with atypical manifestations. Case #1 represents a 19-year-old male patient with clinical characteristics suggestive of tuberculosis, presenting with hemoptysis and receiving antituberculosis treatment. Case #2 represents a 69-year-old man with post-tuberculosis pulmonary disease with cystic bronchiectasis presenting with polymicrobial co-infection. Based on our case experience, lophomoniasis should be considered in patients with pneumonia who do not respond to antibiotic treatment, and the corresponding epidemiological factors should be carefully considered in addition to bronchoscopy for precise diagnosis.

Objective To analyze the clinical characteristics of hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis in order to improve the diagnostic consciousness of clinicians. Methods A total of 341 patients with hematogenous disseminated pulmonary tuberculosis were included in this study, and 83 cases of them were hematogenous disseminated pulmonary tuberculosis complicated with intracranial tuberculosis. Clinical data of patient gender, age, past-history and symptoms were collected and analyzed. Sputum acid fast staining, sputum mycobacterium tuberculosis culture, sputum gene X-pert Mtb/RIF were performed. Intracranial pressure, cerebrospinal fluid routine and biochemistry, cerebrospinal fluid acid fast staining, mycobacterium tuberculosis culture and Xpert were performed. Blood routine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, C-reactive protein, erythrocyte sedimentation rate, tuberculosis antibody, tuberculosis T cell spot test (T-SPOT) were performed. Chest CT scan, head CT scan and contrast-enhanced scan, head MRI scan and enhanced scan were performed. Results The main symptoms of 83 patients with intracranial tuberculosis were fever (74 cases) and headache (53 cases). Eleven patients were combined with diabetes mellitus, and 9 cases were treated with hormone/immunosuppressive agents. There were 4 cases combined with pregnancy/childbirth/abortion, and 6 cases with abdominal tuberculosis. Six cases were combined with osteoarticular tuberculosis, 2 cases with reproductive system tuberculosis, 1 case with lymph node tuberculosis, 1 case with urinary system tuberculosis, and 1 case with oral mucosa tuberculosis. Serum sodium was decreased (< 135 mmol/L) in 49 cases, and the mean serum sodium was 131.0 (126.2, 135.8) mmol/L. Cerebrospinal fluid (CSF) protein levels were ≥1 g/L in 44 patients, CSF glucose levels were < 2.2 mmol/L in 37 patients, and CSF adenosine deaminase (ADA) levels were ≥6 U/L in 25 patients. All 83 patients underwent chest CT examination, and 64 cases showed miliary nodules, 33 cases showed simple acute hematologic disseminated pulmonary tuberculosis. Subacute and chronic hematologic disseminated pulmonary tuberculosis were found in 21 cases, and 29 cases were combined with secondary pulmonary tuberculosis. Among them, 34 patients underwent head CT examination, and result showed infarction in 10 cases, tuberculoma in 4 cases and hydrocephalus in 1 case. Brain MRI was performed in 51 cases, including 10 cases of enhanced meninges in the basal part of brain, 7 cases of cerebral infarction and 4 cases of tuberculoma. Conclusion Fully assessment of age, symptoms, chest CT, head imaging, cerebrospinal fluid, serum sodium of patients with hematopoietic tuberculosis is helpful for the diagnosis of intracranial tuberculosis. [ABSTRACT FROM AUTHOR]

There are various etiologies for extrahepatic bile duct stenosis, and pharmacotherapy and endoscopic intervention can achieve a good clinical effect in benign stenosis. Early diagnosis and timely surgical treatment of malignant stenosis may prolong the survival time of patients. However, there are still difficulties in the differential diagnosis of malignant bile duct stenosis. This article reviews the application of serology, radiology, endoscopic techniques, and artificial intelligence in the differential diagnosis of malignant bile duct stenosis, so as to provide strategies and references for formulating clinical diagnosis and treatment regimens. [ABSTRACT FROM AUTHOR]

To evaluate the potential of quantitative measurements on contrast-enhanced CT (CECT) in differentiating small (≤4 cm) clear cell renal cell carcinoma (ccRCC) from benign renal tumors, including fat-poor angiomyolipoma (fpAML) and renal oncocytoma (RO). 244 patients with pathologically confirmed ccRCC (n = 184) and benign renal tumors (fpAML, n = 50; RO, n = 10) were randomly assigned into training cohort (n = 193) and test cohort 1 (n = 51), while external test cohort 2 (n = 50) was from another hospital. Quantitative parameters were obtained from CECT (unenhanced phase, UP; corticomedullary phase, CMP; nephrographic phase, NP; excretory phase, EP) by measuring attenuation of renal mass and cortex and subsequently calculated. Univariable and multivariable logistic regression analyses were performed to evaluate the association between these parameters and ccRCC. Finally, the constructed models were compared with radiologists' diagnoses. In univariable analysis, UP-related parameters, particularly UP C-T (cortex minus tumor attenuation on UP), demonstrated AUC of 0.766 in training cohort, 0.901 in test cohort 1, 0.805 in test cohort 2. The heterogeneity-related parameter SD (standard deviation) showed AUC of 0.781, 0.834, and 0.875 respectively. In multivariable analysis, model 1 incorporating UP C-T , NP C-T (cortex minus tumor attenuation on NP), CMP T -UP T (tumor attenuation on CMP minus UP), and SD yielded AUC of 0.866, 0.923, and 0.949 respectively. When compared with radiologists, multivariate models demonstrated higher accuracy (0.800–0.860) and sensitivity (0.794–0.971) than radiologists' assessments (accuracy: 0.700–0.720, sensitivity: 0.588–0.706). Quantitative measurements on CECT, particularly UP- and heterogeneity-related parameters, have potential to discriminate ccRCC and benign renal tumors (fpAML, RO). [ABSTRACT FROM AUTHOR]

Background: To develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre‐ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns. Methods: This study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre‐ET, collected from our hospital and through PubMed. Of those, 64 were allocated to the derivation cohort and the rest to the validation cohort. The diagnoses of the ECGs were confirmed using an electrophysiological study. Parameters and classifiers from prior algorithms along with the propagation speeds in the early portion of the QRS complex (initial deflection index) in leads V1, V6, aVR, II, and III were manually measured. The performance of the new algorithm was compared with that of prior algorithms. Results: The initial deflection index in lead III was the strongest predictor of pre‐ET in LBBB‐pattern wide‐QRS tachycardia (p = 0.003, AUC 0.805). The initial deflection index in lead V1 was the most powerful predictor of pre‐ET in RBBB‐pattern wide‐QRS tachycardia (p = 0.001, AUC 0.848). Compared to earlier algorithms, those using the initial deflection indexes: lead III in LBBB patterns (cutoff value >0.3) and lead V1 in RBBB patterns (cutoff value ≤0.48), demonstrated superior performance in screening VT, with AUC values of 0.828. The initial deflection indexes proved effective as discriminators between VT and pre‐ET in the validation cohort. Conclusions: In LBBB‐pattern wide‐QRS tachycardia, the early propagation speed of pre‐ET was faster than that in VT. Conversely, in RBBB‐pattern wide‐QRS tachycardia, it was slower. [ABSTRACT FROM AUTHOR]

Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma. [ABSTRACT FROM AUTHOR]

Skin diseases manifesting as agminated pigmented lesions have overlapping clinical manifestations. Therefore, accurate differentiation is challenging. The clinical characteristics, histopathological findings, and treatment response of patients diagnosed with partial unilateral lentiginosis, nevus spilus, or linear and whorled nevoid hypermelanosis were retrospectively analysed. Each disease demonstrated distinct demographic and clinical characteristics, and the responses to laser treatment varied. The median age at onset varied significantly among the groups: 0.1, 6.6, and 0.5 years in patients with nevus spilus, partial unilateral lentiginosis, and linear and whorled nevoid hypermelanosis, respectively. Regarding the locations of the skin lesions, partial unilateral lentiginosis occurred predominantly on the head and neck, while approximately half of nevus spilus and linear and whorled nevoid hypermelanosis were observed on the extremities. Although linear and whorled nevoid hypermelanosis and partial unilateral lentiginosis share a similar histological feature of basal hyperpigmentation, patients with linear and whorled nevoid hypermelanosis showed the best response to laser treatment, while patients with partial unilateral lentiginosis demonstrated a poor treatment response. The study’s data may provide important clues for the differential diagnosis and clinical decision-making regarding the treatment of these agminated pigmented lesions.

Objective To explore the diagnostic value of the ovarian-adnexal reporting and data system (O-RADS) in differentiating between benign and malignant ovarian tumors, and to analyze risk factors for malignant ovarian tumors. Methods The clinical data of 417 patients with ovarian tumors diagnosed by pathology were retrospectively analyzed. With pathological results as the gold standard, the patients were divided into malignant group and benign group. The clinical data of the two groups were compared. At the same time, the patients were classified according to ultrasound characteristics and O-RADS. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of O-RADS. Results The univariable and mul-tivariable analyses showed that the risk factors for ovarian malignancy included cyst wall thickness ≥3 cm, solid components, blood flow score of 3-4 points, ascites, and peritoneal nodules (P

Objective To explore the value of computed tomography (CT) imaging features and texture analysis in the differential diagnosis of acinar cell carcinoma of the pancreas (ACCP). Methods The clinical data of patients who were patholo-gically diagnosed with ACCP, pancreatic ductal adenocarcinoma (PDAC), or solid pseudopapillary neoplasm (SPN) of the pancreas in our hospital from January 2017 to October 2018 were retrospectively analyzed. The clinical manifestations, tumor markers, CT imaging features, and texture parameters were compared and analyzed. Results The contrast-enhanced CT images of 5 patients with ACCP showed that most of the lesions were solid-cystic masses with a large size and more solid components. The CT images of 12 patients with PDAC showed that most of the lesions were solid masses with a small size. The CT images of 12 patients with SPN showed that most of the lesions were solid-cystic masses with a size greater than that of ACCP lesions and fewer solid components, showing the “floating cloud sign”. Eight texture parameters were valuable for the differential diagnosis between ACCP and PDAC (Z=2.015-2.530,P

Hepatic hemangioma in children is the most common benign angiogenic tumor of the liver in infancy. It is difficult to differentiate hepatic hemangioma from malignant liver tumors in some children, and there is also the possibility of malignant transformation and life-threatening complications. This article reviews the classification, clinical features, diagnosis, treatment, and prognosis of hepatic hemangioma, in order to provide a reference for the clinical diagnosis and treatment of this disease.

The incidence of urinary retention during pregnancy is low which is mainly manifested as dysuria, frequent urination, incomplete urination, lower abdominal distension and abdominal pain and may induce severe complications and adverse pregnancy outcomes, so the early identification and treatment of urinary retention during pregnancy are crucial in clinical practice. Only by timely symptomatic and etiological treatment can the adverse outcome be avoided. This article made a review of the research progress of etiology, diagnosis and treatment, to provide diagnostic and therapeutic approaches and reference for clinical physicians.

Giant cervical polyps are very rare in clinic, and only a few cases have been reported in the literature. The morphology of polyps varies, may present as malignant, and some cases occur in unmarried women without a history of sexual activity, which limits the accuracy of clinical diagnosis. While most cervical polyps are benign, there is a certain probability of malignant transformation, which should be differentiated from rare malignant lesions that manifest as cervical polyps. Hysteroscopic surgery is an important method for the treatment of this disease, and small hysteroscopy is particularly recommended for patients without sexual history. This paper reports a case of unmarried woman with huge excrescence of vaginal orifice, which was confirmed as cervical polyp by hysteroscopy and pathological examination, in order to enrich the understanding of giant cervical polyps and provide guidance for clinical diagnosis and therapy [ABSTRACT FROM AUTHOR]

Pelvic tuberculosis is a form of female pelvic inflammation caused by Mycobacterium tuberculosis, which is a common cause of chronic pelvic inflammation and infertility. The characteristics of abdominal and pelvic blunt pain and abdominal distension caused by pelvic tuberculosis are similar to those of advanced epithelial ovarian cancer. And there are no specific clinical or imaging manifestations of extrapulmonary tuberculosis. The above reasons lead to pelvic peritoneal tuberculosis easily confused with peritoneal carcinoma and advanced epithelial ovarian cancer. In this paper, we analyzed a case of advanced epithelial ovarian cancer. Because no tumor cells were found in ovarian space lesion tissue puncture pathology and ascites exfoliative cytology, examination of tuberculosis was performed. The patient was misdiagnosed as pelvic tuberculosis based on positive tuberculin test and Mycobacterium tuberculosis interferon-γ, but later pathology confirmed the presence of epithelial ovarian cancer. We summarized the diagnosis and treatment process of this case in order to accumulate experiences for the clinical diagnosis and treatment of advanced epithelial ovarian cancer and pelvic tuberculosis. [ABSTRACT FROM AUTHOR]

Objectives: To determine informational CT findings for distinguishing autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) and to review their diagnostic accuracy. Methods: A systematic and detailed literature review was performed through PubMed, EMBASE, and the Cochrane library. Similar descriptors to embody the identical image finding were labeled as a single CT characteristic. We calculated the pooled diagnostic odds ratios (DORs) of each CT characteristic using a bivariate random-effects model. Results: A total of 145 various descriptors from 15 studies (including 562 AIP and 869 PDAC patients) were categorized into 16 CT characteristics. According to the pooled DOR, 16 CT characteristics were classified into three groups (suggesting AIP, suggesting PDAC, and not informational). Seven characteristics suggesting AIP were diffuse pancreatic enlargement (DOR, 48), delayed homogeneous enhancement (DOR, 46), capsule-like rim (DOR, 34), multiple pancreatic masses (DOR, 16), renal involvement (DOR, 15), retroperitoneal fibrosis (DOR, 13), and bile duct involvement (DOR, 8). Delayed homogeneous enhancement showed a pooled sensitivity of 83% and specificity of 85%. The other six characteristics showed relatively low sensitivity (12–63%) but high specificity (93–99%). Four characteristics suggesting PDAC were discrete pancreatic mass (DOR, 23), pancreatic duct cutoff (DOR, 16), upstream main pancreatic duct dilatation (DOR, 8), and upstream parenchymal atrophy (DOR, 7). Conclusion: Eleven CT characteristics were informational to distinguish AIP from PDAC. Diffuse pancreatic enlargement, delayed homogeneous enhancement, and capsule-like rim suggested AIP with the highest DORs, whereas discrete pancreatic mass suggested PDAC. However, pooled sensitivities of informational CT characteristics were moderate. Clinical relevance statement: This meta-analysis underscores eleven distinctive CT characteristics that aid in differentiating autoimmune pancreatitis from pancreatic adenocarcinoma, potentially preventing misdiagnoses in patients presenting with focal/diffuse pancreatic enlargement. Key Points: • Diffuse pancreatic enlargement (pooled diagnostic odds ratio [DOR], 48), delayed homogeneous enhancement (46), and capsule-like rim (34) were CT characteristics suggesting autoimmune pancreatitis. • The CT characteristics suggesting autoimmune pancreatitis, except delayed homogeneous enhancement, had a general tendency to show relatively low sensitivity (12–63%) but high specificity (93–99%). • Discrete pancreatic mass (pooled diagnostic odds ratio, 23) was the CT characteristic suggesting pancreatic ductal adenocarcinoma with the highest pooled DORs. [ABSTRACT FROM AUTHOR]

Abstract Background To develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre‐ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns. Methods This study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre‐ET, collected from our hospital and through PubMed. Of those, 64 were allocated to the derivation cohort and the rest to the validation cohort. The diagnoses of the ECGs were confirmed using an electrophysiological study. Parameters and classifiers from prior algorithms along with the propagation speeds in the early portion of the QRS complex (initial deflection index) in leads V1, V6, aVR, II, and III were manually measured. The performance of the new algorithm was compared with that of prior algorithms. Results The initial deflection index in lead III was the strongest predictor of pre‐ET in LBBB‐pattern wide‐QRS tachycardia (p = 0.003, AUC 0.805). The initial deflection index in lead V1 was the most powerful predictor of pre‐ET in RBBB‐pattern wide‐QRS tachycardia (p = 0.001, AUC 0.848). Compared to earlier algorithms, those using the initial deflection indexes: lead III in LBBB patterns (cutoff value >0.3) and lead V1 in RBBB patterns (cutoff value ≤0.48), demonstrated superior performance in screening VT, with AUC values of 0.828. The initial deflection indexes proved effective as discriminators between VT and pre‐ET in the validation cohort. Conclusions In LBBB‐pattern wide‐QRS tachycardia, the early propagation speed of pre‐ET was faster than that in VT. Conversely, in RBBB‐pattern wide‐QRS tachycardia, it was slower.

Objective To investigate the CT imaging features and pathological results of pulmonary inflammatory myofibroblastic tumor, and to improve the awareness of this disease in clinical practice. Methods A retrospective analysis was performed for the clinical data, CT imaging features, and pathological results of 28 patients who were diagnosed with pulmonary inflammatory myofibroblastic tumor by surgery or lung biopsy. Results All 28 patients had a solitary lesion, among whom 21 had a lesion located in the left and right lower lobes of lungs. Plain CT scan showed inhomogeneous density of the lesion in 21 patients, lesions with smooth margins in 12 patients, and lesions with unsmooth margins in 16 patients, and contrast-enhanced CT scan showed obvious heterogeneous enhancement in 9 patients, flat sign in 12 patients, peach-tip sign in 7 patients, and long spiculation sign in 11 patients. Immunohistochemistry showed positive expression of Vimentin in 26 patients, SMA in 19 patients, ALK in 9 patients, CD-68 in 12 patients, and CD-99 in 9 patients and negative expression of CK in 14 patients, S-100 in 8 patients, and CD-34 in 13 patients. Conclusion The specific imaging findings of pulmonary inflammatory myofibroblastic tumor may help with early clinical diagnosis, and a combination of histopathology and immunohistochemistry is of great significance for prognostic eva-luation and postoperative diagnosis and treatment.

Introduction. Inflammatory myofibroblastic tumors predominantly manifest in the lungs of children and young adults, with tracheal localization being very rare. Genetic alternations involving the anaplastic lymphoma kinase gene are identified in 50 to 70% of cases. A conclusive diagnosis relies on biopsy and histopathological analysis. Surgical resection stands as the primary treatment modality. Case Report. We present a case involving a 3-year-old boy with an inflammatory myofibroblastic tumor who had experienced recurrent wheezing attributed to respiratory infections since the age of eight months. Long-term therapy with budesonide and montelukast was initiated, which effectively managed his wheezing until the age of 3 years. Subsequently, despite ongoing medication, he began experiencing severe bronchial obstructions every month, necessitating repeated hospital admissions. At the age of 3 years and 8 months, he was admitted to our hospital due to persistent wheezing, prompting a bronchoscopy. During the procedure, a tumor-like mass was identified in the lower part of the trachea. Bronchoscopic removal of the tumor was performed, followed by cauterization of the remaining tumor tissue. Histopathological examination confirmed the presence of an inflammatory myofibroblastic tumor. Conclusion. Inflammatory myofibroblastic tumors are uncommon neoplasms associated with a borderline risk of malignancy. Given that the symptoms can resemble those of common childhood respiratory conditions, it is crucial to consider this diagnosis in cases of persisting wheezing despite standard therapy. In such instances, performing a bronchoscopy is necessary for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Background The treatment for functional constipation (FC) generally relies on the classification by clinical symptoms, but whether the classification by clinical symptoms is consistent with that by colorectal and anal function examinations still remains unclear. Objective To examine the consistency between FC classification by clinical symptoms and colorectal and anal functional examinations. Methods Forty FC outpatients and inpatients completing colorectal and anal functional examinations in Department of Gastroenterology, Hebei General Hospital from January 2018 to August 2021 were enrolled in this retrospective study. Symptoms were acquired for classifying FC by use of a questionnaire survey, including the frequency of spontaneous defecation per week, shape and type of stool assessed using the Bristol Stool Scale, difficulty in defecation, sense of anorectal blockage during defecation, requirement for manual assistance in defecation, and the frequency and degree of feeling of incomplete evacuation. And the results detected by examinations, including anorectal manometry (ARM) , defecography and gastrointestinal transit time (GITT) were also used for FC classification. The consistency of FC classification by symptoms and the three examinations was assessed. Results The FC classification by symptoms was as follows: slow transit constipation (STC) 〔27.5% (11/40) 〕, defecation disorder constipation〔20.0% (8/40) 〕, mixed constipation〔37.5% (15/40) 〕, and normal-transit constipation (NTC) 〔15.0% (6/40) 〕. FC classified by ARM included defecation disorder constipation〔80.0% (32/40) 〕and NTC〔20.0% (8/40) 〕, and by defecography also only included defecation disorder constipation〔67.5% (27/40) 〕 and NTC 〔32.5% (13/40) 〕. By GITT, FC classification contained three types: STC〔20.0% (8/40) 〕, defecation disorder constipation 〔15.0% (6/40) 〕, and NTC〔65.0% (26/40) 〕. The weighted Kappa test indicated that the FC classification by symptoms was not consistent with that by ARM, defecography or GITT (Kappa=-0.123, P=0.502; Kappa=-0.040, P=0.794; Kappa=-0.140, P=0.215) , and there was no overall consistency between FC classification by symptoms and the three examinations (Kappa=-0.005, P=0.944) . Conclusion Mixed constipation was the major type of FC classified by symptoms, while defecation disorder constipation was the major type of FC classified by the three examinations. As there are differences between clinical symptom classification and examination classification, FC should be diagnosed based on both clinical symptoms and examination results, accompanied with the individualized analysis.

Objective To investigate the pathological features of Epstein-Barr virus (EBV)-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma (EBVaLELICC), and to improve the understanding of this disease in clinical practice. Methods Clinical and pathological data were collected from one patient with EBVaLELICC, and immunohistochemistry, in situ hybridization, and gene rearrangement test were performed for the paraffin-embedded tissue sample of this patient. The pathological features of this disease were analyzed, and a literature review was performed. Results The female patient, aged 56 years, had the tumor located in the left lateral lobe of the liver, with a clear boundary and a size of 1.8 cm×1.5 cm×1.2 cm. The patient underwent laparoscopic left lateral segment liver resection in Department of Hepatobiliary Surgery. Postoperative pathology showed that tumor cells had a glandular tubular structure, and some cells had an irregular, fused or sieve-like shape, with large nuclei, fine chromatin, small nucleoli, and no mitotic figures; proliferation of lymphocytes and plasma cells was observed with the formation of lymphoid follicles in the stroma. Immunohistochemical staining showed that CK7, CK19, and P53 had an expression rate of 10% in tumor cells, with wild type and a Ki-67 proliferation index of 5%; stromal lymphocytes showed the expression of CD3, CD4, CD8, and CD20, lymphoid follicular germinal center cells showed the expression of BCL-6 and CD10 and had no expression of BCL-2, and plasma cells showed the expression of CD38, Kappa, and Lambda; PD-L1 (22C3) was expressed in both tumor cells and interstitial lymphocytes, with a combined positive score of 30. EBER in situ hybridization assay showed diffuse positivity of tumor cells. Polymerase chain reaction detected multiple clones of lymphocyte immunoglobulin and T cell receptor genes. The patient did not receive any treatment before and after surgery and was alive after 8 months of follow-up, without tumor recurrence or metastasis. Conclusion EBVaLELICC is a rare subtype of cholangiocarcinoma with unique pathological features. Patients can benefit from immunotherapy, and EBVaLELICC tends to have a better prognosis than common cholangiocarcinoma.

Severe post-menopausal abdominal pain is commonly seen in advanced endometrial cancer, ovarian cancer and cervical cancer, but rare in malignant transformation of adenomyosis, endometriotic cysts, gastrointestinal stromal tumors (GIST), and endometrial tuberculosis. The gold standard for the diagnosis of almost all of the above -mentioned diseases is pathological examination, and imaging examination can serve as a reference and auxiliary diagnosis. When patients do not have typical clinical symptoms or B -ultrasonography and magnetic resonance imaging do not have typical imaging features, the imaging findings may influence the doctor′ s diagnosis and delay treatment. A adenomyosis patient presented with post - menopausal abdominal pain without typical clinical manifestations such as endometrial thickening, hydrops of uterus and vaginal bleeding, the clinical data of the patient with stage ⅢC endometrial serous carcinoma diagnosed after operation were analysed, and the related literatures about post-menopausal abdominal pain related diseases were reviewed, and the diagnostic strategies of the patients with recurrent abdominal pain after menopause were discussed, in order to prevent misdiagnosis and mistreatment. [ABSTRACT FROM AUTHOR]

Introduction. Langerhans cell histiocytosis (LCH), as a hematopoietic neoplasm, is a clonal proliferation of Langerhans dendritic cells. A comprehensive clinical examination is sometimes crucial for detecting rare adult diseases, such as LCH with concomitant autoimmune thyroid disease. Case report. A 43-year-old female patient first presented for an endocrinology consultation due to front neck pain and swelling accompanied by fatigue and malaise. The physical examination revealed an enlarged right thyroid gland lobe of extremely firm consistency that was painfully tender on palpation. Echosonographic findings confirmed that the right thyroid gland lobe was enlarged and was not clearly demarcated from the surrounding tissue while exhibiting pronounced parenchyma inhomogeneity characterized by reduced echogenicity of the anterior aspect and pronounced hypoechoicity of the posterior aspect, permeated with fibrous bands and calcifications. The structure of the left thyroid lobe was pseudonodular, with the characteristics of a chronic inflammatory process. Biohumoral findings indicated chronic autoimmune thyroiditis and primary hypothyroidism. Medical history, clinical findings, and personal and family predisposition to malignancy confirmed the need for accelerated additional diagnosis. Fine-needle aspiration biopsy was indicative of atypia of undetermined significance involving Hurthle cells, nuclear overlaps, anisocytosis, anisonucleosis, and the presence of nuclear incisions. Analyses performed after thyroidectomy pointed to the fibrous form of chronic thyroiditis, with suspected monoclonal proliferation of histiocytic and/or lymphoid cells. Immunohistochemical findings confirmed Hashimoto’s thyroiditis and LCH. As the postoperative course was favorable, the patient was prescribed L-thyroxine replacement therapy, along with continuous and systematic monitoring for histiocytosis. Conclusion. Histiocytosis should be suspected more often, given the high incidence of autoimmune thyroid disease in adulthood. A timely LCH diagnosis largely determines the outcome. [ABSTRACT FROM AUTHOR]

As a complex benign vascular disease, fibro-adipose vascular anomaly (FAVA) consists of intramuscular vascular malformation, fibrous tissue and adipose tissue. It is more prevalent among children and adolescents. Its clinical manifestations are persistent pain and contracture in affected extremity. Due to a previous lack of its etiological mechanism, there is a lot of confusion in the diagnosis and treatment of this disease. For further enhancing clinicians' understanding of FAVA, this review focused upon its pathogenesis, clinical manifestations, imaging features and therapeutic advances for optimizing its clinical managements. [ABSTRACT FROM AUTHOR]

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Introduction. Synovial sarcoma is a rare malignant tumor most often localized on the lower limbs near large joints. Histopathology findings is the gold standard for making the diagnosis. However, due to the similarity with other tumors, the findings can be misinterpreted and the correct diagnosis often delayed, and the treatment is inadequate in the early stages of the disease inadequate. Case Report. A 15-year-old female patient came for an examination due to subcutaneous lesion in her hand. The lesion was excised on three occasions due to recurrence, and each time the histopathology findings showed a dermatofibroma. After five years, the patient returned due to the changes under the scar and unpleasant sensations. A surgical excision was performed when dermatofibroma was verified. Two years later, the patient developed necrosis of the entire finger. The finger was amputated, and synovial sarcoma was verified. The patient underwent 25 cycles of radiotherapy. In the following year and a half, the tumor developed metastases, first locoregional and then distant, in the region of the left shoulder joint and the left lung. Conclusion. The histopathological similarity of this tumor with other benign changes indicates the need for further evaluation and differentiation of the pathohistological characteristics from tumors with similar characteristics. Early detection of this type of tumor enables a more favorable course and outcome of the treatment of these patients. Initial radical surgical treatment of this type of tumor is necessary due to the aggressiveness they show and the high frequency of local recurrence. [ABSTRACT FROM AUTHOR]

Objectives: The differentiation of Warthin tumor and pleomorphic adenoma before treatment is crucial for clinical strategies. The aim of this study was to develop and test a T2-weighted-based radiomics model for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. Methods: A total of 117 patients, including 61 cases of Warthin tumor and 56 cases of pleomorphic adenoma, were retrospectively enrolled from two centers between January 2010 and June 2022. The training set included 82 cases, and the validation set included 35 cases. From T2-weighted images, 971 radiomics features were extracted. Seven radiomics features remained after a two-step selection process. We used the seven radiomics features and clinical factors through multivariable logistic regression to build radiomics and clinical models, respectively. A radiomics–clinical model was also built that combined the independent clinical predictors with the radiomics features. Through ROC curves, the three models were evaluated and compared. Results: In the radiomics model, AUCs were 0.826 and 0.796 in training and validation sets, respectively. In the clinical model, the AUCs were 0.923 and 0.926 in the training and validation sets, respectively. Decision curve analysis revealed that the radiomics–clinical model had the best diagnostic performance for distinguishing Warthin tumor from pleomorphic adenoma of the parotid gland (AUC = 0.962 and 0.934 for the training and validation sets, respectively). Conclusion: The radiomics–clinical model performed well in differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. Key points: • The clinical model outperformed the radiomics model in distinguishing pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics features extracted from T2-weighted images could help differentiate pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics–clinical model was superior to the radiomics and the clinical models for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. [ABSTRACT FROM AUTHOR]

Background The past nearly 20-year period has seen a sudden increase in the use of artificial intelligence (AI) in esophageal cancer research, and an emergence of many systematic reviews and meta-analyses of the research. However, most of the reviews and meta-analyses only address a single aspect in summary, making it difficult for researchers to gain a comprehensive understanding of the latest developments and research hotspots in the field. Objective To perform a bibliometric analysis of the use of AI in esophageal cancer research, and the development, hotspots and emerging trend in this field. Methods All literature in English regarding esophageal cancer research using AI included in the Science Citation Index Expanded database of the Web of Science Core Collection was searched from 2000-01-01 to 2022-04-06. Microsoft Excel 2019, CiteSpace (5.8R3-64bit) and VOSviewer (1.6.18) were used to analyze the literature for annual number of publications, country, author, institution, co-citation and keywords. Results Nine hundred and eighteen studies were retrieved, with a total of 23 490 times of being cited. The number of studies published between 2000 and 2016 grew slowly (from 6 to 40), but increased rapidly between 2017 and 2022 (from 62 to 216). Sixty countries, 118 institutions and 5 979 authors were involved in the studies. China (306 articles), the United States (238 articles) and the United Kingdom (113 articles) ranked the top three in terms of number of studies published. The top three institutions in terms of intensity of cooperation were University of Amsterdam (TLS=72), Catherine Hospital (TLS=64) and Eindhoven University of Technology (TLS=53). The top three authors in terms of number of publications were Jacques J G H M Bergman from the Netherlands (n=16), Tomohiro Tada from Japan (n=12), and Fons Van Der Sommen from the Netherlands (n=12). There were 39 962 co-cited authors and 42 992 co-cited studies. Thirty-three burst keywords were identified: the major burst keywords were p53 and mutations in 2001-2008 (early stage), and were esophageal cancer classification, new examination techniques (tomography), differentiation, identification and comparison between esophageal cancer and other cancers in 2013-2018 (middle stage), and were deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis applications in 2019-2022 (late stage). Among which deep learning had the highest burst intensity (burst intensity of 13.89) . Conclusion AI application in esophageal cancer research has entered a new phase, moving gradually from genes and mutations toward accurate examination, diagnosis, and treatment. The latest major burst keywords in recent years (2019-2022) are deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis. The future challenges to the use of AI in esophageal cancer research may include individual data collection, data quality assurance, data processing specifications, AI code reproduction, and reliability assurance of AI-assisted diagnostic decision-making.

Introduction. Ectopic cervical thymus (ECT) occurs as a result of incomplete migration of the thymic primordia during embryogenesis. In the majority of cases, ECT is asymptomatic; however, in 10% of patients, there are different kinds of symptoms. Case report. A four-month-old baby boy was referred to our clinic for an evaluation of a growing large mass on the right side of the neck, present since birth. Physical examination revealed a solid, painless, soft, moderately mobile mass of irregular round shape localized on the right side of the neck, in front of the sternocleidomastoid muscle, below the parotid gland, and above the carotid lodge. The skin above the mass was unchanged. The dimensions of the mass were 40 × 32 × 15 mm. Based on the clinical and ultrasonographic findings, as well as the findings of the magnetic resonance imaging, it was suspected that the mass was an ECT. The mass was removed by surgical excision. The pathohistology report confirmed the presence of an ECT, with Hassall’s corpuscles in the medulla. The postoperative course went smoothly, and the wound healed well. During the regular clinical, immunological, and ultrasound follow-ups over a period of six months, normal findings were registered. Conclusion. Congenital ECT is a rare congenital anomaly that must be, however, taken into account when considering the differential diagnosis of cervical tumor masses.

Introduction. Complex visual hallucinations with retention of insight due to visual impairment are key symptoms of Charles Bonnet syndrome. The syndrome is a standalone diagnosis in the International Classification of Diseases, 11th Revision. Nevertheless, in clinical praxis, it is often misdiagnosed as psychosis or early stages of dementia, and it goes underreported by patients because of the fear of being diagnosed with a mental illness. Case report. We presented four elderly patients, who were referred for psychiatric consultation due to visual hallucinations, with preserved insight, but with impaired vision. All four patients had complex, vivid, and colorful hallucinations consisting of realistic objects, people, animals, or scenery that tend to recur. Their emotional response and impact on quality of life differed, and psychopharmacotherapy was determined according to their psychological symptoms. Empathic explanation of the symptoms’ origin and reassurance of the absence of mental illness for patients and caregivers were of vital importance in all cases. Conclusion. With the aging of the population, the number of patients with impaired vision also increases, and the importance of a multidisciplinary approach in the diagnostic procedures and treatment of Charles Bonnet syndrome is emphasized. Increased aware-ness of clinical characteristics and therapeutic approaches is required among all physicians who are in contact with elderly and/or impaired vision patients.

Introduction. Portal vein (PV) thrombosis (PVT) is a partial or complete obstruction of blood f low as a result of a thrombus mass in the lumen of PV. In the acute phase, the symptoms such as right upper quadrant pain, nausea, and fever are unspecific. A diversity of subacute and chronic symptoms is associated with complications related to PVT and portal hypertension. Case report. A 50-year-old female was admitted to the hospital due to acute abdominal cramping pain. The pain lasted for 15 to 20 min and was followed by defecation of normal stool and hematochezia on three occasions. The abdominal pain recurred after several hours, again followed by hematochezia and tenesmus every 10 min. After admission, a colonoscopy was performed, and it revealed vulnerable, erythematous mucosa of the colon with contact bleeding from the lienal flexure to the rectosigmoid junction. During the colonoscopy, a biopsy was performed. A computed tomography (CT) scan revealed partial PVT of intrahepatic branches of PV, and thrombosis of the inferior mesenteric vein. After conservative treatment with low molecular weight heparin (LMWH) and other supportive measures, the digestive bleeding ceased, and defecation became normal. During the one-month follow-up, the patient had no complications, and the control CT scan revealed normal PV flow without thrombosis. Conclusion. Although rare, a non-malignant and non-cirrhotic PVT should not be neglected in the differential diagnosis because timely and vigilant therapy with LMWH can lead to complete resolution without serious complications.

In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with “ambiguous” diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (P

Background Acute abdominal pain is one of the most common chief complaints in medical emergencies. Due to atypical clinical manifestations, the misdiagnosis rate of acute abdominal pain caused by vascular diseases is high. Objective To assess the value of the checklist of abdominal pain causes in the differential diagnosis of vascular diseases with abdominal pain as a presentation. Methods In accordance with the five diseases (localized organic disease, heart, lung and spine diseases, systemic disease, functional disorders, gynecological disease) with abdominal pain as a manifestation in the checklist of abdominal pain causes, we analyzed the causes of abdominal pain in three patients with acute atypical abdominal pain as the main manifestation for making a proper diagnosis, then assessed the practicability of the checklist in the diagnosis of vascular diseases. Results With the help of the checklist, the time used for diagnosing one patient with acute renal infarction, one with aortic dissection, and the other with pulmonary embolism was 1.5, 1.5, 1.75 hours, respectively. All the patients received timely diagnosis and treatment. Conclusion The checklist is helpful to the differential diagnosis of vascular abdominal pain, making a rapid clinical diagnosis, and forming a systematic diagnostic thinking mode.

The wide application of lung CT scan and lung cancer screening significnatly improves the detection rate of multiple primary lung cancer (MPLC) , namely, lung cancer patients have two or more primaries at the same time. It is a tough problem all the time that how to distinguish between MPLC and intrapulmonary metastases (IM) . Although histological feature analysis is a good means to distinguish them in some circumstances, molecular analysis is also needed generally. Such as the application of next generation sequencing (NGS) is useful for the distinguish between MPLC and IM. For MPLC, surgery remains the main treatment modality. For inoperable MPLC, radiotherapy and local ablation are important treatments. NGS and new therapies such as targeted drug therapy and immune checkpoint inhibitors have become new altenatives for the diagnosis and treatment of MPLC. This article reviews recent advances in the diagnosis and treatment of MPLC.