Differential diagnosis of gastric submucosal masses and external pressure lesions

Lesions of the left triangular ligament of the liver are rare,and there are even fewer cases of vascular tumors misdiagnosed as gastrointestinal stromal tumors.We comment on the two cases reported in the article.The article did not include pictures of laparoscopic surgery,making it unconvincing.For gastric submucosal lesions,enhanced computed tomography venous phase imaging may be beneficial for differential diagnosis.Although endoscopic ultrasound is an effective tool for diagnosing submucosal lesions of the stomach,due to various factors,it cannot achieve an accurate diagnosis.During endoscopic examination,a more accurate diagnosis can be made depending on the personal experience of the operators.

Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica

AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors(SNDTs).METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs(n = 8). RESULTS Buttock masses occurred in three patients with SNDT(37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs(87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm(range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging(MRI).CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.

Ultrasound diagnosis of fractures in mass casualty incidents

The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound protocols,which are used in MCIs,included extremity ultrasound examination as part of them.The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs.The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively.Nevertheless,majority of these studies were in children and they had very high heterogeneity.The portability,safety,repeatability,and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs.Its potential in managing fractures in MCIs needs to be further defined.The operator should master the technique,understand its limitations,and most importantly correlate the sonographic findings with the clinical ones to be useful.This editorial critically reviews the literature on this topic,describes its principles and techniques,and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.

Stochastic resonance of coupled time-delayed system with fluctuation of mass and frequency and its application in bearing fault diagnosis

The stochastic resonance behavior of coupled stochastic resonance(SR)system with time-delay under mass and frequency fluctuations was studied.Firstly,the approximate system model of the time-delay system was obtained by the theory of small time-delay approximation.Then,the random average method and Shapiro-Loginov algorithm were used to calculate the output amplitude ratio of the two subsystems.The simulation analysis shows that increasing the time-delay and the input signal amplitude appropriately can improve the output response of the system.Finally,the system is applied to bearing fault diagnosis and compared with the stochastic resonance system with random mass and random frequency.The experimental results show that the coupled SR system taking into account the actual effect of time-delay and couple can more effectively extract the frequency of the fault signal,and thus realizing the diagnosis of the fault signal,which has important engineering application value.

Diagnosis and laparoscopic excision of accessory cavitated uterine mass in a young woman:A case report

BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.

COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.

DIAGNOSIS AND SURGICAL MANAGEMENT FOR RETROSTERNAL THYROID MASS

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Comparing upper gastrointestinal X-ray and endoscopy for gastric cancer diagnosis in Korea

AIM:To compare the cost and accuracy of upper gastrointestinal(GI)X-ray and upper endoscopy for diagnosis of gastric cancer using data from the 2002-2004 Korean National Cancer Screening Program(NCSP). METHODS:The study population included 1 503 646 participants in the 2002-2004 stomach cancer screening program who underwent upper GI X-ray or endoscopy.The accuracy of screening was defined as the probability of detecting gastric cancer.We calculated the probability by merging data from the NCSP and the Korea Central Cancer Registry.We estimated the direct costs of the medical examination and the tests for up- per GI X-ray,upper endoscopy,and biopsy. RESULTS:The probability of detecting gastric cancervia upper endoscopy was 2.9-fold higher than via upper GI X-ray.The unit costs of screening using upper GI X-ray and upper endoscopy were$32.67 and$34.89, respectively.In 2008,the estimated cost of identifying one case of gastric cancer was$53094.64 using upper GI X-ray and$16 900.43 using upper endoscopy.The cost to detect one case of gastric cancer was the same for upper GI X-ray and upper endoscopy at a cost ratio of 1:3.7. CONCLUSION:Upper endoscopy is slightly more costly to perform,but the cost to detect one case of gastric cancer is lower.

Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

Tuberculosis(TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and preoperative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting imageguided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacillion Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

DIAGNOSIS AND TREATMENT OF MEDIASTINAL ENTEROGENOUS CYSTS IN CHILDREN

Objective To investigate the diagnosis and therapy of mediastinal enterogenous cysts in children. Methods Clinical data of 17 cases with mediastinal enterogenous cysts within 19 years in our hospital were retrospectively analyzed. Results One case was intramural esophageal cyst and 16 cases were enteric cysts, two among which were complicated with abdominal enteric duplications. Most cases presented with symptoms of respiratory distress. Twelve cases were complicated with vertebral anomalies. Ultrasound helpful in confirming the cystic nature of these lesions. posterior mediastinum. of 12 cases and magnetic resonance imaging of 4 cases were Eight cases had technetium-99m pertechnetate scintigraphy of posterior mediastinum.Conclusions Most patients present with symptoms of respiratory distress, complicated with vertebral anomalies. Ultrasonography and magnetic resonance imaging may be helpful in confirming the cystic nature of these lesions. Technetium-99m pertechnetate scintigraphy is the most effective method for differentiation of the disease from other mediastinal cysts.

Static-deformation based fault diagnosis for damping spring of large vibrating screen

Based on the statics theory, a novel and feasible twice-suspended-mass method(TSMM) was proposed to deal with the seldom-studied issue of fault diagnosis for damping springs of large vibrating screen(LVS). With the static balance characteristic of the screen body/surface as well as the deformation compatibility relation of springs considered, static model of the screen surface under a certain load was established to calculate compression deformation of each spring. Accuracy of the model was validated by both an experiment based on the suspended mass method and the properties of the 3D deformation space in a numerical simulation. Furthermore, by adopting the Taylor formula and the control variate method, quantitative relationship between the change of damping spring deformation and the change of spring stiffness, defined as the deformation sensitive coefficient(DSC), was derived mathematically, from which principle of the TSMM for spring fault diagnosis is clarified. In the end, an experiment was carried out and results show that the TSMM is applicable for diagnosing the fault of single spring in a LVS.

Differential diagnosis of a vanishing brain space occupying lesion in a child

We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging(MRI) of the brain revealed presence of intraaxial large mass(25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1 W and hyperintense signals in T2 W and fluid attenuated inversion recovery(FLAIR) images and homogenously enhanced with gadolinium(Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol(2 g/12 h per 2 d) and dexamethasone(8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy(brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion(lymphoma or glioma). Marked clinical improvement(up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1 W and hyperintense signals in T2 W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy(300 mg/12 h). At October 2014, single voxel proton(1H) MR spectroscopy(MRS) showedreduced N-acetyl-aspartate(NAA)/creatine(Cr), choline(Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.

Diagnosis of Tumor-Like Polypoid Lesions of Gallbladder by Serum Proteomic Fingerprint

Objective： To search the specific serum proteins in tumor-like polypoid lesions of the gallbladder（PLG） patients. Methods： Surface enhanced laser desorption/ionization time of flight mass spectrometry （SELDI-TOF-MS） technique and WCX Magnetic Beads were used to detect the serum proteomic fingerprint of 23 patients with tumor-like PLG, 21 patients with non tumor-like PLG and 26 normal persons. Biomarker Wizard and Biomarker Patterns Software were used in combination to analyze the data. Results： In the preliminary screening, 22 representative specific proteins for tumor-like PLG were found. Seven specific proteins showed increased expression and 15 specific proteins showed decreased expression in the tumor-like PLG patients. Three specific proteins are selected for the diagnosis of the tumor-like PLG.. Conclusion： SELDI-TOF-MS technique can be used to select specific proteins for tumor-like PLG patients, which may be useful for the diagnosis of the tumor-like PLG and the differential diagnosis with the non tumor-like PLG.

Pancreatic cancer,autoimmune or chronic pancreatitis,beyond tissue diagnosis:Collateral imaging and clinical characteristics may differentiate them

Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related death.Often,the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses,such as autoimmune pancreatitis(AIP)and massforming chronic pancreatitis(MFCP),making its diagnosis challenging.Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications.Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses;however,the diagnostic accuracy is imperfect.Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis.It is not unusual that after a thorough diagnostic evaluation,the clinician is confronted with a pancreatic mass with uncertain diagnosis.In those cases,a re-evaluation must be entertained,preferably by an experienced multispecialty team including radiologists,pathologists,gastroenterologists,and surgeons,looking for disease-specific clinical,imaging,and histological hallmarks or collateral evidence that could favor a specific diagnosis.Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP,PDAC,and MFCP and to highlight those disease-specific clinical,radiological,serological,and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.

Solid pancreatic masses:What’s hidden beneath?Insights into rare pancreatic lesions

The diagnostic approach to solid pancreatic masses has significantly evolved from the era when a focal pancreatic mass was almost synonymous to pancreatic ductal adenocarcinoma,to a wide spectrum of pancreatic lesions,some of which have good prognosis.With the advent of advanced diagnostic tools,particularly refined imaging and tissue acquisition techniques,a broader spectrum of differential diagnoses has been recognized,encompassing conditions ranging from neuroendocrine tumors or inflammatory masses,to rare entities like metastatic clear cell sarcoma or solitary fibrous tumors.We herein discuss case reports of some rare pancreatic lesions,which were diagnosed by combining clinical and imaging features and endoscopic ultrasound-guided tissue sampling and confirmed on surgical specimens.Further reports on these rare pancreatic tumors will contribute to a better understanding of their pathogenesis and effective management.

基于熵的Mass函数算法及在液压泵故障诊断中的应用

如何确定Mass函数是D-S证据理论的棘手问题,本文从信息论的观点出发,提出一种新的计算Mass函数的算法。该算法依据证据体可信度因素和证据体与目标关联的相对熵来分配证据体的Mass函数,较全面反映证据体的不确定性。将方法应用于液压泵诊断中,结果表明它获取的Mass函数是符合实际情况的,具有较好的实用性,而且其算法容易实现。

Detection and Diagnosis of Small Target Breast Masses Based on Convolutional Neural Networks

Breast mass identification is of great significance for early screening of breast cancer,while the existing detection methods have high missed and misdiagnosis rate for small masses.We propose a small target breast mass detection network named Residual asymmetric dilated convolution-Cross layer attention-Mean standard deviation adaptive selection-You Only Look Once(RCM-YOLO),which improves the identifiability of small masses by increasing the resolution of feature maps,adopts residual asymmetric dilated convolution to expand the receptive field and optimize the amount of parameters,and proposes the cross-layer attention that transfers the deep semantic information to the shallow layer as auxiliary information to obtain key feature locations.In the training process,we propose an adaptive positive sample selection algorithm to automatically select positive samples,which considers the statistical features of the intersection over union sets to ensure the validity of the training set and the detection accuracy of the model.To verify the performance of our model,we used public datasets to carry out the experiments.The results showed that the mean Average Precision(mAP)of RCM-YOLO reached 90.34%,compared with YOLOv5,the missed detection rate for small masses of RCM-YOLO was reduced to 11%,and the single detection time was reduced to 28 ms.The detection accuracy and speed can be effectively improved by strengthening the feature expression of small masses and the relationship between features.Our method can help doctors in batch screening of breast images,and significantly promote the detection rate of small masses and reduce misdiagnosis.

Deep learning with convolutional neural networks for identification of liver masses and hepatocellular carcinoma: A systematic review

BACKGROUND Artificial intelligence,such as convolutional neural networks(CNNs),has been used in the interpretation of images and the diagnosis of hepatocellular cancer(HCC)and liver masses.CNN,a machine-learning algorithm similar to deep learning,has demonstrated its capability to recognise specific features that can detect pathological lesions.AIM To assess the use of CNNs in examining HCC and liver masses images in the diagnosis of cancer and evaluating the accuracy level of CNNs and their performance.METHODS The databases PubMed,EMBASE,and the Web of Science and research books were systematically searched using related keywords.Studies analysing pathological anatomy,cellular,and radiological images on HCC or liver masses using CNNs were identified according to the study protocol to detect cancer,differentiating cancer from other lesions,or staging the lesion.The data were extracted as per a predefined extraction.The accuracy level and performance of the CNNs in detecting cancer or early stages of cancer were analysed.The primary outcomes of the study were analysing the type of cancer or liver mass and identifying the type of images that showed optimum accuracy in cancer detection.RESULTS A total of 11 studies that met the selection criteria and were consistent with the aims of the study were identified.The studies demonstrated the ability to differentiate liver masses or differentiate HCC from other lesions(n=6),HCC from cirrhosis or development of new tumours(n=3),and HCC nuclei grading or segmentation(n=2).The CNNs showed satisfactory levels of accuracy.The studies aimed at detecting lesions(n=4),classification(n=5),and segmentation(n=2).Several methods were used to assess the accuracy of CNN models used.CONCLUSION The role of CNNs in analysing images and as tools in early detection of HCC or liver masses has been demonstrated in these studies.While a few limitations have been identified in these studies,overall there was an optimal level of accuracy of the CNNs used in segmentation and classification of liver cancers images.

Clinical comparison of patients with benign urachal masses versus urachal carcinomas

The clinical features of 17 patients with benign urachal masses and 30 patients with urachal carcinoma treated at Sun Yat-sen University Cancer Center were analyzed retrospectively. Univariate analysis indicated that seven parameters difered signiicantly between the two groups. Binary logistic regression analyses showed that the rate of gross hematuria was signiicantly higher(P = 0.042, Exp[B] = 7.889) and the rate of fatty iniltration of the Retzius space was signiicantly lower(P = 0.006, Exp[B] = 0.028) in patients with urachal carcinoma than in those with benign urachal masses. Gross hematuria and fatty iniltration of the Retzius space may be indications of malignant and benign urachal masses, respectively.

Biopsy of parotid masses:Review of current techniques

Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section(IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.