Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Surgicopathological classification of hepatic space-occupying lesions:A single-center experience with literature review

Accompanying rapid developments in hepatic surgery,the number of surgeries and identifications of histological types of primary hepatic space-occupying lesions (PHSOLs) have increased dramatically.This has led to many changes in the surgicopathological spectrum of PHSOLs,and has contributed to a theoretical basis for modern hepatic surgery and oncological pathology.Between 1982 and 2009 at the Eastern Hepatobiliary Surgery Hospital (EHBH) in Shanghai,31 901 patients underwent surgery and were diagnosed as having a PHSOL.In this paper,we present an analysis of the PHSOL cases at the EHBH for this time period,along with results from a systematic literature review.We describe a surgicopathological spectrum comprising more than 100 types of PHSOLs that can be stratified into three types:tumor-like,benign,and malignant.We also stratified the PHSOLs into six subtypes derived from hepatocytes;cholangiocytes;vascular,lymphoid and hemopoietic tissues;muscular,fibrous and adipose tissues;neural and neuroendocrine tissues;and miscellaneous tissues.The present study provides a new classification system that can be used as a current reference for clinicians and pathologists to make correct diagnoses and differential diagnoses among various PHSOLs.

Space-occupying lesions of the lacrimal gland at one tertiary eye center in China: a retrospective clinical study of 95 patients

AIM: To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS: A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS: Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION: Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis.

Prevalence, risk factors, and BRAF mutation of colorectal sessile serrated lesions among Vietnamese patients

BACKGROUND Sessile serrated lesions(SSLs)are considered precancerous colorectal lesions that should be detected and removed to prevent colorectal cancer.Previous studies in Vietnam mainly investigated the adenoma pathway,with limited data on the serrated pathway.AIM To evaluate the prevalence,risk factors,and BRAF mutations of SSLs in the Vietnamese population.METHODS This is a cross-sectional study conducted on patients with lower gastrointestinal symptoms who underwent colonoscopy at a tertiary hospital in Vietnam.SSLs were diagnosed on histopathology according to the 2019 World Health Organi-zation classification.BRAF mutation analysis was performed using the Sanger DNA sequencing method.The multivariate logistic regression model was used to determine SSL-associated factors.RESULTS There were 2489 patients,with a mean age of 52.1±13.1 and a female-to-male ratio of 1:1.1.The prevalence of SSLs was 4.2%[95%confidence interval(CI):3.5-5.1].In the multivariate analysis,factors significantly associated with SSLs were age≥40[odds ratio(OR):3.303;95%CI:1.607-6.790],male sex(OR:2.032;95%CI:1.204-3.429),diabetes mellitus(OR:2.721;95%CI:1.551-4.772),and hypertension(OR:1.650,95%CI:1.045-2.605).The rate of BRAF mutations in SSLs was 35.5%.CONCLUSION The prevalence of SSLs was 4.2%.BRAF mutations were present in one-third of SSLs.Significant risk factors for SSLs included age≥40,male sex,diabetes mellitus,and hypertension.

Expert consensus on the diagnosis and therapy of endo-periodontal lesions

Endo-periodontal lesions (EPLs) involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms,including unique anatomical and microbiological characteristics and multiple contributing factors.This etiological complexity leads to difficulties in determining patient prognosis,posing great challenges in clinical practice.Furthermore,EPL-affected teeth require multidisciplinary therapy,including periodontal therapy,endodontic therapy and others,but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy.By compiling the most recent findings on the etiology,pathogenesis,clinical characteristics,diagnosis,therapy,and prognosis of EPL-affected teeth,this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

Hepatic cystic lesions mimicking liver abscess on imaging: A report oftwo cases

Hepatic cystic lesions include congenital dysplasia,inflammatory cystic lesions,neoplastic cystic lesions and parasitic cystic lesions.As different treatment modalities can be chosen for these lesions,differential diagnosis is particularly important[1].Clinical features or imaging findings of cystic lesions of the liver are typical;for instance,liver abscess often shows thick-walled enhancement on contrast-enhanced CT.

Effect of negative remodeling of the side branch ostium on the efficacy of a two-stent strategy for distal left main bifurcation lesions:an intravascular ultrasound study

OBJECTIVES To investigate whether negative remodeling(NR) detected by intravascular ultrasound(IVUS) of the side branch ostium(SBO) would affect in-stent neointimal hyperplasia(NIH) at the one-year follow-up and the clinical outcome of target lesion failure(TLF) at the long-term follow-up for patients with left main bifurcation(LMb) lesions treated with a two-stent strategy.METHODS A total of 328 patients with de novo true complex LMb lesions who underwent a 2-stent strategy of percutaneous coronary intervention(PCI) treatment guided by IVUS were enrolled in this study. We divided the study into two phases. Of all the patients, 48 patients who had complete IVUS detection pre-and post-PCI and at the 1-year follow-up were enrolled in phase Ⅰ analysis, which aimed to analyze the correlation between NR and in-stent NIH at SBO at the 1-year follow-up. If the correlation was confirmed, the cutoff value of the remodeling index(RI) for predicting NIH ≥ 50% was analyzed next. The phase Ⅱ analysis focused on the incidence of TLF as the primary endpoint at the 1-to 5-year follow-up for all 328 patients by grouping based on the cutoff value of RI.RESULTS In phase I: according to the results of a binary logistic regression analysis and receiver operating characteristic(ROC) analysis, the RI cutoff value predicting percent NIH ≥ 50% was 0.85 based on the ROC curve analysis, with a sensitivity of 85.7%, a specificity of 88.3%, and an AUC of 0.893(0.778, 1.000), P = 0.002. In phase Ⅱ: the TLR rate(35.8% vs. 5.3%, P < 0.0001)was significantly higher in the several NR(s NR, defined as RI ≤ 0.85) group than in the non-s NR group.CONCLUSION The NR of LCx O is associated with more in-stent NIH post-PCI for distal LMb lesions with a 2-stent strategy,and NR with RI ≤ 0.85 is linked to percent NIH area ≥ 50% at the 1-year follow-up and more TLF at the 5-year follow-up.

Two-Stent Strategy for Bifurcation Lesions in Percutaneous Transluminal Coronary Angioplasty: Real-World Evidence

Background: Bifurcation lesions pose a high risk for adverse events after percutaneous coronary intervention (PCI). Evidence supporting the benefits of the two-stent strategy (2SS) for treating coronary bifurcation lesions in India is limited. This study aimed to evaluate the clinical outcomes of various 2SSs for percutaneous transluminal coronary angioplasty for bifurcation lesions in India. Materials and Methods: This retrospective, observational, multicentric, real-world study included 64 patients over 8 years. Data on demographics, medical history, PCI procedures, and outcomes were recorded. Descriptive statistics were computed using the SPSS software. Results: Patients (n = 64) had an average age of 65.3 ± 11.1 years, with 78.1% males. Acute coronary syndrome was reported in 18.8%, chronic stable angina in 40.6%, and unstable angina in 34.4% of participants. Two-vessel disease was observed in 98.4% of patients, and 99.4% had true bifurcation lesions. The commonly involved vessels were the left anterior descending artery (50%), left circumflex coronary artery (34.4%), and first diagonal artery (43.8%). Mean percent diameter stenosis was 87.2% ± 10.1%. The mean number of stents used was 2.00 ± 0.34. The 2SS techniques included the T and small protrusion (TAP) (39.1%), double kissing (DK) crush (18.8%), and the culotte techniques (14.1%). Procedural and angiographic success rate was 92.18%. Major adverse cardiovascular events at 1-year follow-up occurred in 7.8% of cases. Conclusion: The 2SS for bifurcation lesions showed favorable in-hospital and follow-up outcomes. Findings can serve as a resource for bifurcation angioplasty in India. Larger real-world studies with robust methodology are needed to validate these results.

Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions

BACKGROUND The incidence and mortality of lung cancer have increased annually.Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis.Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer.Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years.AIM To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions.METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People’s Hospital.The patients were randomly divided into two groups:The CEUS-guided before lesion puncture group(contrast group)and conventional ultrasound-guided group(control group).Analyze the diagnostic efficacy of the puncture biopsy,impact of tumor size,and number of puncture needles and complications were analyzed and compared between the two groups.RESULTS Accurate pathological results were obtained for 92.83%(220/237)of peripheral lung lesions during the first biopsy,with an accuracy rate of 95.8%(113/118)in the contrast group and 89.9%(107/119)in the control group.The difference in the area under the curve(AUC)between the contrast and the control groups was not statistically significant(0.952 vs 0.902,respectively;P>0.05).However,when the lesion diameter≥5 cm,the diagnostic AUC of the contrast group was higher than that of the control group(0.952 vs 0.902,respectively;P<0.05).In addition,the average number of puncture needles in the contrast group was lower than that in the control group(2.58±0.53 vs 2.90±0.56,respectively;P<0.05).CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions,especially for lesions with a diameter≥5 cm.Therefore,CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.

Challenges in Diagnosing and Managing Dieulafoy’s Lesions: A Case Report Highlighting the Importance of Clinical Suspicion and Multidisciplinary Approach in Obscure Gastrointestinal Bleeding

Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.

Molecular Mechanism of Rice Necrotic Lesion for Optimized Yield and Disease Resistance

How to balance rice resistance and yield is an important issue in rice breeding.Plants with mutated necrotic lesion genes often have persistent broad-spectrum resistance,but this broad-spectrum resistance usually comes at the expense of yield.Currently,many necrotic lesion mutants in rice have been identified,and these genes are involved in disease resistance pathways.This review provides a detailed introduction to the characteristics,classification,and molecular mechanisms of necrotic lesion formation.Additionally,we review the molecular regulatory pathways of genes involved in rice disease resistance.Concurrently,we summarize the relationship between resistance and yield in rice using newly developed gene editing methods.We discuss a rational and precise breeding strategy to better utilize molecular design technology for breeding disease-resistant and high-yield rice varieties.

Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review

Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.

Scheme Based on Multi-Level Patch Attention and Lesion Localization for Diabetic Retinopathy Grading

Early screening of diabetes retinopathy(DR)plays an important role in preventing irreversible blindness.Existing research has failed to fully explore effective DR lesion information in fundus maps.Besides,traditional attention schemes have not considered the impact of lesion type differences on grading,resulting in unreasonable extraction of important lesion features.Therefore,this paper proposes a DR diagnosis scheme that integrates a multi-level patch attention generator(MPAG)and a lesion localization module(LLM).Firstly,MPAGis used to predict patches of different sizes and generate a weighted attention map based on the prediction score and the types of lesions contained in the patches,fully considering the impact of lesion type differences on grading,solving the problem that the attention maps of lesions cannot be further refined and then adapted to the final DR diagnosis task.Secondly,the LLM generates a global attention map based on localization.Finally,the weighted attention map and global attention map are weighted with the fundus map to fully explore effective DR lesion information and increase the attention of the classification network to lesion details.This paper demonstrates the effectiveness of the proposed method through extensive experiments on the public DDR dataset,obtaining an accuracy of 0.8064.

The gene encoding flavonol synthase contributes to lesion mimic in wheat

Lesion mimic often exhibits leaf disease-like symptoms even in the absence of pathogen infection,and is characterized by a hypersensitive-response(HR)that closely linked to plant disease resistance.Despite this,only a few lesion mimic genes have been identified in wheat.In this investigation,a lesion mimic wheat mutant named je0297 was discovered,showing no alteration in yield components when compared to the wild type(WT).Segregation ratio analysis of the F_(2)individuals resulting from the cross between the WT and the mutant revealed that the lesion mimic was governed by a single recessive gene in je0297.Using Bulked segregant analysis(BSA)and exome capture sequencing,we mapped the lesion mimic gene designated as lm6 to chromosome 6BL.Further gene fine mapping using 3315 F_(2)individuals delimited the lm6 within a 1.18 Mb region.Within this region,we identified 16 high-confidence genes,with only two displaying mutations in je0297.Notably,one of the two genes,responsible for encoding flavonol synthase,exhibited altered expression levels.Subsequent phenotype analysis of TILLING mutants confirmed that the gene encoding flavonol synthase was indeed the causal gene for lm6.Transcriptome sequencing analysis revealed that the DEGs between the WT and mutant were significantly enriched in KEGG pathways related to flavonoid biosynthesis,including flavone and flavonol biosynthesis,isoflavonoid biosynthesis,and flavonoid biosynthesis pathways.Furthermore,more than 30 pathogen infection-related(PR)genes exhibited upregulation in the mutant.Corresponding to this expression pattern,the flavonoid content in je0297 showed a significant decrease in the 4^(th)leaf,accompanied by a notable accumulation of reactive oxygen,which likely contributed to the development of lesion mimic in the mutant.This investigation enhances our comprehension of cell death signaling pathways and provides a valuable gene resource for the breeding of disease-resistant wheat.

Ligation-assisted endoscopic submucosal resection following unroofing technique for small esophageal subepithelial lesions originating from the muscularis propria

BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria(SEL-MPs)are benign in nature,although a subset may exhibit malignant characteristics.Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs.AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection(ESMR-L)following unroofing technique for small esophageal SEL-MPs.METHODS From January 2021 to September 2023,17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People’s Hospital.Details of clinicopathological characteristics and clinical outcomes were collected and analyzed.RESULTS The mean age of the patients was 50.12±12.65 years.The mean size of the tumors was 7.47±2.83 mm and all cases achieved en bloc resection successfully.The average operation time was 12.2 minutes without any complications.Histopathology identified 2 Lesions(11.8%)as gastrointestinal stromal tumors at very low risk,12 Lesions(70.6%)as leiomyoma and 3 Lesions(17.6%)as smooth muscle proliferation.No recurrence was found during the mean follow-up duration of 14.18±9.62 months.CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm,but it cannot ensure en bloc resection and may require further treatment.

How to"pick up"colorectal serrated lesions and polyps in daily histopathology practice:From terminologies to diagnostic pitfalls

Over the last decade,our knowledge of colorectal serrated polyps and lesions has significantly improved due to numerous studies on this group of precursor lesions.Serrated lesions were misleading as benign before 2010,but they are currently reclassified as precancerous lesions that contribute to 30%of colorectal cancer through the serrated neoplasia pathway.The World Health Organization updated the classification for serrated lesions and polyps of the colon and rectum in 2019,which is more concise and applicable in daily practice.The responsible authors prescribe that“colorectal serrated lesions and polyps are characterized by a serrated(sawtooth or stellate)architecture of the epithelium.”From a clinical standpoint,sessile serrated lesion(SSL)and SSL with dysplasia(SSLD)are the two most significant entities.Despite these advancements,the precise diagnosis of SSL and SSLD based mainly on histopathology remains challenging due to various difficulties.This review describes the nomenclature and the terminology of colorectal serrated polyps and lesions and highlights the diagnostic criteria and obstacles encountered in the histopathological diagnosis of SSL and SSLD.