Search Results (273)

Background: Rare appendicular pathologies (RAP) are uncommon clinical entities with important diagnostic and therapeutic implications. These conditions frequently mimic acute appendicitis, yet they may require different operative strategies and, in selected cases, oncological management. Methods: We performed a retrospective cohort study including all patients who underwent surgery with the intention of performing an appendectomy at the First Surgical Clinic, Emergency County University Hospital of Cluj-Napoca, between 2018 and 2021. During this interval, 330 appendectomies were performed. Patients with a histopathological diagnosis of RAP were included. Clinical, imaging, surgical, histopathological, postoperative, and follow-up data were analyzed, with particular attention to the preoperative diagnostic work-up and imaging-based suspicion of rare appendicular pathology. Results: Ten patients (3.03%) were diagnosed with RAP, including low-grade appendiceal mucinous neoplasm (LAMN; n = 5), mucinous cystadenoma (n = 2), appendiceal adenocarcinoma (n = 1), appendicular diverticulum (n = 1), and stump appendicitis (n = 1). Computed tomography was the main diagnostic modality, particularly in patients with atypical presentation or suspicion of complicated or neoplastic appendiceal disease, while magnetic resonance imaging and colonoscopy provided additional information in selected cases. Preoperative suspicion of a rare or neoplastic appendiceal pathology was achieved in 70% of patients. Laparoscopic appendectomy was performed in 6 patients, open appendectomy in 1 patient, open ileocecal resection in 1 patient, open right hemicolectomy in 1 patient, and laparoscopic right hemicolectomy in 1 patient. Histopathological examination confirmed the diagnosis in all cases. Immediate postoperative outcomes were favorable, without perioperative mortality or major complications; during follow-up, the patient with adenocarcinoma required oncological treatment and resection of a local recurrence 1 year after surgery. Conclusions: RAP represent a small but clinically significant subset of appendiceal disease. Structured preoperative imaging, intraoperative recognition of atypical findings, and an individualized surgical strategy are essential for optimal outcomes and appropriate oncological management. Full article

Background: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated necrotizing vasculitis primarily affecting small and medium-sized vessels. The typical presentation commonly includes upper and/or lower respiratory tract and renal involvement. GPA has a particularly strong association with proteinase-3 (PR3) ANCA. Though well defined, GPA may be clinically difficult to recognize, particularly in early disease. Initial presentations may include nonspecific symptoms, including but not limited to fatigue, fever, and sinus congestion or sinusitis, which may be mistaken for infection. Though initial ANCA testing is useful, it is not definitive as early stages of disease may be negative, thus delaying diagnosis; Clinical Significance: This case highlights the importance of including GPA in the differential diagnosis of patients with unremitting upper or lower respiratory and constitutional symptoms despite negative ANCA testing. Though atypical, GPA cases may lack renal involvement and even have negative ANCA serologies, leading to a delay in diagnosis and increased morbidity. ANCA positivity can be as low as 60% in limited GPA cases, and less than 20% of individuals have renal involvement at presentation. If GPA suspicion is high, repeat testing and biopsy are warranted; Case Presentation: A woman in her 50s initially presented to the emergency department with recurrent/persistent fever with nonspecific sinus symptoms that remained unresolved despite multiple outpatient treatments and tests. Infectious work-up was negative. She was found to have multiple pulmonary nodules on various scans. Initial testing on admission was unremarkable or nondiagnostic, including anti-neutrophil cytoplasmic antibody (ANCA) serologies. The patient’s hospital course was complicated by acute hypoxic respiratory failure with distributive shock during bronchoscopy. Repeat serological testing was positive for PR3-ANCA, and lung biopsy demonstrated necrotizing granulomatous vasculitis consistent with a diagnosis of granulomatosis with polyangiitis (GPA). The patient demonstrated clinical improvement with avacopan, glucocorticoids, and rituximab; Conclusions: The diagnosis of GPA should be suspected in all patients with nonspecific constitutional symptoms along with clinical evidence of upper/lower respiratory tract involvement, regardless of renal function. Physicians with a strong suspicion of an autoimmune disease, such as GPA, should utilize a thorough clinical history, physical exam, and other labs in the setting of a negative autoimmune marker and/or negative imaging. Clinical judgment is required to not rule out GPA despite a negative workup when other more serious causes have been excluded, as the diagnosis may be life-threatening. Full article

Background: Primary biliary cholangitis (PBC) is a rare autoimmune liver disease characterized by marked clinical and serological heterogeneity. Although diagnosis is mainly based on antimitochondrial antibodies (AMAs) and alkaline phosphatase (ALP), non-classical presentations remain a relevant cause of diagnostic delay. In this context, laboratory medicine plays a pivotal role in both diagnosis and long-term disease management. Methods: This manuscript represents a structured clinical review of laboratory biomarkers relevant to the diagnosis, monitoring, and prognostic stratification of PBC, integrated with a representative atypical case with long-term follow-up to illustrate the practical application of laboratory-driven diagnostic. Results: The analysis confirms the central role of immunological and biochemical markers in treatment monitoring and prognostic assessment, while highlighting their limitations in selected clinical scenarios. The reported case, characterized by persistent AMA negativity and consistently normal ALP levels, illustrates how expanded laboratory testing can support the identification of non-standard disease phenotypes. In this setting, parallel testing for AMA- and PBC-specific autoantibodies was essential to achieve a correct diagnosis. Moreover, alternative biomarkers, including gamma-glutamyl transferase (GGT) and selected immunological markers, provided clinically meaningful information when conventional markers were not informative. Conclusions: By integrating current evidence with a long-term clinical case, this work moves beyond a descriptive overview and proposes a practical, laboratory-driven diagnostic and follow-up framework for PBC. It highlights laboratory opportunities to facilitate timely diagnosis, appropriate prognostic stratification, and disease monitoring, including the assessment of associated comorbidities. Full article

Homopolymer addition is a widely used strategy to dilate the microdomain spacing of block copolymers, yet the attainable dilation is often limited by macrophase separation in conventional blends at elevated homopolymer loading. In this work, we investigate an architectural route to suppress macrophase separation while retaining homopolymer-driven dilation: a covalently hybridized bottlebrush copolymer (CH-BBC), a copolymacromer-like bottlebrush architecture in which symmetric AB diblock side chains and A-type homopolymer side chains are covalently grafted to a common backbone. Using dissipative particle dynamics (DPD) simulations, we directly compare the phase behavior of CH-BBC melts with that of composition-matched blends of symmetric AB diblocks and A-type homopolymers. Across the explored window, CH-BBC exhibits microphase morphologies and disorder without an observable two-phase region, whereas the corresponding blends show extensive two-phase coexistence at elevated homopolymer loading. Lamellar analysis and one-dimensional density decompositions further reveal that CH-BBC enables substantially larger microphase dilation and stronger selective swelling of the A-rich domain because tethered A-type homopolymer segments preferentially occupy and dilate the A-rich domain interior while diblock A segments remain localized near interfaces. Full article

Background: Human granulocytic anaplasmosis (HGA) is a tick-borne zoonotic infection caused by Anaplasma phagocytophilum and transmitted by Ixodes species. In temperate regions, HGA is considered seasonal, with most cases occurring during late spring and summer. We describe two cases of HGA diagnosed in January during a winter period with episodic temperatures exceeding thresholds for tick activity, highlighting atypical seasonal presentation and diagnostic challenges. Methods: This report details the clinical course, diagnostic reasoning, and management of two patients evaluated at a tertiary care hospital in Suffolk County, New York. Data were derived from direct clinical care and the electronic health record. The institutional review board determined this work did not constitute human subject research. Written informed consent was obtained from both patients. Results: Both patients presented with acute febrile illness and characteristic laboratory abnormalities. Due to winter season, tick-borne infection was not initially suspected, resulting in delayed consideration. PCR testing confirmed A. phagocytophilum infection in Case 1, meeting CDC criteria for confirmed HGA. Case 2 met CDC criteria for probable HGA based on serologic testing showing elevated IgG (1:320) in the appropriate clinical context. Treatment with doxycycline led to rapid clinical improvement and complete recovery. Conclusions: These cases demonstrate that HGA can be diagnosed during winter months in endemic regions. Although the precise timing of infection cannot be determined, these observations occurred during a period when episodic temperatures exceeded thresholds for tick activity. The cases highlight limitations of season-based diagnostic assumptions and suggest maintaining clinical suspicion for anaplasmosis year-round in endemic areas. Full article

Induction motors constitute a major share of industrial drives, making reliable fault detection essential for maintaining operational continuity. This work develops a Bayesian classifier for identifying rotor-bar damage using start-up current measurements represented in the frequency domain. The spectra are modelled as smooth functional curves using a hierarchical B-spline formulation, and posterior sampling provides a generative mechanism for augmenting scarce labelled data. Classification is performed using a Bayesian Gaussian mixture model, where each prediction is obtained by averaging over thousands of posterior samples, yielding stable and interpretable probability estimates. In experimental evaluation, the proposed approach achieves consistent separation between healthy and faulty motors across repeated training runs, correctly identifying all test cases in the binary classification setting and exhibiting more stable probability estimates than logistic and soft-max regression under limited labelled data. The model additionally signals atypical responses for unmodelled faults, indicating potential for anomaly detection. These findings highlight the suitability of Bayesian functional modelling as a reliable tool for induction motor condition monitoring. Full article

Barrel tools are relatively new tools that use atypical geometries to achieve shorter production times and improve surface quality. They have been increasingly used in the finishing operations industry, where they are gaining more and more popularity. For their optimal use, it is necessary to know how these tools behave during work in terms of how they load the machined product and what surface qualities they can achieve. For this reason, this study was conducted to compare two tools when machining a free surface. The obtained surface quality and the force load caused by the tool were evaluated. It was found that barrel tool machining results in a heterogeneous surface caused by different cutting speeds along the length of the tool and that the two obtained regions show differences in the obtained roughness. Even though the operation was classified as a finishing process, a difference of up to 30% was identified in the cutting forces acting on the tool and the workpiece. Full article

The alkaline rocks located in the Hatu area of Dulan county in the middle section of the East Kunlun Orogenic Belt have a relatively high content of light rare earth elements (LREE). This study conducted scanning electron microscopy (SEM) petrographic methods, zircon U-Pb dating, and geochemical work on two REE-mineralized alkaline rock outcrops, providing support for further work and study in the mining area. The REE-mineralized alkaline rocks are composed of alkali feldspar syenite, hornblende alkali feldspar syenite, and quartz alkali feldspar syenite. SEM analysis indicates that the REE are mainly hosted in REE-bearing minerals such as chevkinite, parisite, allanite, and monazite. The alkali feldspar syenite and hornblende alkali feldspar are enriched in REE, with a content of 994 × 10⁻⁶~5054 × 10⁻⁶. The zircon U-Pb dating results show that the ages of the two REE-mineralized alkaline rock are 423.6 ± 2.7 Ma and 431.2 ± 5.3 Ma, respectively. Geochemical analysis indicates that the Hatu alkaline rocks can be classify as A-type granite, and are characterized by evidence of a mixture of materials from the crust and mantle. Considering the regional tectonic history, it is primarily inferred that the Hatu REE-mineralization alkaline rocks were formed after the closure of the Proto-Tethys Ocean Basin and the Eastern Kunlun region experienced extensional tectonic stage, resulting in the upwelling of asthenospheric material and heating of crustal material. This study provides theoretical support for regional geochemical research and further exploration efforts in the Hatu area. Full article

Purpose: The aim of this narrative review is to update current knowledge on Moyamoya vasculopathy (MMV) by addressing key diagnostic debates—including laterality; genetic subtypes; regional epidemiology; and features distinguishing Moyamoya Disease (MMD), Moyamoya Syndrome (MMS) and their mimics. Methods: Key and representative studies were identified through PubMed/MEDLINE and Scopus, focusing on publications from 2014–2025 while also considering earlier seminal works. Results: MMD typically presents with bilateral steno-occlusion of the terminal internal carotid arteries (ICAs) and proximal middle and anterior cerebral arteries (MCAs/ACAs) due to concentric vascular thickening, accompanied by characteristic ‘puff-of-smoke’ collaterals, whereas MMS shows a similar but more often unilateral pattern with fewer collaterals, influenced by the underlying condition. However, this distinction often fails to reflect the full clinical and radiological variability of the Moyamoya spectrum. Atypical moyamoya-like patterns, often confined to M1 or A1 segments, further complicate diagnosis. Clinical manifestations ranged from asymptomatic cases to ischemic or hemorrhagic strokes, and occasionally seizures. Diagnosis relied on multimodal imaging (DSA, MRA, CTA), but genetic mutations, contributing to radiological variability, often complicate differentiation between MMD, MMS, and mimics. Management is pattern-specific: MMS and atypical forms are generally managed conservatively, whereas MMD frequently requires surgical revascularization, particularly in children and symptomatic adults. Nevertheless, variability within diagnostic categories limits the applicability of rigid treatment protocols. Conclusions: Current diagnostic algorithms remain limited. Integrating advanced imaging findings with clinical, genetic, and epidemiological data is essential to define the full disease spectrum, improve diagnostic accuracy, and inform patient management and outcome assessment. Full article

RhoB is an atypical Rho GTPase whose function is tightly linked to its subcellular localization and membrane trafficking, reflecting its unique post-translational modifications and association with endosomal membranes in addition to the plasma membrane. Despite its implication in membrane trafficking and cytoskeletal regulation, tools to directly monitor RhoB activity in space and time have been lacking. Here, we describe the development and validation of a single-chain, genetically encoded Förster resonance energy transfer (FRET) biosensor that enables direct visualization of RhoB activity in living cells while preserving its native membrane-targeting determinants. The biosensor exhibits a large dynamic range and resolves spatially heterogeneous RhoB activity during leading-edge protrusion–retraction cycles in migrating mouse embryonic fibroblasts. To demonstrate the utility of this tool, we performed multiplex live-cell imaging with a previously developed near-infrared FRET biosensor for the exocytic Rho GTPase TC10. Quantitative morphodynamic and cross-correlation analyses reveal coordinated yet antagonistic spatiotemporal patterns of RhoB and TC10 activities at the leading edge and show that perturbation of TC10 regulation reorganizes their spatial coupling. Together, this work introduces a robust biosensor for RhoB and establishes a multiplex imaging framework to study the coordination of trafficking and signaling during cell migration. Full article

Biomimetics, the field of learning from Nature for applications in science, engineering and the arts, offers pathways toward sustainable innovation and integrative education. This contribution presents a conceptual framework that explores plant galls as an inspiration for biomimetic thinking, speculative design, and STEAM-based education. Plant galls are complex structures induced by insects, bacteria, fungi, or other organisms through biochemical signaling that reprograms local plant development. While gall formation is widely understood as a parasitic process that primarily benefits the inducing organism, galls nonetheless represent extreme and highly localized instances of developmental plasticity, information transfer, and morphological novelty. Building on these observations, this paper introduces the speculative Gall-Accelerated Innovation (GAI) framework, which asks whether gall induction can be interpreted, at a conceptual level, as a form of developmental probing that exposes plants to atypical structural and biochemical configurations. Rather than proposing a demonstrated evolutionary mechanism, the framework serves as a thought experiment that bridges gall biology, biomimetics, and artistic research. Through observational examples, interdisciplinary dialogue, and educational visualization, the work invites reflection on how interactions across species and disciplines can stimulate new ways of thinking about programmable living materials, creativity, and learning from Nature. Full article

High-risk benign breast lesions are histological abnormalities that present in breast tissue, typically identified by screening or diagnostic imaging. The presence of invasive or in situ breast cancer can be confirmed or ruled out within these lesions, and the risk of developing breast cancer can be reduced by their appropriate management. These potential high-risk lesions reviewed include atypical ductal hyperplasia, mucocele-like lesions, papillary lesions with or without atypia, radial scar/complex sclerosing lesion with or without atypia, atypical lobular hyperplasia, classical lobular carcinoma in situ, pleomorphic/florid lobular carcinoma in situ, flat epithelial atypia, columnar cell change, fibroepithelial lesions with stromal cellularity, spindle cell lesions/mesenchymal lesions, and microglandular adenosis. The lack of a clear consensus on the management of many of these lesions led the Ontario Health (Cancer Care Ontario) (OH-CCO) Breast Cancer Pathway Map Working Group and Breast Cancer Advisory Committee to identify the need for a recommendation document. A multidisciplinary working group was formed, with members representing surgical oncology, radiology, pathology, medical oncology, and genetic counselling. The working group developed a list of high-risk benign lesions to be included in this recommendation report. An updated literature review was completed, and these publications were reviewed by the working group, and recommendations were drafted. When evidence was lacking, the expert opinion was included. These draft recommendations were subjected to an extensive review by experts both within Cancer Care Ontario and across Canada. The recommendations included in this report are relevant to clinicians, primary care physicians, oncologists, radiologists, and pathologists who treat breast cancer and manage breast conditions. Full article

Background: Feigned restriction of shoulder joint movement for secondary gain is clinically relevant and may misdirect care, distort disability determinations, and inflate system costs. Distinguishing feigning from structural pathology and from functional or psychosocial presentations is difficult because pain is subjective, performance varies, and no single sign or test is definitive. This comprehensive review hypothesizes that the systematic integration of clinical examination, objective biomechanical and neurophysiological testing, and emerging technologies can substantially improve detection accuracy and provide defensible medicolegal documentation. Methods: PubMed and reference lists were searched within a prespecified time frame (primarily 2015–2025, with foundational earlier works included when conceptually essential) using terms related to shoulder movement restriction, malingering/feigning, symptom validity, effort testing, functional assessment, and secondary gain. Evidence was synthesized narratively, emphasizing objective or semi-objective quantification of motion and effort (goniometry, dynamometry, electrodiagnostics, kinematic sensing, and imaging). Results: Detection is best approached as a stepwise, multidimensional evaluation. First-line clinical assessment focuses on reproducible incongruence: non-anatomic patterns, internal inconsistencies, distraction-related improvement, and mismatch between claimed disability and observed function. Repeated examinations and documentation strengthen inference. Instrumented strength testing improves quantification beyond manual testing but remains effort-dependent; repeat-trial variability and atypical agonist–antagonist co-activation can indicate submaximal performance without proving intent. Imaging primarily tests plausibility by confirming lesions or highlighting discordance between claimed limitation and minimal pathology, while recognizing that normal imaging does not exclude pain. Diagnostic anesthetic injections and electrodiagnostics can clarify pain-mediated restriction or exclude neuropathic weakness but require cautious interpretation. Motion capture and inertial sensors can document compensatory strategies and context-dependent normalization, yet validated standalone thresholds are limited. Conclusions: Feigned shoulder impairment cannot be confirmed by any single test. The desirable strategy combines structured assessment of inconsistencies with objective biomechanical and neurophysiologic measurements, interpreted within the whole clinical context and rigorously documented; however, prospective validation is still needed before routine implementation. Full article

Understanding the decision-making behavior of machine learning models is essential in domains where individual predictions matter, such as medical diagnosis or sports analytics. While explainable artificial intelligence (XAI) methods such as SHAP provide instance-level feature attributions, they mainly summarize typical decision behavior and offer limited support for systematically exploring atypical yet correctly classified cases. In this work, we introduce the Classification Outlier Variability Score (COVAS), a framework designed to support hypothesis generation through the analysis of explanation variability. COVAS operates in the explanation space and builds directly on SHAP value representations. It quantifies how strongly an individual instance’s SHAP-based explanation deviates from class-specific attribution patterns by aggregating standardized SHAP deviations into a single score. Consequently, the applicability of COVAS inherits the model- and data-agnostic properties of SHAP, provided that explanations can be computed for the underlying model and data. We evaluate COVAS on publicly available datasets from the medical and sports domains. The results show that COVAS reveals explanation-space outliers not captured by feature-space outlier detection or prediction uncertainty measures. Robustness analyses demonstrate stability across parameter choices, class imbalance, model initialization, and model classes. Overall, COVAS complements existing XAI techniques by enabling targeted instance-level inspection and facilitating XAI-guided hypothesis formulation. Full article

Background: Lung carcinoids—typical and atypical—are rare neuroendocrine tumors (NETs) representing 1–2% of lung cancers. Despite clinicopathological differences, their clinical management often mirrors lung cancer protocols rather than NET-specific recommendations. Objectives: Portray a 12-year real-world experience with lung carcinoids at a Comprehensive Cancer Center, identifying gaps in diagnostic work-up, treatment decision-making, and follow-up. Methods: Retrospective observational cohort study of adult patients with histologically confirmed lung carcinoids diagnosed at IPO Porto between January 2013 and December 2024. Demographic, clinical, imaging, and treatment data were collected from electronic patient records. Analyses were descriptive. Results: Among 179 identified cases, 129 met eligibility criteria. Median age was 62 years (range 18–84); 53.6% were women and 53.5% were non-smokers; 84.5% had ECOG-PS 0–1. The most frequent presentation was respiratory symptoms (34.1%), followed by incidental findings (43.4%, of which ~20% were during staging or surveillance of other cancers). Typical carcinoids accounted for 49.6% and atypical for 43.4%. FDG-PET/CT was requested in 70.9% of cases, including many with typical carcinoid, and SSTR-PET/CT in 64.6% (dual PET in 38.8%). Most patients (65.1%) presented with stage I disease; 17.1% were stage IV. Mean time-to-first treatment was 83 days (range 1–259). Surgery was the first treatment option for 78.3% of patients. Conclusions: This real-world series highlights heterogeneity in diagnostic pathways, excessive FDG-PET use in typical carcinoids, and non-standardized follow-up. Dedicated multidisciplinary lung-NET boards and national reference centers are needed to homogenize and streamline patient management. Full article