Search Results (635)

Spinal vascular malformations (SVMs) are rare and heterogeneous lesions that may lead to progressive neurological decline or hemorrhage, posing significant challenges for management due to their complex angioarchitecture and proximity to critical neural structures. This review examines the role of angiographic imaging modalities used intraoperatively and postoperatively in guiding treatment, confirming therapeutic success, and informing follow-up strategies. We summarize evidence on two-dimensional digital subtraction angiography (2D DSA), indocyanine green videoangiography (ICG–VAG), and emerging adjunctive techniques. 2D DSA remains the reference standard, offering superior temporal and spatial resolution for real-time visualization of vascular anatomy, catheter navigation, and embolic delivery, though its invasive nature, radiation exposure, and two-dimensional projection limit long-term applicability. ICG–VAG provides a complementary, non-ionizing method for intraoperative fluorescence imaging, aiding in shunt localization and venous preservation, although its restricted field of view and limited capacity for quantitative analysis reduce its standalone value. Advances in quantitative angiographic metrics, patient-specific hemodynamic modeling, and artificial intelligence-driven image analysis are anticipated to enhance diagnostic accuracy and reproducibility. The development of standardized multimodal protocols will be crucial for optimizing patient-centered treatment of these complex and rare lesions. Full article

Atherosclerosis is a widespread cardiovascular disease characterized by retention of atherogenic lipoproteins in the arterial wall and the onset of subclinical vascular inflammation; the development of atherosclerotic plaques; eventual narrowing of the arterial lumen and/or plaque disruption; and subsequent manifestation with stable ischemia or acute atherothrombotic events. Numerous cell types are implicated in atherogenesis. Monocytes/macrophages are considered pivotal participants in this complex process. They play a crucial role in the onset and augmentation of inflammation and greatly contribute to atherosclerotic plaque growth and destabilization. However, monocytes/macrophages are also essential for the resolution of inflammation and the stabilization of atherosclerotic lesions. In this regard, studies of the function of monocytes/macrophages in relation to this disease are of considerable interest to researchers, as the results can help to design new drugs aimed at preventing the development of atherosclerosis and its complications. This review presents current data on the classification and functions of monocytes/macrophages; discusses current hypotheses regarding the involvement of monocytes/macrophages in atherogenesis; and highlights existing gaps in evidence. This review is primarily aimed at readers with a background in clinical medicine who are interested in the involvement of monocytes/macrophages in atherogenesis. Full article

Intravascular imaging (IVI), particularly intravascular ultrasound (IVUS) and optical coherence tomography (OCT), addresses the intrinsic limitations of two-dimensional coronary angiography by offering high-resolution information regarding vessel and plaque morphology before percutaneous coronary intervention (PCI) as well as enabling accurate assessment of stent expansion and apposition after implantation. These anatomical insights can translate into improved procedural success and late clinical outcomes. The magnitude of benefit appears closely related to lesion morphology and procedural complexity. While angiographic guidance may be sufficient in straightforward anatomies, IVI assumes a pivotal role in complex disease subsets. IVUS, with its deeper tissue penetration, real-time imaging capability, and lack of need for contrast flushing, is particularly advantageous for large-vessel interventions, chronic total occlusions, and contrast-sparing strategies. In contrast, OCT, offering superior axial resolution, excels in characterizing plaque composition and in detecting stent-related complications. Hybrid IVUS-OCT catheters have the potential to integrate the complementary strengths of both IVI modalities, thereby streamlining procedural workflows and broadening clinical applicability. Although current guidelines endorse IVI use in anatomically complex coronary artery disease, real-world adoption remains low, largely influenced by operator proficiency, regional differences, and reimbursement arrangements. Further research is warranted to identify lesion subsets in which one modality confers clear clinical benefit and to delineate the threshold of procedural complexity at which IVI becomes cost-effective. Full article

Odontogenic cutaneous fistulas (OCFs) are relatively uncommon in veterinary patients. They are typically caused by chronic periapical infections of the maxillary teeth. Mandibular OCFs that extend through the cortical bone into submandibular soft tissues are extremely rare. This report describes the case of a 14-year-old male mixed-breed dog that presented with a submandibular cutaneous lesion initially misdiagnosed as a salivary mucocele. OCFs are frequently misdiagnosed because atypical presentations may lack obvious intraoral abnormalities and mimic salivary gland disease, lymphadenopathy, or cutaneous neoplasia. Computed tomography (CT) revealed a periapical lesion associated with the right mandibular first molar, cortical bone lysis, and extension into the adjacent submandibular tissues, which formed an external fistulous tract. Surgical management included extraction of the affected tooth, resection of the fistulous tract, and excision of the associated lymph nodes, which resulted in a complete and uneventful resolution of the fistula. At the 3-month follow-up, the patient remained clinically stable without evidence of recurrence. This case underscores the clinical pearl that odontogenic origins should always be considered in the differential diagnosis of submandibular or cervical cutaneous lesions and that cross-sectional imaging modalities, such as CT, are indispensable for confirming anatomical continuity and guiding surgical planning. Full article

Rice, a dietary staple for over half of the global population, is highly susceptible to bacterial and fungal diseases such as bacterial blight, brown spot, and leaf smut, which can severely reduce yields. Traditional manual detection is labor-intensive and often results in delayed intervention and excessive chemical use. Although deep learning models like convolutional neural networks (CNNs) achieve high accuracy, their computational demands hinder deployment in resource-limited agricultural settings. We propose MCP-X, an ultra-compact CNN with only 0.21 million parameters for real-time, on-device rice disease classification. MCP-X integrates a shallow encoder, multi-branch expert routing, a bi-level recurrent simulation encoder–decoder (BRSE), an efficient channel attention (ECA) module, and a lightweight classifier. Trained from scratch, MCP-X achieves 98.93% accuracy on PlantVillage and 96.59% on the Rice Disease Detection Dataset, without external pretraining. Mechanistically, expert routing diversifies feature branches, ECA enhances channel-wise signal relevance, and BRSE captures lesion-scale and texture cues—yielding complementary, stage-wise gains confirmed through ablation studies. Despite slightly higher FLOPs than MobileNetV2, MCP-X prioritizes a minimal memory footprint (~1.01 MB) and deployability over raw speed, running at 53.83 FPS (2.42 GFLOPs) on an RTX A5000. It achieves 16.7×, 287×, 420×, and 659× fewer parameters than MobileNetV2, ResNet152V2, ViT-Base, and VGG-16, respectively. When integrated into a multi-resolution ensemble, MCP-X attains 99.85% accuracy, demonstrating exceptional robustness across controlled and field datasets while maintaining efficiency for real-world agricultural applications. Full article

Background/Objectives: Magnetisation Transfer (MT) MRI is used for neuro-degenerative disorders, including Multiple Sclerosis (MS), providing an indirect measure of large biomolecular MR signal sources which cannot be observed directly because their typical T2 is usually much shorter than the echo time (TE) of conventional MR sequences. We investigated a 3D-radial Zero Time of Echo (ZTE) MT-weighted sequence with potentially enhanced sensitivity to short-T2 MR signals indirectly (via MT weighting) and directly (due to the short TE). Methods: The sequence runs on a human 7T MR scanner, producing whole-brain MT-weighted images with isotropic 0.8 mm resolution in 6.5 minutes. One RF pulse is used to suppress the fat signal and generate MT weighting, reducing RF power deposition to moderate levels. The small excitation pulses and the “quasi-adiabatic” MT pulse mitigate the negative effects of inhomogeneous transmit RF fields observed at 7T in the human head, facilitating the generation of uniform Magnetisation Transfer Ratio (MTR) maps. Results: Results from a biologic phantom, a healthy volunteer, and an MS patient illustrate important imaging features of the “SilentMT” sequence. When the MS patient images were compared with Fluid Attenuated Inversion Recovery (FLAIR) images taken on the same patient at 1.5T and 7T, SilentMT was able to detect all the MS lesions observed on the “reference truth” 1.5T FLAIR; 7T FLAIR, however, failed to detect some lesions in the temporal lobe and brain stem. SilentMT detected a lesion which was not immediately apparent on either FLAIR image. Increased MTR was observed in some regions of the brain of the MS patient, notably the left temporal lobe. Conclusions: This initial investigation of an MT-weighted ZTE sequence shows evidence that it may be more sensitive to pathology in a patient with MS. Full article

Coccidiosis, caused by Eimeria spp., is a major economic burden in poultry production, prompting growing interest in natural alternatives to synthetic anticoccidials. This study evaluated the use of Polygain™, a sugarcane-derived polyphenol-rich feed material, as a natural anticoccidial in broiler chickens experimentally challenged with Eimeria tenella, E. maxima, and E. acervulina. A total of 144 Ross 308 chicks were allocated to six groups: uninfected–untreated control, infected–untreated control, infected plus nicarbazin + narasin, and three Polygain™ treatment groups (250, 500, and 1000 ppm). Birds were orally challenged with mixed oocysts on day 14. Parameters assessed included body weight gain (BWG), lesion scores (LS), oocyst per gram (OPG), and calculated indices such as relative oocyst production (ROP), reduction in lesion score (RLS), percent optimum anticoccidial activity (POAA), and anticoccidial index (ACI). Polygain™ reduced intestinal lesions (p < 0.05), particularly in the caecum, with complete lesion resolution observed at 1000 ppm by 21 days post-infection. Polygain™ ACI values (143–146) were limited in comparison to nicarbazin + narasin treatment (ACI 160). These findings demonstrate that Polygain™ supplementation confers measurable protective dose related effects against coccidiosis without impairing growth performance, supporting its potential as a natural feed material for integrated coccidiosis management. Full article

In the context of global agricultural modernization, the early and accurate detection of sugarcane leaf diseases is critical for ensuring stable sugar production. However, existing deep learning models still face significant challenges in complex field environments, such as blurred lesion edges, scale variation, and limited generalization capability. To address these issues, this study constructs an efficient recognition model for sugarcane disease detection, named CaneFocus-Net, specifically designed for precise identification of sugarcane leaf diseases. Based on a single-stage detection architecture, the model introduces a lightweight cross-stage feature fusion module (CP) to optimize feature transfer efficiency. It also designs a module combining a channel-spatial adaptive calibration mechanism with multi-scale pooling aggregation to enhance the backbone network’s ability to extract multi-scale lesion features. Furthermore, by expanding the high-resolution shallow feature layer to enhance sensitivity toward small-sized targets and adopting a phased adaptive nonlinear optimization strategy, detection and localization accuracy along with convergence efficiency have been further improved. Test results on public datasets demonstrate that this method significantly enhances recognition performance for fuzzy lesions and multi-scale targets while maintaining high inference speed. Compared to the baseline model, precision, recall, and mean average precision (mAP50 and mAP50-95) improved by 1.9%, 4.6%, 1.5%, and 1.4%, respectively, demonstrating strong generalization capabilities and practical application potential. This provides reliable technical support for intelligent monitoring of sugarcane diseases in the field. Full article

Background/Objectives: Heart rate variability (HRV) is associated with the risk of vascular events. However, the predictive value of HRV for the presence of intracranial atherosclerosis (ICAS) is unclear. This study aimed to investigate the relationship between daytime HRV measured by 3 min ECG monitoring and ICAS identified by high-resolution magnetic resonance imaging (HR-MRI). Methods: A total of 272 adults (mean age, 63.4 ± 6.8; 43% male) were recruited from November 2022 to December 2024. A series of cardiac function parameters is automatically generated through a 3 min analysis by the electrocardiographic dispersion mapping (ECG-DM) software, including heart rate variability and myocardial ischemic metabolic impairment. HRV was assessed as the standard deviation of normal-to-normal intervals (SDNN), which was categorized into tertiles for data analysis. Myocardial micro-alteration index (MMI, %) was used as an indicator of ischemia, reflecting myocardial abnormalities at the metabolic level. Atrial and ventricular myocardial oxygenation deficits were directly visualized in a color-coded scatter plot, with different colors indicating the severity of pathological changes. On HR-MRI intracranial artery wall scanning, the prevalence of ICAS was assessed in middle cerebral arteries (MCAs), vertebral arteries (VAs), and basilar arteries (BAs), and the associated plaque characteristics (eccentricity, thickening patterns, remodeling index, and surface morphology) were evaluated. Results: Among the subjects, 209 arterial lesions caused by ICAS were detected in 152 subjects (56%), including MCAs (105/544), VAs (68/526), and BAs (36/272). Ninety-four subjects (94/272) with significant HRV deviation had ICAS (p = 0.040). Furthermore, subjects with ICAS were more likely to present with atrial hypoxia (p = 0.030) compared to those without ICAS. In multivariate analyses, lower standard deviation of normal-to-normal intervals (SDNN, odds ratio, OR = 1.55, 95% CI 1.10–2.18, p = 0.012) and atrial deviation (OR = 1.85, 95% CI 1.10–3.14, p = 0.022) were independently associated with the presence of ICAS. Conclusions: Among middle-aged or older adults in a local community, our study suggested that lower HRV and significant atrial hypoxia were independently associated with the presence of ICAS. Full article

Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient’s concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve’s cross-sectional area (CSA) on the affected side (13 mm²) compared to the asymptomatic side (5 mm²). Notably, a positive Tinel’s sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP’s ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm²) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm. Full article

Background/Objectives: This proof-of-concept study evaluated whether optical coherence tomography angiography (OCTA) can non-invasively capture micro-vascular alterations in non-melanoma skin cancer (NMSC) lesions during and after superficial orthovoltage radiotherapy (RT) using radiomics and vascular features analysis. Methods: Eight patients (13 NMSC lesions) received 36–50 Gy in 6–20 fractions. High-resolution swept-source OCTA volumes (1.1 × 10 × 10 mm³) were acquired from each lesion at three time points: pre-RT, immediately post-RT, and three months post-RT. Additionally, healthy skin baseline was scanned. After artifact suppression and region-of-interest cropping, (i) first-order and texture radiomics and (ii) skeleton-based vascular features were extracted. Selected features after LASSO (least absolute shrinkage and selection operator) were explored with principal-component analysis. An XGBoost model was trained to classify time points with 100 bootstrap out-of-bag validations. Kruskal–Wallis tests with Benjamini–Hochberg correction assessed longitudinal changes in the 20 most influential features. Results: Sixty-one OCTA volumes were analyzable. LASSO retained 47 of 103 features. The first two principal components explained 63% of the variance, revealing a visible drift of lesions from pre- to three-month post-RT clusters. XGBoost achieved a macro-averaged AUC of 0.68 ± 0.07. Six features (3 texture, 2 first order, 1 vascular) changed significantly across time points (adjusted p < 0.05), indicating dose-dependent reductions in signal heterogeneity and micro-vascular complexity as early as treatment completion, which deepened by three months. Conclusions: OCTA-derived radiomic and vascular signatures tracked RT-induced micro-vascular remodeling in NMSC. The approach is entirely non-invasive, label-free, and feasible at the point of care. As an exploratory proof-of-concept, this study helps to refine scanning and analysis protocols and generates knowledge to support future integration of OCTA into adaptive skin-cancer radiotherapy workflows. Full article

Objectives: Endometrial cancer is the most common gynaecologic malignancy, and its mortality rate is rising. Advanced or recurrent disease remains challenging because historically there have been limited therapeutic options. We aim to describe a complete and durable response to the HER2-directed antibody–drug conjugate trastuzumab deruxtecan (T-DXd) in a heavily pretreated patient with HER2-positive, mismatch-repair-deficient metastatic serous endometrial cancer. Methods: A 72-year-old woman underwent hysterectomy, bilateral salpingo-oophorectomy, and staging procedures for FIGO stage IIIA, high-grade serous papillary endometrial carcinoma. Tumour profiling revealed dMMR, a p53 abnormal pattern, and HER2 overexpression (IHC 3+). She received carboplatin/paclitaxel plus avelumab, followed by pegylated liposomal doxorubicin and weekly paclitaxel. After progression on paclitaxel, off-label T-DXd was initiated. Molecular data (FoundationOne CDx) were collected, along with and serial imaging and CA125 assessments. Results: The patient developed cough after two cycles of T-DXd; interstitial lung disease was excluded, and treatment resumed with steroid cover. By December 2024, PET/CT demonstrated complete metabolic response, with resolution of vaginal-vault and para-aortic lesions and normalisation of CA125. Real-world progression-free survival exceeded eight months, with ongoing symptom improvement. Treatment was generally well tolerated; the principal adverse event was grade 3 neutropenia requiring dose reduction. No cardiotoxicity or interstitial lung disease occurred. Conclusions: This case illustrates that T-DXd can induce deep and durable remission in HER2-positive, dMMR metastatic serous endometrial cancer after multiple lines of therapy. It adds real-world evidence supporting further investigation of HER2-directed antibody–drug conjugates in gynaecologic malignancies, and underscores the need for confirmatory trials and refined biomarker-driven patient selection. Full article

Background and Clinical Significance: Vesicovaginal leiomyomas are an exceedingly rare form of extrauterine fibroids. They represent less than 1% of all leiomyomas and have been reported in less than 300 cases worldwide since 1733. These benign smooth muscle tumors typically occur in perimenopausal women aged 35–50 years, presenting in young adults extraordinarily uncommonly. The rarity in younger patients creates significant diagnostic challenges, as clinical presentation often mimics malignant entities, particularly embryonal rhabdomyosarcoma. Case Presentation: This paper presents a 20-year-old nulliparous female who developed progressive dyspareunia and urinary dysfunction over 12 months due to a large vesicovaginal mass. Physical examination revealed a 6–7 cm smooth, firm mass obstructing the vaginal canal. Transvaginal ultrasound demonstrated a well-circumscribed, hypoechoic solid lesion measuring 6.9 cm in the vesicovaginal space. Magnetic resonance imaging showed a characteristic T2-hypointense signal with restricted diffusion consistent with leiomyoma, revealing an incidental septate uterus. Ultrasound-guided core needle biopsy confirmed benign leiomyoma with bland spindle cells, absent atypia, and minimal mitotic activity. The patient underwent successful transvaginal enucleation with complete symptom resolution. Conclusion: This case highlights diagnostic challenges posed by benign leiomyomas in young women presenting with solid pelvic masses. Systematic diagnostic approaches incorporating multimodal imaging and guided tissue sampling are essential to avoid misdiagnosis and unnecessary radical surgery. When malignancy is confidently excluded, management should prioritize fertility preservation in young patients. Full article

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematologic malignancy, typically presenting with systemic symptoms and mediastinal involvement. Leukemia cutis (LC) and renal infiltration are rare, especially at disease onset. A 27-year-old man presented with a solitary scalp lesion without systemic symptoms or hematologic abnormalities. Histopathology revealed a blastoid lymphoid infiltrate with a T-ALL immunophenotype. Two weeks later, laboratory tests showed leukocytosis, lymphocytosis, and renal dysfunction. Imaging revealed a large mediastinal mass, scalp soft tissue involvement, and bilateral renal infiltration. Bone marrow biopsy confirmed T-ALL with a mature phenotype. FISH identified TRAD:NKX2 rearrangement and CDKN2AB deletion. The patient received three cycles of pediatric-inspired chemotherapy, achieving complete molecular remission and resolution of extramedullary disease. He subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) from an HLA-matched sibling. Post-transplant complications included febrile neutropenia and mucositis. On day +100, he remained in minimal residual disease (MRD)-negative remission. This case illustrates a rare presentation of T-ALL with isolated skin involvement and renal infiltration at diagnosis, highlighting the importance of early biopsy and immunophenotyping of atypical skin lesions. Intensive chemotherapy followed by HSCT represents a viable strategy for young adults with high-risk T-ALL and extramedullary disease. Full article

Background/Objectives: Despite the reported correlation between white matter hyperintensity (WMH) and intracranial atherosclerosis (ICAS), little is known about the association between intracranial plaque imaging characteristics and the severity of WMH. This study aimed to investigate the relationship between plaque imaging features in the major intracranial large arteries and the severity of WMH by high-resolution magnetic resonance imaging (HR-MRI) in a local community-based cohort. Methods: Stroke-free Chinese aged over 45 years old were recruited. Plaque imaging features of intracranial arteries identified in middle cerebral arteries (MCAs), vertebral arteries (VAs), and basilar arteries (BAs) were analyzed. The plaque characteristics were compared between subjects with or without moderate-to-severe WMH (Fazekas score > 2), and their independent association with the severity of WMH was also assessed using multivariate logistic regression analysis. Results: In the cohort of 272 subjects (mean age, 63.4 ± 6.8 years old; males, n = 118), 24.6% with moderate-to-severe WMH had a significantly higher prevalence of ICAS, eccentric lesions, diffuse thickening pattern, and a heavier plaque burden in the intracranial major arteries compared to those without moderate-to-severe WMH. After adjusting for confounding factors, multivariate logistic regression analysis showed that an eccentric pattern of plaque lesion was independently associated with moderate-to-severe WMH. Conclusions: Eccentric lesions in the major intracranial large arteries, but not diffuse thickening patterns, luminal stenosis, and plaque burden, were independently associated with a greater burden of WMHs among middle-aged or older adults. Eccentricity of major intracranial large artery lesions may be a potential imaging marker to assess WMH burden. Understanding the correlation between atherosclerotic patterns and the severity of WMH would aid in early stratifying the future clinical risk of cerebrovascular events and support the development of individualized treatment strategies. Further studies are warranted to investigate its value in predicting future cerebrovascular events. Full article