Ultrasonographic prevalence and proposed morphologic classification of bilobed gallbladder in cats

Objectives Morphologic anomalies of the feline gallbladder (GB) have been previously reported in the literature. These morphologic variants are frequently encountered on routine abdominal ultrasound examination. The aim of this study was to provide an ultrasonographic classification system of these variants and document the overall incidence in the feline population. Methods A prospective, descriptive study was undertaken; cats that had an abdominal ultrasound examination that included at least one sagittal and transverse plane image of the GB were included. GB shape was evaluated and categorized based on a classification scheme of morphologic variants modified from the human literature. Septated (S), bilobed (B1, B2, B3), duplex (D) and complex (C) categories were described. Results Of 516 cats included in the study, 389 had normal GB morphology, while 127 had anomalous GB morphology. The overall incidence rate of anomalous GB morphology was 24.61%. When examined by morphologic type, the septated (S) morphology had an incidence of 9.69%. A bilobed (B) morphology was the most commonly observed classification; incidence was 14.35% within our population; incidence of B1, B2 and B3 subtypes were 2.91%, 6.98% and 4.46%, respectively. Duplex GBs only made up 0.39% of the total population. The incidence of complex (C) morphologies was 0.19%. Conclusions and relevance The incidence of GB morphologic anomalies was higher in our population than previously reported. Identification of these anomalies on routine ultrasound evaluation is common; numerous different morphologies can be identified and a standardized classification scheme is proposed. Complete evaluation of morphology can be challenging, particularly with regard to cystic duct anatomy. Clinical significance is uncertain and future studies are warranted to determine the relationship between morphologic variants and hepatobiliary disease.

Incidental Gynecomastia on Thoracic Computed Tomography in Clinical Practice: Characteristics, Radiologic Features, and Correlation With Possible Causes in South Korean Men

Gynecomastia is a common incidental finding on thoracic computed tomography (CT). This study aimed to retrospectively determine the prevalence, imaging characteristics, and possible causes of incidental gynecomastia on thoracic CT. Records of male patients who underwent thoracic CT in 2015 were reviewed. The size and morphologic types (nodular, dendritic, and diffuse) were recorded for patients with breast glandular tissue larger than 1 cm, and the cutoff value of gynecomastia was defined as 2 cm. Additionally, the possible causes of gynecomastia obtained by reviewing patients’ charts were recorded. CT-depicted gynecomastia was identified in 12.7% (650 of 5,501) of patients. The median size of the breast glandular tissue was 2.5 cm (interquartile range 2.2–3.1), and 36.8% of patients (239 of 650) had unilateral gynecomastia. The age distribution provided a bimodal pattern with two peaks in the age groups from 20 to 29 years old and greater than 70 years old. Chronic liver disease (CLD; p < .001), all stages of chronic kidney disease (CKD; p < .001), and medications ( p = .002) were significantly associated with gynecomastia. Gynecomastia did not correlate with body mass index ( p = .962). The size of breast glandular tissue was identified to be correlated with the morphologic type of breast tissue and the severity of CLD or CKD. The prevalence of incidental gynecomastia seen on thoracic CT was 12.7%. CT-depicted gynecomastia is not associated with obesity but with CLD, CKD, and medications. When gynecomastia is detected on CT, further evaluations and management might be required for patients with a treatable cause.

Grain size characteristics of surface aeolian sands in the downwind margin of modern Mu Us Sandland

&lt;p&gt;Desert (sandland) margin is the transition region from inner aeolian landforms &amp;#160;to other landforms outside, while it remains as an ambiguous conception in previous researches. Accurately delineating its boundary line and realizing the characteristics of the particle size distribution of surface aeolian sands in margin area can help us understand the formation of modern boundary of desert (sandland). In this research, the criteria of identification of the boundary were proposed and the boundary line was extracted quantitative. Then systematic analyses of grain size of aeolian sand in margin were conducted. Together with the morphologic type, activity and the geomorphological location of collected dunes, the factors controlled the particle-size distributions had also been analyzed. The results reveal the following: (1) There is notable difference in grain size characteristics of aeolian sand between inside and outside of Mu Us sandland. The outside samples are finer than inside. Additionally, the aeolian sand covering on loess is always more poorly sorted and with different grain size fraction composition. (2) The controlling factors on particle size distribution are different in different downwind margins. In southwest margin, the grain size characteristics of aeolian sand are influenced by time and degree of stabilization of sampled dune and locally topographic relief; From the estuary of Lu River to Yuxi River, sediment transport by wind is affected by topographic obstacles including both valley and loess gully. Meanwhile, the small dunefields in Loess Plateau outside of Mu Us sandland may originate from a local alluvial source; In northeast downwind margin, the grain size characteristics of aeolian sand covering on loess are determined by regional gully erosion after its deposition.&lt;/p&gt;

How to Classify Pituitary Neuroendocrine Tumors (PitNET)s in 2020

Adenohypophyseal tumors, which were recently renamed pituitary neuroendocrine tumors (PitNET), are mostly benign, but may present various behaviors: invasive, “aggressive” and malignant with metastases. They are classified into seven morphofunctional types and three lineages: lactotroph, somatotroph and thyrotroph (PIT1 lineage), corticotroph (TPIT lineage) or gonadotroph (SF1 lineage), null cell or immunonegative tumor and plurihormonal tumors. The WHO 2017 classification suggested that subtypes, such as male lactotroph, silent corticotroph and Crooke cell, sparsely granulated somatotroph, and silent plurihormonal PIT1 positive tumors, should be considered as “high risk” tumors. However, the prognostic impact of these subtypes and of each morphologic type remains controversial. In contrast, the French five-tiered classification, taking into account the invasion, the immuno-histochemical (IHC) type, and the proliferative markers (Ki-67 index, mitotic count, p53 positivity), has a prognostic value validated by statistical analysis in 4 independent cohorts. A standardized report for the diagnosis of pituitary tumors, integrating all these parameters, has been proposed by the European Pituitary Pathology Group (EPPG). In 2020, the pituitary pathologist must be considered as a member of the multidisciplinary pituitary team. The pathological diagnosis may help the clinician to adapt the post-operative management, including appropriate follow-up and early recognition and treatment of potentially aggressive forms.

Peliosis Hepatis—The Chameleon: An Unusual Presentation Mimicking Liver Abscess

Peliosis hepatis is a rare vascular condition characterized by multiple randomly distributed blood-filled cavities throughout the liver, ranging in size from a few millimeters to several centimeters in diameter. The appearance of peliotic lesion on imaging varies depending on morphologic type, concomitant hemorrhagic component, and presence or absence of background hepatic steatosis. Here, we report an unusual presentation of peliosis hepatis as an exophytic mass arising in liver parenchyma, mimicking a liver abscess.

A New Approach - Use of effectiveness and efficiency concepts in the identification of activities related to occupational safety management on motorways

The need to improve the safety management in the maintenance and operational works on a motorway is a request that all the organizations demand to achieve better goals on safety and in the use of resources. The use of instruments linked to efficiency and effectiveness is one possible solution to this problem. The objective of the present investigation is to prove that it is possible to identify the main activities contained in the A area of an ABC curve and linked to the Pareto´s concepts, defining this way the 20% most dangerous maintenance and operational activities on motorway works. The methodology used was a DELPHI panel formed by experts from different areas linked to safety at work on motorways. The statistic treatment was made through the informatic program IBM SPSS Statistics 24. The results show that it is possible to identify 36 main activities in maintenance and operational works, being relevant the activities related to emergency response, safety guards, expansion joints, provisional signaling and the access to working stations in toll areas. The conclusions of the study reveal that these 36 activities represent the 20% most dangerous activities in maintenance and operational works on a motorway, and show that besides the risks of the work itself, there are four crucial traffic factors to develop a correct risk analysis: weather conditions, traffic characteristics, pavement characteristics and motorway morphologic type.

Study of Anaemia in Children with Severe Acute Malnutrition

Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children.Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0.Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent.Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.