Systemic lupus erythematosus (SLE) or Lupus is often called the "great mimicker" due to its ability to mimic other systemic disorders. SLE is a multisystem autoimmune disorder with varied manifestations, including ocular involvement. Retinal vascular occlusions are an uncommon but potentially vision-threatening presentation of lupus retinopathy. When coexisting systemic features mimic infectious etiologies such as tuberculosis (TB), diagnosis becomes challenging, delaying appropriate immunosuppressive therapy. We report a diagnostically complex case of a 22-year-old female who presented with sudden, painless loss of vision in the right eye. Initially, she was diagnosed elsewhere as macular branch retinal artery occlusion (BRAO) and chorioretinitis. Systemic symptoms-weight loss, low-grade fever, and neuropathy-along with a positive sputum smear and chest radiograph findings, led to a provisional diagnosis of pulmonary tuberculosis with presumed ocular TB. She was started on anti-tubercular therapy (ATT) and oral corticosteroids. Upon further evaluation at our center, additional ocular findings included disc pallor, active vasculitis, and bilateral chorioretinitis. Imaging studies (Fundus Fluorescein Angiography (FFA), Indocyanine Green Angiography (ICGA), Optical Coherence Tomography (OCT)) confirmed retinal vasculitis. A dermatologic evaluation of her facial rash was inconclusive for SLE. However, subsequent worsening of systemic symptoms and neuropsychiatric events prompted re-investigation. Specific MRI findings and immunological tests that revealed strong positivity for anti-Smith, anti-ribonucleoprotein (anti-RNP), anti-Ro-52, and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibodies with hypocomplementemia confirmed the diagnosis of neuropsychiatric SLE (NPSLE). ATT was discontinued, and the patient was treated with intravenous steroids and cyclophosphamide and later transitioned to mycophenolate mofetil. Over a year, the patient showed significant systemic and ocular improvement, with best-corrected visual acuity in the affected eye improving from perception of light to 6/60. This case highlights the diagnostic dilemma in distinguishing retinal vasculitis of autoimmune etiology from that due to infectious causes such as tuberculosis, especially in endemic regions. Ocular involvement can be an early sign of systemic SLE, underscoring the need for high clinical suspicion, systemic correlation, and immunological workup in young patients with retinal vascular occlusions. Early recognition of lupus retinopathy and timely immunosuppression are key to preserving vision and preventing systemic morbidity.
Severe selective eating in children can lead to clinically important nutritional deficiencies. We report a 5-year-old boy with autism spectrum disorder who presented with progressive weakness and hypoglycemia mimicking a fatty acid oxidation disorder (FAOD). His diet had consisted almost exclusively of white rice, and he had developed clinically significant manifestations of folate and vitamin A deficiency before this presentation. After several months of progressive weakness, he developed a generalized seizure with severe hypoglycemia and blunted ketogenesis during an intercurrent infection. Laboratory testing showed low riboflavin, low free carnitine with an elevated acylcarnitine-to-free carnitine ratio, and mild C6-C10 acylcarnitine elevations. Nerve conduction studies suggested sensory-predominant axonal neuropathy. These findings resembled multiple acyl-CoA dehydrogenase deficiency, a FAOD. Riboflavin and levocarnitine supplementation was followed by recovery of independent walking, with no recurrence over 7 years. This case illustrates a nutritional mimic of FAODs and highlights the need for nutritional and metabolic evaluation in selectively eating children with progressive weakness or hypoglycemia.
Background and Clinical Significance: Malignant melanoma with primary or metastatic intestinal involvement is a rare entity, often diagnosed late and associated with severe complications such as bowel obstruction and perforation. Differential diagnosis of primary intestinal lymphoma may be challenging in the absence of an identifiable primary lesion. Case Presentation: We report the case of a 35-year-old male with no significant medical history who was admitted for persistent abdominal symptoms. Contrast-enhanced abdominal CT revealed a giant circumferential jejunal mass (109/147/156 mm) causing marked luminal stenosis and mesenteric lymphadenopathy, initially raising suspicion of primary intestinal lymphoma. The patient subsequently developed upper intestinal obstruction and severe anemia (Hb 5.5 g/dL), requiring an emergency exploratory laparotomy. Intraoperatively, a voluminous unresectable tumor extending to the mesenteric root was identified, and a feeding jejunostomy was performed. The postoperative course was complicated by tumor perforation and generalized peritonitis, necessitating reoperation. Histopathological examination established the diagnosis of malignant melanoma, with no identifiable primary site, which is most consistent with metastatic melanoma (MUP). PET-CT staging demonstrated metastatic disease (mesenteric, retroperitoneal and supraclavicular lymph nodes, as well as subcutaneous nodules), consistent with a stage IV disease. Molecular analysis revealed a BRAF V600E mutation. Combined immunotherapy (Nivolumab + Ipilimumab) was initiated, resulting in a partial radiological response after three cycles. Conclusions: Intestinal involvement by malignant melanoma might mimic other gastrointestinal malignancies and be the cause of a delayed diagnosis and severe surgical complications. Multidisciplinary management is essential, and modern immunotherapy offers promising outcomes even in advanced-stage disease.
Immunosuppressed patients are at an increased risk for developing odontogenic and orofacial infections, which can present with atypical processes and features that may mimic rare but life-threatening infections such as Ludwig's angina. Differentiating cellulitis from a deep neck space infection is often challenging in this population in acute settings due to a broad differential diagnosis and blunted inflammatory responses. This diagnostic uncertainty complicates acute risk stratification and may delay recognition of conditions requiring early airway evaluation and intervention. We present the case of a 28-year-old male with chronic myelogenous leukemia on immunosuppression with dasatinib who developed unilateral facial swelling and severe odontogenic pain that was refractory to empiric antibiotic therapy. The patient's presentation with rapid clinical progression, early trismus, submandibular involvement, and floor-of-mouth tenderness raised significant concern for evolving Ludwig's angina. Laboratory evaluation demonstrated elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, further complicating early assessment. Imaging was promptly obtained to determine the nature of the infection, and the patient was admitted for intravenous antibiotic therapy and airway monitoring. Clinical improvement ensued. This case highlights the diagnostic overlap between facial cellulitis and Ludwig's angina and underscores the importance of prompt imaging, airway monitoring, and clinical vigilance for risk stratification of immunocompromised patients in the acute setting to prevent life-threatening complications.
Colonic schwannoma is a rare gastrointestinal mesenchymal tumor that is usually benign but may be difficult to distinguish from malignancy before surgery. This case is notable because a benign colonic schwannoma showed both pronounced restricted diffusion on MRI and prominent mesocolic lymphadenopathy, creating a strong radiologic impression of malignancy. A 43-year-old woman presented with a 2-day history of abdominal pain accompanied by altered bowel habits. Colonoscopy revealed a large spherical submucosal mass in the transverse colon. Biopsy suggested a neurogenic tumor favoring schwannoma, but malignancy could not be excluded because of limited sampling. Contrast-enhanced CT showed a large colonic mass with heterogeneous internal density, focal cystic change, irregular serosal appearance, and multiple enlarged mesocolic lymph nodes. MRI demonstrated marked restricted diffusion, with hyperintensity on diffusion-weighted imaging and hypointensity on ADC maps. The lesion was clinically suspected to be a malignant colonic tumor. The patient underwent laparoscopic adhesiolysis and left hemicolectomy. Postoperative histopathology unexpectedly confirmed a benign gastrointestinal schwannoma. All 34 harvested mesocolic lymph nodes showed reactive hyperplasia without metastasis. The patient recovered after surgery and was discharged following supportive treatment. Benign colonic schwannoma can closely mimic malignancy when restricted diffusion and prominent regional lymphadenopathy are present. This single case underscores that such features are not specific for malignancy; because imaging and biopsy could not exclude a malignant tumor, oncologic resection remained appropriate, and the definitive diagnosis still depended on histopathology and immunohistochemistry.
Amebiasis is a disease caused by the protozoan parasite Entamoeba histolytica (Eh) and remains the second leading cause of death due to parasitic infections worldwide. Asymptomatic Eh infections are the most common. Infection with Eh can transition from a harmless colonic colonizer to a pathogenic form, leading to amebic colitis. The clinical presentation of amebic colitis is varied and may include abdominal pain, bloody-mucoid diarrhea, tenesmus, and low-grade fever. These symptoms are often nonspecific and can mimic many other gastrointestinal conditions, both infectious and noninfectious. We report a case of amebic colitis in a 62-year-old male who underwent routine colonoscopy, which revealed an ulceration in the cecum region. He was asymptomatic at presentation and had normal laboratory findings. The case was provisionally diagnosed as inflammatory bowel disease and received oral metronidazole and probiotics. At follow-up endoscopy, the ulceration had worsened. Biopsy from the margin of the ileocecal ulcer confirmed abundant amebic trophozoites. The patient was treated with metronidazole for 14 days. A follow-up colonoscopy after treatment showed that the lesions were completely healed. This case highlights the challenges of diagnosing amebic colitis. Amoebic colitis shows significant variation in presenting symptoms, and current diagnostic methods have limited sensitivity. The absence of obvious symptoms in this patient further increased the diagnostic difficulty. We recommend that clinicians consider invasive amebiasis in their list of differential diagnosis even in asymptomatic patients presenting with colonic ulceration.
Takotsubo syndrome (TTS) is characterized by reversible left ventricular systolic dysfunction that mimics acute coronary syndrome and is often triggered by physical or emotional stress. Left bundle branch area pacing (LBBAP) has emerged as a physiological pacing strategy but requires deep septal lead placement, which may place the lead close to the left anterior descending coronary artery (LAD). When chest discomfort occurs after LBBAP, differentiation from coronary artery injury is essential. An 81-year-old woman with complete atrioventricular block underwent pacemaker implantation using LBBAP. The following day, she developed chest discomfort with elevations in creatine kinase and high-sensitivity troponin I levels. Transthoracic echocardiography revealed wall motion abnormalities extending from the anterior wall to the apex. Because LAD injury was suspected, contrast-enhanced computed tomography (CT) was performed. The lead tip was located near the proximal LAD, but no coronary artery injury or contrast extravasation was observed. ECG-gated CT demonstrated an apical ballooning pattern not confined to a single coronary territory. Based on these findings and the reversible clinical course, TTS was diagnosed. The patient was treated conservatively, and follow-up echocardiography 6 months later showed recovery of left ventricular systolic function. Acute coronary syndrome-like findings after LBBAP require exclusion of coronary artery injury because of the anatomical proximity between the septal lead and the LAD. However, when wall motion abnormalities extend beyond a single coronary territory, TTS should be considered in the differential diagnosis. Multimodality imaging, including CT, may help distinguish these conditions.
Skeletal tuberculosis is an uncommon form of extrapulmonary tuberculosis that may involve multiple osseous sites and occasionally mimic malignant disease, creating a significant diagnostic challenge. We report the case of a 70-year-old male who presented with an eight-month history of progressive thoracolumbar pain, constitutional symptoms, and subsequent development of paraplegia and urinary retention. Computed tomography revealed multifocal osteolytic lesions involving the sternum, thoracic and lumbar vertebrae, and iliac bones, initially raising concern for metastatic malignancy. Magnetic resonance imaging demonstrated destructive thoracic spondylodiscitis with additional noncontiguous vertebral involvement and associated epidural and paravertebral extension resulting in spinal canal compromise. Definitive diagnosis was established through computed tomography-guided biopsy followed by conventional polymerase chain reaction, which detected Mycobacterium tuberculosis complex. Antituberculous therapy was initiated, and the patient was subsequently evaluated by the Neurosurgery service, where he was deemed a candidate for surgical decompression and is currently undergoing preoperative assessment. This case highlights the importance of considering multifocal skeletal tuberculosis in the differential diagnosis of multifocal osteolytic lesions suggestive of malignancy, particularly in endemic regions.
Chronic contained rupture (CCR) of an abdominal aortic aneurysm rarely causes hydronephrosis and may mimic retroperitoneal malignancy. We report the case of a 66-year-old woman presenting with hydronephrosis caused by a CCR-related hematoma and an accessory renal artery originating from the terminal aorta. Biopsies excluded malignancy. Because endovascular repair carried a risk of type II endoleak and renal ischemia, open aneurysm repair with direct arterial reimplantation was performed. This approach relieved ureteral compression, achieved definitive aneurysm exclusion, and preserved renal perfusion. CCR should be considered in the differential diagnosis of irregular retroperitoneal masses associated with hydronephrosis.
Intestinal helminth infections may present with chronic gastrointestinal symptoms and can mimic inflammatory or obstructive bowel pathology, leading to diagnostic challenges. A 27-year-old previously healthy male presented with nine months of intermittent abdominal pain, nausea, and bloating with concern for partial small-bowel obstruction. He reported frequent hunting and environmental exposure associated with field dressing and preparation of wild game. Imaging demonstrated distal ileal wall thickening with upstream dilatation, and laboratory studies revealed marked peripheral eosinophilia. Despite negative stool ova and parasite testing performed after endoscopic retrieval of the parasite, colonoscopy identified a live helminth in the terminal ileum, which was retrieved endoscopically. Histopathologic evaluation demonstrated an intestinal nematode most compatible with Ascaris lumbricoides.​​​​​ Treatment with a single 400-mg oral dose of albendazole resulted in rapid symptom resolution and sustained clinical improvement on follow-up. This case emphasizes the importance of obtaining a detailed exposure history and maintaining suspicion for parasitic infection in patients with chronic gastrointestinal symptoms, eosinophilia, and small-bowel inflammation, even when stool studies are negative.
Sinus of Valsalva aneurysm is a rare structural anomaly that could be congenital or acquired, usually silent until the moment of rupture. Its diagnosis can be challenging as the turbulent jet flow may mimic vegetations or abscesses associated with infective endocarditis (IE). A 31-year-old woman with Down syndrome presented with signs of severe right heart failure and a history of recurrent fevers. Initial echocardiography revealed a massive left-to-right shunt and an echogenic structure in the aortic root, raising suspicion of a paravalvular abscess-patient was treated initially with intravenous antibiotics. However, due to negative blood cultures and imaging findings (coronary computed tomography and cardiac magnetic resonance), lesion was reclassified as a ruptured non-coronary sinus of Valsalva aneurysm (RSOV) fistulizing into the right atrium (Qp:Qs 3.5). Due to the ambiguity of the diagnosis and initial clinical stability, elective surgery was planned after antibiotics course was completed and heart failure treatment optimalization. One month later, the patient presented with acute heart failure event with distribution shock. Emergency surgery was performed. Intraoperative findings confirmed RSOV without signs of infection. The aneurysm was excised with fistula closure, and the aortic valve replaced. The patient made a full recovery. This case highlights the diagnostic overlap between RSOV and IE. It underscores the critical role of multimodality imaging in excluding infection and defining anatomy. Furthermore, it demonstrates that in cases of massive left-to-right shunting, delaying surgery carries a high risk of rapid haemodynamic collapse.
Proliferative vitreoretinopathy (PVR) is driven by the epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells. While palmitic acid (PA) represents a potent metabolic stressor in the subretinal microenvironment, its impact on the microRNA (miRNA) landscape remains poorly defined. This study investigated the role of miR-129-5p in PA-induced transdifferentiation and evaluated the protective potential of ectopic miR-129-5p mimicry in ARPE-19 cells. Low-passage ARPE-19 cells were challenged with sublethal PA to induce lipotoxic stress. miR-129-5p levels were modulated using synthetic mimics under basal and stressed conditions. EMT progression was tracked using immunofluorescence for tight junction topology and transcription factor nuclear localization, Phalloidin-FITC cytoskeletal F-actin staining, and immunoblotting for hallmark epithelial (E-cadherin) and mesenchymal (α-smooth muscle actin, fibronectin) effectors. Functional shifts were evaluated via wound healing and paracellular macromolecular permeability assays. PA exposure triggered a myofibroblastic phenotype and significantly depleted the intracellular miR-129-5p pool, accompanied by parallel vesicle-independent extracellular efflux. Under unchallenged baseline, mimic delivery directly suppressed endogenous ZEB1/2 expression. Under lipid stress, miR-129-5p mimicry neutralized transdifferentiation, successfully restoring E-cadherin and counteracting core transcription factor upregulation (ZEB1, ZEB2, and Snail). Morphologically, mimicry prevented pericellular ZO-1 dissolution, suppressed ZEB2 nuclear translocation, and blocked contractile stress fiber assembly. Functionally, maintaining this miRNA node significantly attenuated PA-enhanced cell migration and rescued outer blood-retinal barrier homeostasis by suppressing paracellular macromolecular flux. miR-129-5p functions as an essential cell-autonomous posttranscriptional gatekeeper of RPE identity, cytoskeletal architecture, and barrier homeostasis. Targeted modulation of this posttranscriptional network offers a promising pharmacological framework for mitigating lipotoxicity-associated subretinal fibrosis in PVR.
Pulmonary collapse is a common and serious respiratory condition, but there is no dedicated bedside tool to estimate prognosis. This study aimed to develop a nomogram to predict 28-day mortality in patients with pulmonary collapse. We extracted data for patients with pulmonary collapse from MIMIC-III, identified predictors using regression analyses, and used MIMIC-IV for temporal validation. We then built a nomogram based on the selected predictors. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), AUC comparisons using the DeLong test, reclassification (NRI and IDI), calibration (calibration curves, calibration slope, and Brier score), and decision curve analysis (DCA). A total of 4,088 patients with pulmonary collapse were included in the study. Logistic regression analysis identified twelve independent predictive factors associated with 28-day mortality: age (OR = 1.01, P =0.040), married status (OR =0 .63, P =0 .040), Glasgow Coma Scale score (OR = 0.94, P = 0.02), creatinine (OR = 0.82, P = 0.03), chloride ions (OR = 0.85, P = 0.03), sodium ions (OR = 1.19, P = 0.02), blood urea nitrogen (OR = 1.02, P < 0.001), white blood cell count (OR = 1.04, P < 0.001), heart rate (OR = 1.02, P = 0.02), respiratory rate (OR = 1.05, P = 0.03), temperature (OR = 0.54, P < 0.001), and metastatic cancer (OR = 6.66, P < 0.001). The nomogram showed moderate discrimination and consistently higher AUC than Age+Gender, SOFA, and SAPSII across cohorts. This study identified factors associated with 28-day mortality in patients with pulmonary collapse and developed a nomogram for early risk stratification.
Tumor-associated macrophages (TAMs) play a pivotal role in shaping the inflammatory microenvironment of colorectal polyps. MiR-146a-5p has been implicated in innate immune regulation, but its function in TAM polarization and polyp pathogenesis remains unclear. Forty paired colorectal polyp and adjacent normal tissues were analyzed for miR-146a-5p, IRAK1, and macrophage markers (CD86/CD206) by qRT-PCR and immunohistochemistry. THP-1-derived macrophages were polarized to M1 or M2 phenotypes, transfected with miR-146a-5p mimic/inhibitor, si-IRAK1, or IRAK1 overexpression plasmids, and treated with polyp-conditioned medium (Polyp-CM) where indicated. Macrophage polarization was evaluated by flow cytometry, qRT-PCR, ELISA, and Western blot. Dual-luciferase reporter assays in HEK293T cells validated direct targeting of IRAK1 by miR-146a-5p. Rescue experiments assessed the functional contribution of IRAK1 and NF-κB signaling to M1 polarization. MiR-146a-5p was significantly downregulated in polyp tissues, whereas IRAK1 and M1 macrophage markers (CD86, iNOS) were upregulated, with a strong negative correlation between miR-146a-5p and IRAK1. Overexpression of miR-146a-5p in macrophages suppressed M1 polarization, decreased pro-inflammatory cytokines (TNF-α, IL-6), and reduced NF-κB activation, while miR-146a-5p inhibition enhanced these responses. Dual-luciferase assays confirmed IRAK1 as a direct target of miR-146a-5p. Silencing IRAK1 or inhibiting NF-κB rescued the pro-M1 effects induced by miR-146a-5p loss. Conversely, IRAK1 overexpression promoted M1 polarization, which was attenuated by miR-146a-5p co-expression. Polyp-CM experiments corroborated these effects under tumor-mimicking inflammatory conditions. These findings suggest that the miR-146a-5p/IRAK1/NF-κB axis may represent a potential therapeutic target for modulating macrophage-mediated inflammatory responses in colorectal polyps.
Cerebral cavernous malformations (CCMs) are vascular anomalies prone to hemorrhage, leading to neurological deficits and reduced quality of life. Current therapies are limited, and molecular mechanisms underlying vascular instability remain incompletely understood. MicroRNAs have emerged as key regulators of vascular integrity. This study investigates the role of microRNA-21-3p (miR-21-3p) in modulating oxidative stress and angiogenesis in CCM. Expression of miR-21-3p, NADPH oxidase 4 (NOX4), and vascular endothelial growth factor A (VEGFA) was assessed in endothelial cells and pericytes from CCM lesions of 20 sporadic patients using fluorescence in situ hybridization. Functional assays of proliferation, permeability, reactive oxygen species (ROS), migration, and tubule formation were performed in human brain microvascular endothelial cells (BMECs) and pericytes with CCM2 gene depletion, following miR-21-3p mimic or inhibitor intervention. In vivo effects on cerebral hemorrhage, vascular permeability, dilation, and angiogenesis were evaluated in ccm2-knockdown zebrafish. CCM lesions exhibited decreased miR-21-3p and increased NOX4 and VEGFA compared to controls, correlating with hemorrhage. In vitro, miR-21-3p mimics suppressed proliferation, permeability, ROS generation, and angiogenic activity by directly targeting NOX4 and VEGFA. In vivo, miR-21-3p supplementation reduced cerebral hemorrhage, vascular leakage, dilation, and sprouting angiogenesis in zebrafish with ccm2 knockdown. MiR-21-3p regulates vascular integrity in CCM by modulating NOX4-mediated oxidative stress and VEGFA-driven angiogenesis. Loss of miR-21-3p contributes to hemorrhage, while its restoration stabilizes vascular function. This study identifies miR-21-3p as a potential therapeutic target for CCM, bridging endothelial and pericyte biology with translational potential to reduce cerebral hemorrhage.
Serum albumin is widely used in clinical practice as a nutrition-related biomarker, yet in sepsis its concentration is strongly influenced by inflammation, capillary leak, fluid redistribution, hepatic dysfunction, and exogenous albumin administration. Although hypoalbuminemia is consistently associated with poor outcomes, exogenous human albumin solution (HAS) has not shown a clear survival benefit in septic patients. We therefore investigated whether the prognostic significance of early serum albumin change differs according to whether the change is spontaneous or occurs in the context of HAS administration. We analyzed septic patients from the MIMIC-IV database and assessed consistency in an independent external cohort from the First Affiliated Hospital of Xi'an Jiaotong University. Delta albumin (ΔALB) was defined as the change in serum albumin during the first 3 ICU days. Patients were stratified according to HAS use during this period. The primary outcome was 90-day survival. Among patients who did not receive HAS, higher ΔALB was significantly associated with lower 90-day mortality risk (HR per 1-g/dL increase = 0.50, 95% CI 0.40-0.62, p < 0.001), whereas this association was not observed in patients who received HAS. In the external cohort, the absence of a clear prognostic association in albumin-treated patients was directionally consistent, although validation of endogenous ΔALB was limited because most patients received HAS. Endogenous ΔALB was associated with baseline albumin, hematocrit change, platelet change, crystalloid volume, and liver-related variables, suggesting important influences of hemodilution, illness severity, circulatory status, and hepatic dysfunction. In the primary MIMIC-IV cohort, spontaneous increases in serum albumin, but not albumin changes among HAS-treated patients, were associated with better outcomes. These findings suggest that early albumin recovery should be interpreted cautiously in nutritional assessment, because its clinical meaning depends on albumin source and on non-nutritional physiological factors rather than nutritional status alone.
Spinal cord schistosomiasis (SCS) is a rare but potentially disabling manifestation of Schistosoma mansoni infection caused by ectopic deposition of parasite eggs within the spinal cord via Batson's vertebral venous plexus, resulting in granulomatous inflammation and neurological injury. Early diagnosis is challenging because the clinical presentation is often nonspecific and mimics other spinal cord disorders, particularly in resource-limited settings. We report the case of a 12-year-old Ethiopian boy who presented with progressive lower back and radicular pain, lower limb paresthesia, and intermittent low-grade fever without objective motor weakness, sensory deficits, or bladder dysfunction. Magnetic resonance imaging demonstrated intramedullary T2-weighted hyperintensity and swelling involving the conus medullaris, while positive schistosomal serology supported the diagnosis. Prompt treatment with praziquantel and corticosteroids resulted in complete clinical recovery without progression to neurological deficits or the need for surgical intervention. We also review the literature on SCS in endemic regions, highlighting the challenges of early diagnosis, current management strategies, and factors influencing neurological outcomes. This case demonstrates that maintaining a high index of suspicion and combining characteristic MRI findings with serological testing can facilitate early diagnosis and timely medical treatment before irreversible neurological damage occurs, leading to excellent clinical outcomes.
Cutaneous spindle cell squamous cell carcinoma (SpSCC) is a rare variant of cutaneous squamous cell carcinoma that can clinically mimic scar change and histologically overlap with other cutaneous spindle cell neoplasms. We report a 60-year-old woman with a nonhealing ulcerated lesion arising within a longstanding childhood abdominal burn scar. Histopathology demonstrated a mitotically active dermal spindle cell tumor with pancytokeratin positivity and patchy cytokeratin 5/6 expression. This rare case highlights that spindle cell squamous cell carcinoma can arise as a late malignant transformation within longstanding burn scars decades after the initial injury. We also review key histopathologic/immunohistochemical diagnostic pitfalls and summarize practical oncologic and surgical management considerations for treating cutaneous spindle cell squamous cell carcinoma in burn scars as a high-risk cutaneous squamous cell carcinoma.
A key challenge for large language models is token cost per query and overall deployment cost. Clinical inputs are long, heterogeneous, and often redundant, while downstream tasks are short and high stakes. We study budgeted context selection, where a subset of document units is chosen under a strict token budget so an off-the-shelf generator can meet fixed cost and latency constraints. We cast this as a knapsack-constrained subset selection problem with two design choices, unitization that defines document segmentation and selection that determines which units are kept. We propose RCD, a monotone submodular objective that balances relevance, coverage, and diversity. We compare sentence, section, window, and cluster-based unitization, and introduce a routing heuristic that adapts to the budget regime. Experiments on MIMIC discharge notes, Cochrane abstracts, and L-Eval show that optimal strategies depend on the evaluation setting. Positional heuristics perform best at low budgets in extractive tasks, while diversity-aware methods such as MMR improve LLM generation. Selector choice matters more than unitization, with cluster-based grouping reducing performance and other schemes behaving similarly. ROUGE saturates for LLM summaries, while BERTScore better reflects quality differences. We release our code at https://github.com/stone-technologies/ACL_budget_paper.
Electrospun nanofibrous membranes, which structurally mimic the extracellular matrix, hold significant promise in wound repair applications. However, in the current gelatin (Gel)/polycaprolactone (PCL) system, the beneficial effects of Gel and PCL are usually discussed only from the material level, and how their spatial organization within fibers affects interfacial bioactivity, wet-state stability, and bacterial barrier performance remains insufficiently distinguished from the effects of added functional agents. In this study, Gel/PCL fibrous membranes were prepared via uniaxial blending (GPC, Gel/PCL composite) and coaxial core-shell electrospinning (GPS, Gel-shell/PCL-core), aiming to investigate how the fiber structure itself affects the performance of wound dressings. The GPS membrane features a PCL core for structural support and a Gel shell for biofunctionalization. This structure simultaneously enhanced surface hydrophilicity, liquid absorption capacity, and water vapor transmission while maintaining mechanical stability. Moreover, compared with the GPC membrane, it exhibited superior bacterial barrier performance, significantly promoted fibroblast adhesion and migration, and showed excellent hemocompatibility with a hemolysis rate below 2%. These results indicate that, even within the same Gel/PCL material system, spatial organization of the two components critically determines the balance among mechanical support, interfacial bioactivity, and barrier function, providing a rational structural-engineering strategy for drug-free multifunctional wound dressings.