Synchronous large tumoral pseudoangiomatous stromal hyperplasia (PASH) in the breast and axilla with subsequent carcinoma in the contralateral breast: routine and strain imaging with histopathological correlation.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast disorder with the tumoral variety being extremely rare. We report a rare case of synchronous, massive axillary and breast tumoral PASH in a 55-year-old post-menopausal woman. Mammography, ultrasonography and sonoelastography features are illustrated with histopathological correlation. A high-grade invasive ductal carcinoma was detected in the contralateral breast on annual follow-up imaging. Radiologists need to be familiar with the imaging appearances of PASH and be aware of its association with subsequent cancer risk. To the best of our knowledge, the present case of synchronous tumoral PASH in the breast and axillary tissue is the second reported case till now.

MRI in necrotizing fasciitis of the extremities.

Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed T2 weighted or short tau inversion-recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that T2-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.

Medial notch of the superior border of the scapula: a rare anatomical variation mimicking a bone tumour.

The scapula is a flat, triangular bone overlying the posterior chest wall and forming the posterior aspect of the shoulder girdle. To the best of our knowledge, there is no previous description of a notch of the medial aspect of the superior border of the scapula in the literature. The imaging findings of a supero-medial scapula border notch mimicking a bone tumour are presented in this case report.

Clinics in diagnostic imaging (137).

A 45-year-old woman presented with generalised body itch, dark-coloured urine and pale stools for six day. Ultrasonography, endoscopic retrograde cholangiopancreatography and computed tomography revealed dilated intrahepatic ducts with stricture at the proximal common bile duct. The gallbladder was replaced by a large heterogeneous mass invading the liver and common bile duct. She underwent gallbladder resection, right hemihepatectomy, Whipple procedure, portal vein resection and reconstruction. Histopathology revealed diffusely infiltrating adenocarcinoma of the gallbladder. The patient made satisfactory postoperative recovery. The imaging features of gallbladder carcinoma are discussed.

Conflict-of-interest, copyright and other declarations.

Declarations of exclusive publication, author contribution, conflict-of-interest and copyright transfer are important formalities required by most biomedical journals. Conflict-of-interest may be personal, commercial, political, academic or financial. It is particularly important for authors to provide a full and complete disclosure of any financial relationship with a commercial organisation that may have an interest in the contents of the submitted manuscript. Editors, editorial board members and reviewers should also declare any possible conflicts-of-interest. The handling of conflict-of-interest during manuscript preparation, peer review and editorial decision making impacts the credibility of published articles and scientific research in general.

Getting to know journal bibliographic databases.

A bibliographic database is an organised digital collection of references to published literature. A bibliographic database may be general in scope or may cover a specific academic discipline. There are many types of medical and general bibliographic databases. They cover biomedical and scientific literature, morbidity and mortality statistics, therapeutic regimens, medical records, images and reviews of evidence-based medicine. Getting to know these databases will help researchers and authors to enhance their writing and publishing endeavours.

Writing a book review.

A book review is a form of academic writing that provides a succinct yet critical analysis evaluating the content, style, merit and significance of a book. The reader should gain insight into the strengths and weaknesses of the book, aided by input from the reviewer. The four stages of writing a book review are: introducing the book, outlining its contents, highlighting parts of the book by selecting particular chapters or themes, and giving a detailed evaluation.

Writing an editorial.

An editorial may be written by the editor or someone invited by the editor. It serves many other purposes, including critiques of original articles published in the same issue of the journal, concise reviews of topics that do not warrant a full-length invited review, and other topics on very recent developments that are deemed by the editor to be important to readers of the journal and the community. As there is typically a limited space in which to deliver its contents, the message contained in the editorial needs to be well thought out and concisely delivered. It should contain the correct sequence of the elements of critical argument, ideally supported by evidence, and end with a clear conclusion.

Writing a letter to the Editor.

A letter to the Editor is a short communication. It can be written on any subject of interest to the journal reader, and is published at the Editor's discretion. Comments on previously published articles are probably the most common reason for writing a letter. A variety of other types of letters exist, depending on individual journal policy. Letters to the Editor should be objective, constructive and purposeful. They should provide new or useful information that merits publication, or additional or alternative viewpoint or experience to a previously published article. Letters should be short and concise, with clear and specific points.

Writing a systematic review.

Evidence-based medicine (EBM) aims to combine the best available scientific evidence with clinical experience and individual judgment of patient needs. In the hierarchy of scientific evidence, systematic reviews (along with meta-analyses) occupy the highest levels in terms of the quality of evidence. A systematic review is the process of searching, selecting, appraising, synthesising and reporting clinical evidence on a particular question or topic. It is currently considered the best, least biased and most rational way to organise, gather, evaluate and integrate scientific evidence from the rapidly-changing medical and healthcare literature. Systematic reviews could be used to present current concepts or serve as review articles and replace the traditional expert opinion or narrative review. This article explains the structure and content of a systematic review.

Writing an invited commentary.

An invited commentary is a short article that describes an author's personal experience of a specific topic. Unlike a review article, the author gives his own opinions and perspectives. It typically addresses a current, hot and often controversial subject. It may take two formats, namely, provide an expert author's personal views of and insight into a current hot topic, or add balance to another paper being commented upon, with addition of the author's own perspective.

Writing an invited review.

An invited review provides a detailed and comprehensive narrative analysis of recent developments in a specific topic, and highlights important points that have been previously published. It usually consists of a short unstructured abstract, introduction, subheadings to organise the topic, and a summary. The text is usually relatively long compared to other paper categories, typically up to 15 manuscript pages or 4,000 words. The reference list is expected to comprehensively cover all the major published work, with up to 50-75 references being typical. The ideal invited review should be topical, current, balanced, accurate, quotable and easily understood, with clear take-home messages.

Writing a pictorial essay.

A pictorial essay is a type of educational article that aims to provide both textual and visual portrayals of a topical issue. It usually consists of a short unstructured abstract, brief introduction, subheadings to organise the material and a summary. The number of references is limited to a few key articles, typically, eight to 15, or fewer. The text is usually short, often approximately 1,000 to 2,000 words in length, with much of the message contained in the figure legends. This type of article allows for a large number of figures, typically up to 20 figures or 30 figure parts. The main criteria for publication are currency, educational value and high quality of illustrations.

Writing a technical note.

A technical note is a short article giving a brief description of a specific development, technique or procedure, or it may describe a modification of an existing technique, procedure or device applicable to medicine. The technique, procedure or device described should have practical value and should contribute to clinical diagnosis or management. It could also present a software tool, or an experimental or computational method. Technical notes are variously referred to as technical innovations or technical developments. The main criteria for publication will be the novelty of concepts involved, the validity of the technique and its potential for clinical applications.

Writing a case report.

A case report is a description of a single case with unique features. This includes a previously-unreported clinical condition, previously-unreported observation of a recognised disease, unique use of imaging or diagnostic test to reveal a disease, previously-unreported treatment in a recognised disease, or previously-unreported complication of a procedure. Case reports should be short and focused, with a limited number of figures and references. The structure of a case report usually comprises a short unstructured (or no) abstract, brief (or no) introduction, succinct but comprehensive report of the case, and to-the-point discussion.

Roles of intestinal glutamate dehydrogenase and glutamine synthetase in environmental ammonia detoxification in the euryhaline four-eyed sleeper, Bostrychus sinensis.

This study aimed to examine the hypothesis that intestinal glutamate dehydrogenase (GDH) and glutamine synthetase (GS) could be involved in ammonia detoxification in the euryhaline Bostrychus sinensis exposed to ammonia in a hyperosmotic environment, whereby drinking was essential for osmoregulation. Our results indicate that there was a significant increase in ammonia content in the intestine of B. sinensis exposed to 15 mmol l(-1) NH(4)Cl in seawater (pH 7.0) for 6 days. There were also significant increases in the amination and deamination activities and protein abundance of intestinal GDH. The GDH amination/deamination ratio remained unchanged, indicating that there could be increases in the turnover of glutamate. However, the difference between the amination and deamination activities increased 2-fold, implying that there could be an increase in glutamate formation in the intestine. Since the intestinal glutamate content remained unchanged, excess glutamate formed might have been channeled into other amino acids and/or transported to other organs. Indeed, the intestinal glutamine content increased significantly by 2-fold, with a significant increase in the activity and protein abundance of intestinal GS. Since the magnitude of glutamine accumulation in the intestine was lower than those in liver and muscle, which lacked changes in GDH activities, intestinal glutamate could have been shuttled to liver and muscle to facilitate increased synthesis of glutamine therein. By contrast, when fish were exposed to a much higher concentration (30 mmol l(-1)) of NH(4)Cl in 5 per thousand water (pH. 7.0), the magnitude of increase in ammonia content in the intestine was less prominent, and there were no changes in activities and kinetic properties of intestinal GDH. Therefore, it can be concluded that the intestine of B. sinensis was involved in the defense against ammonia toxicity during exposure to ammonia in a hyperosmotic medium.

Imaging of giant cell tumour of the tendon sheath.

Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.

Publication ethics and scientific misconduct.

To maintain the readers' trust and to uphold the journal's reputation, it is paramount for the entire research, peer reviewer and publication process to follow ethical principles and decisions. Studies involving humans, animals, medical records and human tissues/organs need to be conducted ethically, and the appropriate approvals obtained. The privacy and confidentiality of patients, authors and reviewers should be respected. When required, rights and permissions should be sought. Common forms of scientific misconduct include misappropriation of ideas, violation of generally accepted research practices, failure to comply with legislative and regulatory requirements, falsification of data, and inappropriate behaviour in relation to misconduct. Authors can expect editorial action to be taken, should duplicate publication, plagiarism and other forms of scientific misconduct be attempted or detected.

Dealing with returned manuscripts.

It is useful for authors to learn to deal with returned manuscripts with a rejection decision or a request for revision. Common reasons for rejection include contents outside the scope of the journal or inappropriate for the journal, incomplete submission, poor methodology, faulty experimental design, major flaws in the interpretation of results, extremely poor writing, and duplicated or plagiarised work. Authors should use the editor's and reviewers' comments to improve their manuscripts and resubmit elsewhere. Common reasons for revision requests include minor faults in the methodology, minor inaccuracies in data, inconsistencies among different sections of the manuscript, faulty deductions, data that do not support the conclusions, excessive data or text, poor or excessive illustrations, and poor but salvageable writing. A request for revision should be viewed positively, as it means that there is a possibility that the manuscript may still be potentially publishable, provided that all the editor's and reviewers' comments are addressed.

Clinics in diagnostic imaging (129). Posterior cruciate ligament ganglion cyst.

Ganglion cysts arising from the posterior cruciate ligament (PCL) of the knee are rare. We describe a 21-year-old Chinese woman who presented with right knee pain following a twisting injury six months prior. Her pain was exacerbated by squatting, although her range of knee motion was full. Magnetic resonance imaging showed a lobulated, well-defined, T1-hypointense and T2-hyperintense, septated cystic mass arising from the posterior aspect of the PCL. The diagnosis of a PCL ganglion cyst was confirmed by computed tomography-guided aspiration of the cyst. Due to persistent mild knee pain, the patient eventually underwent arthroscopic decompression of the ganglion cyst. The clinical features, diagnosis and management of PCL ganglion cysts are discussed.