Role of Neutrophils as Therapeutic Targets in Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is a major health problem. It is one of the most common types of stroke and results in mortality in approximately half of patients. More than half of the fatalities occur in the first 2 days. In addition to the mass effect after ICH hemorrhage, complex pathophysiological mechanisms such as intracranial vessel vasospasm, microthrombosis, and inflammatory immune reaction also increase brain damage. Both resident (including microglia and astrocytes) and circulating immune cells (including neutrophils, macrophages, and lymphocytes) involved in the inflammatory process. The inflammatory response is especially harmful in the acute phase due to harmful substances secreted by infiltrating immune cells. The inflammatory response also has beneficial effects, especially in the later stages. Their role in pathophysiology makes immune cells important therapeutic targets. General immunosuppressive approaches and depleting cell groups such as neutrophils or keeping them away from the lesion site may not be sufficient to prevent poor outcomes after ICH. This is most likely because they suppress anti-inflammatory activities and pro-inflammatory effects. Instead, directing immune cells to the beneficial subpopulation seems like a more rational solution. The pro-inflammatory N1 subpopulation of neutrophils damages the tissue surrounding ICH. In contrast, the N2 subpopulation is associated with anti-inflammatory reactions and tissue repair. Studies show that when neutrophils are polarized toward the N2 subpopulation, clinical outcomes improve and the volume of the infarct decreases. However, more research is still needed. This study aims to evaluate the role of neutrophils as immunotherapeutic targets in ICH in light of current knowledge.

Ultrasonography-based Staging of Inflammatory Granulomatous Mastitis and Estimation of Steroid Response.

OBJECTIVE: The aim of this study is to present novel diagnostic ultrasonography-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. MATERIAL & METHODS: From January 2017 through March 2023 total of 230 biopsy-proven IGM patients were reclassified (Grade I, II, and III) according to ultrasonography-based morphological features.The injection applications were grouped in Group1 [40mg/mL between 2017-2019 years] vs. Group2 [80mg/mL between 2019-2023 years] and effectiveness analyzed for each grade in between groups. RESULTS: Total mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features 79 (34.3%) patients re-defined as Grade I, 64 (27.8%) as Grade II, and 87 (37.8%) as Grade III.All patients underwent loco-regional steroid injection only. The average treatment in the first group was 6 (±3 SD) with effective dose of 40mg/mL and 4 (±2 SD) with 80 mg/mL in the second group. Generalized linear mixed model investigated effects in between groups (p < 0.05). CONCLUSION: High dose steroid treatment was effective in burnout lesions (Grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. ADVANCE IN KNOWLEDGE: This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. And our study is the pioneer in comparing steroid dosage with no relapse on IGM patients.

The melatonin agonist ramelteon attenuates bleomycin-induced lung fibrosis by suppressing the NLRP3/TGF-Β1/HMGB1 signaling pathway.

PURPOSE: The possible effects of ramelteon, a melatonin receptor agonist on bleomycin-induced lung fibrosis were analyzed via transforming growth factor ß1 (TGF-ß1), the high mobility group box 1 (HMGB1) and Nod-like receptor pyrin domain-containing 3 (NLRP3) which are related to the fibrosis process. MATERIALS AND METHODS: Bleomycin (0.1 â€‹mL of 5 â€‹mg/kg) was administered by intratracheal instillation to induce pulmonary fibrosis (PF). Starting 24 â€‹h after bleomycin administration, a single dose of ramelteon was administered by oral gavage to the healthy groups, i.e. PF â€‹+ â€‹RM2 (pulmonary fibrosis model with bleomycin â€‹+ â€‹ramelteon at 2 â€‹mg/kg) and PF â€‹+ â€‹RM4 (pulmonary fibrosis model with bleomycin â€‹+ â€‹ramelteon at 4 â€‹mg/kg) at 2 and 4 â€‹mg/kg doses, respectively. Real-time polymerase chain reaction (real-time PCR) analyses, histopathological, and immunohistochemical staining were performed on lung tissues. Lung tomography images of the rats were also examined. RESULTS: The levels of TGF-ß1, HMGB1, NLRP3, and interleukin 1 beta (IL-1ß) mRNA expressions increased as a result of PF and subsequently decreased with both ramelteon doses (p â€‹< â€‹0.0001). Both doses of ramelteon partially ameliorated the reduction in the peribronchovascular thickening, ground-glass appearances, and reticulations, and the loss of lung volume. CONCLUSIONS: The severity of fibrosis decreased with ramelteon application. These effects of ramelteon may be associated with NLRP3 inflammation cascade.

Evaluation of the value of exhaled carbon monoxide in the differentiation of viral and bacterial pneumonia.

Aim: This study compared exhaled carbon monoxide (CO) levels in patients hospitalized for bacterial and COVID-19-related viral community-acquired pneumonia. Materials & methods: The study included a total of 150 patients: 50 patients hospitalized for COVID-19 between February 2021 and March 2022, 50 patients with bacterial community-acquired pneumonia and 50 healthy controls. Results: In comparisons of exhaled CO levels among the groups, there was no significant difference between patients with bacterial pneumonia and controls, whereas patients with COVID-19 pneumonia had significantly higher exhaled CO levels compared with both the bacterial pneumonia and control groups (p < 0.001). Conclusion: Viral agents can directly affect the heme oxygenase system of the lower respiratory tract, leading to greater increases in ferritin and exhaled CO levels compared with bacterial pneumonia.

Infections in the lung tissue cause stress in the body. Several mechanisms are activated in the body to balance this stress. The heme oxygenase system plays a role in suppressing inflammation, and its overactivation can cause an increase in the amount of carbon monoxide (CO) we exhale. This study examined exhaled CO levels in patients with bacterial lung infection and COVID-19 viral lung infection in comparison with the healthy population. We found that patients with COVID-19 lung infection had higher levels of CO in their breath than patients with bacterial lung infection and healthy control subjects. These findings suggest that measurements of exhaled CO levels in people with signs and symptoms of lung infection might be used to differentiate patients with viral and bacterial lung infections.

Comparison of two antifibrotic treatments for lung fibrosis in post-COVID-19 syndrome: A randomized, prospective study.

Background: Although pulmonary fibrosis secondary to COVID-19 infection is uncommon, it can lead to problems if not treated effectively in the early period. This study aimed to compare the effects of treatment with nintedanib and pirfenidone in patients with COVID-19-related fibrosis. Methods: Thirty patients who presented to the post-COVID outpatient clinic between May 2021 and April 2022 with a history of COVID-19 pneumonia and exhibited persistent cough, dyspnea, exertional dyspnea, and low oxygen saturation at least 12 weeks after diagnosis were included. The patients were randomized to receive off-label treatment with nintedanib or pirfenidone and were followed up for 12 weeks. Results: After 12 weeks of treatment, all pulmonary function test (PFT) parameters, 6MWT distance, and oxygen saturation were increased compared to baseline in both the pirfenidone group and nintedanib groups, while heart rate and radiological score levels were decreased (p < 0.05 for all). The changes in 6MWT distance and oxygen saturation were significantly greater in the nintedanib group than in the pirfenidone group (p = 0.02 and 0.005, respectively). Adverse drug effects were more frequent with nintedanib than pirfenidone, with the most common being diarrhea, nausea, and vomiting. Conclusion: In patients with interstitial fibrosis after COVID-19 pneumonia, both nintedanib and pirfenidone were observed to be effective in improving radiological score and PFT parameters. Nintedanib was more effective than pirfenidone in increasing exercise capacity and saturation values but caused more adverse drug effects.

Introducción: Aunque la fibrosis pulmonar secundaria a la infección por COVID-19 es poco común, puede generar problemas si no se trata de manera efectiva en el período inicial. Este estudio tuvo como objetivo comparar los efectos del tratamiento con nintedanib y pirfenidona en pacientes con fibrosis relacionada con COVID-19. Métodos: Se incluyeron 30 pacientes que acudieron a la consulta externa post-COVID entre mayo de 2021 y abril de 2022 con antecedentes de neumonía por COVID-19 y presentaron tos persistente, disnea, disnea de esfuerzo y baja saturación de oxígeno al menos 12 semanas después del diagnóstico. Los pacientes fueron aleatorizados para recibir un tratamiento no aprobado con nintedanib o pirfenidona y fueron seguidos durante 12 semanas. Resultados: Después de 12 semanas de tratamiento, todos los parámetros de la prueba de función pulmonar (PFT), la distancia de la PM6M y la saturación de oxígeno aumentaron en comparación con los valores basales tanto en el grupo de pirfenidona como en el de nintedanib, mientras que la frecuencia cardíaca y los niveles de puntuación radiológica disminuyeron (p < 0,05 para todos). Los cambios en la distancia de la PM6M y la saturación de oxígeno fueron significativamente mayores en el grupo de nintedanib que en el grupo de pirfenidona (p = 0,02 y p = 0,005, respectivamente). Los efectos adversos del fármaco fueron más frecuentes con nintedanib que con pirfenidona, siendo los más comunes diarrea, náuseas y vómitos. Conclusión: En pacientes con fibrosis intersticial después de neumonía por COVID-19 se observó que tanto nintedanib como pirfenidona son efectivos para mejorar la puntuación radiológica y los parámetros de la PFT. Nintedanib fue más eficaz que pirfenidona para aumentar la capacidad de ejercicio y los valores de saturación, pero provocó más efectos adversos del fármaco.

Comparison of two antifibrotic treatments for lung fibrosis in post-COVID-19 syndrome: A randomized, prospective study / Comparación de dos tratamientos antifibróticos para la fibrosis pulmonar en el síndrome post-COVID-19: un estudio prospectivo aleatorizado

Background Although pulmonary fibrosis secondary to COVID-19 infection is uncommon, it can lead to problems if not treated effectively in the early period. This study aimed to compare the effects of treatment with nintedanib and pirfenidone in patients with COVID-19-related fibrosis. Methods Thirty patients who presented to the post-COVID outpatient clinic between May 2021 and April 2022 with a history of COVID-19 pneumonia and exhibited persistent cough, dyspnea, exertional dyspnea, and low oxygen saturation at least 12 weeks after diagnosis were included. The patients were randomized to receive off-label treatment with nintedanib or pirfenidone and were followed up for 12 weeks. Results After 12 weeks of treatment, all pulmonary function test (PFT) parameters, 6MWT distance, and oxygen saturation were increased compared to baseline in both the pirfenidone group and nintedanib groups, while heart rate and radiological score levels were decreased (p<0.05 for all). The changes in 6MWT distance and oxygen saturation were significantly greater in the nintedanib group than in the pirfenidone group (p=0.02 and 0.005, respectively). Adverse drug effects were more frequent with nintedanib than pirfenidone, with the most common being diarrhea, nausea, and vomiting. Conclusion In patients with interstitial fibrosis after COVID-19 pneumonia, both nintedanib and pirfenidone were observed to be effective in improving radiological score and PFT parameters. Nintedanib was more effective than pirfenidone in increasing exercise capacity and saturation values but caused more adverse drug effects (AU)

Introducción Aunque la fibrosis pulmonar secundaria a la infección por COVID-19 es poco común, puede generar problemas si no se trata de manera efectiva en el período inicial. Este estudio tuvo como objetivo comparar los efectos del tratamiento con nintedanib y pirfenidona en pacientes con fibrosis relacionada con COVID-19. Métodos Se incluyeron 30 pacientes que acudieron a la consulta externa post-COVID entre mayo de 2021 y abril de 2022 con antecedentes de neumonía por COVID-19 y presentaron tos persistente, disnea, disnea de esfuerzo y baja saturación de oxígeno al menos 12semanas después del diagnóstico. Los pacientes fueron aleatorizados para recibir un tratamiento no aprobado con nintedanib o pirfenidona y fueron seguidos durante 12semanas. Resultados Después de 12semanas de tratamiento, todos los parámetros de la prueba de función pulmonar (PFT), la distancia de la PM6M y la saturación de oxígeno aumentaron en comparación con los valores basales tanto en el grupo de pirfenidona como en el de nintedanib, mientras que la frecuencia cardíaca y los niveles de puntuación radiológica disminuyeron (p<0,05 para todos). Los cambios en la distancia de la PM6M y la saturación de oxígeno fueron significativamente mayores en el grupo de nintedanib que en el grupo de pirfenidona (p=0,02 y p=0,005, respectivamente). Los efectos adversos del fármaco fueron más frecuentes con nintedanib que con pirfenidona, siendo los más comunes diarrea, náuseas y vómitos. Conclusión En pacientes con fibrosis intersticial después de neumonía por COVID-19 se observó que tanto nintedanib como pirfenidona son efectivos para mejorar la puntuación radiológica y los parámetros de la PFT. Nintedanib fue más eficaz que pirfenidona para aumentar la capacidad de ejercicio y los valores de saturación, pero provocó más efectos adversos del fármaco (AU)

Automated LVO detection and collateral scoring on CTA using a 3D self-configuring object detection network: a multi-center study.

The use of deep learning (DL) techniques for automated diagnosis of large vessel occlusion (LVO) and collateral scoring on computed tomography angiography (CTA) is gaining attention. In this study, a state-of-the-art self-configuring object detection network called nnDetection was used to detect LVO and assess collateralization on CTA scans using a multi-task 3D object detection approach. The model was trained on single-phase CTA scans of 2425 patients at five centers, and its performance was evaluated on an external test set of 345 patients from another center. Ground-truth labels for the presence of LVO and collateral scores were provided by three radiologists. The nnDetection model achieved a diagnostic accuracy of 98.26% (95% CI 96.25-99.36%) in identifying LVO, correctly classifying 339 out of 345 CTA scans in the external test set. The DL-based collateral scores had a kappa of 0.80, indicating good agreement with the consensus of the radiologists. These results demonstrate that the self-configuring 3D nnDetection model can accurately detect LVO on single-phase CTA scans and provide semi-quantitative collateral scores, offering a comprehensive approach for automated stroke diagnostics in patients with LVO.

Comparison of two antifibrotic treatments for lung fibrosis in post-COVID-19 syndrome: A randomized, prospective study.

BACKGROUND: Although pulmonary fibrosis secondary to COVID-19 infection is uncommon, it can lead to problems if not treated effectively in the early period. This study aimed to compare the effects of treatment with nintedanib and pirfenidone in patients with COVID-19-related fibrosis. METHODS: Thirty patients who presented to the post-COVID outpatient clinic between May 2021 and April 2022 with a history of COVID-19 pneumonia and exhibited persistent cough, dyspnea, exertional dyspnea, and low oxygen saturation at least 12 weeks after diagnosis were included. The patients were randomized to receive off-label treatment with nintedanib or pirfenidone and were followed up for 12 weeks. RESULTS: After 12 weeks of treatment, all pulmonary function test (PFT) parameters, 6MWT distance, and oxygen saturation were increased compared to baseline in both the pirfenidone group and nintedanib groups, while heart rate and radiological score levels were decreased (p<0.05 for all). The changes in 6MWT distance and oxygen saturation were significantly greater in the nintedanib group than in the pirfenidone group (p=0.02 and 0.005, respectively). Adverse drug effects were more frequent with nintedanib than pirfenidone, with the most common being diarrhea, nausea, and vomiting. CONCLUSION: In patients with interstitial fibrosis after COVID-19 pneumonia, both nintedanib and pirfenidone were observed to be effective in improving radiological score and PFT parameters. Nintedanib was more effective than pirfenidone in increasing exercise capacity and saturation values but caused more adverse drug effects.

Bladder paraganglioma treated with open partial cystectomy: a case report.

BACKGROUND: Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension, palpitation, syncope, and macroscopic hematuria are the most common findings. Treatment modalities include transurethral resection, and partial or total cystectomy. CASE PRESENTATION: A 38-year-old Turkish female patient was examined for hematuria that had been persisting for 6 months. Among the clinical findings, only hematuria was present. Absence of adrenergic symptoms such as hypertension, palpitations, and syncope at the first presentation made it difficult to consider bladder paraganglioma in the differential diagnosis. Therefore, cystoscopy and transurethral resection were performed with the thought of urothelial cancer. Findings such as hypertension and bradycardia that developed during diagnostic transurethral resection suggested that it might be bladder paraganglioma. After the radiological evaluation and endocrinological preparation, the patient underwent partial cystectomy. CONCLUSION: The rarity of cases having been reported in the literature leads to uncertainties in the management of bladder paraganglioma. Adrenergic symptoms developing during transurethral resection should suggest paraganglioma in the differential diagnosis. A multidisciplinary approach and medical treatment are mandatory to prevent life-threatening complications such as hypertensive crisis, vascular collapse, and multiple-organ system failure. We aimed to report the clinical presentation that includes only macroscopic hematuria mimicking urothelial cancer and to emphasize the multidisciplinary approach in the treatment.

Evaluation of pulmonary nodules by magnetic resonance imaging sequences: which sequence will replace computed tomography?

OBJECTIVE: This study aimed to determine the role of magnetic resonance imaging in minimizing radiation exposure, especially in the follow-up of pulmonary nodules. METHODS: Patients who applied to our hospital between April 2013 and August 2018 for various reasons and had lung-mediastinal dynamic magnetic resonance imaging and thoracic computed tomography were included in the study. A total of 194 patients were included in the study, involving 84 females and 110 males. Scanning of the nodules was done retrospectively. This study was conducted by two readers: a thoracic radiologist with 15 years of experience and a nonspecific radiologist with 4 years of experience. Evaluations were made using the double-blind method. RESULTS: Of the 194 patients, 84 (43.3%) were female and 110 (56.7%) were male. For the first reader, 135 (69.5%) nodules were detected in postcontrast T1 vibe images, 130 (67%) in T2 fast spin echo, 128 (66%) in precontrast T1 vibe, and 98 (50.5%) in T2 turbo inversion recovery magnitude sequence. For the second reader, 133 (68%) nodules were detected in postcontrast T1 vibe images, 120 (61.9%) in T2 fast spin echo, 122 (62.9%) in precontrast T1 vibe, and 99 (51%) in T2 turbo inversion recovery magnitude sequence. Capability levels were examined in detecting nodules between the first and second readers, and the ratios were reached at 0.92 in T2 fast spin echo, 0.81 in postcontrast T1 vibe images, 0.93 in precontrast T1 vibe, and 0.96 in T2 turbo inversion recovery magnitude sequence. CONCLUSION: In this study of detecting pulmonary nodules by magnetic resonance imaging, which we performed with two different readers, one of whom was an experienced thoracic radiologist, both readers found the highest detection rate in the postcontrast T1 vibe sequence.

Evaluation of pulmonary nodules by magnetic resonance imaging sequences: which sequence will replace computed tomography?

SUMMARY OBJECTIVE: This study aimed to determine the role of magnetic resonance imaging in minimizing radiation exposure, especially in the follow-up of pulmonary nodules. METHODS: Patients who applied to our hospital between April 2013 and August 2018 for various reasons and had lung-mediastinal dynamic magnetic resonance imaging and thoracic computed tomography were included in the study. A total of 194 patients were included in the study, involving 84 females and 110 males. Scanning of the nodules was done retrospectively. This study was conducted by two readers: a thoracic radiologist with 15 years of experience and a nonspecific radiologist with 4 years of experience. Evaluations were made using the double-blind method. RESULTS: Of the 194 patients, 84 (43.3%) were female and 110 (56.7%) were male. For the first reader, 135 (69.5%) nodules were detected in postcontrast T1 vibe images, 130 (67%) in T2 fast spin echo, 128 (66%) in precontrast T1 vibe, and 98 (50.5%) in T2 turbo inversion recovery magnitude sequence. For the second reader, 133 (68%) nodules were detected in postcontrast T1 vibe images, 120 (61.9%) in T2 fast spin echo, 122 (62.9%) in precontrast T1 vibe, and 99 (51%) in T2 turbo inversion recovery magnitude sequence. Capability levels were examined in detecting nodules between the first and second readers, and the ratios were reached at 0.92 in T2 fast spin echo, 0.81 in postcontrast T1 vibe images, 0.93 in precontrast T1 vibe, and 0.96 in T2 turbo inversion recovery magnitude sequence. CONCLUSION: In this study of detecting pulmonary nodules by magnetic resonance imaging, which we performed with two different readers, one of whom was an experienced thoracic radiologist, both readers found the highest detection rate in the postcontrast T1 vibe sequence.

When and how important is anti-fibrotic therapy in the post-COVID-19 period?

PURPOSE: In addition to the highly variable clinical presentation of acute COVID-19 infection, it can also cause various post-acute signs and symptoms. In our study, we aimed to examine the efficacy of anti-fibrotic therapy in patients who developed pulmonary fibrosis after COVID-19. METHODS: In total, 15 patients who applied to the Post-Covid Outpatient Clinic between May 2021 and August 2021 and were diagnosed with COVID-19 pneumonia, and whose cough, dyspnea, exertional dyspnea and low saturation continued to be present at least 12 weeks after the diagnosis, were included in the study. Off-label pirfenidone treatment was started according to the radiological findings, pulmonary function test parameters (PFT) and 6-minute walking test (6MWT) results. The patients were followed up for 12 weeks. RESULTS: While all of the FVC, FVC%, FEV1, FEV1%, DLCO%, DLCO/VA%, 6MWT, and room air saturation levels were observed to increase statistically significantly in the patients at the 12th week, it was determined that there was a statistically significant decrease in the pulse level in room air (p = 0.01, 0.01, 0.01, 0.01, 0.004, 0.001, 0.002, 0.001, and 0.002, respectively). In regression analysis based on radiological scoring, it was observed that the DLCO and room air saturation levels at the 12th week of the treatment were statistically significantly higher in patients with lower scores at the beginning (p = 0.04, 0.03). In addition, it was observed that anti-fibrotic treatment, which was started in the earliest period, i.e., 12 weeks after the diagnosis, resulted in an improvement in radiological, PFT and 6MWT parameters. CONCLUSION: Patients who still had dyspnea and low saturation 12 weeks after the diagnosis, defined as chronic COVID-19, should be evaluated for anti-fibrotic therapy after the necessary radiological and PFT evaluation. Early treatment commencement brings about, besides radiological improvement, a better response obtained in PFT and 6MWT (Tab. 2, Fig. 2, Ref. 21).

Comparison of the Efficacy of Systemic Versus Local Steroid Treatment in Idiopathic Granulomatous Mastitis: A Cohort Study.

INTRODUCTION: Steroid therapy is known to be effective against granulomatous mastitis. We aimed to compare the efficacy of local versus systemic steroid administration in patients with idiopathic granulomatous mastitis. MATERIALS AND METHODS: This prospective cohort study included 58 patients who had either local (n = 42) or systemic (n = 16) treatment due to granulomatous mastitis between 2015 and 2019. Recurrence rates were determined as per ultrasound and magnetic resonance imaging examinations and the rate of side effects was evaluated as per patient complaints and physical examinations at the end of a 2-year follow-up period. RESULTS: Median doses of 140 mg and 3810 mg were administered to the local and systemic group, respectively. Six (14.3%) patients in the local treatment group and 13 (81.3%) in the systemic treatment group had steroid-related side effects. The local treatment group had significantly fewer side effects than the systemic treatment group (P < 0.001). The recurrence rates were similar in both groups (P > 0.05). CONCLUSIONS: Local steroid injection was as effective as systemic steroid therapy. Compared to systemic therapy, local steroid administration can be considered as a new therapeutic protocol with a lower dose and side effect rate.

Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition).

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.