Hursts rescaled range (R/S) analysis and Wolfs attractor reconstruction technique have been adopted to estimate the local fractal dimensions and the local largest Lyapunov exponents in terms of the time series pressur...Hursts rescaled range (R/S) analysis and Wolfs attractor reconstruction technique have been adopted to estimate the local fractal dimensions and the local largest Lyapunov exponents in terms of the time series pressure fluctuations obtained from a gas liquid solid three phase self aspirated reversed flow jet loop reactor,respectively.The results indicate that the local fractal dimensions and the local largest Lyapunov exponents in both the jet region and the tubular region inside the draft tube increase with the increase in the jet liquid flowrates and the solid loadings,the local fractal dimension profiles are similar to those of the largest Lyapunov exponent,the local largest lyapunov exponents are positive for all cases,and the flow behavior of such a reactor is chaotic.The local nonlinear characteristic parameters such as the local fractal dimension and the local largest Lyapunov exponent could be applied to further study the flow properties such as the flow regime transitions and flow structures of this three phase jet loop reactor.展开更多
The local chaos characteristics of the time series pressure fluctuations of gas liquid two phase flow in a self aspirated reversed flow jet loop reactor are studied by the deterministic chaos analysis technique. It...The local chaos characteristics of the time series pressure fluctuations of gas liquid two phase flow in a self aspirated reversed flow jet loop reactor are studied by the deterministic chaos analysis technique. It is found that the estimated local largest Lyapunov exponent is positive in all cases and the profile is similar to that of the local fractal dimension in this reactor. The positive largest Lyapunov exponent shows that the reactor is a nonlinear chaotic system. The obvious distribution indicates that the local nonlinear characteristic parameters such as the Lyapunov exponent and the fractal dimension could be applied to further study the flow characteristics such as the flow regine transitions and flow structures of the multi phase reactors.展开更多
Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in ch...Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.展开更多
Background: Foreign body aspiration is a common yet preventable health problem. Headscarf pin aspiration is a unique example of aspirated foreign bodies in young Muslim women usually removed using the rigid bronchosco...Background: Foreign body aspiration is a common yet preventable health problem. Headscarf pin aspiration is a unique example of aspirated foreign bodies in young Muslim women usually removed using the rigid bronchoscope. However, the flexible bronchoscope is increasingly used for this purpose. This prospective study was conducted in Sulaimaniyah Teaching Hospital, Sulaimaniyah, Iraq and aimed to evaluate the usefulness of fiberoptic bronchoscope for removal of aspirated headscarf pins in view of the relevant literature. Methodology: Fifty female patients with headscarf pin aspiration were managed by fiberoptic bronchoscopy over an 8-year period (January 2008 to December 2015). The procedure was performed under local anesthesia and conscious sedation through the mouth. Results: The age ranged from 10 to 45 years with a mean of 27.5. All patients had cough, five had unilateral wheeze (10%) while haemoptysis occurred twice (4%). Fiberoptic bronchoscopy succeeded in 45 cases (90%). Rigid bronchoscopy under general anesthesia was necessary in (n = 4, 8%) while one patient (2%) required thoracotomy. ?Conclusion: Fiberoptic bronchoscopy is safe and effective in removal of aspirated headscarf pins and should be tried first.展开更多
In the present paper,computational fluid dynamics(CFD) simulations were executed to exploring the intent of using aspirated cascade to replace tandem cascades.Firstly,the ONERA tandem cascades were investigated,and th...In the present paper,computational fluid dynamics(CFD) simulations were executed to exploring the intent of using aspirated cascade to replace tandem cascades.Firstly,the ONERA tandem cascades were investigated,and the performance of the cascades at the design point were listed,such as diffusion factor,total pressure loss coefficient,deviation angle etc.For replacing the ONERA tandem cascades,a new cascade was designed with the codes BLADEGEN developed by the authors.The quasi 3-D calculations were carried out using the collection of programs for cascade analysis and design,MISES.The cascade was analyzed and designed by using this code.And the cascade was simulated and analyzed by commercial CFD software.It is found there is an obvious separation on the suction side.Based on the 3D CFD simulation results of the cascade without aspiration,an aspirated cascade was designed by introducing a slot on the suction side.The performance of the aspirated cascade was investigated and compared with the tandem cascades,indicated that under the same inlet condition,the total pressure loss of the single row aspirated cascade was less than that of the tandem cascades,and the outlet static pressure is higher than that of the tandem cascades.Meanwhile,the different suction slot location,suction width and suction mass flow are studied for the aspirated cascade.展开更多
BACKGROUND Orthobiologics-biological substances like platelet-rich plasma(PRP),bone marrow aspirate concentrate,and stem cells-are increasingly used in musculoskeletal care to promote tissue repair and reduce reliance...BACKGROUND Orthobiologics-biological substances like platelet-rich plasma(PRP),bone marrow aspirate concentrate,and stem cells-are increasingly used in musculoskeletal care to promote tissue repair and reduce reliance on invasive surgery.Despite global momentum,India's clinical adoption remains underexplored.AIM To inform education,policy,and resource allocation for the safe and effective adoption of orthobiologics in musculoskeletal care.METHODS A cross-sectional electronic survey was conducted from January to March 2025 among orthopaedic surgeons,academicians,and trainees across India.The questionnaire assessed demographics,knowledge of orthobiologics,attitudes toward training and subspecialization,usage trends,regulatory awareness,and perceived barriers.Data were analyzed using descriptive statistics andχ2/Fisher’s exact tests,with P<0.05 considered significant.RESULTS A total of 1280 valid responses were collected.Awareness of orthobiologics was high(97%),with PRP being the most familiar and widely used(80%).Formal training was reported by only 31%,though 85%showed interest in structured education,and 68%supported orthobiologics as a subspecialty.Satisfaction with clinical outcomes averaged 6.5±2.3 out of 10 points.Barriers included high treatment cost(64%),poor patient awareness(90%),and limited access to biologics labs(18%).Regulatory understanding was moderate,with academic-affiliated clinicians more informed about stem cell guidelines.CONCLUSION Indian orthopaedic professionals demonstrate strong awareness and optimism toward orthobiologics,but widespread gaps in training,infrastructure,and regulation hinder broader adoption.Strategic investments in education,standardized protocols,and accessible facilities are essential to support safe and evidence-driven integration of regenerative therapies into clinical practice.展开更多
BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention...BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention for its role in influencing their function,accessibility,and readiness for clinical use.AIM To identify the most suitable adipose source for MSC isolation and expansion for further applications.METHODS We isolated MSCs from solid adipose tissue and liposuction aspirates using the enzyme method.The MSCs were examined for their expansion using population doubling time,differentiation capacity using multilineage differentiation induction,surface markers using flow cytometry,and stability of chromosomes using the karyotyping method.Growth factors and cytokines in MSC-conditioned media were analyzed using the Luminex assay.RESULTS MSCs were isolated from solid adipose tissue and lipoaspirates and expanded from passage 0 to passage 2.All adipose-derived MSCs(AD-MSCs)exhibited the typical elongated,spindle-shaped morphology and comparable proliferation rate.They expressed positive surface markers(cluster of differentiation 73[CD73]:>97%,CD90:>98%,and CD105:>95%),and negative markers(<1%).All MSCs expressed similar levels of stemness genes(octamer-binding transcription factor 4,SRY-box 2,Krüppel-like factor,and MYC),colonyforming,and trilineage differentiation potential.Karyotyping analysis revealed normal chromosomal patterns in all samples,except one sample exhibiting a polymorphism(1qh+).Furthermore,the growth factors and cytokines of hepatocyte growth factor,vascular endothelial growth factor A,interleukin 6(IL-6),and IL-8 were detected in all AD-MSC conditioned media;but fibroblast growth factor-2 and keratinocyte growth factor were selectively expressed in conditioned media from solid or lipoaspirate AD-MSCs,respectively.CONCLUSION These findings indicate that AD-MSCs from both adipose sources possess all of the characteristic features of MSCs with source-specific secretome differences,which are suitable for further expansion and various clinical applications.展开更多
On the occasion of the New Year,I would like to extend my sincere gratitude and New Year greetings to the experts,scholars,author teams,and readers who have long supported the development of Animal Models and Experime...On the occasion of the New Year,I would like to extend my sincere gratitude and New Year greetings to the experts,scholars,author teams,and readers who have long supported the development of Animal Models and Experimental Medicine(AMEM).Over the past year,we have faced challenges together and achieved breakthroughs in academic influence,internationalization,and fulfilling social respon-sibilities.Looking ahead,we are filled with confidence as we strive to build an important bridge connecting laboratory animal science and technology with academic research.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,neces...BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.展开更多
Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnos...Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-ye...BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.展开更多
A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing rel...A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.展开更多
BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intra...BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injur...Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.展开更多
Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It ...Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.展开更多
This article expands upon of endoscopic ultrasound’s(EUS)role in the evaluation of pancreatic lesions,building on findings presented by Ayesha et al and Tasneem et al regarding neuroendocrine tumors.We emphasize the ...This article expands upon of endoscopic ultrasound’s(EUS)role in the evaluation of pancreatic lesions,building on findings presented by Ayesha et al and Tasneem et al regarding neuroendocrine tumors.We emphasize the diagnostic and therapeutic utility of EUS not only in solid pancreatic tumors but also in the increasingly prevalent cystic lesions,highlighting its particular relevance in resource-limited settings.By integrating high-resolution imaging,tissue acquisition,biomarker analysis,and minimally invasive interventions into a single platform,EUS addresses key diagnostic and therapeutic challenges,reducing the need for multiple costly procedures and enabling effective management even when access to advanced technologies is limited.展开更多
BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous di...BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.展开更多
文摘Hursts rescaled range (R/S) analysis and Wolfs attractor reconstruction technique have been adopted to estimate the local fractal dimensions and the local largest Lyapunov exponents in terms of the time series pressure fluctuations obtained from a gas liquid solid three phase self aspirated reversed flow jet loop reactor,respectively.The results indicate that the local fractal dimensions and the local largest Lyapunov exponents in both the jet region and the tubular region inside the draft tube increase with the increase in the jet liquid flowrates and the solid loadings,the local fractal dimension profiles are similar to those of the largest Lyapunov exponent,the local largest lyapunov exponents are positive for all cases,and the flow behavior of such a reactor is chaotic.The local nonlinear characteristic parameters such as the local fractal dimension and the local largest Lyapunov exponent could be applied to further study the flow properties such as the flow regime transitions and flow structures of this three phase jet loop reactor.
文摘The local chaos characteristics of the time series pressure fluctuations of gas liquid two phase flow in a self aspirated reversed flow jet loop reactor are studied by the deterministic chaos analysis technique. It is found that the estimated local largest Lyapunov exponent is positive in all cases and the profile is similar to that of the local fractal dimension in this reactor. The positive largest Lyapunov exponent shows that the reactor is a nonlinear chaotic system. The obvious distribution indicates that the local nonlinear characteristic parameters such as the Lyapunov exponent and the fractal dimension could be applied to further study the flow characteristics such as the flow regine transitions and flow structures of the multi phase reactors.
文摘Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.
文摘Background: Foreign body aspiration is a common yet preventable health problem. Headscarf pin aspiration is a unique example of aspirated foreign bodies in young Muslim women usually removed using the rigid bronchoscope. However, the flexible bronchoscope is increasingly used for this purpose. This prospective study was conducted in Sulaimaniyah Teaching Hospital, Sulaimaniyah, Iraq and aimed to evaluate the usefulness of fiberoptic bronchoscope for removal of aspirated headscarf pins in view of the relevant literature. Methodology: Fifty female patients with headscarf pin aspiration were managed by fiberoptic bronchoscopy over an 8-year period (January 2008 to December 2015). The procedure was performed under local anesthesia and conscious sedation through the mouth. Results: The age ranged from 10 to 45 years with a mean of 27.5. All patients had cough, five had unilateral wheeze (10%) while haemoptysis occurred twice (4%). Fiberoptic bronchoscopy succeeded in 45 cases (90%). Rigid bronchoscopy under general anesthesia was necessary in (n = 4, 8%) while one patient (2%) required thoracotomy. ?Conclusion: Fiberoptic bronchoscopy is safe and effective in removal of aspirated headscarf pins and should be tried first.
基金funded by the International S&T Cooperation Program (No.2010DFB70620) of china
文摘In the present paper,computational fluid dynamics(CFD) simulations were executed to exploring the intent of using aspirated cascade to replace tandem cascades.Firstly,the ONERA tandem cascades were investigated,and the performance of the cascades at the design point were listed,such as diffusion factor,total pressure loss coefficient,deviation angle etc.For replacing the ONERA tandem cascades,a new cascade was designed with the codes BLADEGEN developed by the authors.The quasi 3-D calculations were carried out using the collection of programs for cascade analysis and design,MISES.The cascade was analyzed and designed by using this code.And the cascade was simulated and analyzed by commercial CFD software.It is found there is an obvious separation on the suction side.Based on the 3D CFD simulation results of the cascade without aspiration,an aspirated cascade was designed by introducing a slot on the suction side.The performance of the aspirated cascade was investigated and compared with the tandem cascades,indicated that under the same inlet condition,the total pressure loss of the single row aspirated cascade was less than that of the tandem cascades,and the outlet static pressure is higher than that of the tandem cascades.Meanwhile,the different suction slot location,suction width and suction mass flow are studied for the aspirated cascade.
文摘BACKGROUND Orthobiologics-biological substances like platelet-rich plasma(PRP),bone marrow aspirate concentrate,and stem cells-are increasingly used in musculoskeletal care to promote tissue repair and reduce reliance on invasive surgery.Despite global momentum,India's clinical adoption remains underexplored.AIM To inform education,policy,and resource allocation for the safe and effective adoption of orthobiologics in musculoskeletal care.METHODS A cross-sectional electronic survey was conducted from January to March 2025 among orthopaedic surgeons,academicians,and trainees across India.The questionnaire assessed demographics,knowledge of orthobiologics,attitudes toward training and subspecialization,usage trends,regulatory awareness,and perceived barriers.Data were analyzed using descriptive statistics andχ2/Fisher’s exact tests,with P<0.05 considered significant.RESULTS A total of 1280 valid responses were collected.Awareness of orthobiologics was high(97%),with PRP being the most familiar and widely used(80%).Formal training was reported by only 31%,though 85%showed interest in structured education,and 68%supported orthobiologics as a subspecialty.Satisfaction with clinical outcomes averaged 6.5±2.3 out of 10 points.Barriers included high treatment cost(64%),poor patient awareness(90%),and limited access to biologics labs(18%).Regulatory understanding was moderate,with academic-affiliated clinicians more informed about stem cell guidelines.CONCLUSION Indian orthopaedic professionals demonstrate strong awareness and optimism toward orthobiologics,but widespread gaps in training,infrastructure,and regulation hinder broader adoption.Strategic investments in education,standardized protocols,and accessible facilities are essential to support safe and evidence-driven integration of regenerative therapies into clinical practice.
文摘BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention for its role in influencing their function,accessibility,and readiness for clinical use.AIM To identify the most suitable adipose source for MSC isolation and expansion for further applications.METHODS We isolated MSCs from solid adipose tissue and liposuction aspirates using the enzyme method.The MSCs were examined for their expansion using population doubling time,differentiation capacity using multilineage differentiation induction,surface markers using flow cytometry,and stability of chromosomes using the karyotyping method.Growth factors and cytokines in MSC-conditioned media were analyzed using the Luminex assay.RESULTS MSCs were isolated from solid adipose tissue and lipoaspirates and expanded from passage 0 to passage 2.All adipose-derived MSCs(AD-MSCs)exhibited the typical elongated,spindle-shaped morphology and comparable proliferation rate.They expressed positive surface markers(cluster of differentiation 73[CD73]:>97%,CD90:>98%,and CD105:>95%),and negative markers(<1%).All MSCs expressed similar levels of stemness genes(octamer-binding transcription factor 4,SRY-box 2,Krüppel-like factor,and MYC),colonyforming,and trilineage differentiation potential.Karyotyping analysis revealed normal chromosomal patterns in all samples,except one sample exhibiting a polymorphism(1qh+).Furthermore,the growth factors and cytokines of hepatocyte growth factor,vascular endothelial growth factor A,interleukin 6(IL-6),and IL-8 were detected in all AD-MSC conditioned media;but fibroblast growth factor-2 and keratinocyte growth factor were selectively expressed in conditioned media from solid or lipoaspirate AD-MSCs,respectively.CONCLUSION These findings indicate that AD-MSCs from both adipose sources possess all of the characteristic features of MSCs with source-specific secretome differences,which are suitable for further expansion and various clinical applications.
文摘On the occasion of the New Year,I would like to extend my sincere gratitude and New Year greetings to the experts,scholars,author teams,and readers who have long supported the development of Animal Models and Experimental Medicine(AMEM).Over the past year,we have faced challenges together and achieved breakthroughs in academic influence,internationalization,and fulfilling social respon-sibilities.Looking ahead,we are filled with confidence as we strive to build an important bridge connecting laboratory animal science and technology with academic research.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.
基金supported by the Special Project for the Construction of Innovative Provinces in Hunan Province,China(2020SK2013)。
文摘Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
文摘BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.
文摘A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.
文摘BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
基金supported by the National Natural Science Foundation of China(No.82272243)the Science and Technology Commission of Shanghai Municipality(No.22Y11900800).
文摘Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.
文摘Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.
文摘This article expands upon of endoscopic ultrasound’s(EUS)role in the evaluation of pancreatic lesions,building on findings presented by Ayesha et al and Tasneem et al regarding neuroendocrine tumors.We emphasize the diagnostic and therapeutic utility of EUS not only in solid pancreatic tumors but also in the increasingly prevalent cystic lesions,highlighting its particular relevance in resource-limited settings.By integrating high-resolution imaging,tissue acquisition,biomarker analysis,and minimally invasive interventions into a single platform,EUS addresses key diagnostic and therapeutic challenges,reducing the need for multiple costly procedures and enabling effective management even when access to advanced technologies is limited.
文摘BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.
