BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence...BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.展开更多
Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the causative agent of COVID-19,encodes several accessory proteins that have been shown to play crucial roles in regulating the innate immune response.Howeve...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the causative agent of COVID-19,encodes several accessory proteins that have been shown to play crucial roles in regulating the innate immune response.However,their expressions in infected cells and immunogenicity in infected humans and mice are still not fully understood.This study utilized various techniques such as luciferase immunoprecipitation system(LIPS),immunofluorescence assay(IFA),and western blot(WB)to detect accessory protein-specific antibodies in sera of COVID-19 patients.Specific antibodies to proteins 3a,3b,7b,8 and 9c can be detected by LIPS,but only protein 3a antibody was detected by IFA or WB.Antibodies against proteins 3a and 7b were only detected in ICU patients,which may serve as a marker for predicting disease progression.Further,we investigated the expression of accessory proteins in SARS-CoV-2-infected cells and identified the expressions of proteins 3a,6,7a,8,and 9b.We also analyzed their ability to induce antibodies in immunized mice and found that only proteins 3a,6,7a,8,9b and 9c were able to induce measurable antibody productions,but these antibodies lacked neutralizing activities and did not protect mice from SARS-CoV-2 infection.Our findings validate the expression of SARS-CoV-2 accessory proteins and elucidate their humoral immune response,providing a basis for protein detection assays and their role in pathogenesis.展开更多
The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct....The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional(3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In thisreport, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.展开更多
The development of accessory breast tissue,which is found anywhere along the milk line,is attributed to the failure of milk line remnants to regress during embryogenesis.Primary tumors may arise from any ectopic breas...The development of accessory breast tissue,which is found anywhere along the milk line,is attributed to the failure of milk line remnants to regress during embryogenesis.Primary tumors may arise from any ectopic breast tissue.Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare.Two such cases were reported in this article.One was a 43-year-old Chinese female who exhibited bilateral breast cancer(invasive ductal carcinoma,not otherwise specified,IDC-NOS) and an accessory breast carcinoma(IDC-NOS) incidentally identified in her left axilla.The ectopic breast tissue in her right axilla presented with adenosis.The patient was surgically treated,followed by postoperative docetaxel epirubicin(TE) chemotherapy.The second case was a 53-year-old Chinese female with bilateral breast cancer(apocrine carcinoma) accompanied by an accessory breast carcinoma(IDC-NOS) in her right axilla that was also incidentally identified.The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel(CET) neoadjuvant chemotherapy,followed by adjuvant chemotherapy of the same regimen.展开更多
We have previously demonstrated a high frequency of premature ejaculation （PE） among patients with male accessory gland infection （MAGI）. The aim of this study was to evaluate the ultrasound （US） features of pat...We have previously demonstrated a high frequency of premature ejaculation （PE） among patients with male accessory gland infection （MAGI）. The aim of this study was to evaluate the ultrasound （US） features of patients with MAGI and acquired premature ejaculation （APE） associated （MAGI-APEpos）. US evaluation of 50 MAGI-APEpos patients compared to 50 patients with MAGI without PE （MAGI-PEneg） which represent the control group. The diagnosis of APE was made through the evaluation of Intravaginal ejaculation latency time （IELT） and confirmed with the questionnaire PEDT （Premature Ejaculation Diagnostic Tool）. The main outcome measure was represented by the frequency of US criteria suggestive of P （prostatitis）, V （vesiculitis）, and E （epididymitis） in MAGI-APEpos and MAGI-PEneg patients. MAGI-APEpos patients showed a total number of US criteria significantly higher compared to MAGI-PEneg patients. MAGI-APEpos showed a higher frequency of US criteria of V and E （complicated forms of MAGI）. Finally, in MAGI-APEpos group, it was found a positive relationship between the anteroposterior diameter （APD） of the caudal tract of the epididymis and the APD of the seminal vesicles, as well as between both diameters and the PEDT score. MAGI-APEpos patients have a peculiar US characterization compared to MAGI-PEneg patients. According to these results, US evaluation of the epididymal and of the prostato vesicular tract should be considered in the practical clinical approach of patients with MAGI and APE. In particular, it could be a SUDDort for a possible Dathoahysiological interpretation of this clinical problem in these patients.展开更多
Male accessory gland inflammation or infection （MAGI） is a potentially underdiagnosed complication of type 2 diabetes （DM2）; specifically, we reported in a recent study that the frequency of MAGI was 43% among DM2...Male accessory gland inflammation or infection （MAGI） is a potentially underdiagnosed complication of type 2 diabetes （DM2）; specifically, we reported in a recent study that the frequency of MAGI was 43% among DM2 patients. In previous studies, we have demonstrated that diabetic autonomic neuropathy （DAN） is associated with a peculiar ultrasound characterization of the seminal vesicles （SVs） in DM2 patients. The aim of the present study was to evaluate the frequency of MAGI in two different categories of DM2 patients （i.e. patients with and without symptoms that possibly reflect DAN） and the respective ultrasound characterizations. Sixty DM2 patients with a mean （± s.e.m.） age of 42.0 ± 6.0 years （range： 34-47 years） were classified according to the presence or the absence of symptoms that could possibly reflect DAN （group A： DM2 with symptoms possibly reflecting DAN, n = 28 patients and group B： DM2 without symptoms possibly reflecting DAN, n = 32 patients）. The patients in Group A exhibited a significantly higher frequency of MAGI compared with those in group B patients （P 〈 0.05）; moreover, the Group A patients exhibited a significantly higher frequency of ultrasound signs suggestive of vesiculitis （P 〈 0.05）. Finally, the concentrations of lymphocytes but not the concentrations of the leukocytes in the semen were significantly higher （P 〈 0.05） in group A compared with group B.展开更多
Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic...Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.展开更多
A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity origina...A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.展开更多
BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The...BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.展开更多
The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes v...The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end.Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography.Patency of the APD in 46 patients with acute pancreatitis was only 17%,which was significantly lower than in control cases (P < 0.01).The terminal shape of the APD was correlated with APD patency.Based on the data about correlation between the terminal shape of the APD and its patency,the estimated APD patency in 167 patients with acute pancreatitis was 21%,which was signif icantly lower than in control cases (P < 0.01).A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute pancreatitis.Pancreatographic f indings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients).While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma,n=42;bile duct carcinoma,n=6) were identified in PBM with a normal pancreatic duct system,only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05).Concentration of amylase in the bile of DPD dominance was signifi cantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L,P < 0.05).In PBM with DPD dominance,most pancreatic juice in the upper DPD is drained into the duodenum via the MIP,and reflux of pancreatic juice to the biliary tract might be reduced,resulting in less frequency of associated biliary carcinoma.展开更多
Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not d...Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct(H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.展开更多
Here,we report a case of intrapancreatic accessory spleen confirmed by pathologic diagnosis and discuss its differential diagnosis and surgical management with a review of the literature.
To gain insight into the function of AOB and MOB during different social interaction and in different vole species,the behaviors and neural activation of the olfactory bulbs in social interactions of mandarin voles Mi...To gain insight into the function of AOB and MOB during different social interaction and in different vole species,the behaviors and neural activation of the olfactory bulbs in social interactions of mandarin voles Microtus mandarinus and reed voles Microtus fortis were compared in the present research.Mandarin voles spent significantly more time attacking and sniffing their opponents and sniffing sawdust than reed voles.During same sex encounters,mandarin voles attacked their opponents for a significantly longer time and sniffed its opponent for shorter time compared with male-female interactions.However,no significant behavioral differences were found during encounters of two individual reed voles,regardless of gender composition of the pair.Using c-Fos as an indicator of neural activation,we observed that neural activation was significantly higher in almost all sub-regions of the main olfactory bulb(MOB)and the accessory olfactory bulb(AOB)of mandarin voles compared with reed voles.Numbers of c-Fos-ir neurons in almost all sub-regions of the AOB and the MOB during male-female interactions were also higher than those in interactions of the same sex.Anterior-posterior ratios of Fos-ir neurons in the AOBM(AOBMR)and the AOBG(AOBGR)in male-female interaction were significantly higher than those in interaction of the same sex.The AOBMR of male mandarin voles and reed voles were larger than those of females in male-female interactions.Behavioral patterns are consistent with cellular activity patterns.Consistent level of neural activation in MOB and AOB suggests important roles of both the main olfactory bulb and the accessory olfactory bulb in social interaction in two species.展开更多
In order to investigate the neuroendocrine mechanism of the mating behavior in the adult male mandarin voles Microtus mandarinus,the radioimmunoassay(RIA)and immunohistochemistry methods were used to investigate the d...In order to investigate the neuroendocrine mechanism of the mating behavior in the adult male mandarin voles Microtus mandarinus,the radioimmunoassay(RIA)and immunohistochemistry methods were used to investigate the differences in plasma testosterone(T)concentrations and distribution of T immunoreactive neurons(T-IRs),androgen receptor immunoreactive neurons(AR-IRs)and Fos protein immunoreactive neurons(Fos-IRs)in the accessory olfactory bulb(AOB)and the main olfactory bulb(MOB)following exposure to clean hard-wood shavings(control group),soiled bedding(exposure group)or contact with an estrous female(mating group).Results showed that plasma T concentration was significantly higher in the mating group than that in the exposure group,and both the mating group and the exposure group displayed significantly higher plasma T concentration than the control group.T-IRs,AR-IRs and Fos-IRs were investigated with the immunohistochemistry method in granule cell(GC)and mitral cell(MC)of the MOB and the AOB in the three groups.There were significantly more T-IRs,AR-IRs and Fos-IRs in MC and GC of the AOB in the mating group than that in the exposure group or the control group.T-IRs,AR-IRs and Fos-IRs did not show significant differences between the exposure group and the control group.Furthermore,obvious differences in MC and GC of the MOB were not found among the three groups.The results confirm that both changes of T and AR in the AOB might be underlying mating behavior in the adult male mandarin voles.展开更多
Intrapancreatic accessory spleen(IPAS)is a rare differential diagnosis of a solitary hypervascular lesion.It is not uncommon to misdiagnose IPAS as pancreatic tumors since no specific imaging has been developed for th...Intrapancreatic accessory spleen(IPAS)is a rare differential diagnosis of a solitary hypervascular lesion.It is not uncommon to misdiagnose IPAS as pancreatic tumors since no specific imaging has been developed for the differential diagnosis.We described a rare case of a male patient with a unilateral accessory nipple and a solitary hypervascular lesion in the pancreas.The patient underwent a distal pancreaticosplenectomy,and IPAS was finally diagnosed.展开更多
BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diag...BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.展开更多
After the establishment of the global stratotype section and point (GSSP) of the Permian Triassic boundary (PTB), the definition of the accessory section and point (ASP) of the terrestrial Permian Triassic boundary ...After the establishment of the global stratotype section and point (GSSP) of the Permian Triassic boundary (PTB), the definition of the accessory section and point (ASP) of the terrestrial Permian Triassic boundary (TPTB) is now on the agenda. However, all good TPTB sections so far known have the following shortcomings: (1) the exact TPTB horizon is difficult to define paleontologically with high resolution, and (2) accurate correlation between marine and terrestrial PTBs is hard to attain. In order to enhance the understanding of the nature of the global life crisis in both the marine and terrestrial environments across the Paleozoic Mesozoic transition, these shortcomings need to be addressed. In western Guizhou and eastern Yunnan, Southwest China, some fossiliferous PTB sections which include marine, paralic and terrestrial are well developed, allowing bed to bed correlation of the PTB sequences. Fortunately, the marine PTB sequence in this area is almost the same as found at the Meishan Section, where the GSSP of the PTB is located, which may provide a reliable auxiliary marker for high resolution demarcation of the TPTB. These features found in western Guizhou and eastern Yunnan make this area a good place to study the ASP of the TPTB, so we propose to study the ASP of the TPTB in this area.展开更多
AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were rec...AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.展开更多
Background: Primary poorly differentiated adenocarcinoma of the accessory breast is rare. We report such a case in a 56-year-old Malaysian woman of Indian ethnicity. Case Presentation: An axillary swelling measuring 5...Background: Primary poorly differentiated adenocarcinoma of the accessory breast is rare. We report such a case in a 56-year-old Malaysian woman of Indian ethnicity. Case Presentation: An axillary swelling measuring 5 × 5 cm on excisional biopsy revealed a poorly differentiated adenocarcinoma with positive HER2 gene amplification. Conclusion: Overall prognosis is similar to that of a carcinoma of the normal breast, therefore early diagnosis is imperative to ascertain curable status and improve prognosis.展开更多
文摘BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.
基金supported by grants from the National Natural Science Foundation of China(82002127,81971500,82025001,82172240)National Key R&D Program of China(2021YFC2301700,2022YFC2604100)+1 种基金Guangdong Basic and Applied Basic Research Foundation(2022B1515020059,2021B1515130005)R&D Program of Guangzhou Laboratory(EKPG21-30-2).
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the causative agent of COVID-19,encodes several accessory proteins that have been shown to play crucial roles in regulating the innate immune response.However,their expressions in infected cells and immunogenicity in infected humans and mice are still not fully understood.This study utilized various techniques such as luciferase immunoprecipitation system(LIPS),immunofluorescence assay(IFA),and western blot(WB)to detect accessory protein-specific antibodies in sera of COVID-19 patients.Specific antibodies to proteins 3a,3b,7b,8 and 9c can be detected by LIPS,but only protein 3a antibody was detected by IFA or WB.Antibodies against proteins 3a and 7b were only detected in ICU patients,which may serve as a marker for predicting disease progression.Further,we investigated the expression of accessory proteins in SARS-CoV-2-infected cells and identified the expressions of proteins 3a,6,7a,8,and 9b.We also analyzed their ability to induce antibodies in immunized mice and found that only proteins 3a,6,7a,8,9b and 9c were able to induce measurable antibody productions,but these antibodies lacked neutralizing activities and did not protect mice from SARS-CoV-2 infection.Our findings validate the expression of SARS-CoV-2 accessory proteins and elucidate their humoral immune response,providing a basis for protein detection assays and their role in pathogenesis.
文摘The development of diagnostic imaging technology, such as multidetector computed tomography(MDCT) and magnetic resonance cholangiopancreatography(MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional(3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In thisreport, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.
基金supported by the National Natural Science Foundation of China(No.30930038)National"973"Program of China(No.2009CB521700+1 种基金2009CB918903)Program for Changjiang Scholars and Innovative Research Team in University(No.IRT0743)
文摘The development of accessory breast tissue,which is found anywhere along the milk line,is attributed to the failure of milk line remnants to regress during embryogenesis.Primary tumors may arise from any ectopic breast tissue.Accessory breast cancer occurring concurrently with primary invasive breast cancer is extremely rare.Two such cases were reported in this article.One was a 43-year-old Chinese female who exhibited bilateral breast cancer(invasive ductal carcinoma,not otherwise specified,IDC-NOS) and an accessory breast carcinoma(IDC-NOS) incidentally identified in her left axilla.The ectopic breast tissue in her right axilla presented with adenosis.The patient was surgically treated,followed by postoperative docetaxel epirubicin(TE) chemotherapy.The second case was a 53-year-old Chinese female with bilateral breast cancer(apocrine carcinoma) accompanied by an accessory breast carcinoma(IDC-NOS) in her right axilla that was also incidentally identified.The patient was surgically treated after three doses of cyclophosphamide epirubicin docetaxel(CET) neoadjuvant chemotherapy,followed by adjuvant chemotherapy of the same regimen.
文摘We have previously demonstrated a high frequency of premature ejaculation （PE） among patients with male accessory gland infection （MAGI）. The aim of this study was to evaluate the ultrasound （US） features of patients with MAGI and acquired premature ejaculation （APE） associated （MAGI-APEpos）. US evaluation of 50 MAGI-APEpos patients compared to 50 patients with MAGI without PE （MAGI-PEneg） which represent the control group. The diagnosis of APE was made through the evaluation of Intravaginal ejaculation latency time （IELT） and confirmed with the questionnaire PEDT （Premature Ejaculation Diagnostic Tool）. The main outcome measure was represented by the frequency of US criteria suggestive of P （prostatitis）, V （vesiculitis）, and E （epididymitis） in MAGI-APEpos and MAGI-PEneg patients. MAGI-APEpos patients showed a total number of US criteria significantly higher compared to MAGI-PEneg patients. MAGI-APEpos showed a higher frequency of US criteria of V and E （complicated forms of MAGI）. Finally, in MAGI-APEpos group, it was found a positive relationship between the anteroposterior diameter （APD） of the caudal tract of the epididymis and the APD of the seminal vesicles, as well as between both diameters and the PEDT score. MAGI-APEpos patients have a peculiar US characterization compared to MAGI-PEneg patients. According to these results, US evaluation of the epididymal and of the prostato vesicular tract should be considered in the practical clinical approach of patients with MAGI and APE. In particular, it could be a SUDDort for a possible Dathoahysiological interpretation of this clinical problem in these patients.
文摘Male accessory gland inflammation or infection （MAGI） is a potentially underdiagnosed complication of type 2 diabetes （DM2）; specifically, we reported in a recent study that the frequency of MAGI was 43% among DM2 patients. In previous studies, we have demonstrated that diabetic autonomic neuropathy （DAN） is associated with a peculiar ultrasound characterization of the seminal vesicles （SVs） in DM2 patients. The aim of the present study was to evaluate the frequency of MAGI in two different categories of DM2 patients （i.e. patients with and without symptoms that possibly reflect DAN） and the respective ultrasound characterizations. Sixty DM2 patients with a mean （± s.e.m.） age of 42.0 ± 6.0 years （range： 34-47 years） were classified according to the presence or the absence of symptoms that could possibly reflect DAN （group A： DM2 with symptoms possibly reflecting DAN, n = 28 patients and group B： DM2 without symptoms possibly reflecting DAN, n = 32 patients）. The patients in Group A exhibited a significantly higher frequency of MAGI compared with those in group B patients （P 〈 0.05）; moreover, the Group A patients exhibited a significantly higher frequency of ultrasound signs suggestive of vesiculitis （P 〈 0.05）. Finally, the concentrations of lymphocytes but not the concentrations of the leukocytes in the semen were significantly higher （P 〈 0.05） in group A compared with group B.
基金Supported by Zhejiang Provincial Public Welfare Technology Application Research Projects under Grant,No.2013C33214Zhejiang Provincial Natural Science Foundation of China under Grant,No.LQ14H160001
文摘Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.
文摘A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.
文摘BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.
文摘The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end.Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography.Patency of the APD in 46 patients with acute pancreatitis was only 17%,which was significantly lower than in control cases (P < 0.01).The terminal shape of the APD was correlated with APD patency.Based on the data about correlation between the terminal shape of the APD and its patency,the estimated APD patency in 167 patients with acute pancreatitis was 21%,which was signif icantly lower than in control cases (P < 0.01).A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute pancreatitis.Pancreatographic f indings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients).While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma,n=42;bile duct carcinoma,n=6) were identified in PBM with a normal pancreatic duct system,only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05).Concentration of amylase in the bile of DPD dominance was signifi cantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L,P < 0.05).In PBM with DPD dominance,most pancreatic juice in the upper DPD is drained into the duodenum via the MIP,and reflux of pancreatic juice to the biliary tract might be reduced,resulting in less frequency of associated biliary carcinoma.
文摘Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct(H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.
文摘Here,we report a case of intrapancreatic accessory spleen confirmed by pathologic diagnosis and discuss its differential diagnosis and surgical management with a review of the literature.
基金supported by National Natural Science Foundation of China(No.30670273No.30200026)Ministry of Education Key Project of Peoples Republic of China(20060718)
文摘To gain insight into the function of AOB and MOB during different social interaction and in different vole species,the behaviors and neural activation of the olfactory bulbs in social interactions of mandarin voles Microtus mandarinus and reed voles Microtus fortis were compared in the present research.Mandarin voles spent significantly more time attacking and sniffing their opponents and sniffing sawdust than reed voles.During same sex encounters,mandarin voles attacked their opponents for a significantly longer time and sniffed its opponent for shorter time compared with male-female interactions.However,no significant behavioral differences were found during encounters of two individual reed voles,regardless of gender composition of the pair.Using c-Fos as an indicator of neural activation,we observed that neural activation was significantly higher in almost all sub-regions of the main olfactory bulb(MOB)and the accessory olfactory bulb(AOB)of mandarin voles compared with reed voles.Numbers of c-Fos-ir neurons in almost all sub-regions of the AOB and the MOB during male-female interactions were also higher than those in interactions of the same sex.Anterior-posterior ratios of Fos-ir neurons in the AOBM(AOBMR)and the AOBG(AOBGR)in male-female interaction were significantly higher than those in interaction of the same sex.The AOBMR of male mandarin voles and reed voles were larger than those of females in male-female interactions.Behavioral patterns are consistent with cellular activity patterns.Consistent level of neural activation in MOB and AOB suggests important roles of both the main olfactory bulb and the accessory olfactory bulb in social interaction in two species.
基金funded by theNatural Science Foundation of China(30670273)Natural Science Foundation of ShaanXi(2008C269)+1 种基金Science and Technology Plan Project of Xi'an Burea of Science and Technology(YF07194)Special Science Research Fund for Xi'an University of Arts and Science(KY200520)
文摘In order to investigate the neuroendocrine mechanism of the mating behavior in the adult male mandarin voles Microtus mandarinus,the radioimmunoassay(RIA)and immunohistochemistry methods were used to investigate the differences in plasma testosterone(T)concentrations and distribution of T immunoreactive neurons(T-IRs),androgen receptor immunoreactive neurons(AR-IRs)and Fos protein immunoreactive neurons(Fos-IRs)in the accessory olfactory bulb(AOB)and the main olfactory bulb(MOB)following exposure to clean hard-wood shavings(control group),soiled bedding(exposure group)or contact with an estrous female(mating group).Results showed that plasma T concentration was significantly higher in the mating group than that in the exposure group,and both the mating group and the exposure group displayed significantly higher plasma T concentration than the control group.T-IRs,AR-IRs and Fos-IRs were investigated with the immunohistochemistry method in granule cell(GC)and mitral cell(MC)of the MOB and the AOB in the three groups.There were significantly more T-IRs,AR-IRs and Fos-IRs in MC and GC of the AOB in the mating group than that in the exposure group or the control group.T-IRs,AR-IRs and Fos-IRs did not show significant differences between the exposure group and the control group.Furthermore,obvious differences in MC and GC of the MOB were not found among the three groups.The results confirm that both changes of T and AR in the AOB might be underlying mating behavior in the adult male mandarin voles.
文摘Intrapancreatic accessory spleen(IPAS)is a rare differential diagnosis of a solitary hypervascular lesion.It is not uncommon to misdiagnose IPAS as pancreatic tumors since no specific imaging has been developed for the differential diagnosis.We described a rare case of a male patient with a unilateral accessory nipple and a solitary hypervascular lesion in the pancreas.The patient underwent a distal pancreaticosplenectomy,and IPAS was finally diagnosed.
基金Supported by the National Natural Science foundation of China,No. 82202135, and No. 82171925Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No. 2023QB0112+1 种基金Innovative Development Foundation of Department in Jiangsu Hospital of Chinese Medicine,No. Y2021CX19Developing Program for High-level Academic Talent in Jiangsu Hospital of TCM,No. y2021rc03
文摘BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.
文摘After the establishment of the global stratotype section and point (GSSP) of the Permian Triassic boundary (PTB), the definition of the accessory section and point (ASP) of the terrestrial Permian Triassic boundary (TPTB) is now on the agenda. However, all good TPTB sections so far known have the following shortcomings: (1) the exact TPTB horizon is difficult to define paleontologically with high resolution, and (2) accurate correlation between marine and terrestrial PTBs is hard to attain. In order to enhance the understanding of the nature of the global life crisis in both the marine and terrestrial environments across the Paleozoic Mesozoic transition, these shortcomings need to be addressed. In western Guizhou and eastern Yunnan, Southwest China, some fossiliferous PTB sections which include marine, paralic and terrestrial are well developed, allowing bed to bed correlation of the PTB sequences. Fortunately, the marine PTB sequence in this area is almost the same as found at the Meishan Section, where the GSSP of the PTB is located, which may provide a reliable auxiliary marker for high resolution demarcation of the TPTB. These features found in western Guizhou and eastern Yunnan make this area a good place to study the ASP of the TPTB, so we propose to study the ASP of the TPTB in this area.
文摘AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.
文摘Background: Primary poorly differentiated adenocarcinoma of the accessory breast is rare. We report such a case in a 56-year-old Malaysian woman of Indian ethnicity. Case Presentation: An axillary swelling measuring 5 × 5 cm on excisional biopsy revealed a poorly differentiated adenocarcinoma with positive HER2 gene amplification. Conclusion: Overall prognosis is similar to that of a carcinoma of the normal breast, therefore early diagnosis is imperative to ascertain curable status and improve prognosis.
