BACKGROUND Gallbladder neuroendocrine carcinoma(NEC)represents a subtype of gallbladder malignancies characterized by a low incidence,aggressive nature,and poor prognosis.Despite its clinical severity,the genetic alte...BACKGROUND Gallbladder neuroendocrine carcinoma(NEC)represents a subtype of gallbladder malignancies characterized by a low incidence,aggressive nature,and poor prognosis.Despite its clinical severity,the genetic alterations,mechanisms,and signaling pathways underlying gallbladder NEC remain unclear.CASE SUMMARY This case study presents a rare instance of primary gallbladder NEC in a 73-year-old female patient,who underwent a radical cholecystectomy with hepatic hilar lymphadenectomy and resection of liver segments IV-B and V.Targeted gene sequencing and bioinformatics analysis tools,including STRING,GeneMANIA,Metascape,TRRUST,Sangerbox,cBioPortal and GSCA,were used to analyze the biological functions and features of mutated genes in gallbladder NEC.Twelve mutations(APC,ARID2,IFNA6,KEAP1,RB1,SMAD4,TP53,BTK,GATA1,GNAS,and PRDM3)were identified,and the tumor mutation burden was determined to be 9.52 muts/Mb via targeted gene sequencing.A protein-protein interaction network showed significant interactions among the twelve mutated genes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were used to assess mutation functions and pathways.The results revealed 40 tumor-related pathways.A key regulatory factor for gallbladder NEC-related genes was identified,and its biological functions and features were compared with those of gallbladder carcinoma.CONCLUSION Gallbladder NEC requires standardized treatment.Comparisons with other gallbladder carcinomas revealed clinical phenotypes,molecular alterations,functional characteristics,and enriched pathways.展开更多
BACKGROUND Renal tubular acidosis(RTA)refers to a group of kidney disorders characterized by defective acid excretion or bicarbonate reabsorption,leading to metabolic acidosis.This case series presents three cases of ...BACKGROUND Renal tubular acidosis(RTA)refers to a group of kidney disorders characterized by defective acid excretion or bicarbonate reabsorption,leading to metabolic acidosis.This case series presents three cases of RTA with distinct etiologies and clinical manifestations.These cases emphasize the necessity of a comprehensive evaluation of RTA,considering both renal and systemic origins.CASE SUMMARY The first case describes a female patient with osteopetrosis-related RTA,diagnosed with Guibaud-Vainsel syndrome,emphasizing the importance of genetic assessment.The second case delineates RTA secondary to focal segmental glomerulosclerosis,associating tubular dysfunction with glomerular pathology.In the first two cases whole exome sequencing confirmed genetic diagnosis.The third case illuminates RTA as a complication of Graves’disease,highlighting autoimmune implications.CONCLUSION These cases underscore the interdisciplinary approach essential in RTA management.Understanding the diverse pathophysiology of RTA aids in tailored therapeutic strategies and improved patient outcomes.展开更多
BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are...BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.展开更多
BACKGROUND Gastrointestinal diseases in young children are often anatomic or inflammatory in nature and can present with symptoms similar to those of Cow’s milk protein allergy(CMPA),complicating diagnosis.This case ...BACKGROUND Gastrointestinal diseases in young children are often anatomic or inflammatory in nature and can present with symptoms similar to those of Cow’s milk protein allergy(CMPA),complicating diagnosis.This case series highlights 3 pediatric patients initially misdiagnosed with CMPA,emphasizing the need for a thorough evaluation.CASE SUMMARY Case 1:A 3-year-old child with chronic abdominal distension and constipation was initially treated for CMPA and was later diagnosed with Hirschsprung disease through rectal biopsy.Surgical intervention involved a laparoscopic colostomy followed by a pull-through procedure,leading to a successful recovery.Case 2:A 2-month-old infant presented with greenish-yellow vomiting and abdominal distension.Initially misdiagnosed with CMPA,further investigation using barium studies revealed partial intestinal malrotation.The patient underwent a laparoscopic Ladd’s procedure and recovered well.Case 3:A 6-month-old infant with persistent vomiting and failure to thrive had been treated for CMPA.Detailed imaging studies indicated achalasia.The child underwent a Heller myotomy,which resulted in significant symptom improvement and weight gain CONCLUSION Thorough evaluation of gastrointestinal symptoms is necessary in children.A high suspicion for alternative diagnoses will prevent delays in accurate diagnosis and proper treatment,leading to improved outcomes.展开更多
String validation routines have been widely used in many real-world applications,such as email validation and postcode validation.String test cases are adopted to test these validation routines,to identify potential d...String validation routines have been widely used in many real-world applications,such as email validation and postcode validation.String test cases are adopted to test these validation routines,to identify potential defects and security risks.Random Testing(RT)is a well-known testing approach to randomly generate string test cases from the input domain(i.e.,the set of all possible test inputs),which is simple to implement at a low cost.However,its testing effectiveness may be unsatisfactory for string validation routines.The main reason for this is that RT may have a high probability to generate invalid rather than valid string test cases,due to its randomness property.This research proposes a new RT approach based on the output types(i.e.,valid and invalid strings)for string validation routines,namely Output-type-guided Random Testing(RTO),which attempts to randomly generate both valid and invalid string test cases with a certain probability.This research performed an empirical study involving several real-world string validation routines collected from ten Java open-source projects,to investigate and compare testing performances of RT-O against the previous two widely-used RT methods.The results show that the generated string test cases by RT-O outperform test cases generated by other RT methods.展开更多
BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring except...BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.展开更多
BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on pati...BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per y...BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple pri...BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.展开更多
High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relati...High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.展开更多
BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding s...BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding structured,multimodal rehabilitation programs targeting biomechanical deficits in IFI.This case report evaluates the efficacy of a multimodal rehabilitation program addressing a critical gap in conservative management strategies.CASE SUMMARY The patient underwent comprehensive physical and clinical examination,including hip X-ray and magnetic resonance imaging investigations.The patient completed the Musculoskeletal Health Questionnaire(MSK-HQ)and numerical pain rating scale(NPRS).The patient underwent a two-month tailored structured physical therapy intervention and repeated the same assessment afterwards.The patient's substantial reduction in pain,reflected by a significant decrease in the patient’s NPRS score from 9 to 3 points,signifies a positive clinical response.This outcome,coupled with the significant improvement in the patient's health-related quality of life according to the MSK-HQ score,which increased from 12 to 48 points,underscores the success of our research.CONCLUSION The study highlights the importance of a comprehensive approach to diagnosing and managing IFI,combining clinical assessment with imaging and implementing a multimodal rehabilitation program for optimal outcomes.展开更多
BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
Objective This study reports the first imported case of Lassa fever(LF)in China.Laboratory detection and molecular epidemiological analysis of the Lassa virus(LASV)from this case offer valuable insights for the preven...Objective This study reports the first imported case of Lassa fever(LF)in China.Laboratory detection and molecular epidemiological analysis of the Lassa virus(LASV)from this case offer valuable insights for the prevention and control of LF.Methods Samples of cerebrospinal fluid(CSF),blood,urine,saliva,and environmental materials were collected from the patient and their close contacts for LASV nucleotide detection.Whole-genome sequencing was performed on positive samples to analyze the genetic characteristics of the virus.Results LASV was detected in the patient’s CSF,blood,and urine,while all samples from close contacts and the environment tested negative.The virus belongs to the lineage IV strain and shares the highest homology with strains from Sierra Leone.The variability in the glycoprotein complex(GPC)among different strains ranged from 3.9%to 15.1%,higher than previously reported for the seven known lineages.Amino acid mutation analysis revealed multiple mutations within the GPC immunogenic epitopes,increasing strain diversity and potentially impacting immune response.Conclusion The case was confirmed through nucleotide detection,with no evidence of secondary transmission or viral spread.The LASV strain identified belongs to lineage IV,with broader GPC variability than previously reported.Mutations in the immune-related sites of GPC may affect immune responses,necessitating heightened vigilance regarding the virus.展开更多
BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver fu...BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.展开更多
BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes t...BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a ...BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a total of 13 procedures within our medical facility,including five performed under local anesthesia and eight performed under general anesthesia.The source of the ailment was ultimately identified as Enterobacter cloacae.After the last procedure,the patient's symptoms were alleviated,and the recovery process was satisfactory.Three months post-operation,the Japanese Orthopaedic Association scores had improved to 100%.Imageological examination revealed a satisfactory position of internal fixation,and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.CONCLUSION The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection,providing an alternative to traditional surgery.展开更多
基金Supported by School-Level Key Projects at Bengbu Medical College,No.2021byzd109.
文摘BACKGROUND Gallbladder neuroendocrine carcinoma(NEC)represents a subtype of gallbladder malignancies characterized by a low incidence,aggressive nature,and poor prognosis.Despite its clinical severity,the genetic alterations,mechanisms,and signaling pathways underlying gallbladder NEC remain unclear.CASE SUMMARY This case study presents a rare instance of primary gallbladder NEC in a 73-year-old female patient,who underwent a radical cholecystectomy with hepatic hilar lymphadenectomy and resection of liver segments IV-B and V.Targeted gene sequencing and bioinformatics analysis tools,including STRING,GeneMANIA,Metascape,TRRUST,Sangerbox,cBioPortal and GSCA,were used to analyze the biological functions and features of mutated genes in gallbladder NEC.Twelve mutations(APC,ARID2,IFNA6,KEAP1,RB1,SMAD4,TP53,BTK,GATA1,GNAS,and PRDM3)were identified,and the tumor mutation burden was determined to be 9.52 muts/Mb via targeted gene sequencing.A protein-protein interaction network showed significant interactions among the twelve mutated genes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were used to assess mutation functions and pathways.The results revealed 40 tumor-related pathways.A key regulatory factor for gallbladder NEC-related genes was identified,and its biological functions and features were compared with those of gallbladder carcinoma.CONCLUSION Gallbladder NEC requires standardized treatment.Comparisons with other gallbladder carcinomas revealed clinical phenotypes,molecular alterations,functional characteristics,and enriched pathways.
文摘BACKGROUND Renal tubular acidosis(RTA)refers to a group of kidney disorders characterized by defective acid excretion or bicarbonate reabsorption,leading to metabolic acidosis.This case series presents three cases of RTA with distinct etiologies and clinical manifestations.These cases emphasize the necessity of a comprehensive evaluation of RTA,considering both renal and systemic origins.CASE SUMMARY The first case describes a female patient with osteopetrosis-related RTA,diagnosed with Guibaud-Vainsel syndrome,emphasizing the importance of genetic assessment.The second case delineates RTA secondary to focal segmental glomerulosclerosis,associating tubular dysfunction with glomerular pathology.In the first two cases whole exome sequencing confirmed genetic diagnosis.The third case illuminates RTA as a complication of Graves’disease,highlighting autoimmune implications.CONCLUSION These cases underscore the interdisciplinary approach essential in RTA management.Understanding the diverse pathophysiology of RTA aids in tailored therapeutic strategies and improved patient outcomes.
文摘BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.
文摘BACKGROUND Gastrointestinal diseases in young children are often anatomic or inflammatory in nature and can present with symptoms similar to those of Cow’s milk protein allergy(CMPA),complicating diagnosis.This case series highlights 3 pediatric patients initially misdiagnosed with CMPA,emphasizing the need for a thorough evaluation.CASE SUMMARY Case 1:A 3-year-old child with chronic abdominal distension and constipation was initially treated for CMPA and was later diagnosed with Hirschsprung disease through rectal biopsy.Surgical intervention involved a laparoscopic colostomy followed by a pull-through procedure,leading to a successful recovery.Case 2:A 2-month-old infant presented with greenish-yellow vomiting and abdominal distension.Initially misdiagnosed with CMPA,further investigation using barium studies revealed partial intestinal malrotation.The patient underwent a laparoscopic Ladd’s procedure and recovered well.Case 3:A 6-month-old infant with persistent vomiting and failure to thrive had been treated for CMPA.Detailed imaging studies indicated achalasia.The child underwent a Heller myotomy,which resulted in significant symptom improvement and weight gain CONCLUSION Thorough evaluation of gastrointestinal symptoms is necessary in children.A high suspicion for alternative diagnoses will prevent delays in accurate diagnosis and proper treatment,leading to improved outcomes.
基金supported by the Science and Technology Development Fund of Macao,Macao SAR(Nos.0021/2023/RIA1 and 0046/2021/A)a Faculty Research Grant of Macao University of Science and Technology(No.FRG-22-103-FIE)supported by the National Natural Science Foundation of China(Nos.61872167 and 61502205).
文摘String validation routines have been widely used in many real-world applications,such as email validation and postcode validation.String test cases are adopted to test these validation routines,to identify potential defects and security risks.Random Testing(RT)is a well-known testing approach to randomly generate string test cases from the input domain(i.e.,the set of all possible test inputs),which is simple to implement at a low cost.However,its testing effectiveness may be unsatisfactory for string validation routines.The main reason for this is that RT may have a high probability to generate invalid rather than valid string test cases,due to its randomness property.This research proposes a new RT approach based on the output types(i.e.,valid and invalid strings)for string validation routines,namely Output-type-guided Random Testing(RTO),which attempts to randomly generate both valid and invalid string test cases with a certain probability.This research performed an empirical study involving several real-world string validation routines collected from ten Java open-source projects,to investigate and compare testing performances of RT-O against the previous two widely-used RT methods.The results show that the generated string test cases by RT-O outperform test cases generated by other RT methods.
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
文摘BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.
文摘BACKGROUND Middle meningeal artery embolization(MMAE)is emerging as a promising treatment for chronic subdural hematoma(CSDH),serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation.Due to its low recurrence rate and minimal complications,MMAE has gained increasing acceptance among clinicians in recent years.This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery,aiming to enhance awareness of this complication.CASE SUMMARY A 60-year-old male patient presented with a headache following head trauma,and cranial computed tomography revealed a left-sided CSDH.The patient underwent left MMAE;however,polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery,resulting in diplopia due to impaired abduction of the left eye.The diplopia resolved by postoperative day 40.The patient’s headache resolved by postoperative day 7,and the hematoma completely resolved by postoperative day 108.CONCLUSION Potential anastomotic arteries in the middle meningeal artery(MMA)can lead to serious complications.Superselective angiography of the MMA or its branches prior to embolization is essential.Performing embolization distal to potential anastomotic sites can reduce risks,and the presence of an anastomosis may warrant coil embolization or termination of the procedure.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
文摘BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
基金Supported by Gansu Provincial Natural Science Foundation,No.21JR1RA010In-Hospital Research Fund of Gansu Provincial Hospital,No.23GSSYD-5.
文摘BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.
文摘High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.
文摘BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding structured,multimodal rehabilitation programs targeting biomechanical deficits in IFI.This case report evaluates the efficacy of a multimodal rehabilitation program addressing a critical gap in conservative management strategies.CASE SUMMARY The patient underwent comprehensive physical and clinical examination,including hip X-ray and magnetic resonance imaging investigations.The patient completed the Musculoskeletal Health Questionnaire(MSK-HQ)and numerical pain rating scale(NPRS).The patient underwent a two-month tailored structured physical therapy intervention and repeated the same assessment afterwards.The patient's substantial reduction in pain,reflected by a significant decrease in the patient’s NPRS score from 9 to 3 points,signifies a positive clinical response.This outcome,coupled with the significant improvement in the patient's health-related quality of life according to the MSK-HQ score,which increased from 12 to 48 points,underscores the success of our research.CONCLUSION The study highlights the importance of a comprehensive approach to diagnosing and managing IFI,combining clinical assessment with imaging and implementing a multimodal rehabilitation program for optimal outcomes.
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
基金supported by Public Health Talent Training and Surport Plan(National Administration of Disease Prevention and Control)Research and application of new technology for rapid monitoring and tracing of emergent infectious diseases among entry-exit population(2024YFFK0056)Monitoring,Early warning and Response of Major Infectious Diseases(2022ZDZX0017).
文摘Objective This study reports the first imported case of Lassa fever(LF)in China.Laboratory detection and molecular epidemiological analysis of the Lassa virus(LASV)from this case offer valuable insights for the prevention and control of LF.Methods Samples of cerebrospinal fluid(CSF),blood,urine,saliva,and environmental materials were collected from the patient and their close contacts for LASV nucleotide detection.Whole-genome sequencing was performed on positive samples to analyze the genetic characteristics of the virus.Results LASV was detected in the patient’s CSF,blood,and urine,while all samples from close contacts and the environment tested negative.The virus belongs to the lineage IV strain and shares the highest homology with strains from Sierra Leone.The variability in the glycoprotein complex(GPC)among different strains ranged from 3.9%to 15.1%,higher than previously reported for the seven known lineages.Amino acid mutation analysis revealed multiple mutations within the GPC immunogenic epitopes,increasing strain diversity and potentially impacting immune response.Conclusion The case was confirmed through nucleotide detection,with no evidence of secondary transmission or viral spread.The LASV strain identified belongs to lineage IV,with broader GPC variability than previously reported.Mutations in the immune-related sites of GPC may affect immune responses,necessitating heightened vigilance regarding the virus.
文摘BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.
文摘BACKGROUND Bioabsorbable interference screws are a widely used option for graft fixation in anterior cruciate ligament(ACL)reconstruction.Their ability to degrade over time and avoid secondary hardware removal makes them advantageous.However,complications such as breakage and intra-articular migration of screws can cause significant clinical issues,including joint pain,swelling,and cartilage damage.Early diagnosis and management are critical in such cases.CASE SUMMARY A 26-year-old male presented with knee pain and swelling one year after ACL reconstruction using a hamstring graft and bioabsorbable tibial interference screw.The patient had been engaged in rigorous physical activity as part of military training.Clinical examination revealed mild effusion without instability,and imaging showed screw breakage with intra-articular migration.Therapeutic arthroscopy confirmed intact graft tension,and broken screw fragments were removed successfully.The patient resumed normal activity two weeks after surgery.CONCLUSION This case highlights the potential complications associated with bioabsorbable screws,emphasizing the need for meticulous surgical technique,postoperative monitoring,and timely intervention.A comprehensive review of the literature illustrates the mechanisms,risk factors,and preventive strategies associated with screw-related complications.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
基金Supported by Natural Science Foundation of Shandong Province,No.ZR2023MH331.
文摘BACKGROUND A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage(VSD)surgeries were treated.CASE SUMMARY The patient underwent a total of 13 procedures within our medical facility,including five performed under local anesthesia and eight performed under general anesthesia.The source of the ailment was ultimately identified as Enterobacter cloacae.After the last procedure,the patient's symptoms were alleviated,and the recovery process was satisfactory.Three months post-operation,the Japanese Orthopaedic Association scores had improved to 100%.Imageological examination revealed a satisfactory position of internal fixation,and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.CONCLUSION The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection,providing an alternative to traditional surgery.
