This research aims to construct a case resource library for programming course,which can be used for either teachers’teaching or students’learning.The cases cannot be simply piled up but rather require a systematic ...This research aims to construct a case resource library for programming course,which can be used for either teachers’teaching or students’learning.The cases cannot be simply piled up but rather require a systematic planning.The solution to this is to design a case system model.The outcome-based education(OBE)concept is adopted to guide the research,and a three-dimensional case system model matching the course objectives is designed.Under the guidance of the model,the case resource library construction is more planned.Cases based on the model can provide all-round support for the cultivation of students’ability by gradually promoting knowledge and technology,frequently exercising one’s abilities,as well as expanding diverse and innovative problems.展开更多
BACKGROUND Thrombophilia contributes to a significant increased risk of venous thromboembolism and can be either inherited or acquired.Hereditary thrombophilia may arise from various gene mutations,some of which have ...BACKGROUND Thrombophilia contributes to a significant increased risk of venous thromboembolism and can be either inherited or acquired.Hereditary thrombophilia may arise from various gene mutations,some of which have not even been adequately reported or poorly understood.Previous studies reported a rare and novel missense mutation in the prothrombin gene(p.Arg596Gln),known as prothrombin Belgrade.The mechanisms and therapeutic strategies associated with prothrombin Belgrade mutation have not been fully elucidated.CASE SUMMARY We present the case of a 26-year-old woman with recurrent systemic thrombosis induced by prothrombin Belgrade mutation.The patient suffered from cerebral venous sinus thrombosis that rapidly progressed to systemic thrombosis,alongside a family history of cerebral thrombosis,and no traditional risk factors or abnormal coagulation function.Whole-genome sequencing detected a novel and rare heterozygous prothrombin missense mutation,c.1787G>T(p.Arg596Gln),which was responsible for the major etiology of the systemic thrombosis.CONCLUSION This case strengthens our understanding about hereditary basis of thrombophilia and provokes considerations for therapeutic options on prothrombin Belgrade mutation.展开更多
BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat t...BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neu...BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to...BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.展开更多
This paper deals with reduction of losses in electric power distribution system through a dynamic reconfiguration case study of a grid in the city of Mostar,Bosnia and Herzegovina.The proposed solution is based on a n...This paper deals with reduction of losses in electric power distribution system through a dynamic reconfiguration case study of a grid in the city of Mostar,Bosnia and Herzegovina.The proposed solution is based on a nonlinear model predictive control algorithm which determines the optimal switching operations of the distribution system.The goal of the control algorithm is to find the optimal radial network topology which minimizes cumulative active power losses and maximizes voltages across the network while simultaneously satisfying all system constraints.The optimization results are validated through multiple simulations(using real power demand data collected for a few characteristic days during winter and summer)which demonstrate the efficiency and usefulness of the developed control algorithm in reducing the grid losses by up to 14%.展开更多
BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause...BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause high misdiagnosis and missed diagnosis rates.CASE SUMMARY A 20-year-old male developed persistent neck and back pain after consuming raw snail meat,followed by urinary retention and low fever.After admission,the patient was misdiagnosed as viral infection and Mycobacterium tuberculosis in central nervous system.After detection of Angiostrongylus cantonensis in blood and cerebrospinal fluid by metagenomics next generation sequencing,albendazole was administered with ceftriaxone and methylprednisolone treatment simultaneously.With effective antiparasitic treatment,the patient weaned from mechanical ventilation successfully and transferred out of intensive care unit for hyperbaric oxygen and rehabilitation treatment.CONCLUSION This case highlights the diagnostic challenges of Angiostrongylus cantonensis infection and the importance of advanced sequencing techniques in identifying rare pathogens.展开更多
BACKGROUND Immunoglobulin A(IgA)vasculitis,formerly known as Henoch-Schönlein purpura,is a small vessel vasculitis predominantly affecting children.It commonly presents with a triad of purpuric rash,arthralgia,an...BACKGROUND Immunoglobulin A(IgA)vasculitis,formerly known as Henoch-Schönlein purpura,is a small vessel vasculitis predominantly affecting children.It commonly presents with a triad of purpuric rash,arthralgia,and abdominal pain.However,dermatologic manifestations of IgA vasculitis in black-skinned individuals are poorly documented in literature.CASE SUMMARY This case report describes an 11-year-old black girl with acute onset of rash,joint pain,and abdominal pain,subsequently diagnosed with IgA vasculitis.CONCLUSION The case highlights the importance of early recognition and supportive management in ensuring a favorable outcome,particularly in dark-skinned populations.展开更多
BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,...BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.展开更多
BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis a...BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis and treatment.There is a limited number of case reports in the literature and there has been no recent analysis of the literature to consolidate their common features.The purpose of the featured study is to review the available cases of adolescent/adult PB and analyze the common genetic features,histologic features,treatment regimens,tumor sizes,tumor locations,and areas of metastasis to advance ongoing research and better understand and treat this rare condition.AIM To present a patient case and systematically review all available cases in the literature to consolidate the common physical,genetic,and histologic features of PB.METHODS This is a systematic review of the literature with a case study.A total of 89 patient cases were discovered in the literature database for adolescent/adult PB,all of which were reviewed and are included in our research.Patients aged 16-18 were considered adolescent and patients aged greater than 18 were considered adult.Adolescents and adults were grouped together for the purpose of this study.The patient from the case report was seen in a community hospital setting.RESULTS The 89 cases analyzed from the literature were found in 51 references(our case report included),which were consolidated into the six categories mentioned above.A plurality of references reports PB in the head of the pancreas,4.0-10.0 cm in size,and with the most common site of metastasis to the liver.Histology studies most commonly included acinar groups,squamous corpuscles/nests,cytokeratin,chromogranin,trypsin,chymotrypsin,and synaptophysin.Genetic studies most commonly included adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin mutations.The mainstay of treatment was surgery with chemotherapy typically including cisplatin,carboplatin,doxorubicin,5 fluorouracil,mitomycin,bleomycin,gemcitabine,and vindesine.Radiation was also often used.CONCLUSION Common pancreatoblastoma features include acinar groups,chromogranin,chymotrypsin,squamous corpuscles,synaptophysin and trypsin on histology and adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin genetic mutations.展开更多
介绍了高温蠕变工况下运行的压力容器可能出现的失效模式,结合工程设计现状,指出了我国当前压力容器标准体系在确定高温蠕变工况许用压应力时存在的技术瓶颈,在此基础之上引出ASME Code Case 3029,对其适用范围、发展历程、产生背景及...介绍了高温蠕变工况下运行的压力容器可能出现的失效模式,结合工程设计现状,指出了我国当前压力容器标准体系在确定高温蠕变工况许用压应力时存在的技术瓶颈,在此基础之上引出ASME Code Case 3029,对其适用范围、发展历程、产生背景及工程意义进行了简单的介绍,以某工程设计项目中的实际结构为例,介绍了该方法的使用过程及注意事项,并结合压力容器工程设计领域的实际需求,对我国标准体系下一步的制定或修订方向提出了展望。展开更多
Test case prioritization and ranking play a crucial role in software testing by improving fault detection efficiency and ensuring software reliability.While prioritization selects the most relevant test cases for opti...Test case prioritization and ranking play a crucial role in software testing by improving fault detection efficiency and ensuring software reliability.While prioritization selects the most relevant test cases for optimal coverage,ranking further refines their execution order to detect critical faults earlier.This study investigates machine learning techniques to enhance both prioritization and ranking,contributing to more effective and efficient testing processes.We first employ advanced feature engineering alongside ensemble models,including Gradient Boosted,Support Vector Machines,Random Forests,and Naive Bayes classifiers to optimize test case prioritization,achieving an accuracy score of 0.98847 and significantly improving the Average Percentage of Fault Detection(APFD).Subsequently,we introduce a deep Q-learning framework combined with a Genetic Algorithm(GA)to refine test case ranking within priority levels.This approach achieves a rank accuracy of 0.9172,demonstrating robust performance despite the increasing computational demands of specialized variation operators.Our findings highlight the effectiveness of stacked ensemble learning and reinforcement learning in optimizing test case prioritization and ranking.This integrated approach improves testing efficiency,reduces late-stage defects,and improves overall software stability.The study provides valuable information for AI-driven testing frameworks,paving the way for more intelligent and adaptive software quality assurance methodologies.展开更多
AIM:To report and analyze cases of sterile intraocular inflammation(IOI)following intravitreal faricimab injections in patients treated for neovascular age-related macular degeneration(nAMD)and diabetic macular edema(...AIM:To report and analyze cases of sterile intraocular inflammation(IOI)following intravitreal faricimab injections in patients treated for neovascular age-related macular degeneration(nAMD)and diabetic macular edema(DME).METHODS:This double-center case series included nine eyes of six patients who developed uveitis after faricimab therapy.Comprehensive clinical evaluation was performed,including slit-lamp examination,intraocular pressure(IOP)measurement,fluorescein and indocyanine green angiography(ICGA),and laboratory tests.Inflammatory responses were treated with topical or systemic corticosteroids,and patients were monitored for visual acuity and inflammatory activity.RESULTS:The incidence of IOI was 0.8%per patient(Innsbruck)and 0.23%(Czechia),with inflammation typically occurring between the third and sixth injection(mean interval:10d post-injection).Inflammator y presentations ranged from anterior uveitis to posterior segment involvement.One notable case demonstrated novel choroidal hypofluorescent lesions on angiography,suggesting deeper ocular involvement.The mean patient age was 76y;five of six affected patients were female.All cases responded to local and systemic corticosteroids,with full recovery of initial visual acuity.CONCLUSION:Sterile IOI after faricimab appears to be a rare but relevant adverse event.Although the incidence falls within expected ranges for anti-vascular endothelial growth factor(anti-VEGF)agents,the observed choroidal involvement represents a potentially new safety signal.Prompt diagnosis and corticosteroid therapy are effective in all cases.Our findings support the need for vigilant post-marketing surveillance and further studies to better understand the underlying mechanisms and risk factors of faricimab-associated inflammation.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Background:Urologic cancers typically metastasize to common organs,while spread to sites such as the heart,hand,cranial bones,penis,or tonsil is exceedingly rare.The clinical relevance and prognostic impact of these u...Background:Urologic cancers typically metastasize to common organs,while spread to sites such as the heart,hand,cranial bones,penis,or tonsil is exceedingly rare.The clinical relevance and prognostic impact of these unusual metastases remain unclear.This case series highlights six exceptional cases,providing unique insights to support awareness and management.Case Description:We retrospectively analyzed six cases of patients diagnosed with urologic cancers who developed metastases at uncommon sites.Each case was evaluated based on clinical presentation,imaging findings,histopathological confirmation,treatment course,and outcomes.Relevant literature was reviewed to contextualize findings.Among the six cases,metastatic involvement was identified in atypical locations including the right atrium(testicular cancer),hand(bladder cancer),perineum and penis(sarcomatoid bladder cancer),cranial bones(prostate cancer),penis(rectal cancer),and tonsillar region(renal pelvis rhabdomyosarcoma).Timely imaging and histopathological confirmation guided personalized treatment strategies,primarily involving surgical interventions.Despite aggressive treatments,the prognosis remained poor in most cases,reflecting the aggressive nature of these metastases.Conclusion:Rare metastases from urologic malignancies,although uncommon,have significant implications on patient management.Early detection through advanced imaging and aggressive multimodal interventions are pivotal for improving outcomes.Awareness of such atypical metastatic patterns is essential for clinicians managing urologic cancers.展开更多
BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patie...BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.展开更多
Aconitines are a group of highly bioactive and toxic compounds found in aconitum species.[1]It is clinically used to treat rheumatism,rheumatoid arthritis,osteoarthritis,and cancer.[2]In folk medicine,aconitine is oft...Aconitines are a group of highly bioactive and toxic compounds found in aconitum species.[1]It is clinically used to treat rheumatism,rheumatoid arthritis,osteoarthritis,and cancer.[2]In folk medicine,aconitine is often soaked in white wine to make medicinal wine,which is used to treat rheumatism,joint pain,and other diseases.[3]Improper use of aconitine can cause adverse effects in the nervous system and digestive system,as well as cardiovascular dysfunction,especially arrhythmia.[4]Because of its high toxicity when it is improperly handled,aconitine has attracted widespread attention.展开更多
Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching t...Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching the construction of an emergency care system based on the concept of“linkage”,delving into its theoretical foundations,exploring innovative construction models,and analyzing practical cases.The study indicates that an emergency care system under the“linkage”concept can effectively integrate resources and enhance efficiency,providing new insights for improving the construction of the emergency care system.It aims to promote the development of the emergency care system towards a more scientific,efficient,and collaborative direction.展开更多
BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sar...BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver;it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components.CASE SUMMARY This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS.After chemotherapy with the vincristine+doxorubicin+cyclophosphamide regimen,the alpha-fetoprotein level increased significantly.Therefore,a second liver puncture was performed,the pathological result of which was hepatic sarcomatoid carcinoma.Next-generation sequencing revealed MET gene amplification with an average copy number of 9 in the tumor tissue;however,both fluorescence in situ hybridization and immunohistochemical tests were negative for MET amplification.The treatment regimen was adjusted to chemotherapy combined with immunotherapy;however,the disease progressed rapidly,and the overall survival was only 6 months.CONCLUSION By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature,we aim to help clinicians enhance their understanding of two rare diseases,namely pleomorphic RMS and sarcomatoid carcinoma of the liver.展开更多
基金The“OBE-Oriented Programming Course Practice Teaching Research and Resource Construction”Project supported by the Association of Fundamental Computing Education in Chinese Universities in 2021.(Project Number:2021-AFCEC-246)。
文摘This research aims to construct a case resource library for programming course,which can be used for either teachers’teaching or students’learning.The cases cannot be simply piled up but rather require a systematic planning.The solution to this is to design a case system model.The outcome-based education(OBE)concept is adopted to guide the research,and a three-dimensional case system model matching the course objectives is designed.Under the guidance of the model,the case resource library construction is more planned.Cases based on the model can provide all-round support for the cultivation of students’ability by gradually promoting knowledge and technology,frequently exercising one’s abilities,as well as expanding diverse and innovative problems.
文摘BACKGROUND Thrombophilia contributes to a significant increased risk of venous thromboembolism and can be either inherited or acquired.Hereditary thrombophilia may arise from various gene mutations,some of which have not even been adequately reported or poorly understood.Previous studies reported a rare and novel missense mutation in the prothrombin gene(p.Arg596Gln),known as prothrombin Belgrade.The mechanisms and therapeutic strategies associated with prothrombin Belgrade mutation have not been fully elucidated.CASE SUMMARY We present the case of a 26-year-old woman with recurrent systemic thrombosis induced by prothrombin Belgrade mutation.The patient suffered from cerebral venous sinus thrombosis that rapidly progressed to systemic thrombosis,alongside a family history of cerebral thrombosis,and no traditional risk factors or abnormal coagulation function.Whole-genome sequencing detected a novel and rare heterozygous prothrombin missense mutation,c.1787G>T(p.Arg596Gln),which was responsible for the major etiology of the systemic thrombosis.CONCLUSION This case strengthens our understanding about hereditary basis of thrombophilia and provokes considerations for therapeutic options on prothrombin Belgrade mutation.
文摘BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.
基金Supported by STI2030-Major Projects,No.2021ZD0202001Capital Funds for Health Improvement and Research,No.CFH 2022-2-4012.
文摘BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
文摘BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.
基金supported in part by the European Regional Development Fund under Grant KK.01.1.1.01.0009(DATACROSS).
文摘This paper deals with reduction of losses in electric power distribution system through a dynamic reconfiguration case study of a grid in the city of Mostar,Bosnia and Herzegovina.The proposed solution is based on a nonlinear model predictive control algorithm which determines the optimal switching operations of the distribution system.The goal of the control algorithm is to find the optimal radial network topology which minimizes cumulative active power losses and maximizes voltages across the network while simultaneously satisfying all system constraints.The optimization results are validated through multiple simulations(using real power demand data collected for a few characteristic days during winter and summer)which demonstrate the efficiency and usefulness of the developed control algorithm in reducing the grid losses by up to 14%.
基金Supported by the Hainan Provincial Natural Science Foundation of China,No.824MS173 and No.823MS165the Project of Hainan Province Clinical Medical Center.
文摘BACKGROUND Angiostrongylus cantonensis-induced acute parasitic infection is a rare food-borne disease in clinical practice.Lack of its specific laboratory markers and subsequent difficulty in detecting pathogens cause high misdiagnosis and missed diagnosis rates.CASE SUMMARY A 20-year-old male developed persistent neck and back pain after consuming raw snail meat,followed by urinary retention and low fever.After admission,the patient was misdiagnosed as viral infection and Mycobacterium tuberculosis in central nervous system.After detection of Angiostrongylus cantonensis in blood and cerebrospinal fluid by metagenomics next generation sequencing,albendazole was administered with ceftriaxone and methylprednisolone treatment simultaneously.With effective antiparasitic treatment,the patient weaned from mechanical ventilation successfully and transferred out of intensive care unit for hyperbaric oxygen and rehabilitation treatment.CONCLUSION This case highlights the diagnostic challenges of Angiostrongylus cantonensis infection and the importance of advanced sequencing techniques in identifying rare pathogens.
文摘BACKGROUND Immunoglobulin A(IgA)vasculitis,formerly known as Henoch-Schönlein purpura,is a small vessel vasculitis predominantly affecting children.It commonly presents with a triad of purpuric rash,arthralgia,and abdominal pain.However,dermatologic manifestations of IgA vasculitis in black-skinned individuals are poorly documented in literature.CASE SUMMARY This case report describes an 11-year-old black girl with acute onset of rash,joint pain,and abdominal pain,subsequently diagnosed with IgA vasculitis.CONCLUSION The case highlights the importance of early recognition and supportive management in ensuring a favorable outcome,particularly in dark-skinned populations.
基金Supported by the 135 High-end Talent Project of West China Hospital,Sichuan University,No.ZYDG23029.
文摘BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.
基金Supported by the Honor Health Foundation,Michael and Mary Ellen Francisthe Seena Magowitz Foundation.
文摘BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis and treatment.There is a limited number of case reports in the literature and there has been no recent analysis of the literature to consolidate their common features.The purpose of the featured study is to review the available cases of adolescent/adult PB and analyze the common genetic features,histologic features,treatment regimens,tumor sizes,tumor locations,and areas of metastasis to advance ongoing research and better understand and treat this rare condition.AIM To present a patient case and systematically review all available cases in the literature to consolidate the common physical,genetic,and histologic features of PB.METHODS This is a systematic review of the literature with a case study.A total of 89 patient cases were discovered in the literature database for adolescent/adult PB,all of which were reviewed and are included in our research.Patients aged 16-18 were considered adolescent and patients aged greater than 18 were considered adult.Adolescents and adults were grouped together for the purpose of this study.The patient from the case report was seen in a community hospital setting.RESULTS The 89 cases analyzed from the literature were found in 51 references(our case report included),which were consolidated into the six categories mentioned above.A plurality of references reports PB in the head of the pancreas,4.0-10.0 cm in size,and with the most common site of metastasis to the liver.Histology studies most commonly included acinar groups,squamous corpuscles/nests,cytokeratin,chromogranin,trypsin,chymotrypsin,and synaptophysin.Genetic studies most commonly included adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin mutations.The mainstay of treatment was surgery with chemotherapy typically including cisplatin,carboplatin,doxorubicin,5 fluorouracil,mitomycin,bleomycin,gemcitabine,and vindesine.Radiation was also often used.CONCLUSION Common pancreatoblastoma features include acinar groups,chromogranin,chymotrypsin,squamous corpuscles,synaptophysin and trypsin on histology and adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin genetic mutations.
文摘介绍了高温蠕变工况下运行的压力容器可能出现的失效模式,结合工程设计现状,指出了我国当前压力容器标准体系在确定高温蠕变工况许用压应力时存在的技术瓶颈,在此基础之上引出ASME Code Case 3029,对其适用范围、发展历程、产生背景及工程意义进行了简单的介绍,以某工程设计项目中的实际结构为例,介绍了该方法的使用过程及注意事项,并结合压力容器工程设计领域的实际需求,对我国标准体系下一步的制定或修订方向提出了展望。
文摘Test case prioritization and ranking play a crucial role in software testing by improving fault detection efficiency and ensuring software reliability.While prioritization selects the most relevant test cases for optimal coverage,ranking further refines their execution order to detect critical faults earlier.This study investigates machine learning techniques to enhance both prioritization and ranking,contributing to more effective and efficient testing processes.We first employ advanced feature engineering alongside ensemble models,including Gradient Boosted,Support Vector Machines,Random Forests,and Naive Bayes classifiers to optimize test case prioritization,achieving an accuracy score of 0.98847 and significantly improving the Average Percentage of Fault Detection(APFD).Subsequently,we introduce a deep Q-learning framework combined with a Genetic Algorithm(GA)to refine test case ranking within priority levels.This approach achieves a rank accuracy of 0.9172,demonstrating robust performance despite the increasing computational demands of specialized variation operators.Our findings highlight the effectiveness of stacked ensemble learning and reinforcement learning in optimizing test case prioritization and ranking.This integrated approach improves testing efficiency,reduces late-stage defects,and improves overall software stability.The study provides valuable information for AI-driven testing frameworks,paving the way for more intelligent and adaptive software quality assurance methodologies.
文摘AIM:To report and analyze cases of sterile intraocular inflammation(IOI)following intravitreal faricimab injections in patients treated for neovascular age-related macular degeneration(nAMD)and diabetic macular edema(DME).METHODS:This double-center case series included nine eyes of six patients who developed uveitis after faricimab therapy.Comprehensive clinical evaluation was performed,including slit-lamp examination,intraocular pressure(IOP)measurement,fluorescein and indocyanine green angiography(ICGA),and laboratory tests.Inflammatory responses were treated with topical or systemic corticosteroids,and patients were monitored for visual acuity and inflammatory activity.RESULTS:The incidence of IOI was 0.8%per patient(Innsbruck)and 0.23%(Czechia),with inflammation typically occurring between the third and sixth injection(mean interval:10d post-injection).Inflammator y presentations ranged from anterior uveitis to posterior segment involvement.One notable case demonstrated novel choroidal hypofluorescent lesions on angiography,suggesting deeper ocular involvement.The mean patient age was 76y;five of six affected patients were female.All cases responded to local and systemic corticosteroids,with full recovery of initial visual acuity.CONCLUSION:Sterile IOI after faricimab appears to be a rare but relevant adverse event.Although the incidence falls within expected ranges for anti-vascular endothelial growth factor(anti-VEGF)agents,the observed choroidal involvement represents a potentially new safety signal.Prompt diagnosis and corticosteroid therapy are effective in all cases.Our findings support the need for vigilant post-marketing surveillance and further studies to better understand the underlying mechanisms and risk factors of faricimab-associated inflammation.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
文摘Background:Urologic cancers typically metastasize to common organs,while spread to sites such as the heart,hand,cranial bones,penis,or tonsil is exceedingly rare.The clinical relevance and prognostic impact of these unusual metastases remain unclear.This case series highlights six exceptional cases,providing unique insights to support awareness and management.Case Description:We retrospectively analyzed six cases of patients diagnosed with urologic cancers who developed metastases at uncommon sites.Each case was evaluated based on clinical presentation,imaging findings,histopathological confirmation,treatment course,and outcomes.Relevant literature was reviewed to contextualize findings.Among the six cases,metastatic involvement was identified in atypical locations including the right atrium(testicular cancer),hand(bladder cancer),perineum and penis(sarcomatoid bladder cancer),cranial bones(prostate cancer),penis(rectal cancer),and tonsillar region(renal pelvis rhabdomyosarcoma).Timely imaging and histopathological confirmation guided personalized treatment strategies,primarily involving surgical interventions.Despite aggressive treatments,the prognosis remained poor in most cases,reflecting the aggressive nature of these metastases.Conclusion:Rare metastases from urologic malignancies,although uncommon,have significant implications on patient management.Early detection through advanced imaging and aggressive multimodal interventions are pivotal for improving outcomes.Awareness of such atypical metastatic patterns is essential for clinicians managing urologic cancers.
文摘BACKGROUND Edwardsiella tarda(E.tarda)belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish,but is also capable of infecting humans.Extraintestinal infections occur in patients with certain risk factors,including immunocompromised status.We recently diagnosed a case of spontaneous bacterial peritonitis(SBP)due to E.tarda in an immuno-compromised dialysis patient.CASE SUMMARY Patient was a 55-year-old male,with a history of diabetic nephropathy being treated with hemodialysis three times a week.He was referred to our hospital due to an increased volume of ascites,and blood examination revealed increased inflammatory reaction.At our emergency department,he developed fever,disturbance of consciousness,abdominal distension,and abdomen-wide pain.In addition,a dialysis shunt was confirmed in his right forearm,and the shunt site showed no signs of inflammation.No wounds were confirmed on or in his body.A blood examination revealed increased values of white blood cells,C-reactive protein,and creatinine.Plain chest and abdominal computed tomography scanning revealed increased ascites volume.Abdominal paracentesis was performed and a Gram stain revealed Gramnegative bacillus.These findings prompted diagnosis of SBP.The patient was admitted and treated with cefmetazole,causing fever resolution and symptom improvements.Later,E.tarda was identified in ascites culture.The patient improved with decreased inflammatory response and was discharged on the 12th day of hospitalization.The antibiotic was terminated after 14 days of treatment.SBP in this case may have developed from chronic renal failure and diabetes mellitus.CONCLUSION We report the first known case of SBP due to E.tarda in an immuno-compromised dialysis patient.
基金supported by grants from the National Natural Science Foundation of China(82360387)the Key Laboratory of Emergency Medicine of Yunnan Province(202449CE340015).
文摘Aconitines are a group of highly bioactive and toxic compounds found in aconitum species.[1]It is clinically used to treat rheumatism,rheumatoid arthritis,osteoarthritis,and cancer.[2]In folk medicine,aconitine is often soaked in white wine to make medicinal wine,which is used to treat rheumatism,joint pain,and other diseases.[3]Improper use of aconitine can cause adverse effects in the nervous system and digestive system,as well as cardiovascular dysfunction,especially arrhythmia.[4]Because of its high toxicity when it is improperly handled,aconitine has attracted widespread attention.
文摘Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching the construction of an emergency care system based on the concept of“linkage”,delving into its theoretical foundations,exploring innovative construction models,and analyzing practical cases.The study indicates that an emergency care system under the“linkage”concept can effectively integrate resources and enhance efficiency,providing new insights for improving the construction of the emergency care system.It aims to promote the development of the emergency care system towards a more scientific,efficient,and collaborative direction.
基金Supported by Shaanxi Provincial Natural Science Basic Research Program,No.2020JQ-951.
文摘BACKGROUND Rhabdomyosarcoma(RMS)is a type of malignant tumor originating from rhabdomyocytes or mesenchymal cells differentiating into rhabdomyocytes.Hepatic pleomorphic RMS is a rare malignant liver tumor.Hepatic sarcomatoid carcinoma is also a rare epithelial malignant tumor originating from the liver;it is characterized by the coexistence of both carcinomatous and sarcomatoid spindle cell components.CASE SUMMARY This paper reports a special case of an elderly woman whose initial liver puncture biopsy showed pleomorphic RMS.After chemotherapy with the vincristine+doxorubicin+cyclophosphamide regimen,the alpha-fetoprotein level increased significantly.Therefore,a second liver puncture was performed,the pathological result of which was hepatic sarcomatoid carcinoma.Next-generation sequencing revealed MET gene amplification with an average copy number of 9 in the tumor tissue;however,both fluorescence in situ hybridization and immunohistochemical tests were negative for MET amplification.The treatment regimen was adjusted to chemotherapy combined with immunotherapy;however,the disease progressed rapidly,and the overall survival was only 6 months.CONCLUSION By sharing the diagnosis and treatment process of this patient and reviewing the relevant literature,we aim to help clinicians enhance their understanding of two rare diseases,namely pleomorphic RMS and sarcomatoid carcinoma of the liver.
