The key parameters that characterize the morphological quality of multi-layer and multi-pass metal laser deposited parts are the surface roughness and the error between the actual printing height and the theoretical m...The key parameters that characterize the morphological quality of multi-layer and multi-pass metal laser deposited parts are the surface roughness and the error between the actual printing height and the theoretical model height.The Taguchi method was employed to establish the correlations between process parameter combinations and multi-objective characterization of metal deposition morphology(height error and roughness).Results show that using the signal-to-noise ratio and grey relational analysis,the optimal parameter combination for multi-layer and multi-pass deposition is determined as follows:laser power of 800 W,powder feeding rate of 0.3 r/min,step distance of 1.6 mm,and scanning speed of 20 mm/s.Subsequently,a Genetic Bayesian-back propagation(GB-BP)network is constructed to predict multi-objective responses.Compared with the traditional back propagation network,the GB-back propagation network improves the prediction accuracy of height error and surface roughness by 43.14%and 71.43%,respectively.This network can accurately predict the multi-objective characterization of morphological quality of multi-layer and multi-pass metal deposited parts.展开更多
At present,the emerging solid-phase friction-based additive manufacturing technology,including friction rolling additive man-ufacturing(FRAM),can only manufacture simple single-pass components.In this study,multi-laye...At present,the emerging solid-phase friction-based additive manufacturing technology,including friction rolling additive man-ufacturing(FRAM),can only manufacture simple single-pass components.In this study,multi-layer multi-pass FRAM-deposited alumin-um alloy samples were successfully prepared using a non-shoulder tool head.The material flow behavior and microstructure of the over-lapped zone between adjacent layers and passes during multi-layer multi-pass FRAM deposition were studied using the hybrid 6061 and 5052 aluminum alloys.The results showed that a mechanical interlocking structure was formed between the adjacent layers and the adja-cent passes in the overlapped center area.Repeated friction and rolling of the tool head led to different degrees of lateral flow and plastic deformation of the materials in the overlapped zone,which made the recrystallization degree in the left and right edge zones of the over-lapped zone the highest,followed by the overlapped center zone and the non-overlapped zone.The tensile strength of the overlapped zone exceeded 90%of that of the single-pass deposition sample.It is proved that although there are uneven grooves on the surface of the over-lapping area during multi-layer and multi-pass deposition,they can be filled by the flow of materials during the deposition of the next lay-er,thus ensuring the dense microstructure and excellent mechanical properties of the overlapping area.The multi-layer multi-pass FRAM deposition overcomes the limitation of deposition width and lays the foundation for the future deposition of large-scale high-performance components.展开更多
The huge impact kinetic energy cannot be quickly dissipated by the energy-absorbing structure and transferred to the other vehicle through the car body structure,which will cause structural damage and threaten the liv...The huge impact kinetic energy cannot be quickly dissipated by the energy-absorbing structure and transferred to the other vehicle through the car body structure,which will cause structural damage and threaten the lives of the occupants.Therefore,it is necessary to understand the laws of energy conversion,dissipation and transfer during train collisions.This study proposes a multi-layer progressive analysis method of energy flow during train collisions,considering the characteristics of the train.In this method,the train collision system is divided into conversion,dissipation,and transfer layers from the perspective of the train,collision interface,and car body structure to analyze the energy conversion,dissipation and transfer characteristics.Taking the collision process of a rail train as an example,a train collision energy transfer path analysis model was established based on power flow theory.The results show that when the maximum mean acceleration of the vehicle meets the standard requirements,the jerk may exceed the allowable limit of the human body,and there is a risk of injury to the occupants of a secondary collision.The decay rate of the collision energy along the direction of train operation reaches 79%.As the collision progresses,the collision energy gradually converges in the structure with holes,and the structure deforms when the gathered energy is greater than the maximum energy the structure can withstand.The proposed method helps to understand the train collision energy flow law and provides theoretical support for the train crashworthiness design in the future.展开更多
The growing incidence of cyberattacks necessitates a robust and effective Intrusion Detection Systems(IDS)for enhanced network security.While conventional IDSs can be unsuitable for detecting different and emerging at...The growing incidence of cyberattacks necessitates a robust and effective Intrusion Detection Systems(IDS)for enhanced network security.While conventional IDSs can be unsuitable for detecting different and emerging attacks,there is a demand for better techniques to improve detection reliability.This study introduces a new method,the Deep Adaptive Multi-Layer Attention Network(DAMLAN),to boost the result of intrusion detection on network data.Due to its multi-scale attention mechanisms and graph features,DAMLAN aims to address both known and unknown intrusions.The real-world NSL-KDD dataset,a popular choice among IDS researchers,is used to assess the proposed model.There are 67,343 normal samples and 58,630 intrusion attacks in the training set,12,833 normal samples,and 9711 intrusion attacks in the test set.Thus,the proposed DAMLAN method is more effective than the standard models due to the consideration of patterns by the attention layers.The experimental performance of the proposed model demonstrates that it achieves 99.26%training accuracy and 90.68%testing accuracy,with precision reaching 98.54%on the training set and 96.64%on the testing set.The recall and F1 scores again support the model with training set values of 99.90%and 99.21%and testing set values of 86.65%and 91.37%.These results provide a strong basis for the claims made regarding the model’s potential to identify intrusion attacks and affirm its relatively strong overall performance,irrespective of type.Future work would employ more attempts to extend the scalability and applicability of DAMLAN for real-time use in intrusion detection systems.展开更多
In practical engineering construction,multi-layered barriers containing geomembranes are extensively applied to retard the migration of pollutants.However,the associated analytical theory on pollutants diffusion still...In practical engineering construction,multi-layered barriers containing geomembranes are extensively applied to retard the migration of pollutants.However,the associated analytical theory on pollutants diffusion still needs to be further improved.In this work,general analytical solutions are derived for one-dimensional diffusion of degradable organic contaminant(DOC)in the multi-layered media containing geomembranes under a time-varying concentration boundary condition,where the variable substitution and separated variable approaches are employed.These analytical solutions with clear expressions can be used not only to study the diffusion behaviors of DOC in bottom and vertical composite barrier systems,but also to verify other complex numerical models.The proposed general analytical solutions are then fully validated via three comparative analyses,including comparisons with the experimental measurements,an existing analytical solution,and a finite-difference solution.Ultimately,the influences of different factors on the composite cutoff wall’s(CCW,which consists of two soil-bentonite layers and a geomembrane)service performance are investigated through a composite vertical barrier system as the application example.The findings obtained from this investigation can provide scientific guidance for the barrier performance evaluation and the engineering design of CCWs.This application example also exhibits the necessity and effectiveness of the developed analytical solutions.展开更多
Transportation structures such as composite pavements and railway foundations typically consist of multi-layered media designed to withstand high bearing capacity.A theoretical understanding of load transfer mechanism...Transportation structures such as composite pavements and railway foundations typically consist of multi-layered media designed to withstand high bearing capacity.A theoretical understanding of load transfer mechanisms in these multi-layer composites is essential,as it offers intuitive insights into parametric influences and facilitates enhanced structural performance.This paper employs an improved transfer matrix method to address the limitations of existing theoretical approaches for analyzing multi-layer composite structures.By establishing a twodimensional composite pavement model,it investigates load transfer characteristics and validates the accuracy through finite element simulation.The proposed method offers a straightforward analytical approach for examining internal interactions between structural layers.Case studies indicate that the concrete surface layer is the main load-bearing layer for most vertical normal and shear stresses.The soil base layer reduces the overall mechanical response of the substructure,while horizontal actions increase the risk of interfacial slip and cracking.Structural optimization analysis demonstrates that increasing the thickness of the concrete surface layer,enhancing the thickness and stiffness of the soil base layer,or incorporating gradient layers can significantly mitigate these risks of interfacial slip and cracking.The findings of this study can guide the optimization design,parameter analysis,and damage prevention of multi-layer composite structures.展开更多
This study proposes a general imperfect thermal contact model to predict the thermal contact resistance at the interface among multi-layered composite structures.Based on the Green-Lindsay(GL)thermoelastic theory,semi...This study proposes a general imperfect thermal contact model to predict the thermal contact resistance at the interface among multi-layered composite structures.Based on the Green-Lindsay(GL)thermoelastic theory,semi analytical solutions of temperature increment and displacement of multi-layered composite structures are obtained by using the Laplace transform method,upon which the effects of thermal resistance coefficient,partition coefficient,thermal conductivity ratio and heat capacity ratio on the responses are studied.The results show that the generalized imperfect thermal contact model can realistically describe the imperfect thermal contact problem.Accordingly,it may degenerate into other thermal contact models by adjusting the thermal resistance coefficient and partition coefficient.展开更多
Low Earth Orbit(LEO)mega-constellation networks,exemplified by Starlink,are poised to play a pivotal role in future mobile communication networks,due to their low latency and high capacity.With the massively deployed ...Low Earth Orbit(LEO)mega-constellation networks,exemplified by Starlink,are poised to play a pivotal role in future mobile communication networks,due to their low latency and high capacity.With the massively deployed satellites,ground users now can be covered by multiple visible satellites,but also face complex handover issues with such massive high-mobility satellites in multi-layer.The end-to-end routing is also affected by the handover behavior.In this paper,we propose an intelligent handover strategy dedicated to multi-layer LEO mega-constellation networks.Firstly,an analytic model is utilized to rapidly estimate the end-to-end propagation latency as a key handover factor to construct a multi-objective optimization model.Subsequently,an intelligent handover strategy is proposed by employing the Dueling Double Deep Q Network(D3QN)-based deep reinforcement learning algorithm for single-layer constellations.Moreover,an optimal crosslayer handover scheme is proposed by predicting the latency-jitter and minimizing the cross-layer overhead.Simulation results demonstrate the superior performance of the proposed method in the multi-layer LEO mega-constellation,showcasing reductions of up to 8.2%and 59.5%in end-to-end latency and jitter respectively,when compared to the existing handover strategies.展开更多
BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major...BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.展开更多
Stab-resistant textiles play a critical role in personal protection,necessitating a deeper understanding of how structural and layering factors influence their performance.The current study experimentally examines the...Stab-resistant textiles play a critical role in personal protection,necessitating a deeper understanding of how structural and layering factors influence their performance.The current study experimentally examines the effects of textile structure,layering,and ply orientation on the stab resistance of multi-layer textiles.Three 3D warp interlock(3DWI)structures({f1},{f2},{f3})and a 2D woven fabric({f4}),all made of high-performance p-aramid yarns,were engineered and manufactured.Multi-layer specimens were prepared and subjected to drop-weight stabbing tests following HOSBD standards.Stabbing performance metrics,including Depth of Trauma(DoT),Depth of Penetration(DoP),and trauma deformation(Ymax,Xmax),were investigated and analyzed.Statistical analyses(Two-and One-Way ANOVA)indicated that fabric type and layer number significantly impacted DoP(P<0.05),while ply orientation significantly affected DoP(P<0.05)but not DoT(P>0.05).Further detailed analysis revealed that 2D woven fabrics exhibited greater trauma deformation than 3D WIF structures.Increasing the number of layers reduced both DoP and DoT across all fabric structures,with f3 demonstrating the best performance in multi-layer configurations.Aligned ply orientations also enhanced stab resistance,underscoring the importance of alignment in dissipating impact energy.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 SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a highly aggressive tumor,and spontaneous splenic rupture(SSR)as its presenting manifestation is rarely reported among pancreatic mal...BACKGROUND SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a highly aggressive tumor,and spontaneous splenic rupture(SSR)as its presenting manifestation is rarely reported among pancreatic malignancies.CASE SUMMARY We herein report a rare case of a 59-year-old female who presented with acute left upper quadrant abdominal pain without any history of trauma.Abdominal imaging demonstrated a heterogeneous splenic lesion with hemoperitoneum,raising clinical suspicion of SSR.Emergency laparotomy revealed a pancreatic tumor invading the spleen and left kidney,with associated splenic rupture and dense adhesions,necessitating en bloc resection of the distal pancreas,spleen,and left kidney.Histopathology revealed a biphasic malignancy composed of moderately differentiated pancreatic ductal adenocarcinoma and an undifferentiated carcinoma with rhabdoid morphology and loss of SMARCB1 expression.Immunohistochemical analysis confirmed complete loss of SMARCB1/INI1 in the undifferentiated component,along with a high Ki-67 index(approximately 80%)and CD10 positivity.The ductal adenocarcinoma component retained SMARCB1/INI1 expression and was positive for CK7 and CK-pan.Transitional zones between the two tumor components suggested progressive dedifferentiation and underlying genomic instability.The patient received adjuvant chemotherapy with gemcitabine and nab-paclitaxel and maintained a satisfactory quality of life at the 6-month follow-up.CONCLUSION This study reports a rare case of SMARCB1/INI1-deficient undifferentiated rhabdoid carcinoma of the pancreas combined with ductal adenocarcinoma,presenting as SSR-an exceptionally uncommon initial manifestation of pancreatic malignancy.展开更多
BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary app...BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.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
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
BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupt...BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
BACKGROUND Well-differentiated small bowel mesenteric liposarcoma(LPS)is rare,with high malignancy,poor prognosis,and high preponderance to local recurrence.CASE SUMMARY Here we described a 71-year-old male,who compla...BACKGROUND Well-differentiated small bowel mesenteric liposarcoma(LPS)is rare,with high malignancy,poor prognosis,and high preponderance to local recurrence.CASE SUMMARY Here we described a 71-year-old male,who complains of persistent abdominal distension for a month.The clinical manifestation is a huge abdominal mass occupying almost the entire abdomen.Physical examination indicated palpable massive mass in the abdomen,hard texture,indefinable boundary,poor mobility.The abdominal enhanced computed tomography at another hospital scan showed multiple abdominal masses originating from the small bowel mesentery.Abdominal and pelvic magnetic resonance imaging at our hospital showed multiple masses in the abdominal and pelvic cavities,indicating that the tumor originated from the mesentery or peritoneum.Results of exploratory laparotomy indicated that the tremendous mass primarily results from the mesentery of the small intestine,occupying the entire abdominal cavity in a polymorphic and lobulated shape.The patient underwent complete surgical resection of the tumor,and the weight of the tumor was approximately 11 kg.The histopathological examination of the resected specimens confirmed the diagnosis of well-differentiated LPS of the small bowel mesentery.CONCLUSION Completed surgical resection was cornerstone,and histopathological and molecular confirmations were crucial.The necessity of adjuvant therapy should be phrased as a potential consideration to improve patient’s survival time.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both co...BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.展开更多
It is challenging to diagnose isolated hyperbilirubinemia with rare and complex etiologies under the constraints of traditional testing conditions.Herein,we present a rare case of coexisting Gilbert syndrome(GS)and er...It is challenging to diagnose isolated hyperbilirubinemia with rare and complex etiologies under the constraints of traditional testing conditions.Herein,we present a rare case of coexisting Gilbert syndrome(GS)and erythropoietic protoporphyria(EPP),which has not been previously documented.CASE SUMMARY We present a rare case of coexisting GS and EPP in a 23-year-old Chinese male with a long history of jaundice and recently found splenomegaly.Serial nonspecific hemolysis screening tests yielded inconsistent results,and investigations for common hemolytic etiologies were negative.However,Levitt’s carbon monoxide breath test,which measures erythrocyte lifespan(the gold-standard marker of hemolysis),demonstrated significant hemolysis,revealing a markedly shortened erythrocyte lifespan of 11 days(normal average 120 days).Genetic testing subsequently confirmed EPP with a homozygous ferrochelatase gene mutation and GS with a heterozygous uridine diphosphate glucuronosyl trans-ferase 1A1 gene mutation.CONCLUSION The rapid,non-invasive Levitt’s carbon monoxide breath test resolved the diagnostic challenge posed by a rare and complex cause of hyperbilirubinemia.展开更多
基金National Natural Science Foundation of China(52175237)。
文摘The key parameters that characterize the morphological quality of multi-layer and multi-pass metal laser deposited parts are the surface roughness and the error between the actual printing height and the theoretical model height.The Taguchi method was employed to establish the correlations between process parameter combinations and multi-objective characterization of metal deposition morphology(height error and roughness).Results show that using the signal-to-noise ratio and grey relational analysis,the optimal parameter combination for multi-layer and multi-pass deposition is determined as follows:laser power of 800 W,powder feeding rate of 0.3 r/min,step distance of 1.6 mm,and scanning speed of 20 mm/s.Subsequently,a Genetic Bayesian-back propagation(GB-BP)network is constructed to predict multi-objective responses.Compared with the traditional back propagation network,the GB-back propagation network improves the prediction accuracy of height error and surface roughness by 43.14%and 71.43%,respectively.This network can accurately predict the multi-objective characterization of morphological quality of multi-layer and multi-pass metal deposited parts.
基金supported by the National Key Research and Development Program of China(No.2022YFB3404700)the National Natural Science Foundation of China(Nos.52105313 and 52275299)+2 种基金the Research and Development Program of Beijing Municipal Education Commission,China(No.KM202210005036)the Natural Science Foundation of Chongqing,China(No.CSTB2023NSCQ-MSX0701)the National Defense Basic Research Projects of China(No.JCKY2022405C002).
文摘At present,the emerging solid-phase friction-based additive manufacturing technology,including friction rolling additive man-ufacturing(FRAM),can only manufacture simple single-pass components.In this study,multi-layer multi-pass FRAM-deposited alumin-um alloy samples were successfully prepared using a non-shoulder tool head.The material flow behavior and microstructure of the over-lapped zone between adjacent layers and passes during multi-layer multi-pass FRAM deposition were studied using the hybrid 6061 and 5052 aluminum alloys.The results showed that a mechanical interlocking structure was formed between the adjacent layers and the adja-cent passes in the overlapped center area.Repeated friction and rolling of the tool head led to different degrees of lateral flow and plastic deformation of the materials in the overlapped zone,which made the recrystallization degree in the left and right edge zones of the over-lapped zone the highest,followed by the overlapped center zone and the non-overlapped zone.The tensile strength of the overlapped zone exceeded 90%of that of the single-pass deposition sample.It is proved that although there are uneven grooves on the surface of the over-lapping area during multi-layer and multi-pass deposition,they can be filled by the flow of materials during the deposition of the next lay-er,thus ensuring the dense microstructure and excellent mechanical properties of the overlapping area.The multi-layer multi-pass FRAM deposition overcomes the limitation of deposition width and lays the foundation for the future deposition of large-scale high-performance components.
基金Supported by the National Natural Science Foundation of China(Grant No.52172409)Postdoctoral Innovation Talents Support Program(Grant No.BX20240298)+1 种基金the Fundamental Research Funds for the Central Universities(Grant No.2682024GF023)Heilongjiang Province Postdoctoral Foundation Project(Grant No.LBH-Z23041).
文摘The huge impact kinetic energy cannot be quickly dissipated by the energy-absorbing structure and transferred to the other vehicle through the car body structure,which will cause structural damage and threaten the lives of the occupants.Therefore,it is necessary to understand the laws of energy conversion,dissipation and transfer during train collisions.This study proposes a multi-layer progressive analysis method of energy flow during train collisions,considering the characteristics of the train.In this method,the train collision system is divided into conversion,dissipation,and transfer layers from the perspective of the train,collision interface,and car body structure to analyze the energy conversion,dissipation and transfer characteristics.Taking the collision process of a rail train as an example,a train collision energy transfer path analysis model was established based on power flow theory.The results show that when the maximum mean acceleration of the vehicle meets the standard requirements,the jerk may exceed the allowable limit of the human body,and there is a risk of injury to the occupants of a secondary collision.The decay rate of the collision energy along the direction of train operation reaches 79%.As the collision progresses,the collision energy gradually converges in the structure with holes,and the structure deforms when the gathered energy is greater than the maximum energy the structure can withstand.The proposed method helps to understand the train collision energy flow law and provides theoretical support for the train crashworthiness design in the future.
基金Nourah bint Abdulrahman University for funding this project through the Researchers Supporting Project(PNURSP2025R319)Riyadh,Saudi Arabia and Prince Sultan University for covering the article processing charges(APC)associated with this publication.Special acknowledgement to Automated Systems&Soft Computing Lab(ASSCL),Prince Sultan University,Riyadh,Saudi Arabia.
文摘The growing incidence of cyberattacks necessitates a robust and effective Intrusion Detection Systems(IDS)for enhanced network security.While conventional IDSs can be unsuitable for detecting different and emerging attacks,there is a demand for better techniques to improve detection reliability.This study introduces a new method,the Deep Adaptive Multi-Layer Attention Network(DAMLAN),to boost the result of intrusion detection on network data.Due to its multi-scale attention mechanisms and graph features,DAMLAN aims to address both known and unknown intrusions.The real-world NSL-KDD dataset,a popular choice among IDS researchers,is used to assess the proposed model.There are 67,343 normal samples and 58,630 intrusion attacks in the training set,12,833 normal samples,and 9711 intrusion attacks in the test set.Thus,the proposed DAMLAN method is more effective than the standard models due to the consideration of patterns by the attention layers.The experimental performance of the proposed model demonstrates that it achieves 99.26%training accuracy and 90.68%testing accuracy,with precision reaching 98.54%on the training set and 96.64%on the testing set.The recall and F1 scores again support the model with training set values of 99.90%and 99.21%and testing set values of 86.65%and 91.37%.These results provide a strong basis for the claims made regarding the model’s potential to identify intrusion attacks and affirm its relatively strong overall performance,irrespective of type.Future work would employ more attempts to extend the scalability and applicability of DAMLAN for real-time use in intrusion detection systems.
基金Project(2023YFC3707800)supported by the National Key Research and Development Program of China。
文摘In practical engineering construction,multi-layered barriers containing geomembranes are extensively applied to retard the migration of pollutants.However,the associated analytical theory on pollutants diffusion still needs to be further improved.In this work,general analytical solutions are derived for one-dimensional diffusion of degradable organic contaminant(DOC)in the multi-layered media containing geomembranes under a time-varying concentration boundary condition,where the variable substitution and separated variable approaches are employed.These analytical solutions with clear expressions can be used not only to study the diffusion behaviors of DOC in bottom and vertical composite barrier systems,but also to verify other complex numerical models.The proposed general analytical solutions are then fully validated via three comparative analyses,including comparisons with the experimental measurements,an existing analytical solution,and a finite-difference solution.Ultimately,the influences of different factors on the composite cutoff wall’s(CCW,which consists of two soil-bentonite layers and a geomembrane)service performance are investigated through a composite vertical barrier system as the application example.The findings obtained from this investigation can provide scientific guidance for the barrier performance evaluation and the engineering design of CCWs.This application example also exhibits the necessity and effectiveness of the developed analytical solutions.
基金supported by Fundamental Research Funds for the Central Universities(No.lzujbky-2024-05)Innovation Foundation of Provincial Education Department of Gansu(2024B-005)+2 种基金Scientific Department of Gansu(24CXGA083,24CXGA024,JK2024-28,JK2024-32 and 23CXJA0007)Industrial Support Plan Project of Provincial Education Department of Gansu(2025CYZC-003 and CYZC-2024-10)the Hunan Natural Science Foundation Science and Education Joint Fund Project(2022JJ60109).
文摘Transportation structures such as composite pavements and railway foundations typically consist of multi-layered media designed to withstand high bearing capacity.A theoretical understanding of load transfer mechanisms in these multi-layer composites is essential,as it offers intuitive insights into parametric influences and facilitates enhanced structural performance.This paper employs an improved transfer matrix method to address the limitations of existing theoretical approaches for analyzing multi-layer composite structures.By establishing a twodimensional composite pavement model,it investigates load transfer characteristics and validates the accuracy through finite element simulation.The proposed method offers a straightforward analytical approach for examining internal interactions between structural layers.Case studies indicate that the concrete surface layer is the main load-bearing layer for most vertical normal and shear stresses.The soil base layer reduces the overall mechanical response of the substructure,while horizontal actions increase the risk of interfacial slip and cracking.Structural optimization analysis demonstrates that increasing the thickness of the concrete surface layer,enhancing the thickness and stiffness of the soil base layer,or incorporating gradient layers can significantly mitigate these risks of interfacial slip and cracking.The findings of this study can guide the optimization design,parameter analysis,and damage prevention of multi-layer composite structures.
基金Projects(42477162,52108347,52178371,52168046,52178321,52308383)supported by the National Natural Science Foundation of ChinaProjects(2023C03143,2022C01099,2024C01219,2022C03151)supported by the Zhejiang Key Research and Development Plan,China+6 种基金Project(LQ22E080010)supported by the Exploring Youth Project of Zhejiang Natural Science Foundation,ChinaProject(LR21E080005)supported by the Outstanding Youth Project of Natural Science Foundation of Zhejiang Province,ChinaProject(2022M712964)supported by the Postdoctoral Science Foundation of ChinaProject(2023AFB008)supported by the Natural Science Foundation of Hubei Province for Youth,ChinaProject(202203)supported by Engineering Research Centre of Rock-Soil Drilling&Excavation and Protection,Ministry of Education,ChinaProject(202305-2)supported by the Science and Technology Project of Zhejiang Provincial Communication Department,ChinaProject(2021K256)supported by the Construction Research Founds of Department of Housing and Urban-Rural Development of Zhejiang Province,China。
文摘This study proposes a general imperfect thermal contact model to predict the thermal contact resistance at the interface among multi-layered composite structures.Based on the Green-Lindsay(GL)thermoelastic theory,semi analytical solutions of temperature increment and displacement of multi-layered composite structures are obtained by using the Laplace transform method,upon which the effects of thermal resistance coefficient,partition coefficient,thermal conductivity ratio and heat capacity ratio on the responses are studied.The results show that the generalized imperfect thermal contact model can realistically describe the imperfect thermal contact problem.Accordingly,it may degenerate into other thermal contact models by adjusting the thermal resistance coefficient and partition coefficient.
基金supported by the National Natural Science Foundation of China(No.62401597)Natural Science Foundation of Hunan Province,China(No.2024JJ6469)the Research Project of National University of Defense Technology,China(No.ZK22-02).
文摘Low Earth Orbit(LEO)mega-constellation networks,exemplified by Starlink,are poised to play a pivotal role in future mobile communication networks,due to their low latency and high capacity.With the massively deployed satellites,ground users now can be covered by multiple visible satellites,but also face complex handover issues with such massive high-mobility satellites in multi-layer.The end-to-end routing is also affected by the handover behavior.In this paper,we propose an intelligent handover strategy dedicated to multi-layer LEO mega-constellation networks.Firstly,an analytic model is utilized to rapidly estimate the end-to-end propagation latency as a key handover factor to construct a multi-objective optimization model.Subsequently,an intelligent handover strategy is proposed by employing the Dueling Double Deep Q Network(D3QN)-based deep reinforcement learning algorithm for single-layer constellations.Moreover,an optimal crosslayer handover scheme is proposed by predicting the latency-jitter and minimizing the cross-layer overhead.Simulation results demonstrate the superior performance of the proposed method in the multi-layer LEO mega-constellation,showcasing reductions of up to 8.2%and 59.5%in end-to-end latency and jitter respectively,when compared to the existing handover strategies.
基金Supported by the Zhejiang Medical Science and Technology Project,No.2022KY1325 and No.2023KY381Public Welfare Project of Jinhua Science and Technology Plan,No.2023-4-084Major Project of Jinhua Science and Technology Plan,No.2023-3-066.
文摘BACKGROUND Ganglioneuroma is a rare,well-differentiated,slow-growing benign tumor of the peripheral nerves,with surgical resection being the only curative treatment.Surgical resection of ganglioneuromas encasing major blood vessels remains a substantial clinical challenge.Traditionally,these cases often require open abdominal surgery or combined organ resections,and in some instances,the tumors are considered unresectable.Currently,no reports have described the resection of such tumors via laparoscopy.CASE SUMMARY A 35-year-old woman was admitted to our hospital after the incidental discovery of a retroperitoneal space-occupying lesion.Imaging revealed a mass with the celiac axis and superior mesenteric artery passing through it.A neurogenic tumor was suspected,with ganglioneuroma being the most likely diagnosis.Following comprehensive preoperative preparation,the retroperitoneal tumor was resected using a three-dimensional laparoscopy combined with an organ suspension technique.The surgical approach involved incising the tumor along the vascular axis and conducting meticulous,vascular-preserving tumor excision.The operation lasted approximately 458 minutes,with an estimated blood loss of 50 mL.The patient was discharged on the 8th postoperative day.A transient liver injury occurred after surgery but improved rapidly.After 11 months of postoperative follow-up,no complications or tumor recurrence were observed.CONCLUSION This case illustrates the feasibility of minimally invasive laparoscopic resection for retroperitoneal ganglioneuromas encasing major blood vessels.
文摘Stab-resistant textiles play a critical role in personal protection,necessitating a deeper understanding of how structural and layering factors influence their performance.The current study experimentally examines the effects of textile structure,layering,and ply orientation on the stab resistance of multi-layer textiles.Three 3D warp interlock(3DWI)structures({f1},{f2},{f3})and a 2D woven fabric({f4}),all made of high-performance p-aramid yarns,were engineered and manufactured.Multi-layer specimens were prepared and subjected to drop-weight stabbing tests following HOSBD standards.Stabbing performance metrics,including Depth of Trauma(DoT),Depth of Penetration(DoP),and trauma deformation(Ymax,Xmax),were investigated and analyzed.Statistical analyses(Two-and One-Way ANOVA)indicated that fabric type and layer number significantly impacted DoP(P<0.05),while ply orientation significantly affected DoP(P<0.05)but not DoT(P>0.05).Further detailed analysis revealed that 2D woven fabrics exhibited greater trauma deformation than 3D WIF structures.Increasing the number of layers reduced both DoP and DoT across all fabric structures,with f3 demonstrating the best performance in multi-layer configurations.Aligned ply orientations also enhanced stab resistance,underscoring the importance of alignment in dissipating impact energy.
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 SMARCB1/INI1-deficient pancreatic undifferentiated rhabdoid carcinoma is a highly aggressive tumor,and spontaneous splenic rupture(SSR)as its presenting manifestation is rarely reported among pancreatic malignancies.CASE SUMMARY We herein report a rare case of a 59-year-old female who presented with acute left upper quadrant abdominal pain without any history of trauma.Abdominal imaging demonstrated a heterogeneous splenic lesion with hemoperitoneum,raising clinical suspicion of SSR.Emergency laparotomy revealed a pancreatic tumor invading the spleen and left kidney,with associated splenic rupture and dense adhesions,necessitating en bloc resection of the distal pancreas,spleen,and left kidney.Histopathology revealed a biphasic malignancy composed of moderately differentiated pancreatic ductal adenocarcinoma and an undifferentiated carcinoma with rhabdoid morphology and loss of SMARCB1 expression.Immunohistochemical analysis confirmed complete loss of SMARCB1/INI1 in the undifferentiated component,along with a high Ki-67 index(approximately 80%)and CD10 positivity.The ductal adenocarcinoma component retained SMARCB1/INI1 expression and was positive for CK7 and CK-pan.Transitional zones between the two tumor components suggested progressive dedifferentiation and underlying genomic instability.The patient received adjuvant chemotherapy with gemcitabine and nab-paclitaxel and maintained a satisfactory quality of life at the 6-month follow-up.CONCLUSION This study reports a rare case of SMARCB1/INI1-deficient undifferentiated rhabdoid carcinoma of the pancreas combined with ductal adenocarcinoma,presenting as SSR-an exceptionally uncommon initial manifestation of pancreatic malignancy.
文摘BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.
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 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.
文摘BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
文摘BACKGROUND Well-differentiated small bowel mesenteric liposarcoma(LPS)is rare,with high malignancy,poor prognosis,and high preponderance to local recurrence.CASE SUMMARY Here we described a 71-year-old male,who complains of persistent abdominal distension for a month.The clinical manifestation is a huge abdominal mass occupying almost the entire abdomen.Physical examination indicated palpable massive mass in the abdomen,hard texture,indefinable boundary,poor mobility.The abdominal enhanced computed tomography at another hospital scan showed multiple abdominal masses originating from the small bowel mesentery.Abdominal and pelvic magnetic resonance imaging at our hospital showed multiple masses in the abdominal and pelvic cavities,indicating that the tumor originated from the mesentery or peritoneum.Results of exploratory laparotomy indicated that the tremendous mass primarily results from the mesentery of the small intestine,occupying the entire abdominal cavity in a polymorphic and lobulated shape.The patient underwent complete surgical resection of the tumor,and the weight of the tumor was approximately 11 kg.The histopathological examination of the resected specimens confirmed the diagnosis of well-differentiated LPS of the small bowel mesentery.CONCLUSION Completed surgical resection was cornerstone,and histopathological and molecular confirmations were crucial.The necessity of adjuvant therapy should be phrased as a potential consideration to improve patient’s survival time.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.
文摘It is challenging to diagnose isolated hyperbilirubinemia with rare and complex etiologies under the constraints of traditional testing conditions.Herein,we present a rare case of coexisting Gilbert syndrome(GS)and erythropoietic protoporphyria(EPP),which has not been previously documented.CASE SUMMARY We present a rare case of coexisting GS and EPP in a 23-year-old Chinese male with a long history of jaundice and recently found splenomegaly.Serial nonspecific hemolysis screening tests yielded inconsistent results,and investigations for common hemolytic etiologies were negative.However,Levitt’s carbon monoxide breath test,which measures erythrocyte lifespan(the gold-standard marker of hemolysis),demonstrated significant hemolysis,revealing a markedly shortened erythrocyte lifespan of 11 days(normal average 120 days).Genetic testing subsequently confirmed EPP with a homozygous ferrochelatase gene mutation and GS with a heterozygous uridine diphosphate glucuronosyl trans-ferase 1A1 gene mutation.CONCLUSION The rapid,non-invasive Levitt’s carbon monoxide breath test resolved the diagnostic challenge posed by a rare and complex cause of hyperbilirubinemia.
