Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bon...Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. Metastasis to spleen is mostly via hematogenous metastasis, direct metastasis to spleen was very rare. We report a case of P-HCC presenting as a left upper abdominal lesions which involved the spleen that was actually a P-HCC with splenic metastasis. This case is unique as P-HCC directly involved the spleen which is not via hematogenous metastasis.展开更多
Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate stagin...Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from nonpedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.展开更多
BACKGROUND Large pedunculated colorectal polyps are not frequent among colonic polyps.We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lym...BACKGROUND Large pedunculated colorectal polyps are not frequent among colonic polyps.We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lymph node invasion in a patient who ultimately underwent additional surgery.Clinicians should attach importance to pedunculated colorectal polyps and choose the most appropriate therapy.CASE SUMMARY A 52-year-old female farmer underwent routine screening colonoscopy and denied constipation,diarrhea,hematochezia,or other gastrointestinal symptoms.Her past medical history and general biochemical examination results were unremarkable.During the colonoscopy,a 25-mm pedunculated polyp in the sigmoid colon was identified.The superficial epithelium was macroscopically congestive,rough,and granular,showing characteristic features of adenoma.We first ligated the root of the pedunculated polyp using nylon loops as well as a titanium clip.Histopathological examination revealed high-grade intraepithelial neoplasia of the tumor surface and a negative margin with signet ring cell adenocarcinoma infiltrating the submucosal layer.The deepest infiltration was approximately 0.9 cm from the tumor surface and 0.55 cm from the stratum basale.We performed radical resection of the left colon with lymph node dissection after two weeks.The lesion was completely resected,and pathological assessment revealed signet ring cell adenocarcinoma infiltrating the submucosal layer as well as lymph node invasion(stage PT1N1M0 and grade IIIA in pathological grading,NRAS-,BRAF V600E-,KRAS-).CONCLUSION This case highlights the importance of paying attention to the malignancy of large pedunculated polyps.Polyps or adenomas removed via endoscopy must be evaluated histologically.Even if adenomas may be fragile,endoscopy doctors should still remove polyps as completely as possible and choose perpendicular sections through the stalk and base to fix by formaldehyde solution.展开更多
We report a case who was a 74-year-old female with hepatitis B virus （HBV） carrier for more than 30 years. The serum levels of AFP, CEA and CA199 were within normal range. CT scan demonstrated that a huge pedunculat...We report a case who was a 74-year-old female with hepatitis B virus （HBV） carrier for more than 30 years. The serum levels of AFP, CEA and CA199 were within normal range. CT scan demonstrated that a huge pedunculated mass of the right hepatic lobe presenting as Iobulated and cystic-solid appearance and heterogeneous density of the solid portion composed of multiple nodules. The patient was performed surgery, and the tumor was removed. Sarcomatoid hepatocallular carcinoma （SHC） was diagnosed by pathological and immunohistochemical test. The patient has been living for 4 months without tumor recurrence, which indicates that pedunculated SHC might have a high probability for resection and acquire better survival.展开更多
Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibro...Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.展开更多
Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortali...Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.展开更多
Colorectal cancer is a significant public health concern,and large non-pedunculated colorectal polyps pose a substantial risk for malignancy and incomplete resection,which may lead to interval cancer.The choice of res...Colorectal cancer is a significant public health concern,and large non-pedunculated colorectal polyps pose a substantial risk for malignancy and incomplete resection,which may lead to interval cancer.The choice of resection technique is influenced by various factors,including polyp size,morphology,location,submucosal invasion depth and endoscopist expertise.For non-cancerous superficial large non-pedunculated polyps,conventional hot or cold snare polypectomy,endoscopic mucosal resection and endoscopic submucosal dissection are common techniques for non-surgical therapeutic endoscopic resection of these polyps.This manuscript provides a comprehensive review of literature on current endoscopic resection techniques for large non-pedunculated colorectal polyps,emphasising indications,advantages,limitations and outcomes.展开更多
Acorn production in oaks(Quercus spp.)shows considerable inter-annual variation,known as masting.The effects of pollen sourced from trees within or outside the stand on acorn production were investigated in pedunculat...Acorn production in oaks(Quercus spp.)shows considerable inter-annual variation,known as masting.The effects of pollen sourced from trees within or outside the stand on acorn production were investigated in pedunculate oak(Quercus robur L.)in an ancient mixed woodland during two moderate masting years.Comparisons were made between natural pollination,hand pollinations with out-of-stand pollen,in-stand pollen or a 1:1 combination of the two pollen sources,and for bagged flowers left unpollinated.After all treatments,>85%of the flowers or developing acorns were aborted between May and August of both years.When flowers were protected with pollen bags and no pollen added,no acorns were produced.In contrast,hand pollination with out-of-stand pollen produced the most acorns both years and significantly more than within-stand pollen or natural pollination in 2022.Hand pollination with out-of-stand or within-stand pollen provided significantly more acorns than natural pollination in 2023.In 2022,hand pollination with a 1:1 mixture of out-of-stand and within-stand pollen yielded an intermediate number of mature acorns between those for the out-of-stand and within-stand pollination treatments.The study provides clear evidence of maternal choice during acorn development in pedunculate oak and of the benefits of pollen supplementation.It also confirms that pedunculate oak is a fruit-maturation masting species;abortion of pollinated flowers and immature acorns determines a mast year(rather than the number of flowers produced)at this site.展开更多
BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stoma...BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.展开更多
Acorn production in oak(Quercus spp.)shows considerable inter-annual variation,known as masting,which provides a natural defence against seed predators but a highly-variable supply of acorns for uses such as in commer...Acorn production in oak(Quercus spp.)shows considerable inter-annual variation,known as masting,which provides a natural defence against seed predators but a highly-variable supply of acorns for uses such as in commercial tree planting each year.Anthropogenic emissions of greenhouse gases have been very widely reported to influence plant growth and seed or fruit size and quantity via the‘fertilisation effect’that leads to enhanced photosynthesis.To examine if acorn production in mature woodland communities will be affected by further increase in CO_(2),the contents of litter traps from a Free Air Carbon Enrichment(FACE)experiment in deciduous woodland in central England were analysed for numbers of flowers and acorns of pedunculate oak(Quercus robur L.)at different stages of development and their predation levels under ambient and elevated CO_(2) concentrations.Inter-annual variation in acorn numbers was considerable and cyclical between 2015 and 2021,with the greatest numbers of mature acorns in 2015,2017 and 2020 but almost none in 2018.The numbers of flowers,enlarged cups,immature acorns,empty acorn cups,and galls in the litter traps also varied amongst years;comparatively high numbers of enlarged cups were recorded in 2018,suggesting Q.robur at this site is a fruit maturation masting species(i.e.,the extent of abortion of pollinated flowers during acorn development affects mature acorn numbers greatly).Raising the atmospheric CO_(2) concentration by 150μL L^(−1),from early 2017,increased the numbers of immature acorns,and all acorn evidence(empty cups+immature acorns+mature acorns)detected in the litter traps compared to ambient controls by 2021,but did not consistently affect the numbers of flowers,enlarged cups,empty cups,or mature acorns.The number of flowers in the elevated CO_(2) plots’litter traps was greater in 2018 than 2017,one year after CO_(2) enrichment began,whereas numbers declined in ambient plots.Enrichment with CO_(2) also increased the number of oak knopper galls(Andricus quercuscalicis Burgsdorf).We conclude that elevated CO_(2) increased the occurrence of acorns developing from flowers,but the putative benefit to mature acorn numbers may have been hidden by excessive pre-and/or post-dispersal predation.There was no evidence that elevated CO_(2) altered masting behaviour.展开更多
A review of the development of the key performance metrics of endoscopic mucosal resection(EMR),learning from the experience of the establishment of widespread colonoscopy quality measurements.Potential future perform...A review of the development of the key performance metrics of endoscopic mucosal resection(EMR),learning from the experience of the establishment of widespread colonoscopy quality measurements.Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.展开更多
Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after s...Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus(3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.展开更多
The epulis is a relatively frequent benign oral lesion that originates from the gingival and which has no degenerative potential. A 73-year-old-woman came to our attention for a mass, located in the oral cavity and mo...The epulis is a relatively frequent benign oral lesion that originates from the gingival and which has no degenerative potential. A 73-year-old-woman came to our attention for a mass, located in the oral cavity and more precisely in the right inferior maxillary alveolar ridge, that the patient firstly noticed 2 years earlier. Its dimensions increased over time and now were relevant. The mass was mobile, and non-ulcerated e did not evoke pain when palpated. It was characterized by a thin pedicle and its resection, under local anesthesia, allowed a complete removal of the mass itself. The histological examination showed a fibrous and plasmacellular epulis with calcific spots and mixoid aspects. We here report this case for the unique dimensions of this epulis and in order to give a useful example that could help in the differential diagnosis of the lesions located in the oral cavity.展开更多
The vitality of European forests continues to decline due to new pests and diseases,climate-change related disturbances and high loads of atmospheric nitrogen deposition.Deteriorating soil health is a major factor und...The vitality of European forests continues to decline due to new pests and diseases,climate-change related disturbances and high loads of atmospheric nitrogen deposition.Deteriorating soil health is a major factor underpinning the low vitality of West-European forests.Selecting tree species with soil ameliorative traits is proposed as an avenue to counteract soil acidification and improve overall forest vitality.Here we evaluate the impact of black cherry(Prunus serotina Ehrh.),a known rich litter species,on the vitality of neighboring pedunculate oak(Quercus robur L.)in ten mixed forests on sand in Germany,Belgium and the Netherlands.We found that black cherry admixture increases foliar N and P to a surplus whereas it causes deficiencies in foliar Mg,thereby resulting in an overall negative effect on oak foliar nutrient concentrations.Contrary,defoliation of oak leaves by herbivory decreases with the proximity of black cherry.Using structural equation modelling(SEM),we tested the hypothesized‘improved soil health’pathway.Our analyses showed that black cherry admixture leads to lower accumulation in the humus layer,resulting in higher soil base saturation which has a positive effect on foliar Ca yet a negative effect on total chlorophyll.Moreover,the SEM illustrated that herbivory of oak leaves decreases when black cherry is admixed,both via dilution and improved soil health.Indirect effects of black cherry on oak vitality via“improved soil health”in our SEM are however small in comparison to direct relations.Hence,our study showed that the combined positive and negative impacts of black cherry on oak vitality are limited,which tempers the potential benefits of using the rich litter species to counteract oak decline via improved soil health–yet,the concern of black cherry as an invasive alien species negatively affecting the vitality of mature pedunculate oak trees may also be exaggerated.展开更多
文摘Only a few cases of pedunculated hepatocellular carcinoma (P-HCC) have been reported in the literature. The common sites of extrahepatic metastases in patients with HCC are the lungs, regional lymph nodes, kidney, bone marrow and adrenals. Metastasis to spleen is mostly via hematogenous metastasis, direct metastasis to spleen was very rare. We report a case of P-HCC presenting as a left upper abdominal lesions which involved the spleen that was actually a P-HCC with splenic metastasis. This case is unique as P-HCC directly involved the spleen which is not via hematogenous metastasis.
文摘Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from nonpedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.
基金the National Natural Science Foundation of China,No.81702367the Science and Technology Development Funds of Ningbo of China(Normal Program),No.2020F028.
文摘BACKGROUND Large pedunculated colorectal polyps are not frequent among colonic polyps.We present a clinical case of a large pedunculated colorectal polyp with signet ring cell cancer infiltrating the submucosa and lymph node invasion in a patient who ultimately underwent additional surgery.Clinicians should attach importance to pedunculated colorectal polyps and choose the most appropriate therapy.CASE SUMMARY A 52-year-old female farmer underwent routine screening colonoscopy and denied constipation,diarrhea,hematochezia,or other gastrointestinal symptoms.Her past medical history and general biochemical examination results were unremarkable.During the colonoscopy,a 25-mm pedunculated polyp in the sigmoid colon was identified.The superficial epithelium was macroscopically congestive,rough,and granular,showing characteristic features of adenoma.We first ligated the root of the pedunculated polyp using nylon loops as well as a titanium clip.Histopathological examination revealed high-grade intraepithelial neoplasia of the tumor surface and a negative margin with signet ring cell adenocarcinoma infiltrating the submucosal layer.The deepest infiltration was approximately 0.9 cm from the tumor surface and 0.55 cm from the stratum basale.We performed radical resection of the left colon with lymph node dissection after two weeks.The lesion was completely resected,and pathological assessment revealed signet ring cell adenocarcinoma infiltrating the submucosal layer as well as lymph node invasion(stage PT1N1M0 and grade IIIA in pathological grading,NRAS-,BRAF V600E-,KRAS-).CONCLUSION This case highlights the importance of paying attention to the malignancy of large pedunculated polyps.Polyps or adenomas removed via endoscopy must be evaluated histologically.Even if adenomas may be fragile,endoscopy doctors should still remove polyps as completely as possible and choose perpendicular sections through the stalk and base to fix by formaldehyde solution.
文摘We report a case who was a 74-year-old female with hepatitis B virus （HBV） carrier for more than 30 years. The serum levels of AFP, CEA and CA199 were within normal range. CT scan demonstrated that a huge pedunculated mass of the right hepatic lobe presenting as Iobulated and cystic-solid appearance and heterogeneous density of the solid portion composed of multiple nodules. The patient was performed surgery, and the tumor was removed. Sarcomatoid hepatocallular carcinoma （SHC） was diagnosed by pathological and immunohistochemical test. The patient has been living for 4 months without tumor recurrence, which indicates that pedunculated SHC might have a high probability for resection and acquire better survival.
文摘Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.
文摘Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.
文摘Colorectal cancer is a significant public health concern,and large non-pedunculated colorectal polyps pose a substantial risk for malignancy and incomplete resection,which may lead to interval cancer.The choice of resection technique is influenced by various factors,including polyp size,morphology,location,submucosal invasion depth and endoscopist expertise.For non-cancerous superficial large non-pedunculated polyps,conventional hot or cold snare polypectomy,endoscopic mucosal resection and endoscopic submucosal dissection are common techniques for non-surgical therapeutic endoscopic resection of these polyps.This manuscript provides a comprehensive review of literature on current endoscopic resection techniques for large non-pedunculated colorectal polyps,emphasising indications,advantages,limitations and outcomes.
基金supported by Future Trees TrustThe Patsy Wood Trust+2 种基金Scottish Forestry TrustAitchinson Tait TrustAction Oak
文摘Acorn production in oaks(Quercus spp.)shows considerable inter-annual variation,known as masting.The effects of pollen sourced from trees within or outside the stand on acorn production were investigated in pedunculate oak(Quercus robur L.)in an ancient mixed woodland during two moderate masting years.Comparisons were made between natural pollination,hand pollinations with out-of-stand pollen,in-stand pollen or a 1:1 combination of the two pollen sources,and for bagged flowers left unpollinated.After all treatments,>85%of the flowers or developing acorns were aborted between May and August of both years.When flowers were protected with pollen bags and no pollen added,no acorns were produced.In contrast,hand pollination with out-of-stand pollen produced the most acorns both years and significantly more than within-stand pollen or natural pollination in 2022.Hand pollination with out-of-stand or within-stand pollen provided significantly more acorns than natural pollination in 2023.In 2022,hand pollination with a 1:1 mixture of out-of-stand and within-stand pollen yielded an intermediate number of mature acorns between those for the out-of-stand and within-stand pollination treatments.The study provides clear evidence of maternal choice during acorn development in pedunculate oak and of the benefits of pollen supplementation.It also confirms that pedunculate oak is a fruit-maturation masting species;abortion of pollinated flowers and immature acorns determines a mast year(rather than the number of flowers produced)at this site.
文摘BACKGROUND The gastrointestinal tract is a well-known extranodal site of lymphoma.B-cell lymph-oma is the most common type,while T-cell lymphoma is uncommon.Primary gastrointestinal lymphoma mainly occurs in the stomach and small intestine,and the colon is less frequently involved,especially in females.CASE SUMMARY A 45-year-old woman was admitted to our hospital for physical examination.Gastroenteroscopy revealed a visible pedunculated polyp in the transverse colon,for which endoscopic submucosal dissection(ESD)was performed.Pathology suggested highly active proliferation of T lymphocytes with atypical hyperplasia.CONCLUSION A middle-aged female patient was found to have colonic T-cell lymphoma by endoscopy.The lesion was successfully removed by ESD,and the surgical margin was negative.It is essential to raise awareness of colonic T-cell lymphoma and choose the appropriate treatment.
基金supported by Future Trees Trust,The Patsy Wood Trust,Scottish Forestry Trust,Aitchinson Tait Trust,and Action Oak for fundingsupport from the UK Natural Environment Research Council (NE/S015833/1 (QUINTUS))+1 种基金support from the JABBS Trust,Norbury Park Estate,The John Horseman Trust,Ecological Continuity Trust,and the University of BirminghamAccess to BIFoR Core Data was funded by Royal Society University Research Fellowship URFR1191326
文摘Acorn production in oak(Quercus spp.)shows considerable inter-annual variation,known as masting,which provides a natural defence against seed predators but a highly-variable supply of acorns for uses such as in commercial tree planting each year.Anthropogenic emissions of greenhouse gases have been very widely reported to influence plant growth and seed or fruit size and quantity via the‘fertilisation effect’that leads to enhanced photosynthesis.To examine if acorn production in mature woodland communities will be affected by further increase in CO_(2),the contents of litter traps from a Free Air Carbon Enrichment(FACE)experiment in deciduous woodland in central England were analysed for numbers of flowers and acorns of pedunculate oak(Quercus robur L.)at different stages of development and their predation levels under ambient and elevated CO_(2) concentrations.Inter-annual variation in acorn numbers was considerable and cyclical between 2015 and 2021,with the greatest numbers of mature acorns in 2015,2017 and 2020 but almost none in 2018.The numbers of flowers,enlarged cups,immature acorns,empty acorn cups,and galls in the litter traps also varied amongst years;comparatively high numbers of enlarged cups were recorded in 2018,suggesting Q.robur at this site is a fruit maturation masting species(i.e.,the extent of abortion of pollinated flowers during acorn development affects mature acorn numbers greatly).Raising the atmospheric CO_(2) concentration by 150μL L^(−1),from early 2017,increased the numbers of immature acorns,and all acorn evidence(empty cups+immature acorns+mature acorns)detected in the litter traps compared to ambient controls by 2021,but did not consistently affect the numbers of flowers,enlarged cups,empty cups,or mature acorns.The number of flowers in the elevated CO_(2) plots’litter traps was greater in 2018 than 2017,one year after CO_(2) enrichment began,whereas numbers declined in ambient plots.Enrichment with CO_(2) also increased the number of oak knopper galls(Andricus quercuscalicis Burgsdorf).We conclude that elevated CO_(2) increased the occurrence of acorns developing from flowers,but the putative benefit to mature acorn numbers may have been hidden by excessive pre-and/or post-dispersal predation.There was no evidence that elevated CO_(2) altered masting behaviour.
文摘A review of the development of the key performance metrics of endoscopic mucosal resection(EMR),learning from the experience of the establishment of widespread colonoscopy quality measurements.Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
文摘Left ventricular(LV) thrombus is a life-threatening complication of severe LV dysfunction. Ventriculotomy has been a commonly performed procedure for LV thrombus; however, it often further decrease LV function after surgery. We present an alternative approach to thrombectomy in order to minimize the postoperative LV dysfunction. A 37-year-old female with a postpartum cardiomyopathy found to have poor LV function and a large left ventricular apical thrombus(3 cm × 3 cm) attached to the apex by a narrow stalk. Given her severe LV dysfunction, the LV thrombus was approached via left atriotomy under cardiopulmonary bypass. The LV thrombus was easily extracted with gentle traction via the mitral valve. Postoperatively, the patient was discharged home without any embolization event or inotropic support. LV thrombectomy via left atriotomy through the mitral valve could be an alternative option for the patients with poor LV function with a mobile LV thrombus.
文摘The epulis is a relatively frequent benign oral lesion that originates from the gingival and which has no degenerative potential. A 73-year-old-woman came to our attention for a mass, located in the oral cavity and more precisely in the right inferior maxillary alveolar ridge, that the patient firstly noticed 2 years earlier. Its dimensions increased over time and now were relevant. The mass was mobile, and non-ulcerated e did not evoke pain when palpated. It was characterized by a thin pedicle and its resection, under local anesthesia, allowed a complete removal of the mass itself. The histological examination showed a fibrous and plasmacellular epulis with calcific spots and mixoid aspects. We here report this case for the unique dimensions of this epulis and in order to give a useful example that could help in the differential diagnosis of the lesions located in the oral cavity.
基金E.D. held a SB-doctoral fellowship of the Research Foundation Flanders (FWO, 1S43617N) at the time of data collection
文摘The vitality of European forests continues to decline due to new pests and diseases,climate-change related disturbances and high loads of atmospheric nitrogen deposition.Deteriorating soil health is a major factor underpinning the low vitality of West-European forests.Selecting tree species with soil ameliorative traits is proposed as an avenue to counteract soil acidification and improve overall forest vitality.Here we evaluate the impact of black cherry(Prunus serotina Ehrh.),a known rich litter species,on the vitality of neighboring pedunculate oak(Quercus robur L.)in ten mixed forests on sand in Germany,Belgium and the Netherlands.We found that black cherry admixture increases foliar N and P to a surplus whereas it causes deficiencies in foliar Mg,thereby resulting in an overall negative effect on oak foliar nutrient concentrations.Contrary,defoliation of oak leaves by herbivory decreases with the proximity of black cherry.Using structural equation modelling(SEM),we tested the hypothesized‘improved soil health’pathway.Our analyses showed that black cherry admixture leads to lower accumulation in the humus layer,resulting in higher soil base saturation which has a positive effect on foliar Ca yet a negative effect on total chlorophyll.Moreover,the SEM illustrated that herbivory of oak leaves decreases when black cherry is admixed,both via dilution and improved soil health.Indirect effects of black cherry on oak vitality via“improved soil health”in our SEM are however small in comparison to direct relations.Hence,our study showed that the combined positive and negative impacts of black cherry on oak vitality are limited,which tempers the potential benefits of using the rich litter species to counteract oak decline via improved soil health–yet,the concern of black cherry as an invasive alien species negatively affecting the vitality of mature pedunculate oak trees may also be exaggerated.
