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
Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 199...Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.T...To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.This source is based on spontaneous four-wave mixing(SFWM)in a piece of shallow-ridge silicon waveguide.Theoretical analysis shows that the waveguide dispersion could be tailored by adjusting the ridge width,enabling broadband photon pair generation by SFWM across C band and O band.The spontaneous Raman scattering(SpRS)in silicon waveguides is also investigated experimentally.It shows that there are two regions in the spectrum of generated photons from SpRS,which could be used to achieve cross-band photon pair generation.A chip of shallow-ridge silicon waveguide samples with different ridge widths has been fabricated,through which cross-band photon pair generation is demonstrated experimentally.The experimental results show that the source can be achieved using dispersion-optimized shallow-ridge silicon waveguides.This cross-band quantum light source provides a way to develop new fiber-based quantum communication functions utilizing both C band and O band and extends applications of quantum networks.展开更多
CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be...CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.展开更多
Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabe...Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabetic patients in Dakar. Methodology: It was a retrospective, multicenter and descriptive study, carried out over a period of 12 months from 19 September 2019 to 19 September 2020 in four cardiology centers in Dakar. Included was any diabetic patient admitted for STEMI. Data analysis was done with the SPSS (Statistical Package for Sciences Socials) software. Results: A total of 87 diabetic patients were included, for a prevalence of 29.7%. The average age of patients was 60 years. The predominance was male with a sex ratio of 1.1. Diabetes was mostly type 2 (99%) and most patients were on oral antidiabetics (56%). Glycemic imbalance was noted in 24.1% of patients. The associated cardiovascular risk factors were hypertension (51%), dyslipidemia (51%) and physical inactivity (41.4%). Chest pain was typical in 76% of cases. The average time between onset of pain and first medical contact was 47 hours. The electrocardiogram had reached mainly the anterior (25%) and inferior (27%) territories with necrosis Q waves in 37.9% of cases. The coronary angiography was done for 63 patients and found one hundred and twenty-three significant lesions distributed in three-vessel (48%), single-vessel (33%) and two-vessel (14%) disease. Percutaneous coronary intervention (PCI) was performed in 37 patients (42.2%) and thrombolysis in 7 patients. The evolution was favourable in most cases (82%). The reported complications were: 4 cardiogenic shocks, 3 rhythm disorders, 2 conduction disorders and 2 strokes. Four patients had died during hospitalization, for a hospital mortality of 4.59%. Conclusion: STEMI in diabetics are diagnosed with considerable delay in Dakar. The coronary involvement is severe. Their support under optimal. Improving management requires a multidisciplinary approach involving the diabetologist, emergency physician and cardiologist.展开更多
Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following...Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.展开更多
The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exace...The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.展开更多
Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October...Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October 2019 were randomly divided into two groups (control group and observation group) with 43 cases in each group. The operation time, incidence of side effects and satisfaction were observed. Results: the operation time of the observation group was 21.33±4.81 min, and the satisfaction score (89.37±2.61) was lower than that of the control group (P < 0.05). The incidence of adverse reactions in the observation group (4.65%) was lower than that in the control group (20.93%), P < 0.05. Conclusion: the application of four-hand operation in the nursing cooperation of stomatology department can reduce the operation time, reduce the incidence of adverse reactions and improve patient satisfaction, which is worthy of reference.展开更多
The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a ...The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a novel carrier-interleaved pulse width modulation(CIPWM)method that satisfies the volt-sec balance principle is proposed with an advanced carrier distribution rule.By adopting the proposed CIPWM method,the redundant switching states of 4L-NNPC inverters can be evenly distributed into the output PWM waveform in each carrier period,and natural flying-capacitor voltage balance can be achieved.Furthermore,an active balancing strategy is also proposed to eliminate the voltage unbalance caused by nonideal factors,which is realized by simply adjusting the duty cycle and with no need to adjust the redundant switching states for 4L-NNPC inverters.The simulation and experimental results verify the effectiveness of the proposed CIPWM method and the flying-capacitor voltage balancing strategy.展开更多
Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)at...Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.展开更多
VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a ra...VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.展开更多
Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with m...Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
Grapes are the main reason why the grapevine (Vitis vinifera L.) is cultivated. However, climate, soil conditions, vegetation and anthropogenic effects on the soil greatly affect grapevine production. The organoleptic...Grapes are the main reason why the grapevine (Vitis vinifera L.) is cultivated. However, climate, soil conditions, vegetation and anthropogenic effects on the soil greatly affect grapevine production. The organoleptic properties of grape-derived products, such as wine, are influenced by these factors, which are becoming increasingly popular in Africa. Thus, grapevines, which are commonly grown in warm regions, are acclimatized in Africa using grapevine varieties that can adjust to tropical conditions. This study, which was carried out in 2019, aimed to promote grapevine cultivation in Côte d’Ivoire by examining the influence of pedoclimatic factors on the agro-physiological characteristics of grapevines. In Côte d’Ivoire, there were four distinct agro-ecological zones (North, South, Southeast and West) where three grapevine varieties, Bequignol, Muscat Rouge and Aleatico, were grown. Grapevine plants could grow robustly in morpho-physiological ways because the soils had sufficient fertility, as revealed by the analysis of experimental sites. Grapevine varieties have successfully adapted to different terroirs, with the exception of Muscat Rouge, which only displayed favorable morphological characteristics in the Man zone (West). Regardless of the grape variety, the regions with the best grapevine-growing conditions were Man (West), followed by Aboisso (Southeast). Consequently, grapevine development was less favorable in Korhogo (North) and Abidjan (South) zones. Thus, the cultivation of grapevine varieties in Côte d’Ivoire was greatly influenced by terroir.展开更多
Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and manag...Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.展开更多
The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imag...The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.展开更多
BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a ne...BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a neglected tropical disease,a World Health Organi-zation report estimates that it affects approximately 2.4 million people worldwide,with high endemicity in regions characterized by poor sanitation and limited access to clean water.Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multiorgan involvement.CASE SUMMARY We report 4 cases with varied and unusual presentations.Case 1:A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy.Case 2:A 34-year-old woman who presented with urticaria and eosinophilia,initially suspected to be vasculitis.Case 3:A 67-year-old man who presented with dyspeptic symptoms,easy fatigability,headache,and fever.Case 4:A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.CONCLUSION Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools,especially in resource-limited settings.It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management.This case report aims to contribute to the growing body of literature on F.hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide,as these are effective and reduce unnecessary interventions.展开更多
Background:The use of third-generation different tyrosine kinase inhibitors(TKIs)is considered the most effective option for treating advanced non-small cell lung cancer(aNSCLC)with epidermal growth factor receptor(EG...Background:The use of third-generation different tyrosine kinase inhibitors(TKIs)is considered the most effective option for treating advanced non-small cell lung cancer(aNSCLC)with epidermal growth factor receptor(EGFR)mutations.However,there is limited information on the efficacy and safety of aumolertinib in patients remains these cases.Methods:The clinical records of patients receiving aumolertinib as first-line therapy across four hospitals in the Guangxi Zhuang Autonomous Region from April 2020 to December 2021 were retrospectively analyzed,using progression-free survival(PFS)as the primary endpoint and overall survival(OS)representing the secondary endpoint.Adverse events(AEs)were assessed using the Common Terminology Criteria for Adverse Events(CTCAE v5.0).Results:Approximately 47 patients with EGFR-Mutant aNSCLC were recruited,including 1 squamous cell carcinoma(SCC)patient,1 EGFR G719C mutated patient,1 EGFR S768 patient mutated,and 1 EGFR KDD mutated patient.The average follow-up duration was 48.1 months concluding in August 2024.The median PFS(mPFS)was 22.2 months(95%CI 17.6 to 26.7),while the median OS(mOS)was 39.7 months(95%CI 32.6 to 46.9).Patients with deletion of exon19 in EGFR(19del)showeda mPFS of 28.4 months,markedlylonger than those with the L858R point mutation(L858R),who had a mPFS of 15.2 months(p<0.036).Overall,22 patients(46.8%)had central nervous system(CNS)metastases at the=basal level.The mPFS for this cohort was 19.7 months.Rashes(17.0%),skin decrustation(4.2%),pruritus(4.2%),dental ulcers(4.2%),increased creatine kinase(2.1%),and musculoskeletal pains(2.1%)were the most prevalent AEs in this study.Grade 3 and higher AEs were observed at a rate of 4.2%.Conclusion:This study concluded that aumolertinib has considerable safety and efficacy for EGFR-mutant NSCLC in a first-line defense.展开更多
BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminat...BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.展开更多
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.
基金Supported by the National Natural Science Foundation of China(No.82070991).
文摘Dear Editor,Torpedo maculopathy(TM),first described by Roseman and Gass in 1992[1],is a rare congenital unilateral retinal pigment epithelium(RPE)abnormality.The term“torpedo maculopathy”was coined by Daily[2]in 1993.TM typically spares the foveal center,is asymptomatic,and is often detected incidentally during routine ophthalmic examinations.Through literature search,we did not identify racial or regional differences in TM.It predominantly affects children,with an estimated prevalence of 2 per 100000 in individuals under 16 ages[3].While previous reports have focused on pediatric and adult populations,this study presents four cases of TM in preterm infants.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
基金supported by the Quantum Science and Technology-National Science and Technology Major Project (Grant No.2024ZD0302502 for WZ)the National Natural Science Foundation of China(Grant No.92365210 for WZ)+1 种基金Tsinghua Initiative Scientific Research Program (for WZ)the project of Tsinghua University-Zhuhai Huafa Industrial Share Company Joint Institute for Architecture Optoelectronic Technologies (JIAOT,for YH)。
文摘To fully utilize the resources provided by optical fiber networks,a cross-band quantum light source generating photon pairs,where one photon in a pair is at C band and the other is at O band,is proposed in this work.This source is based on spontaneous four-wave mixing(SFWM)in a piece of shallow-ridge silicon waveguide.Theoretical analysis shows that the waveguide dispersion could be tailored by adjusting the ridge width,enabling broadband photon pair generation by SFWM across C band and O band.The spontaneous Raman scattering(SpRS)in silicon waveguides is also investigated experimentally.It shows that there are two regions in the spectrum of generated photons from SpRS,which could be used to achieve cross-band photon pair generation.A chip of shallow-ridge silicon waveguide samples with different ridge widths has been fabricated,through which cross-band photon pair generation is demonstrated experimentally.The experimental results show that the source can be achieved using dispersion-optimized shallow-ridge silicon waveguides.This cross-band quantum light source provides a way to develop new fiber-based quantum communication functions utilizing both C band and O band and extends applications of quantum networks.
文摘CT-scan is the most irradiating tool in diagnostic radiology. For 5% - 10% of diagnostic X-ray procedures, it is responsible for 34% of irradiation according to UNSCEAR. Patients radiation protection must therefore be increased during CT-scan procedures. This requires the rigorous application of optimization principle which imposes to have “diagnostic reference levels”. Objective: The aim of this study was to determine the diagnostic reference levels (DRLs) of the four most frequent CT-scans examinations of adults in Cameroon. Material and Method: It was a cross-sectional pilot study carried out from April to September 2015 in five health facilities using CT-scan in Cameroon. The studied variables were: patients age and sex, type of CT-scan examination (cerebral, chest, abdomino-pelvic, lumbar spine), Used of IV contrast (IV﹣/ IV+), acquisition length, time of tube rotation, voltage (kV), mAs, pitch, thickness of slices, CTDIvol and DLP. For each type of examination, at least 30 patients were included per center, consecutively on the randomly predetermined days. The DRL for each type of examination was defined as the 75th percentile of its PDL and CTDIvol. Results: Of the 696 examinations, 41.2% were cerebral, 26.9% abdomino-pelvic, 17.7% lumbar spine and 14.2% chest. The mean age of patients was 52 ± 15 years [20 - 90 years], 58.9% were 50 years and older. The sex-ratio was 1.26 (55.9% males). The CT machines were 4, 8 and 16 multidetectors. The 75th percentile of DLP or DRLs [standard deviation] was: [1150 ± 278 mGy·cm], [770 ± 477 mGy·cm], [720 ± 170 mGy·cm] and [715 ± 187 mGy·cm] respectively for cerebral, lumbar spine, abdominopelvic and chest CT-scans. Taking in consideration the number of detectors, the 75th percentile of the Dose-Length product decreased with the increase number of detectors for cerebral examinations but was the highest with 16 MDCT for the abdominopelvic, lumbar spine and chest CT-scans. For the chest and lumbar spine examinations, there was a significant increase in patient-dose with the increase in the number of detectors. Conclusion: Our DRLs values lie between the norms of some European countries and those of some African countries. There is remarquable variation in dose for the commonest CT-scans examinations in Cameroon, requiring then an optimization process from these determined DRLs and establishment of national DRLs. Special attention to optimization should be paid when using 16 MDCT.
文摘Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabetic patients in Dakar. Methodology: It was a retrospective, multicenter and descriptive study, carried out over a period of 12 months from 19 September 2019 to 19 September 2020 in four cardiology centers in Dakar. Included was any diabetic patient admitted for STEMI. Data analysis was done with the SPSS (Statistical Package for Sciences Socials) software. Results: A total of 87 diabetic patients were included, for a prevalence of 29.7%. The average age of patients was 60 years. The predominance was male with a sex ratio of 1.1. Diabetes was mostly type 2 (99%) and most patients were on oral antidiabetics (56%). Glycemic imbalance was noted in 24.1% of patients. The associated cardiovascular risk factors were hypertension (51%), dyslipidemia (51%) and physical inactivity (41.4%). Chest pain was typical in 76% of cases. The average time between onset of pain and first medical contact was 47 hours. The electrocardiogram had reached mainly the anterior (25%) and inferior (27%) territories with necrosis Q waves in 37.9% of cases. The coronary angiography was done for 63 patients and found one hundred and twenty-three significant lesions distributed in three-vessel (48%), single-vessel (33%) and two-vessel (14%) disease. Percutaneous coronary intervention (PCI) was performed in 37 patients (42.2%) and thrombolysis in 7 patients. The evolution was favourable in most cases (82%). The reported complications were: 4 cardiogenic shocks, 3 rhythm disorders, 2 conduction disorders and 2 strokes. Four patients had died during hospitalization, for a hospital mortality of 4.59%. Conclusion: STEMI in diabetics are diagnosed with considerable delay in Dakar. The coronary involvement is severe. Their support under optimal. Improving management requires a multidisciplinary approach involving the diabetologist, emergency physician and cardiologist.
文摘Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.
基金The Henan Key Research and Development and Promotion Project(Grant No.232102310245)the Joint Construction Project of Medical Science and Technology of Henan Province(Grant No.LHGJ20220426).
文摘The rise of antimicrobial resistance,particularly in healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens,poses a critical global challenge.The extensive use of carbapenems has exacerbated this issue by increasing selective pressure within bacterial populations.This study aimed to investigate the association between carbapenem consumption and resistance rates in four priority Gram-negative bacteria:Escherichia coli(EC),Klebsiella pneumoniae(KP),Acinetobacter baumannii(AB),and Pseudomonas aeruginosa(PA).Retrospective data were collected from the First Affiliated Hospital of Zhengzhou University,covering the period from January 2010 to December 2022.Trends in carbapenem consumption and resistance were analyzed using the Mann-Kendall test to assess statistical significance and the Sen’s slope(SS)estimator to determine the magnitude of change.Correlations between carbapenem use and bacterial resistance rates were evaluated via Spearman correlation analysis.Over the study period,the consumption of meropenem,imipenem,biapenem,and total carbapenems exhibited a significant upward trend(|Z|>1.96,SS>0).Correspondingly,the resistance rates of EC and KP to meropenem and imipenem also increased significantly(|Z|>1.96,SS>0).A strong positive correlation was observed between the resistance rate of EC to meropenem and the defined daily doses(DDDs)of meropenem(r=0.732,P<0.05)and between EC resistance to imipenem and its DDDs(r=0.49,P<0.05).Similar significant correlations were identified for KP.However,no significant associations were found between carbapenem resistance in AB or PA and carbapenem consumption.These findings underscored the strong correlation between carbapenem use and the resistance rates of EC and KP,highlighting the urgent need for stringent control and stewardship of carbapenem use in clinical settings to mitigate or delay the development of bacterial drug resistance.
文摘Objective: to study the effect of four-handed surgery on improving the therapeutic effect in the repair and nursing cooperation. Methods: 86 patients who received oral repair in our hospital from April 2018 to October 2019 were randomly divided into two groups (control group and observation group) with 43 cases in each group. The operation time, incidence of side effects and satisfaction were observed. Results: the operation time of the observation group was 21.33±4.81 min, and the satisfaction score (89.37±2.61) was lower than that of the control group (P < 0.05). The incidence of adverse reactions in the observation group (4.65%) was lower than that in the control group (20.93%), P < 0.05. Conclusion: the application of four-hand operation in the nursing cooperation of stomatology department can reduce the operation time, reduce the incidence of adverse reactions and improve patient satisfaction, which is worthy of reference.
基金supported by Beijing Natural Science Foundation under Grant L242006.
文摘The four-level nested neutral-point-clamped(4L-NNPC)inverter is a competitive topology among the various medium-voltage multilevel converters,and its main issue is flying-capacitor voltage unbalance.In this article,a novel carrier-interleaved pulse width modulation(CIPWM)method that satisfies the volt-sec balance principle is proposed with an advanced carrier distribution rule.By adopting the proposed CIPWM method,the redundant switching states of 4L-NNPC inverters can be evenly distributed into the output PWM waveform in each carrier period,and natural flying-capacitor voltage balance can be achieved.Furthermore,an active balancing strategy is also proposed to eliminate the voltage unbalance caused by nonideal factors,which is realized by simply adjusting the duty cycle and with no need to adjust the redundant switching states for 4L-NNPC inverters.The simulation and experimental results verify the effectiveness of the proposed CIPWM method and the flying-capacitor voltage balancing strategy.
文摘Let f be a primitive holomorphic cusp form with even integral weight k≥2 for the full modular groupΓ=SL(2,Z)andλ_(sym^(j)f)(n)be the n-th coefficient of Dirichlet series of j-th symmetric L-function L(s,sym^(j)f)attached to f.In this paper,we study the mean value distribution over a specific sparse sequence of positive integers of the following sum∑(a^(2)+b^(2)+c^(2)+d^(2)≤x(a,b,c,d)∈Z^(4))λ_(sym^(j))^(i)f(a^(2)+b^(2)+c^(2)+d^(2))where j≥2 is a given positive integer,i=2,3,4 andαis sufficiently large.We utilize Python programming to design algorithms for higher power conditions,combining Perron's formula,latest results of representations of natural integers as sums of squares,as well as analytic properties and subconvexity and convexity bounds of automorphic L-functions,to ensure the accuracy and verifiability of asymptotic formulas.The conclusion we obtained improves previous results and extends them to a more general settings.
基金National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital).
文摘VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.
文摘Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
文摘Grapes are the main reason why the grapevine (Vitis vinifera L.) is cultivated. However, climate, soil conditions, vegetation and anthropogenic effects on the soil greatly affect grapevine production. The organoleptic properties of grape-derived products, such as wine, are influenced by these factors, which are becoming increasingly popular in Africa. Thus, grapevines, which are commonly grown in warm regions, are acclimatized in Africa using grapevine varieties that can adjust to tropical conditions. This study, which was carried out in 2019, aimed to promote grapevine cultivation in Côte d’Ivoire by examining the influence of pedoclimatic factors on the agro-physiological characteristics of grapevines. In Côte d’Ivoire, there were four distinct agro-ecological zones (North, South, Southeast and West) where three grapevine varieties, Bequignol, Muscat Rouge and Aleatico, were grown. Grapevine plants could grow robustly in morpho-physiological ways because the soils had sufficient fertility, as revealed by the analysis of experimental sites. Grapevine varieties have successfully adapted to different terroirs, with the exception of Muscat Rouge, which only displayed favorable morphological characteristics in the Man zone (West). Regardless of the grape variety, the regions with the best grapevine-growing conditions were Man (West), followed by Aboisso (Southeast). Consequently, grapevine development was less favorable in Korhogo (North) and Abidjan (South) zones. Thus, the cultivation of grapevine varieties in Côte d’Ivoire was greatly influenced by terroir.
文摘Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.
文摘The article"Assessment of superior mesenteric vascular flow quantitation in children using four-dimensional flow magnetic resonance imaging"suggests to use of four-dimensional(4D)flow magnetic resonance imaging(MRI)which is also to measure the blood flow in the superior mesenteric vein(SMV)in pediatric patients over the traditional method.The study focuses on assessing the potential of SMV and superior mesenteric artery(SMA)flow quantification in children utilizing 4D flow MRI.It included 9 pediatric patients aged 18 years and below where 5 were male and 4 were female patients,on whom magnetic resonance enterorrhaphy(MRE)with 4D flow MRI protocol was used.Statistical analysis was performed using MedCalc.Measurements of SMV and SMA between two readers were calculated using Bland-Altman analysis.The results stated that six patients showed no MRE evidence of active inflammatory bowel disease,two patients showed unmarkable bowel appearance on MRI and one patient showed normal MRE without endoscopy performed at the same timeframe.The study utilized available 4D flow MRI sequences in this study aiming to show the feasibility of 4D flow quantitation of SMA and SMV flow in pediatric patients.The study also discovered good agreement for both peak velocity and peak speed measurements of SMA and SMV.
文摘BACKGROUND Fasciola hepatica(F.hepatica)(liver fluke)is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite.Despite being a neglected tropical disease,a World Health Organi-zation report estimates that it affects approximately 2.4 million people worldwide,with high endemicity in regions characterized by poor sanitation and limited access to clean water.Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multiorgan involvement.CASE SUMMARY We report 4 cases with varied and unusual presentations.Case 1:A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy.Case 2:A 34-year-old woman who presented with urticaria and eosinophilia,initially suspected to be vasculitis.Case 3:A 67-year-old man who presented with dyspeptic symptoms,easy fatigability,headache,and fever.Case 4:A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.CONCLUSION Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools,especially in resource-limited settings.It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management.This case report aims to contribute to the growing body of literature on F.hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide,as these are effective and reduce unnecessary interventions.
基金supported by the National Natural Science Foundation of China(grant nos.82260498 and 82160471)Quzhou City Qujiang District Life Oasis PublicWelfare Service Center,Health Development Promotion Project-Cancer Research Project(grant no.BJHA-CRP-033)+1 种基金Guangxi Medical and Health Key Discipline Construction Project,2021 Guilin City Science Research and Technology Development Plan Project(grant no.20210227-7-9)Beijing Xisike Clinical Oncology Research Foundation(grant no.Y-QL202101-0214).
文摘Background:The use of third-generation different tyrosine kinase inhibitors(TKIs)is considered the most effective option for treating advanced non-small cell lung cancer(aNSCLC)with epidermal growth factor receptor(EGFR)mutations.However,there is limited information on the efficacy and safety of aumolertinib in patients remains these cases.Methods:The clinical records of patients receiving aumolertinib as first-line therapy across four hospitals in the Guangxi Zhuang Autonomous Region from April 2020 to December 2021 were retrospectively analyzed,using progression-free survival(PFS)as the primary endpoint and overall survival(OS)representing the secondary endpoint.Adverse events(AEs)were assessed using the Common Terminology Criteria for Adverse Events(CTCAE v5.0).Results:Approximately 47 patients with EGFR-Mutant aNSCLC were recruited,including 1 squamous cell carcinoma(SCC)patient,1 EGFR G719C mutated patient,1 EGFR S768 patient mutated,and 1 EGFR KDD mutated patient.The average follow-up duration was 48.1 months concluding in August 2024.The median PFS(mPFS)was 22.2 months(95%CI 17.6 to 26.7),while the median OS(mOS)was 39.7 months(95%CI 32.6 to 46.9).Patients with deletion of exon19 in EGFR(19del)showeda mPFS of 28.4 months,markedlylonger than those with the L858R point mutation(L858R),who had a mPFS of 15.2 months(p<0.036).Overall,22 patients(46.8%)had central nervous system(CNS)metastases at the=basal level.The mPFS for this cohort was 19.7 months.Rashes(17.0%),skin decrustation(4.2%),pruritus(4.2%),dental ulcers(4.2%),increased creatine kinase(2.1%),and musculoskeletal pains(2.1%)were the most prevalent AEs in this study.Grade 3 and higher AEs were observed at a rate of 4.2%.Conclusion:This study concluded that aumolertinib has considerable safety and efficacy for EGFR-mutant NSCLC in a first-line defense.
文摘BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.
