A case of primary malignant fibrous histiocytoma of the pancreas: CT and MRI findings

Primary malignant fibrous histiocytoma (MFH) of the pancreas is rare and a distinct clinical entity. We report a case of recurrence of pancreatic MFH with computed tomography (CT) and magnetic resonance imaging (MRI) findings. A 67-year-old man presented with a history of decreased body weight over the past 6 mo. Abdominal CT revealed a large, multilocular cystic mass in the head of the pancreas with obvious atrophy in the body and tail of the pancreas. After 6 mo postoperatively, MRI demonstrated a recurrent large mass in the primary area of the head of the pancreas. The lesion was heterogeneous, hypointense to the liver on T1-weighted imaging, and heterogeneously hyperintense to the liver with a hypointense area in the central part of the tumor on fat-saturated T2-weighted imaging. Contrast- enhanced T1-weighted imaging demonstrated a large multilocular cystic mass with a cystic wall, fibrous septa and enhancement of solid components. To the best of our knowledge, this is the first report on recurrence of primary MFH of the pancreas, and the first with MRI findings.

Association of proton pump inhibitors with risk of hepatic encephalopathy in advanced liver disease: A meta-analysis

BACKGROUND Several studies have explored the association between the use of proton pump inhibitors (PPIs) and the risk of developing hepatic encephalopathy (HE) in patients with advanced liver disease. However, the evidence-based conclusions are controversial. We hypothesized that using PPIs may increase the risk of HE in patients with advanced liver disease. If confirmed, clinicians must strictly adhere to the indications for PPI treatment in this population. AIM To evaluate the pooled risk of HE in patients with advanced liver disease who use PPIs. METHODS Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched from the date of database inception through January 8, 2019 to identify comparative studies evaluating the association between PPI use and the risk of HE. Data from the included studies were extracted. The random-effects model was used for pooling risk estimates and the corresponding 95% confidence intervals (CIs). Subgroup and sensitivity analyses were also performed. RESULTS In total, 4342 patients from five case-control studies and 188053 patients from four cohort studies were included in this analysis. In patients with advanced liver disease, PPI use was associated with an elevated risk of developing HE, with significant heterogeneity. The pooled odds ratio for case-control studies was 2.58 (95%CI: 1.68-3.94, I2 = 72%). The pooled RR for cohort studies was 1.67 (95%CI: 1.30-2.14, I2 = 67%). The results of the subgroup analyses suggested that the heterogeneity may be the result of differences in the study designs and the definitions of PPI use. The sensitivity and subgroup analyses did not alter our findings. CONCLUSION In patients with advanced liver disease, PPI use is associated with an elevated risk of HE. Future large prospective studies are needed to confirm this association.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

Background:The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients.LEAD in diabetic patients occurs earlier and is often more severe and diffuse;however,it is largely underdiagnosed and untreated.The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.Methods:The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients.The patients were divided into 5 groups based on the screening results:non-LEAD group and LEAD group;the LEAD group was divided into mild stenosis group,moderate stenosis group,and severe stenosis group.Results:The percentage of patients who had LEAD was 43%.Significant difference in age,diabetes duration,peak velocity,microalbuminuria,and vibratory sensory neuropathy was observed between patients with and without LEAD;regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD.Significant difference in age,body mass index (BMI),peak velocity,urinary albumin,and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group,moderate stenosis group,and severe stenosis group;regression analysis showed that urinary albumin,BMI,and HDL-C were independent risk factors for accelerating vascular stenosis.Conclusions:The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high;age,diabetes duration,peak velocity,BMI,urinary microalbumin,vibratory sensory neuropathy,and HDL-C are the maior risk factors for LEAD.Active control of risk factors is helpful to reduce or delay LEAD.

The characteristics of walking strategy in elderly patients with type 2 diabetes

Objective:To explore the walking strategy by monitoring the characteristics of center of pressure(COP)of gait in the elderly with type2 diabetes.Methods:All of the elderly patients with type2 diabetes(n=543)were enrolled from Huadong Hospital Affiliated to Fudan University.Dynamic barefoot plantar pressure was assessed by Footscan7 USB2 flat.Outcome measures included excursion,the x-and ycoordinates displacement of COP and falling frequency.Results:There were 64.5%of cases with abnormal COP trajectory.Among them,45.2%were with abnormal fold-back,14.0%with two or more abnormal fold-back,20.5%with abnormal beginning point deviating from the heel to the arch and metatarsal region,18.0%with abnormal terminal point deviating from the hallux to toe 2e5 and the x-and y-coordinates displacement of COP in both feet are asymmetry.Conclusions:It highlights to put forward the walking strategy according to the abnormal COP trajectory.Due to the elderly diabetics with high risks of falling,the rehabilitation nursing should be strengthened mainly including the training of enhancing proprioception to prevent the elderly patients with type2 diabetes from falling.

Effect of combining music media therapy with lower extremity exercise on elderly patients with diabetes mellitus

Objective:To evaluate the compliance with lower extremity exercise and blood circulation in the feet of elderly diabetics following a combination of music media therapy and a lower extremity exercise regimen.Method:The 72 elderly diabetic patient subjects were divided into two groups:control group(n=38)and intervention group(n=34).Both groups were exposed to the same comprehensive therapy to control glucose levels.While the control group was given the lower extremity exercise,the intervention group received the extremity exercise in addition to the music media.Result:After three months of intervention,the adherence to the lower extremity exercise regimen in the intervention group was significantly higher than that of the control group(p<0.05).Additionally,following six months of treatment,both the dorsal artery peak values and ankle-brachial indices(ABIs)showed significant differences between the control and intervention groups(p<0.05).Conclusion:Music media treatment combined with lower extremity exercise can both significantly increase the extent of exercise compliance of elderly patients suffering from diabetes mellitus,as well as improve blood circulation in their feet.

Resection of non-cystic adenocarcinoma in pancreatic body and tail

AIM: To report the outcome of Chinese patents with non-cystic adenocarcinoma in pancreatic body and tail (NCAPBT) after resection and to discuss its surgical strategy. METHODS: Resection of NCAPBT was performed in eight Chinese patients with complete clinical-pathological data in our hospital from January 2000 to May 2004. The surgical strategy was explored by analyzing the results of these patients. RESULTS: The resection rate of NCAPBT in patients without back pain was higher than that in patients with back pain (66.67% vs 20%, 2/3 vs 1/5). The prognosis in the group receiving palliative resection was poorer than that in the group receiving curative resection. The median survival time was 12 mo in the curative resection group and 6 mo in the palliative resection group, respectively. CONCLUSION: The overall survival time of the Chinese patients with NCAPBT is dismal. The Chinese patients after curative resection of NCAPBT have a longer survival time. The Chinese NCAPBT patients with back pain trend to have a lower curative resection rate, but back pain should not be considered a contraindication for curative resection.

Detection of plasmid-mediated IMP-1 metallo-β-lactamase and quinolone resistance determinants in an ertapenem-resistant Enterobacter cloacae isolate

Objective： To investigate the mechanism of carbapenem resistance and the occurrence ofplasmid-mediated quinolone resistance determinants qnr and aac（6＇）-Ib-cr in a clinical isolate of Enterobacter cloacae. Methods： An ertapenem-resistant E. cloacae ZY106, which was isolated from liquor puris of a female gastric cancer patient in a Chinese hospital, was investigated. Antibiotic susceptibilities were determined by agar dilution method. Conjugation experiments, isoelectric focusing, polymerase chain reaction （PCR）, and DNA sequence analyses of plasmid-mediated carbapenemases and quinolone resistance determinants were preformed to confirm the genotype. Outer membrane proteins （OMPs） were examined by urea-sodium dodecyl sulfate- polyacrylamide gel electrophoresis （Urea-SDS-PAGE）. Results： Minimum inhibitory concentrations （MICs） of imipenem, mer- openem, and ertapenem for ZY 106 were 2, 4, and 16 pg/ml, respectively. Conjugation studies with Escherichia coli resulted in the transfer of significantly reduced carbapenem susceptibility. ZY106 produced IMP-1 metallo-β-lactamase and CTX-M-3 extended-spectrum β-1actamase, and E. coli transconjugant produced IMP-1. Plasrnid-mediated quinolone resistance determinant qnrS1 was detected in ZY106. Transfer of the qnrSl-encoding-plasmid into E. coli by conjugation resulted in intermediate resistance to ciprofloxacin in E. coli transconjugant. Urea-SDS-PAGE analysis of OMPs showed that ZYI06 lacked an OMP of approximately 38 kDa. Conclusion： It is the first IMP-l-producing Enterobacteriaceae in China and the first report of a clinical isolate that harbors both blalMP and qnrS genes as well. The blalMP-1, blaCTX-M-3, and qnrS1 are encoded at three different plasmids. IMP-1 combined with the loss of an OMP possibly resulted in ertapenem resistance and reduced imipenem and mero- penern susceptibility in E. cloacae.

Symbiotic bacteria attenuate Drosophila oviposition repellence to alkaline through acidification

Metazoans harbor a wealth of symbionts that are ever-changing the environment by taking up resources and/or excreting metabolites.One such common environmental modification is a change in pH.Conventional wisdom holds that symbionts facilitate the survival and production of their hosts in the wild,but this notion lacks empirical evidence.Here,we report that symbiotic bacteria in the genus Enterococcus attenuate the oviposition avoidance of alkaline environments in Drosophila.We studied the effects of alkalinity on oviposition preference for the first time,and found that flies are robustly disinclined to oviposit on alkali-containing substrates.This innate repulsion to alkaline environments is explained,in part,by the fact that alkalinity compromises the health and lifespan of both offspring and parent Drosophila.Enterococcus dramatically diminished or even completely reversed the ovipositional avoidance of alkalinity in Drosophila.Mechanistically,Enterococcus generate abundant lactate during fermentation,which neutralizes the residual alkali in an egg-laying substrate.In conclusion,Enterococcus protects Drosophila from alkali stress by acidifying the ovipositional substrate,and ultimately improves the fitness of the Drosophila population.Our results demonstrate that symbionts are profound factors in the Drosophila ovipositional decision,and extend our understanding of the intimate interactions between Drosophila and their symbionts.

A CLASS OF TWO-STEP CONTINUITY RUNGE-KUTTA METHODS FOR SOLVING SINGULAR DELAY DIFFERENTIAL EQUATIONS AND ITS STABILITY ANALYSIS

In this paper, a class of two-step continuity Runge-Kutta（TSCRK） methods for solving singular delay differential equations（DDEs） is presented. Analysis of numerical stability of this methods is given. We consider the two distinct cases： （i）τ≥ h, （ii）τ 〈 h, where the delay τ and step size h of the two-step continuity Runge-Kutta methods are both constant. The absolute stability regions of some methods are plotted and numerical examples show the efficiency of the method.

PARALLEL COMPOUND METHODS FOR SOLVING PARTITIONED STIFF SYSTEMS

Deals with the solution of partitioned systems of nonlinear stiff differential equations. Discussion on parallel compound methods; Nonstiff equations; Order conditions of the parallel compound methods (PCM); Numerical stability of PCM.

PARALLEL ROSENBROCK METHODS FOR SOLVING STIFF SYSTEMS IN REAL-TIME SIMULATION

In this paper parallel Rosenbrock methods in real-time simulation are presented on parallel computers. Their construction, their convergence and their numerical stability are studied, and the numerical simulation experiments are conducted on a personal computer and a parallel computer respectively. [ABSTRACT FROM AUTHOR]