Coinfection with hepatic cystic and alveolar echinococcosis with abdominal wall abscess and sinus tract formation:A case report

BACKGROUND Hepatic cystic and alveolar echinococcosis coinfections,particularly with concurrent abscesses and sinus tract formation,are extremely rare.This article presents a case of a patient diagnosed with this unique presentation,discussing the typical imaging manifestations of both echinococcosis types and detailing the diagnosis and surgical treatment experience thereof.CASE SUMMARY A 39-year-old Tibetan woman presented with concurrent hepatic cystic and alveolar echinococcosis,accompanied by abdominal wall abscesses and sinus tract formation.Initial conventional imaging examinations suggested only hepatic cystic echinococcosis,but intraoperative and postoperative pathological examination revealed the coinfection.Following radical resection of the lesions,the patient’s condition improved,and she was discharged soon thereafter.Subsequent outpatient follow-ups confirmed no recurrence of the hydatid lesion and normal surgical wound healing.Though mixed hepatic cystic and alveolar echinococcosis with abdominal wall abscesses and sinus tract formations are rare,the general treatment approach remains consistent with that of simpler infections of alveolar echinococcosis.CONCLUSION Lesions involving the abdominal wall and sinus tract formation,may require radical resection.Long-term prognosis includes albendazole and follow-up examinations.

Tenofovir alafenamide significantly increased serum lipid levels compared with entecavir therapy in chronic hepatitis B virus patients

BACKGROUND Tenofovir alafenamide(TAF)has a serum lipid-raising effect in patients with HIV;however,its effect on serum lipids and nonalcoholic fatty liver disease(NAFLD)risk in patients with chronic hepatitis B(CHB)is unclear.AIM To compare the effects of TAF and entecavir(ETV)on serum lipid levels in patients with CHB.METHODS In this retrospective cohort study,the data including the clinical features,serum lipids,and metabolic factors of patients with CHB at baseline and approximately 1 year after TAF or ETV treatment were collected and analyzed.We used propensity score-matched models to assess the effects on high-density lipoprotein,lowdensity lipoprotein,triglycerides,and total cholesterol(TCHO).RESULTS A total of 336 patients(75.60%male)were included;63.69%received TAF and 36.31%received ETV.Compared with the ETV group,the TAF group had significantly higher TCHO levels after treatment(4.67±0.90 vs 4.36±1.05,P=0.006).In a propensity score-matched model for body mass index,age,sex,smoking,drinking,presence of comorbidities such as NAFLD,cirrhosis,diabetes mellitus,and hypertension,TAF-treated patients had significantly increased TCHO levels compared to that at baseline(P=0.019).There was no difference for the ETV group.Body mass index,sex,hypertension,baseline TCHO,and creatine kinase-MB isoenzyme levels were significantly associated with elevated TCHO levels in logistic regression analysis.However,1-year TAF treatment did not increase the incidence of NAFLD.CONCLUSION A greater increase in TCHO was observed in patients with CHB receiving TAF compared to those receiving ETV.However,TAF-induced dyslipidemia did not increase the incidence of NAFLD.

Development and validation of an online calculator to predict the pathological nature of colorectal tumors

BACKGROUND No single endoscopic feature can reliably predict the pathological nature of colorectal tumors(CRTs).AIM To establish and validate a simple online calculator to predict the pathological nature of CRTs based on white-light endoscopy.METHODS This was a single-center study.During the identification stage,530 consecutive patients with CRTs were enrolled from January 2015 to December 2021 as the derivation group.Logistic regression analysis was performed.A novel online calculator to predict the pathological nature of CRTs based on white-light images was established and verified internally.During the validation stage,two series of 110 images obtained using white-light endoscopy were distributed to 10 endoscopists[five highly experienced endoscopists and five less experienced endoscopists(LEEs)]for external validation before and after systematic training.RESULTS A total of 750 patients were included,with an average age of 63.6±10.4 years.Early colorectal cancer(ECRC)was detected in 351(46.8%)patients.Tumor size,left semicolon site,rectal site,acanthosis,depression and an uneven surface were independent risk factors for ECRC.The C-index of the ECRC calculator prediction model was 0.906(P=0.225,Hosmer-Lemeshow test).For the LEEs,significant improvement was made in the sensitivity,specificity and accuracy(57.6%vs 75.5%;72.3%vs 82.4%;64.2%vs 80.2%;P<0.05),respectively,after training with the ECRC online calculator prediction model.CONCLUSION A novel online calculator including tumor size,location,acanthosis,depression,and uneven surface can accurately predict the pathological nature of ECRC.

锥轴分布式球形柱塞泵润滑性能分析

圆锥轴配流是液压元件中的一种新型流量分配结构设计,它有圆柱轴配流和平面流配流的优点。本文研究了圆锥轴配流的稳态工况及其在变载荷作用下的动态响应。基于特殊的结构形式,建立了球面坐标系下的润滑模型。通过受力分析,建立了锥轴配流在轴向和径向自由度分布的动力学模型。采用数值方法对模型进行求解,得到了包括轴偏心率和分布间隙高度在内的静、动态润滑性能。结果表明,在冲击载荷作用下,轴的偏心距和分布间隙会剧烈振荡,并在短时间内恢复到平衡位置。这种无需外部调整的锥轴配流的润滑方式具有自适应性,对保证球柱塞泵工作的可靠性具有重要意义。

自身免疫性胰腺炎19例临床特征分析并文献回顾

背景自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是由免疫介导的,以影像学胰腺肿大、组织学淋巴浆细胞浸润伴席纹状纤维化为特征性表现的疾病,发病机制尚不明确,我国的流行病学资料尚不完善,临床表现多无特异性,起病隐匿.因此,总结该病的临床特点及预后情况可对今后的诊治起指导作用.目的旨在总结AIP的临床特征,提高临床医师对该病的认识.方法收集了2011-01/2020-05期间在首都医科大学附属北京世纪坛医院确诊为AIP的患者,共19例,对其进行回顾性分析.结果(1)一般情况:19例患者中男女比例为16:3,平均年龄为(71.0±10.7)岁,均符合1型AIP诊断标准;(2)临床表现:常见的临床症状是梗阻性黄疸,体重下降,血糖升高,纳差乏力,腹胀.合并症最常见为硬化性胆管炎及淋巴结肿大;(3)血清学:16例IgG4升高,且均大于2倍正常上限;11例CA199升高,治疗后CAl99下降明显,有统计学意义(P<0.05),11例胆红素系列升高;(4)影像学表现:腹部超声可作为AIP的初筛检查,CT/MRI是重要的影像学方法,典型征象为胰腺弥漫性或局部肿大,EUS典型征象为胰腺弥漫性回声减低,呈网格样改变,周围可见低/无回声带;(5)治疗:16例患者接受糖皮质激素治疗,2例未经治疗,1例误诊行外科手术;(6)预后:14例好转,1例复发,2例死亡,2例未经治疗患者,随访至目前病情无变化.结论AIP在临床上属罕见病,且临床表现、血清学指标等均不具有特异性,因而诊断需结合影像学、糖皮质激素诊断性治疗及随访情况等反复验证.

儿童肝囊型包虫病诊治进展

肝包虫病是一种全世界广泛分布的由棘球蚴感染引起的人畜共患寄生虫病.儿童处于特殊的年龄阶段,不仅是棘球蚴病的重点防治人群,也是大规模防治中的重点监测对象.儿童肝囊性包虫病症状不典型,易误诊,治疗不规范易导致复发甚至死亡,因此本文从儿童肝囊型包虫病的诊断和治疗方式作一综述.

腹腔镜治疗儿童肝囊型包虫病的研究进展

肝囊型包虫病是一种流行于畜牧业区的人兽共患性寄生虫疾病,目前该疾病仍以手术治疗为主;相对于传统开腹手术,近年来随着微创手术及精准手术理念的发展,腹腔镜手术治疗肝囊型包虫病已在临床广泛应用;目前成人应用腹腔镜技术治疗肝囊型包虫病已得到临床肯定,但儿童肝囊型包虫病由于其腹腔空间小、囊壁薄、易破裂等因素目前临床尚未普及,故本文根据国内外相关文献归纳并着重阐述腹腔镜下治疗儿童肝囊型包虫病的不同手术方式在临床中的应用情况,为儿童肝囊型包虫病的微创手术治疗提供一定的参考.

Clinical value of predictive models based on liver stiffness measurement in predicting liver reserve function of compensated chronic liver disease

BACKGROUND Assessment of liver reserve function(LRF)is essential for predicting the prognosis of patients with chronic liver disease(CLD)and determines the extent of liver resection in patients with hepatocellular carcinoma.AIM To establish noninvasive models for LRF assessment based on liver stiffness measurement(LSM)and to evaluate their clinical performance.METHODS A total of 360 patients with compensated CLD were retrospectively analyzed as the training cohort.The new predictive models were established through logistic regression analysis and were validated internally in a prospective cohort(132 patients).RESULTS Our study defined indocyanine green retention rate at 15 min(ICGR15)≥10%as mildly impaired LRF and ICGR15≥20%as severely impaired LRF.We constructed predictive models of LRF,named the mLPaM and sLPaM,which involved only LSM,prothrombin time international normalized ratio to albumin ratio(PTAR),age and model for end-stage liver disease(MELD).The area under the curve of the mLPaM model(0.855,0.872,respectively)and sLPaM model(0.869,0.876,respectively)were higher than that of the methods for MELD,albumin bilirubin grade and PTAR in the two cohorts,and their sensitivity and negative predictive value were the highest among these methods in the training cohort.In addition,the new models showed good sensitivity and accuracy for the diagnosis of LRF impairment in the validation cohort.CONCLUSION The new models had a good predictive performance for LRF and could replace the indocyanine green(ICG)clearance test,especially in patients who are unable to undergo ICG testing.

Outcomes of Preimplantation Genetic Diagnosis Cycles by Fluorescent In situ Hybridization of Infertile Males with Nonmosaic 47,XYY Syndrome

Background： The 47,XYY syndrome could result in fertility problems. However, seldom studies reported comprehensive researches on the embryonic development and pregnancy outcomes of these patients. This study aimed to evaluate the clinical outcomes of nonmosaic 47,XYY patients performed with fluorescent in situ hybridization （FISH） and preimplantation genetic diagnosis （PGD） treatment. Methods： This was a retrospective study. Between January 2012 and May 2017, 51 infertile males with nonmosaic 47,XYY syndrome underwent FISH-PGD were included in the study. According to sex chromosomal FISH results, embryos were classified as normal signal, no nuclei fixed, no signal in fixed nuclei, suspensive signal, and abnormal signal groups, respectively. The incidence of each group, the fixation rate, and hybridization rate were calculated. Embryonic development and pregnancy outcomes were also analyzed. The measurement data were analyzed with Student＇s t-test. The comparison of categorical data was analyzed with the Chi-square test and Fisher＇s exact test when expected cell count was 〈5. Results： The 53 PGD cycles with 433 embryos were analyzed. The fixation rate was 89.6%, while the hybridization rate was 96.4%. There were 283 embryos with two sex chromosomal signals with clear diagnosis （65.4%）. The numbers of no nuclei fixed, no signal in fixed nuclei, suspensive signal, and abnormal signal groups were 45 （10.4%）, 14 （3.2%）, 24 （5.5%）, and 67 （15.5%）, respectively. Embryos with abnormal signals were abandoned. The number of good-quality embryos was 210 （57.4%）, including implanted embryos on day 4/day 5 a.ld cryopreserved. The rates of good-quality embryos in the no nuclei fixed （22.2%）, no signal in fixed nuclei （28.6%）, and suspensive signal groups （33.3%） were comparable （P 〉 0.05）, and were significantly lower than the normal signal group （66.4%, P 〈 0.001 ）. The clinical pregnancy rates of fresh and frozen embryos transferred cycles were 70.6% and 85.7%, respectively. Conclusions： Among embryos with a clear diagnosis of sex chromosome, about one-fifth showed abnormal signals. Embryos with two sex chromosomal signals are more likely to develop into good-quality ones. The application of the PGD by FISH may help to improve the clinical outcomes.