Clinical features of cardiac nodularity-like appearance induced by Helicobacter pylori infection

We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of H.pylori infection.In the previous study,we included only the patients who were evaluated for H.pylori infection for the
rst time,and excluded patients with a history of eradication.Therefore,the prevalence and clinical features of cardiac nodularity remains unknown.AIM To perform this cross-sectional study to explore the characteristics of cardiac nodularity.METHODS Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy Clinic were enrolled in this study.We included H.pylori-negative,H.pylori-positive,and H.pylorieradicated patients,and excluded patients with unclear H.pylori status and eradication failure.H.pylori infection was diagnosed according to serum anti-H.pylori antibody and the urea breath test or histology.Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction.Nodularity was visualized as whitish in the narrow-band imaging mode.We collected data on the patients’baseline characteristics.RESULTS A total of 1078 patients were finally included.Among H.pylori-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%each.Among H.pylori-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,respectively.Among H.pylori-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,respectively.The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H.pylori-positive and-eradicated patients.The frequencies of cardiac nodularity and antral nodularity in H.pylori-eradicated patients were significantly lower than those in H.pylori-positive patients(P<0.001).The patients with cardiac nodularity were significantly younger than those without cardiac nodularity(P=0.0013).Intestinal metaplasia score of the patients with cardiac nodularity were significantly lower than those without cardiac nodularity(P=0.0216).Among H.pylori-eradicated patients,the patients with cardiac nodularity underwent eradication significantly more recently compared with those without cardiac nodularity(P<0.0001).CONCLUSION This report outlines the prevalence and clinical features of cardiac nodularity,and confirm its close association with active H.pylori infection.

Effect of nodularity on mechanical properties and fracture of ferritic spheroidal graphite iron

Ferritic spheroidal graphite irons with nodularity from 72%to 96%were prepared.The relationship between the nodularity and the mechanical properties of the ferritic spheroidal graphite iron was investigated.The effect of nodularity on the mechanical properties and tensile fracture of the cast iron were studied.Results showed that the tensile strength Rm,yield strength Rp0.2,elongation to failure A5,and impact energy KV2 of the cast iron had a good linear relationship with its nodularity.Nodularity and annealing treatment would obviously affect the fracture characteristics of ferritic spheroidal graphite iron.The annealed ferritic spheroidal graphite iron with 93%nodularity showed a completely ductile rupture.With the decrease of nodularity from 93%to 72%,the cleavage fracture area ratio increased gradually from 0%to 8.3%.Compared with as-cast ferritic spheroidal graphite iron,annealing treatment reduced the cleavage fracture area of the ferritic spheroidal graphite iron.

Microstructure and properties of LZQT600-3 HCCDIBs for plunger pump cylinder

It is important to improve the comprehensive performance of the ductile iron bars(DIBs)for the cylinder block of the extra high pressure hydraulic plunger pump and accelerate the industrial application.In this work,the LZQT600-3 DIBs with the diameter of 145 mm were prepared by the horizontal continuous casting(HCC)process,that is,LZQT600-3 HCCDIBs.The microstructure and room temperature tensile properties of different sections[left-edge(surface layer),left-1/2R(left half of the radius),and the center of the HCCDIBs]were studied.The results show that the spheroidization of LZQT600-3 HCCDIBs matrix from the left-edge,left-1/2R to the center is at nodulizing grade II and above.As the cooling rate gradually decreases from surface to the center of the HCCIBs,the number of spheroidized graphite is gradually reduced,the size is gradually increased,the shape factor is decreased,and the pearlite content and lamellate spacing are increased.Along the horizontal direction of the section,the hardness of the material is distributed symmetrically around the center of the HCCDIBs.In the vertical direction,the hardness distribution in the center of the HCCDIBs is asymmetrical due to the gravity during the solidification process.Therefore,the microstructure in the lower part of the section solidifies relatively quickly.The left-edge has the best tensile mechanical properties,and the ultimate tensile strength,yield tensile strength and elongation are 597.3 MPa,418.5 MPa and 9.6%,respectively.The tensile fracture belongs to the ductile-brittle hybrid fracture.The comprehensive performances of LZQT600-3 HCCDIBs meet the actual application requirements of ultra-high pressure hydraulic plunger pump cylinder.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Nodular Pulmonary Amyloidosis with Interstitial Lung Disease—Case Report and Literature Review

Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis;however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.

Nodular fasciitis of the external auditory canal: Clinical case report and review of the literature

Nodular fasciitis is a benign reactive soft tissue tumor arising from fibroblasts and myofibroblasts.Its incidence is low and misdiagnosis is frequent especially for malignant lesions.This can lead to inappropriate and unnecessary invasive treatment.Nodular fasciitis of the external auditory canal is extremely rare.So far,around fifteen cases have been reported.We present here the case of a 90-year-old patient with nodular fasciitis of the right external auditory canal.The lesion extends anteriorly for 6.5 cm and reaches the posterior wall of the maxillary sinus.To our knowledge,this is the first case in the literature of an external auditory canal nodular fasciitis presenting as an inflammatory ear polyp with such a wide extension.

Inflammatory cutaneous metastases originating from gastric cancer: A case report

BACKGROUND Cutaneous metastasis with gastric cancer(GC)origin is extremely rare and associated with poor prognosis.Nodular type is the most common type,while other forms are extremely rare.CASE SUMMARY This study describes severe skin redness,swelling,pain,and fever in a 65-year-old man diagnosed with GC,whose left chest wall,left upper limb,and left back were mainly affected.Firstly,the patient was diagnosed with“lymphangitis”and treated to promote lymphatic return.However,the symptoms were constantly deteriorating,and skin thickening and scattered small nodules gradually appeared.Finally,the skin biopsy confirmed cutaneous metastases,and the patient died 7 d later.CONCLUSION Our case highlights that cutaneous metastasis should be considered when skin lesions appear in patients with GC.

Development of preoperative prognostic models including radiological features for survival of singular nodular HCC patients

Background:Early singular nodular hepatocellular carcinoma(HCC)is an ideal surgical indication in clinical practice.However,almost half of the patients have tumor recurrence,and there is no reliable prognostic prediction tool.Besides,it is unclear whether preoperative neoadjuvant therapy is necessary for patients with early singular nodular HCC and which patient needs it.It is critical to identify the patients with high risk of recurrence and to treat these patients preoperatively with neoadjuvant therapy and thus,to improve the outcomes of these patients.The present study aimed to develop two prognostic models to preoperatively predict the recurrence-free survival(RFS)and overall survival(OS)in patients with singular nodular HCC by integrating the clinical data and radiological features.Methods:We retrospective recruited 211 patients with singular nodular HCC from December 2009 to January 2019 at Eastern Hepatobiliary Surgery Hospital(EHBH).They all met the surgical indications and underwent radical resection.We randomly divided the patients into the training cohort(n=132)and the validation cohort(n=79).We established and validated multivariate Cox proportional hazard models by the preoperative clinicopathologic factors and radiological features for association with RFS and OS.By analyzing the receiver operating characteristic(ROC)curve,the discrimination accuracy of the models was compared with that of the traditional predictive models.Results:Our RFS model was based on HBV-DNA score,cirrhosis,tumor diameter and tumor capsule in imaging.RFS nomogram had fine calibration and discrimination capabilities,with a C-index of 0.74(95%CI:0.68-0.80).The OS nomogram,based on cirrhosis,tumor diameter and tumor capsule in imaging,had fine calibration and discrimination capabilities,with a C-index of 0.81(95%CI:0.74-0.87).The area under the receiver operating characteristic curve(AUC)of our model was larger than that of traditional liver cancer staging system,Korea model and Nomograms in Hepatectomy Patients with Hepatitis B VirusRelated Hepatocellular Carcinoma,indicating better discrimination capability.According to the models,we fitted the linear prediction equations.These results were validated in the validation cohort.Conclusions:Compared with previous radiography model,the new-developed predictive model was concise and applicable to predict the postoperative survival of patients with singular nodular HCC.Our models may preoperatively identify patients with high risk of recurrence.These patients may benefit from neoadjuvant therapy which may improve the patients’outcomes.

Generalized granuloma annulare in an infant clinically manifested as papules and atrophic macules:A case report

BACKGROUND Granuloma annulare(GA)has diverse clinical manifestations including papules,plaques,and nodules on the extremities that are skin-colored,pink,or purple.Approximately 15%of all GA cases are considered generalized GA.CASE SUMMARY Herein,we describe the case of a pediatric patient who initially presented with papules and later developed generalized atrophic macules.Upon examination,two different morphologic lesions were histopathologically confirmed:Epithelioid nodular GA and scattered histiocytic infiltrative GA.This patient exhibited rare clinical manifestations that differed throughout the course of the disease.The varying histopathological types and clinical manifestations of GA may be linked to the different stages of the disease.CONCLUSION This rare case demonstrates the different histopathological features of different stages and clinical manifestations of granuloma annulare in an infant.

Advances in the Intervention of Prunella Spica Capsules on Postoperative Recurrence of Nodular Goiter

As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.

Papillary thyroid carcinoma with nodular fasciitis-like stroma-an unusual variant with distinctive histopathology:A case report

BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.

Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis

Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.

Collagenous gastritis: Review

Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamina propria. Collagenous colitis and collagenous sprue have similar histological characteristics to collagenous gastritis and are thought to be part of the same disease entity. However, while collagenous colitis has become more common in the field of gastroenterology, presenting with clinical symptoms of chronic diarrhea in older patients,collagenous gastritis is rare. Since the disease was first reported in 1989, only 60 cases have been documented in the English literature. No safe and effective treatments have been identified from randomized, controlled trials. Therefore, better understanding of the disease and the reporting of more cases will help to establish diagnostic criteria and to develop therapeutic strategies. Therefore, here we review the clinical characteristics, endoscopic and histological findings, treatment, and clinical outcomes from case reports and case series published to date, and provide a summary of the latest information on the disease. This information will contribute to improved knowledge of collagenous gastritis so physicians can recognize and correctly diagnose the disease, and will help to develop a standard therapeutic strategy for future clinical trials.

A reliable and consistent production technology for high volume compacted graphite iron castings

The demands for improved engine performance,fuel economy,durability,and lower emissions provide a continual challenge for engine designers.The use of Compacted Graphite Iron(CGI)has been established for successful high volume series production in the passenger vehicle,commercial vehicle and industrial power sectors over the last decade.The increased demand for CGI engine components provides new opportunities for the cast iron foundry industry to establish efficient and robust CGI volume production processes,in China and globally.The production window range for stable CGI is narrow and constantly moving.Therefore,any one step single addition of magnesium alloy and the inoculant cannot ensure a reliable and consistent production process for complicated CGI engine castings.The present paper introduces the SinterCast thermal analysis process control system that provides for the consistent production of CGI with low nodularity and reduced porosity,without risking the formation of flake graphite.The technology is currently being used in high volume Chinese foundry production.The Chinese foundry industry can develop complicated high demand CGI engine castings with the proper process control technology.

结节性类弹性纤维病一例

结节性类弹性纤维病（nodular elastoidosis）是一种日光弹力组织变性,笔者曾收治1例,现报道如下。1临床资料患者,男,69岁,因面部起皮疹7年就诊。患者7年前发现面部出现大片皮色丘疹及黑头粉刺,无自觉症状,一直未曾就诊,后皮损逐渐增多,自行外用多种外用软膏,无明显效果。

Property enhancement of cast iron used for nuclear casks

Ductile iron （DI） is a preferred material for use in various structural, automotive, and engineering fields because of its excellent combination of strength, toughness, and ductility. In the current investigation, we elucidate the relationship between the morphological and mechanical properties of DI intended for use in safety applications in the nuclear industry. DI specimens with various alloying elements were subjected to annealing and austempering heat treatment processes. A faster cooling rate appeared to increase the nodule count in austempered specimens, compensating for their nodularity value and subsequently decreasing their ductility and impact strength. The ductility and impact energy values of annealed specimens increased with increasing ferrite area fraction and nodularity, whereas an increase in the amounts of Ni and Cr resulted in an increase of hardness via solid solution strengthening. Austempered specimens were observed to be stronger than an- nealed specimens and failed in a somewhat brittle manner characterized by a river pattern, whereas the ductile failure mode was character- ized by the presence of dimples.

Microstructural analysis of EN-GJS-450-10 ductile cast iron via vibrational casting

EN-GJS-450-10 ductile cast iron was produced with and without vibration to evaluate microstructural features. To investigate the effect of vibration, a reference, and two different castings having amplitudes of 0.9 mm and 1.8 mm were cast with a fixed vibration frequency of 50 Hz. The nodule count (density), form (type), size distribution, nodularity, and the fraction of graphite, percentages of both ferrite and pearlite phases, length of ferrite shell, and pore, were evaluated via optical microscopy using an image analysis software. It is observed that the microstructure of the cast iron is more uniform by vibrational casting than that by non-vibrational casting. Additionally, mechanical vibration enhances nodule count and nodularity, also, more ferritic matrix could be obtained after the application of vibration. Nodule count and nodularity of vibrational casting with 1.8 mm amplitude increased from 226 nodule per mm2 and 80% to 311 nodule per mm2 and 86.5% of non-vibrational casting. Percentages of ferrite and graphite area dramatically improved from 24% and 16.5% for non-vibrational casting to 57% and 22.3% for vibrational casting with 1.8 mm amplitude, whereas the percentages of pearlite and pores decreased significantly from 56.1% and 5% to 20% and 1%, respectively.

“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)and number,this model identifies three groups with different survival time(the sum is≤6;or>6 but≤12;or>12);a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve.Recently,Wang ZW et al showed that the“6&12”model was the best system correlated with radiological response after the first TACE.Thus,we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems(Barcelona Clinic Liver Cancer,Hong Kong Liver Cancer(HKLC)staging,Albumin-Bilirubin grade,tumor nodularity,infiltrative nature of the tumor,alpha-fetoprotein,Child-Pugh class,and Performance Status score,Cancer of the Liver Italian Program,Model to Estimate Survival for HCC scores,up-to-seven criteria)different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled.As previously demonstrated,we show that the"6&12”score can classify survival within this French cohort,with a prognostic value comparable to that of other systems,except HKLC staging.More importantly,the“6&12”score simplicity and ability in patients’stratification outperform other systems for a routine clinical practice.

Characterization of focal liver masses using acoustic radiation force impulse elastography

AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their stiffness.METHODS:This prospective study included 62 patients with a focal liver mass that was well visualized on conventional ultrasonography performed in our institution from February 2011 to November 2011.Among them,12 patients were excluded for ARFI measurement failure due to a lesion that was smaller than the region of the interest and at an inaccessible location(deeper than 8 cm)(n = 7) or poor compliance to hold their breath as required(n = 5).Finally,50 patients with valid ARFI measurements were enrolled.If a patient had multiple liver masses,only one mass of interest was chosen.The masses were diagnosed by histological examination or clinical diagnostic criteria.During ultrasonographic evaluation,stiffness,expressed as velocity,was checked 10 times per focal liver mass and the surrounding liver parenchyma.RESULTS:After further excluding three masses that were non-diagnostic on biopsy,a total of 47 focal mass lesions were tested,including 39(83.0%) malignant masses [24 hepatocellular carcinomas(HCC),seven cholangiocellular carcinomas(CCC),and eight liver metastases] and eight(17.0%) benign masses(five hemangiomas and three focal nodular hyperplasias,FNH).Thirty-seven(74.0%) masses were confirmed by histological examination.The mean velocity was 2.48 m/s in HCCs,1.65 m/s in CCCs,2.35 m/s in metastases,1.83 m/s in hemangiomas,and 0.97 m/s in FNHs.Although considerable overlap was still noted between malignant and benign masses,significant differences in ARFI values were observed between malignant and benign masses(mean 2.31 m/s vs 1.51 m/s,P = 0.047),as well as between HCCs and benign masses(mean 2.48 m/s vs 1.51 m/s,P = 0.006).The areas under the receiver operating characteristics curves(AUROC) for discriminating the malignant masses from benign masses was 0.724(95%CI,0.566-0.883,P = 0.048),and the AUROC for discriminating HCCs from benign masses was 0.813(95%CI,0.649-0.976,P = 0.008).To maximize the sum of sensitivity and specificity,an ARFI value of 1.82 m/s was selected as the cutoff value to differentiate malignant from benign liver masses.Furthermore,the cutoff value for distinguishing HCCs from benign masses was also determined to be 1.82 m/s.The diagnostic performance of the sum of the ARFI values for focal liver masses and the surrounding liver parenchyma to differentiate liver masses improved(AUROC = 0.853;95%CI,0.745-0.960;P = 0.002 in malignant liver masses vs benign ones and AUROC = 0.948;95%CI,0.896-0.992,P < 0.001 in HCCs vs benign masses).CONCLUSION:ARFI elastography provides additional information for the differential diagnosis of liver masses.However,our results should be interpreted in clinical context,because considerable overlap in ARFI values existed among liver masses.

Nodular regenerative hyperplasia:Evolving concepts on underdiagnosed cause of portal hypertension

Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrhotic portal hypertension.There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series.NRH may develop via autoimmune,hematological,infectious,neoplastic,or drug-related causes.The disease is usually asymptomatic,slowly or nonprogressive unless complications of portal hypertension develop.Accurate diagnosis is made by histopathology,which demonstrates diffuse micronodular transformation without fibrous septa.Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver.While the initial treatment is to address the underlying disease,ultimately the therapy is directed to the management of portal hypertension.The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension.In this review we detail the epidemiology,pathogenesis,diagnosis,management,and prognosis of NRH.