Pulmonary alveolar proteinosis induced by X-linked agammaglobulinemia:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)and X-linked agammaglobulinemia(XLA)are rare diseases in children.Many theories infer that immunodeficiency can induce PAP,but these reports are almost all review articles,and there is little clinical evidence.We report the case of a child with both PAP and XLA.CASE SUMMARY A 4-month-old boy sought medical treatment due to coughing and difficulty in breathing for>2 wk.He had been hospitalized multiple times due to respiratory infections and diarrhea.Chest computed tomography and alveolar lavage fluid showed typical PAP-related manifestations.Genetic testing confirmed that the boy also had XLA.Following total lung alveolar lavage and intravenous immunoglobulin replacement therapy,the boy recovered and was discharged.During the follow-up period,the number of respiratory infections was significantly reduced,and PAP did not recur.CONCLUSION XLA can induce PAP and improving immune function contributes to the prognosis of children with this type of PAP.

Clinical approach for pulmonary alveolar proteinosis in children

In this editorial,we discuss the clinical implications of the article by Zhang et al.Pulmonary alveolar proteinosis(PAP)is a rare lung disease characterized by excessive surfactant accumulation in the alveoli.It is classified into four categories:Primary,secondary,congenital,and unclassified forms.Primary PAP is caused by the disruption of granulocyte-macrophage colony-stimulating factor(GM-CSF)receptor signaling,which is necessary for the clearance of surfactant by alveolar macrophages.It is further divided into autoimmune PAP,caused by anti-GM-CSF antibodies blocking alveolar macrophage activation,and hereditary PAP,resulting from mutations in genes encoding GM-CSF receptors.Secondary PAP develops due to conditions affecting the number or function of alveolar macrophages,such as infections,immunodeficiency,hematological disorders,or exposure to inhaled toxins.Congenital PAP is linked to mutations in genes involved in surfactant protein production.Notably,the causes of PAP differ between children and adults.Diagnostic features include a characteristic"crazypaving"pattern on high-resolution computed tomography,accompanied by diffuse ground-glass opacities and interlobular septal thickening.The presence of PAP can be identified by the milky appearance of bronchoalveolar lavage fluid and histological evaluation.However,these methods cannot definitively determine the cause of PAP.Whole lung lavage remains the standard treatment,often combined with specific therapies based on the underlying cause.

Age-related alveolar bone maladaptation in adult orthodontics:finding new ways out

Compared with teenage patients,adult patients generally show a slower rate of tooth movement and more pronounced alveolar bone loss during orthodontic treatment,indicating the maladaptation of alveolar bone homeostasis under orthodontic force.However,this phenomenon is not well-elucidated to date,leading to increased treatment difficulties and unsatisfactory treatment outcomes in adult orthodontics.Aiming to provide a comprehensive knowledge and further inspire insightful understanding towards this issue,this review summarizes the current evidence and underlying mechanisms.The age-related abatements in mechanosensing and mechanotransduction in adult cells and periodontal tissue may contribute to retarded and unbalanced bone metabolism,thus hindering alveolar bone reconstruction during orthodontic treatment.To this end,periodontal surgery,physical and chemical cues are being developed to reactivate or rejuvenate the aging periodontium and restore the dynamic equilibrium of orthodontic-mediated alveolar bone metabolism.We anticipate that this review will present a general overview of the role that aging plays in orthodontic alveolar bone metabolism and shed new light on the prospective ways out of the impasse.

Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis:A retrospective study

BACKGROUND Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis(AE).Currently,there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial.Radical hepatectomy combined with regional lymph node dissection is a better treatment.AIM To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy.METHODS A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed.Fifty-five patients with combined lymph node metastasis were analysed for their clinical data,diagnosis and treatment methods,follow-up efficacy,and characteristics of lymph node metastasis.Finally,we comparatively analysed the lymph node metastasis rates at different sites.Categorical variables are expressed as frequencies and percentages,and the analysis of difference was performed using theχ2 test.The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables.RESULTS A lymph node metastasis rate of 8.8%(55/623)was reported in patients with hepatic AE,with a female predilection(69.1%)and a statistically significant sex difference(χ2=8.018,P=0.005).Of the 55 patients with lymph node metastasis,72.7%had a parasite lesion,neighbouring organ invasion,and metastasis stage of P3N1M0 and above,of which 67.3%,78.2%,and 34.5%of hepatic AE lesions invaded the bile ducts,blood vessels,and distant metastases,respectively.Detection rates of lymph node metastasis of 16.4%,21.7%,and 34.2%were reported for a preoperative abdominal ultrasound,magnetic resonance imaging,and computed tomography examinations.All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection.After surgery,a routine pathological examination was conducted on the resected lymph nodes.A total of 106 positive lymph nodes were detected in six groups at various sites,including 51 single-group metastasis cases and four multi-group metastasis cases.When the metastasis rates at different sites were statistically analysed,we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites(χ^(2)=128.089,P=0.000<0.05).No statistical difference was observed in the metastasis rate between the five other groups.Clavien-Dindo grade IIIa complication occurred in 14 cases,which improved after administering symptomatic treatment.Additionally,lymph node dissection-related complications were not observed.Recurrence after 2 years was observed in one patient.CONCLUSION Lymph node metastasis is a rare form of metastasis in hepatic AE,which is more frequent in women.Parahepatoduodenal ligament lymph nodes are commonly observed.Radical hepatectomy combined with regional lymph node dissection is a safe,effective,and feasible treatment for liver AE combined with lymph node metastasis.

Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve

BACKGROUND Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve(IAN).AIM To proposes a method for the partial grinding of an impacted mandibular third molar(IMM3)near the IAN to prevent IAN injury during IMM3 extraction.METHODS Between January 1996 and March 2022,25 patients with IMM3 roots near the IAN were enrolled.The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3.After 6 months,when the root tips were observed to be away from the IAN on X-ray examination,the remaining part of the IMM3 was completely removed.RESULTS All IMM3s were extracted easily without symptoms of IAN injury after extraction.CONCLUSION Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

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.

Characteristics of the imaging diagnosis of alveolar echinococcosis

Alveolar echinococcosis(AE)primarily manifests in the liver and exhibits charac-teristics resembling those of slow-growing malignant tumours.Untreated Echino-coccus multilocularis infection can be lethal.By infiltrating the vascular systems,biliary tracts,and the hilum of the liver,it might lead to various problems.Due to its ability to infiltrate neighbouring tissues or metastasize to distant organs,AE can often be mistaken for malignancies.We present a concise overview of the epi-demiological and pathophysiological characteristics of AE,as well as the clinical manifestations of the disease.This article primarily examines the imaging charac-teristics of AE using various imaging techniques such as ultrasonography,com-puted tomography(CT),magnetic resonance imaging,diffusion-weighted ima-ging,and virtual non-enhanced dual-energy CT.We additionally examined the contribution of radiography in the diagnosis,treatment,and monitoring of the condition.

Effect and mechanism of reactive oxygen species-mediated NOD-like receptor family pyrin domain-containing 3 inflammasome activation in hepatic alveolar echinococcosis

BACKGROUND The NOD-like receptor family pyrin domain-containing 3(NLRP3)inflammasome is a significant component of the innate immune system that plays a vital role in the development of various parasitic diseases.However,its role in hepatic alveolar echinococcosis(HAE)remains unclear.AIM To investigate the NLRP3 inflammasome and its mechanism of activation in HAE.METHODS We assessed the expression of NLRP3,caspase-1,interleukin(IL)-1β,and IL-18 in the marginal zone and corresponding normal liver of 60 patients with HAE.A rat model of HAE was employed to investigate the role of the NLRP3 inflammasome in the marginal zone of HAE.Transwell experiments were conducted to investigate the effect of Echinococcus multilocularis(E.multilocularis)in stimulating Kupffer cells and hepatocytes.Furthermore,immunohistochemistry,Western blotting,and enzyme-linked immunosorbent assay were used to evaluate NLRP3,caspase-1,IL-1β,and IL-18 expression;flow cytometry was used to detect apoptosis and reactive oxygen species(ROS).RESULTS NLRP3 inflammasome activation was significantly associated with ROS.Inhibition of ROS production decreased NLRP3-caspase-1-IL-1βpathway activation and mitigated hepatocyte damage and inflammation.CONCLUSION E.multilocularis induces hepatocyte damage and inflammation by activating the ROS-mediated NLRP3-caspase-1-IL-1βpathway in Kupffer cells,indicating that ROS may serve as a potential target for the treatment of HAE.

Percutaneous management in hepatic alveolar echinococcosis:A sum of single center experiences and a brief overview of the literature

BACKGROUND Hepatic alveolar echinococcosis(HAE)is a serious zoonotic infection that affects humans.It may have a tumor-like appearance at times.Percutaneous treatment of HAE patients is extremely relaxing for them.HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae.It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period.The disease is endemic over central Europe,Asia,and North America.AIM To characterize HAE patients who were treated percutaneously,their outcomes,and the major technical features of percutaneous treatment in HAE.METHODS Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study.Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded.RESULTS Thirty-two patients underwent percutaneous cyst drainage,two patients underwent percutaneous biliary drainage,and four patients underwent percutaneous biliary drainage alone.Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver,as well as diseased and clogged bile ducts.CONCLUSION Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial.Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery,even when the mass resolves with long-term treatment.

Sclerostin antibody improves alveolar bone quality in the Hyp mouse model of X-linked hypophosphatemia

X-linked hypophosphatemia (XLH) is a rare disease of elevated fibroblast growth factor 23 (FGF23) production that leads tohypophosphatemia and impaired mineralization of bone and teeth. The clinical manifestations of XLH include a high prevalence ofdental abscesses and periodontal disease, likely driven by poorly formed structures of the dentoalveolar complex, including thealveolar bone, cementum, dentin, and periodontal ligament. Our previous studies have demonstrated that sclerostin antibody (SclAb) treatment improves phosphate homeostasis, and increases long bone mass, strength, and mineralization in the Hyp mousemodel of XLH. In the current study, we investigated whether Scl-Ab impacts the dentoalveolar structures of Hyp mice. Male andfemale wild-type and Hyp littermates were injected with 25 mg·kg−1 of vehicle or Scl-Ab twice weekly beginning at 12 weeks of ageand euthanized at 20 weeks of age. Scl-Ab increased alveolar bone mass in both male and female mice and alveolar tissue mineraldensity in the male mice. The positive effects of Scl-Ab were consistent with an increase in the fraction of active(nonphosphorylated) β-catenin, dentin matrix protein 1 (DMP1) and osteopontin stained alveolar osteocytes. Scl-Ab had no effecton the mass and mineralization of dentin, enamel, acellular or cellular cementum. There was a nonsignificant trend towardincreased periodontal ligament (PDL) attachment fraction within the Hyp mice. Additional PDL fiber structural parameters were notaffected by Scl-Ab. The current study demonstrates that Scl-Ab can improve alveolar bone in adult Hyp mice.

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss:A case report and review of literature

BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bone resorption.The pathology is diagnosed clinically with some caution.However,the diagnosis and treatment are usually corroborated with histopathological evidence.CASE SUMMARY Three clinical cases of PG associated with bone loss were described in this study.The three patients presented tumor-like growth which bled on touch,and were associated with local irritant factors.Radiographs showed bone loss.All cases were treated with conservative surgical excision.The scarring was satisfactory,and there was no case of recurrence.The diagnoses were based on clinical findings,and were confirmed histopathologically.CONCLUSION The occurrence of oral PG with bone loss is unusual.Therefore,clinical and radiographic evaluations are important for the diagnosis.

Pneumocystis jirovecii diagnosed by next-generation sequencing of bronchoscopic alveolar lavage fluid: A case report and review of literature

BACKGROUND The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma(RCC), thus significantly improving patient survival. The incidence of rare drug-related adverse events has gained increased attention.CASE SUMMARY We report a patient with advanced RCC treated with multiple lines of molecular targeted agents and immune checkpoint inhibitors, who developed a pulmonary infection after treatment with everolimus in combination with lenvatinib. Determining the pathogenic organism was difficult, but it was eventually identified as Pneumocystis jirovecii by next-generation sequencing(NGS) of bronchoscopic alveolar lavage fluid(BALF) and successfully treated with trimethoprim-sulfamethoxazole.CONCLUSION Rare pulmonary infections caused by molecular targeted agents are not uncommon in clinical practice, but their diagnosis is difficult. Evaluating BALF with NGS is a good method for rapid diagnosis of such infections.

Minimally Invasive Maxillofacial Surgery Using Digital Work Surgery: A Case of Alveolar Ridge Reconstruction after Maxillary Cystectomy

Introduction: Iliac particulate cancellous bone and marrow (PCBM) is commonly used as a high-quality reconstruction material;however, PCBM cannot be extracted in sufficient amounts to meet demand. To determine the appropriate amount of iliac PCBM to be collected, we used digital technology to measure the volume required for jaw reconstruction before surgery. Clinical Case: The patient, a 23-year-old man, underwent surgery for a calcifying odontogenic cyst. A maxillary cyst occupied the left anterior-premolar region (tooth 21 - 25) and the deciduous canine remained;a permanent canine was included in the cyst. We planned to preserve the teeth except for the impacted canine, completely excise the maxillary cyst, and preserve the alveolar ridge morphology. Preoperative digital imaging was used to determine the amount of alveolar ridge reconstruction required and accordingly determine the amount of iliac cancellous bone to be harvested. We used a titanium mesh tray and grafts of iliac particulate cancellous bone and marrow to reconstruct the alveolar ridge. The amount of iliac cancellous bone that needed to be collected was clarified and the supply amount could be collected in just the right amount;thus, the cortical bone of the iliac inner plate could be preserved. The alveolar bone morphology was reconstructed to allow the placement of dental implants as per the preoperative digital surgery. Three years after the operation, no sign of recurrence has been observed. Conclusion: Minimally invasive surgery was performed by clarifying the amount of iliac cancellous bone graft that needs to be harvested, which improved the accuracy of surgery.

Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)often presents nonspecifically and can be easily confused with:(1)Idiopathic interstitial lung fibrosis;(2)alveolar carcinoma;(3)pulmonary tuberculosis;and(4)other lung diseases such as viral pneumonia,mycoplasma pneumonia,and chlamydial pneumonia.CASE SUMMARY Diagnosis:In this case,a patient was diagnosed with PAP through transbronchial cryobiopsy(TBCB)and quantitative metagenomic next-generation sequencing,which confirmed the impairment of surfactant turnover as the underlying cause of PAP.Interventions:High-volume total lung lavage was performed for this patient.Outcomes:The patient's clinical condition had improved significantly by the 6-month follow-up,with a 92%finger oxygen saturation.A repeat chest computed tomography scan revealed scattered patchy ground-glass shadows in both lungs,which was consistent with alveolar protein deposition but with a lower density than in the radiograph from October 23,2022.CONCLUSION TBCB has unique advantages in diagnosing atypical alveolar protein deposition,particularly for enabling the early detection of PAP.This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.

Incidence,characteristics and risk factors for alveolar recruitment maneuver-related hypotension in patients undergoing laparoscopic colorectal cancer resection

BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

FDG-PET in Bronchial Alveolar Carcinoma

Objective： The purpose of this study was to assess the features of bronchial alveolar carcinoma in fluorine-18 fluorodeoxyglucose （FDG） uptake by Positron emission tomography（PET）. Methods： From December 1998 to October 2004, 35 patients with bronchial alveolar carcinoma （BAC） were imaged with FDG-PET before surgery. The PET results were interpreted using visual and semiquantitative assessment. For semiquantitative analysis, standardized uptake value （SUV） was calculated. Results： All tumors of the patients could be detected by FDG-PET and identified by visual method. By semiquantitative analysis, FDG uptake of the tumor （SUVmax and SUVmean） was higher than that of normal lung （SUVlung） （P〈0.001）, SUVmax, SUVmean of the tumor and SUVlung were 3.14±1.65, 2.40±1.34 and 0.38±0.08 respectively. Correlations were found between FDG uptake and tumor size （P〈0.05）. SUVmean in 21 tumors （21/35, 60.0%） and SUVmax in 15 tumors （15/35, 42.9%） were lower than 2.5. These 21 tumors were all considered as benign by visual method and semiquantitative analysis. Conclusion： （1） FDG uptake was higher in bronchial alveolar carcinoma than that in normal lung tissue. （2） FDG uptake and tumor size appear to be correlated with each other. （3） Bronchial alveolar carcinomas lead to many false negative cases in FDG-PET.

Proposal of a computed tomography classification for hepatic alveolar echinococcosis

AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.RESULTS: Within the classification a lesion was dedicated to one out of five &#x0201c;primary morphologies&#x0201d; as well as to one out of six &#x0201c;patterns of calcification&#x0201d;. &#x0201c;primary morphology&#x0201d; and &#x0201c;pattern of calcification&#x0201d; are primarily focussed on separately from each other and combined, whereas the &#x0201c;primary morphology&#x0201d; V is not further characterized by a &#x0201c;pattern of calcification&#x0201d;. Based on the five primary morphologies, further descriptive sub-criteria were appended to types&#x02005;I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.

Pulmonary alveolar proteinosis complicated with tuberculosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)is a rare lung disease characterized by the accumulation of phospholipoproteinaceous material in the alveoli.Cases of PAP complicated with tuberculosis are much more complex and have rarely been well recorded.CASE SUMMARY We describe a 21-year-old Han Chinese patient with suspicious lung infection associated with mild restrictive ventilatory dysfunction and diffusion reduction.High resolution computed tomography revealed a“crazy-paving”appearance and multiple pulmonary miliary nodules around the bronchi.Bronchoalveolar lavage demonstrated a small amount of periodic acid-Schiff positive proteinaceous materials.A serological test for the presence of a Mycobacterium tuberculosis antibody and an interferon-gamma release assay were both positive.The patient received a standard course of first-line anti-tuberculosis treatment after diagnostic bronchoalveolar lavage.To date,clinical remission has been achieved and maintained for five years.CONCLUSION In summary,the diagnosis of PAP complicated with tuberculosis was supported by a combination of clinical manifestations,imaging,pulmonary function,laboratory examinations,bronchoalveolar lavage,etc.This case highlighted that diagnostic bronchoalveolar lavage in combination with anti-tuberculosis treatment is a safe and effective option for mild PAP patients with tuberculosis.

ISOFLURANE REDUCES THE SYNTHESIS OF SURFACTANT-RELATED PROTEIN A OF ALVEOLAR TYPE II CELLS INJURED BY H_2O_2

Objective To explore the influence of isoflurane(Iso) on the synthesis of surfactant-related protein(SP-A) of alveolar type II cells(AT II cells) cultured in primary and injured by hydrogen peroxide(H2O2).Methods AT II cells were isolated from adult SD rats and used for experiments after 32h in primary culture and randomized into six groups: control group,0.28 mM Iso group,2.8mM Iso group,75 μM H2O2 group,75 μM H2O2 +0.28 mM Iso group and 75 μM H2O2 +2.8 mM Iso group. Each group was continuously incubated for 3 h after administration of Iso or/and H2O2. The intracellular SP-A and the SP-A of cultured medium were measured with an enzyme-linked immunosorbent assay(ELISA).Results Iso significantly decreased SP-A content of cultured medium and the intracellular,and aggravated the decrease of SP-A content induced by H2O2 in a dose-dependent manner.Conclusion Iso itself may decrease SP-A synthesis of AT II cells in vitro,and aggravate the damage of AT II cells especially under peroxidation condition.