Drug-induced entero-colitis due to interleukin-17 inhibitor use;capsule endoscopic findings and pathological characteristics:A case report

BACKGROUND Interleukin-17(IL-17)inhibitors are known to cause exacerbation or new onset of inflammatory bowel disease upon administration.However,few reports have described characteristic endoscopic and histopathologic findings,and no small intestinal lesions have been reported so far.CASE SUMMARY A woman in her 60s with psoriasis was administered ixekizumab(IXE),an anti-IL-17A antibody,for the treatment of psoriasis.Twenty months after commencing treatment,the patient visited our hospital because of persistent diarrhea.Blood tests performed at the time of the visit revealed severe inflammation,and colonoscopy revealed multiple round ulcers throughout the colon.A tissue biopsy of the ulcer revealed infiltration of inflammatory cells and granuloma-like findings in the submucosal layer.Capsule endoscopy revealed multiple jejunal erosions.After the withdrawal of IXE,the symptoms gradually improved,and ulcer reduction and scarring of the colon were endoscopically confirmed.CONCLUSION To the best of our knowledge,17 reports have documented IL-17 inhibitorinduced entero-colitis with endoscopic images,endoscopic findings,and pathological characteristics,including the present case.Nine of these cases showed diffuse loss of vascular pattern,coarse mucosa/ulcer formation in the left colon,and endoscopic findings similar to those of ulcerative colitis.In the remaining eight cases,discontinuous erosions and ulcerations from the terminal ileum to the rectum were seen,with endoscopic findings similar to those of Crohn’s disease.In this case,the findings were confirmed by capsule endoscopy,which has not been previously reported.

Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques:A case report

BACKGROUND This case report demonstrates the simultaneous development of a gastrointestinal stromal tumour(GIST)with arteriovenous malformations(AVMs)within the jejunal mesentery.A 74-year-old male presented to the department of surgery at our institution with a one-month history of abdominal pain.Contrast-enhanced computed tomography revealed an AVM.During exploratory laparotomy,hyperspectral imaging(HSI)and indocyanine green(ICG)fluorescence were used to evaluate the extent of the tumour and determine the resection margins.Intraoperative imaging confirmed AVM,while histopathological evaluation showed an epithelioid,partially spindle cell GIST.CASE SUMMARY This is the first case reporting the use of HSI and ICG to image GIST intermingled with an AVM.The resection margins were planned using intraoperative analysis of additional optical data.Image-guided surgery enhances the clinician’s knowledge of tissue composition and facilitates tissue differentiation.CONCLUSION Since image-guided surgery is safe,this procedure should increase in popularity among the next generation of surgeons as it is associated with better postoperative outcomes.

Surgical treatment for infra-cardiac total anomalous pulmonary venous drainage and early-mid follow-up results in 17 cases

Objective To evaluate effectiveness of urgent surgical correction for infra cardiac total anomalous pulmonary venous drainage (TAPVD) in infants and children. Methods From July 2000 to April 2009,seventeen patients with infra-cardiac type of total anomalous pulmonary venous connection received surgical correction

17α-hydroxylase/17,20 carbon chain lyase deficiency caused by p.Tyr329fs homozygous mutation:Three case reports

p.Tyr329fs is a cytochrome P450c17 mutation among Chinese individuals.However,data on 17-α-hydroxylase deficiency caused by cytochrome P450c17 p.Tyr329fs homozygous mutation are lacking.This paper is a case report of three patients homozygous for p.Tyr329fs who were diagnosed with 17-α-hydroxylase deficiency between 2005 and 2019.CASE SUMMARY Case 1 presented with hypertension,hypokalemia,sexual infantilism and delayed bone age.The patient had a 46,XY karyotype,was homozygous for p.Tyr329fs and was recently treated with dexamethasone 0.375 mg qn.Case 2 presented with hypokalemia,sexual infantilism,osteoporosis and delayed bone age.The patient had a 46,XY karyotype,was homozygous for p.Tyr329fs and was treated with dexamethasone 0.75 mg qn at the last follow-up.Serum potassium and blood pressure could be maintained within normal range for cases 1 and 2.Case 3 presented with amenorrhea,sexual infantilism,osteopenia and delayed bone age.The patient had a 46,XX karyotype,was homozygous for p.Tyr329fs and was treated with dexamethasone 0.75 mg qn and progynova 1 mg qd.Outpatient follow-up revealed an adrenocorticotropic hormone(8 AM)of<5.00 pg/mL.CONCLUSION The homozygous p.Tyr329fs mutation usually manifests as a combined deficiency,and definitive diagnosis depends primarily on genetic testing.

Cytochrome P450 family 17 subfamily A member 1 mutation causes severe pseudohermaphroditism: A case report

BACKGROUND 17α-Hydroxylase deficiency(17-OHD)is a rare form of congenital adrenal hyperplasia,characterized by hypertension,hypokalemia,and gonadal dysplasia.However,due to the lack of a comprehensive understanding of this disease,it is prone to misdiagnosis and missed diagnosis,and there is no complete cure.CASE SUMMARY We report a female patient with 17-OHD.The patient was admitted to the Department of Neurology of our hospital due to limb weakness.During treatment,it was found that the patient’s condition was difficult to correct except for hypokalemia,and her blood pressure was difficult to control with various antihypertensive drugs.She was then transferred to our department for further treatment.On physical examination,the patient's gonadal development was found to be abnormal,and chromosome analysis demonstrated karyotype 46,XY.Considering the possibility of 17-OHD,the cytochrome P450 family 17 subfamily A member 1(CYP17A1)test was performed to confirm the diagnosis.CONCLUSION The clinical manifestations of 17-OHD are complex.Hormone determination,imaging examination,chromosome determination and CYP17A1 gene test are helpful for early diagnosis.

Three-dimensional printing technology for patient-matched instrument in treatment of cubitus varus deformity:A case report

BACKGROUND Recently,medical three-dimensional printing technology(3DPT)has demonstrated potential benefits for the treatment of cubitus varus deformity(CVD)by improving accuracy of the osteotomy through the use of an osteotomy guide,with or without a patient-mated plate.Here,we present an interesting CVD case,involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury.A computer simulation was processed using images from computerized tomography scans of both upper extremities.The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus.Next,the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed.A simulation osteotomy was created for the real-sized bone model,and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy.Our method allowed for successful treatment of the CVD case,significantly improving the patient’s radiographic and clinical outcomes,with satisfactory result.CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.

Successful steroid treatment for acute fibrinous and organizing pneumonia: A case report

BACKGROUND Since the acute fibrinous and organizing pneumonia(AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no standard therapy for this disease and the treatment methods remain controversial. Both steroid and immunosuppressive agents, such as cyclophosphamide or mycophenolate mofetil, have been reported to be effective in some studies, but with many side effects, especially in patients of advanced age. CASE SUMMARY We herein report an 81-year-old female patient who was admitted to our hospital due to dry cough, and breathlessness for 1 mo. She was treated with broadspectrum antibiotics and anti-fungal therapy, but without improvement in both symptoms and radiological findings, and her respiratory status worsened, and she required bed rest almost the whole day. Computed tomography-guided percutaneous needle lung biopsy was performed and histopathology examination confirmed the diagnosis of AFOP. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications. CONCLUSION We conclude that complete remission of AFOP can be achieved by steroid monotherapy in patients of advanced age.

Novel economic treatment for coronary wire perforation:A case report

BACKGROUND Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention(PCI),however if recognized and managed promptly,its adverse consequences can be minimized.Risk factors include the use of advanced PCI technique(such as atherectomy and chronic total occlusion interventions)and treatment of severely calcified lesions.Large vessel perforation is usually treated with implantation of a covered stent,whereas distal and collateral vessel perforations are usually treated with embolization of coils,fat,thrombin,or collagen.We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation.we advocate this method as a simple method of managing distal vessel perforation.CASE SUMMARY A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex.At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation.A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.CONCLUSION The use of a balloon remnant for embolization in coronary perforation presents a simple,efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome.Prevention remains the most important part with meticulous attention to the distal wire position,particularly with hydrophilic wires.

A Case Report of Immediate Implant Placement Combined with Flap Surgery,Guided Bone Regeneration and Non-submerged Healing with a Labial Bone Wall Defect in the Esthetic Zone

[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presentation]A 27-year-old female patient was complaining of the aesthetic complication that was caused via metallic staining of the neck of ceramic crowns in the maxillary right anterior region for one year.She has experienced immediate implantation along with flap surgery,guided bone regeneration(GBR),and non-submerged healing.The torque of the implant reached to the 35 N·cm to confirm primary stability.Six months after surgery,the healing abutment and the implant were fixed,the gingiva was healthy in the surgical area,and the nearby teeth and the opposite teeth were normal.[Results]The results of cone-beam computer tomography(CBCT)revealed that bone defects were filled with the newly formed bone.At the same time,the final impressions accomplished,and an all-ceramic crown was fit-placed.As a whole,the patient satisfaction rate was high.[Conclusions]Immediate implant placement with flap surgery,GBR,and non-submerged healing with a facial bone wall defect in the esthetic zone is an achievable process.

Pediatric acute myeloid leukemia patients with i(17)(q10)mimicking acute promyelocytic leukemia:Two case reports

BACKGROUND Chromosome i(17)(q10)abnormality is mainly associated with chronic myeloid leukemia(CML),myelodysplastic syndrome/myeloproliferative tumors(MDS/MPD),and acute myeloid leukemia(AML).The role of i(17)(q10)in AML is still unknown,the differences between AML and acute promyelocytic leukemia(APL)-like AML with i(17)(q10)need more research.This study aimed to investigate the clinical characteristics and laboratory evidence of 2 AML cases with i(17)(q10),similar to APL phenotype.CASE SUMMARY Both pediatric patients were males;case 1 had newly diagnosed AML,and case 2 showed relapsed tumor after 1 year of drug withdrawal.Bone marrow cell morphology,chromosome karyotype analysis,Fully-instrumented submersible housing test,immunological assays,molecular biological methods,and blood tumor panoramic gene test were performed.All-trans retinoic acid(ATRA)combined with arsenic acid(As2O3)were used in the first course of treatment.Bone marrow was dominated by abnormal promyelocytic granulocytes.Karyotype test revealed i(17)(q10)isochromosome.Immunological phenotype mainly included positive expressions of CD9,CD13,CD33,and CD38.Case 1 suffered intracranial hemorrhage after re-chemotherapy and died on D162.For case 2,on D145 and D265,bone marrow promyelocytic granulocytes accounted for 2%.Flow cytometric residual lesion detection showed no abnormal immunophenotype cells.The copy number of WT1 gene in two cases were 1087 and 1010,respectively,and the expression rates were 55.29% and 59.5%,respectively.CONCLUSION ATRA,As2O3,and chemotherapy may be ineffective in treating APL-like AML with i(17)(q10)but without t(15;17)and PML-RARA fusion gene.

Removal of a pulmonary artery foreign body during pulse ablation in a patient with atrial fibrillation:A case report

BACKGROUND Foreign bodies in the pulmonary circulation have been documented in the literature and are typically caused by interventional procedures.However,reports of pulmonary artery foreign bodies during femoral vein puncture are rare,and there is no description of this complication from the guidewire surface flows into the pulmonary artery during a pulse ablation in a patient with atrial fibrillation.CASE SUMMARY We described a case in which a linear foreign body suddenly appeared on fluoroscopy image during pulsed ablation of atrial fibrillation.Multiposition angiography showed that the foreign body was currently lodged in the pulmonary artery but was hemodynamically stable.We then chose to use an interventional approach to remove the foreign body from the pulmonary artery.This foreign body was subsequently confirmed to be from the hydrophilic coating of the guidewire surface.This may be related to the difficulties encountered during the puncture of the femoral vein.This is a rare and serious complication of femoral vein puncture.Therefore,we reported this case in order to avoid a similar situation.CONCLUSION Mismatches between interventional devices from different manufacturers used for femoral venipuncture may result in pulmonary artery foreign bodies.

Diagnosis of gastric duplication cyst by positron emission tomography/computed tomography: A case report

BACKGROUND Gastric duplication cysts(GDCs)are extremely uncommon lesions and the definitive diagnosis of GDCs is challenging for gastrointestinal specialists.It is important that a differential diagnosis is performed to rule out the possibility of other diseases,mainly malignancies with a cystic component.Despite the use of multiple diagnostic modalities including endoscopy,the preoperative diagnosis of GDCs is challenging.CASE SUMMARY A 53-year-old female patient with a GDC was confirmed by positron emission tomography/computed tomography(PET/CT)instead of more conventional procedures such as endoscopic ultrasonography-guided fine needle aspiration(EUS-FNA).We propose that 18F-FDG-PET/CT has higher accuracy than EUSFNA and may be an effective technique for the characterization of duplication cysts.CONCLUSION Preoperative diagnosis of GDCs in adults is difficult largely due to their rarity and the absence of characteristic findings.In addition,few endoscopists include GDCs in the differential diagnosis when they encounter a lesion with cystic characteristics.18F-FDG-PET/CT with additional imaging data,may complement EUS-FNA in the diagnosis of GDCs.

离子渗氮工艺对17-4PH不锈钢性能的影响

对17-4PH不锈钢分别进行了真空固溶和时效处理及离子渗氮。结果表明:17-4PH不锈钢经1040℃真空固溶处理随后480℃时效处理后的硬度为41.0~41.5 HRC;离子渗氮温度对17-4PH不锈钢表面硬度影响不大,对基体硬度的影响较大,对渗氮层深度有一定的影响;渗氮剂的氮氢比对17-4PH钢表面和基体的硬度影响不大,对渗氮层深度有一定影响;在500℃采用N_(2)∶H_(2)=1∶3的渗剂对17-4PH钢进行离子渗氮时,随着渗氮时间的延长,渗层深度增加,表面硬度变化不大,基体硬度降低。

指导性案例制度的运行思路再定位

指导性案例制度旨在通过各级法院参照适用前案的方式,推进法律适用的统一。但该制度的运行存在效力不明确、供给量不足、适用范围不广等诸多问题。鉴于遵循先例以实现同案同判的运行机制与指导性案例以确保法律适用统一的运行机制具有相似性,通过分析判例法上遵循先例的运行条件,融入指导性案例的运行环境观察其运行效果,发现由于两者的法律适用逻辑存在根本性差异,指导性案例制度实现法律适用统一的效率性、稳定性、权威性和发展性等方面皆不尽如人意。指导性案例应当回归其指导示范价值而非硬性拘束,并围绕覆盖司法分歧和增加案例竞争,完善相应的遴选与退出机制。

《临证指南医案》自汗证治探析

自汗是特殊汗出的一种类型,该病易见而难治。基于清代名家叶天士之《临证指南医案》,深入阐析自汗之定义、病机、治法,总结叶天士杂症自汗证治特色及具体方药,并据此探讨特殊自汗证型,进一步丰富临床汗证诊疗经验。

基于OBE理论的案例引导式C语言程序设计实验课程教学改革研究

为了突破C语言程序设计实验教学的难点,基于成果导向教育(OBE)理论对C语言程序设计实验课程进行了教学改革:通过实验教学的模式改革,加强实验教学的结果导向,突出实验教学的学生主体作用,完善实验教学的组织方式;通过引导案例的设计、引导案例与实验项目的耦合以及引导案例在实验教学中的应用,实现实验教学方法的改革与实验教学内容的更新。实践结果表明,C语言程序设计实验课程的教学改革,优化了实验课程的教学目标,强化了计算机程序设计类实验课程教学创新的理论基础,提高了实验课程的教学质量。

“电气传动课程设计”引导式教学

传统的“电气传动课程设计”缺乏具有实际背景的实践项目,导致学生学习热情不高,知识掌握不牢固。为了培养学生探究式自主学习能力,开发了基于项目案例的实验内容,研究了具体案例的设计任务和要求,运用翻转式教学形式,实现线上线下混合式学习;为培养学生的团队合作精神,设计了责任分工表和团队考核方式;为增强学生的创新意识,设置了阶段性交流和成果展示环节。研究结果表明,引导式教学使学生从被动式学习转变为主动式、探索式,极大地提高学生的学习热情和学习效率。

滚动轴承保持架引导方式及典型案例

对滚动轴承保持架引导方式及其适用工况作了概要介绍,凝练了保持架引导方式的一般选用准则,重点对高速轴承中保持架引导方式的关键控制要素进行了阐述,给出了保持架引导面失效的解决对策,列举了不同保持架引导方式以及不同线膨胀系数材料保持架引导间隙设计等典型案例,形成了有关保持架引导方式的系统化知识。

基于数字图像相关原理的埋头弹程序燃烧特性试验研究

为分析埋头弹的装药程序燃烧特性和上膛挤进运动特性,对埋头弹两级点火发射过程进行试验研究。设计并建立程序燃烧特性试验系统,采用高速摄像系统获得各组弹丸的运动图像序列。基于数字图像相关原理,对各组图像序列进行定性和定量分析,对回收的弹带刻槽形貌分析测量,获得一级点火的弹丸运动特性,两级点火的程序燃烧特性以及弹带刻槽形貌特性。研究结果表明:速燃点火药的质量直接影响一级点火弹丸上膛性能,质量增加时弹丸上膛时间显著缩短,上膛速度大幅提高;可燃导向筒过早的破碎会导致上膛速度大幅增加,使弹带刻槽形貌非常恶劣,不能可靠密封弹后火药燃气和可靠导转弹丸运动,影响内弹道性能和弹丸的膛内运动姿态;需要对速燃点火药与可燃导向筒进行合理的匹配设计,保证可燃导向筒的破碎时机处于可控范围,从而实现理想的两级点火和程序燃烧设计目标。

资源环境类研究生“工程伦理”课程思政教学探索与成效

工程伦理教育最终目标是培养“社会责任合格”的卓越工程师,而课程思政要培养德才兼备的社会主义建设者,两者具有内在的一致性。中国地质大学(北京)水资源与环境学院工程类研究生专业均属于资源环境大类,该领域涉及人类活动对自然的改造和保护,伦理问题十分突出。自2019年增设“工程伦理”课程以来,我校尝试将思政理论和经典案例融于教学过程中,发挥MOOC+SPOC线上教学平台优势,综合使用案例引导式线下教学方法,探索出一条资源环境类研究生工程伦理教育之路。本课程改革成果表明,将思政内容融于资源环境类研究生工程伦理教学中,不仅完成了思政理论的学习,而且丰富了案例库,支撑了工程伦理教育。