BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEU...BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEUS)findings are lacking.The diagnosis and imaging modalities for this condition remain challenging.CASE SUMMARY A 53-year-old Chinese man presented with mild signs and symptoms of the digestive tract.He underwent routine examinations after GIST surgery.Magnetic resonance imaging showed a 2.3 cm hepatic space-occupying lesion.All the laboratory test results were within normal limits.For further diagnostic confirmation,we conducted high frame rate CEUS(H-CEUS)and found a malignant perfusion pattern.Heterogeneous concentric hyper-enhancement,earlier wash-in than the liver parenchyma,and two irregular vessel columns could be observed at the periphery of the lesion during the arterial phase.Ultrasound-guided puncture biopsy was used to confirm the diagnosis of the lesion as liver metastasis of duodenal GIST.Imatinib was prescribed after biopsy,and the patient’s clinical course was monitored.CONCLUSION H-CEUS is useful for detecting microcirculation differences,wash-in patterns,and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.展开更多
Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predic...Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predict the miRNA targets of Erxian decoction for the treatment of postmenopausal osteoporosis,and the results were validated by clinical trials.Methods:In this study,we identified possible targets of Erxian decoction in osteoporosis by means of network pharmacological analysis and bioinformatic prediction.Fifteen cases of postmenopausal osteoporosis with kidney Yin and Yang deficiency(In traditional Chinese medicine,kidney Yin nourishes and moistens the tissues of the internal organs of the body,while kidney Yang promotes and warms the tissues of the internal organs of the body.)were treated with Erxian decoction for four weeks,and serum bone metabolism indices(P1NP,osteocalcin,andβ-CTX)and miRNA-335-5p expression were measured before and after treatment.Results:The constructed miRNA postmenopausal osteoporosis related gene network of the effective compound of the Erxian decoction has 296 points and 981 edges.The 39 postmenopausal osteoporosis related genes regulated by miRNA-335-5p were enriched in ossification,while the signaling pathways were enriched in rheumatoid arthritis,the Toll signaling pathway,the HIF-1 signaling pathway,and the MAPK signaling pathway.After taking Erxian decoction,the expression of the serum bone formation index(P1NP,osteocalcin)and miRNA-335-5p gene expression levels increased significantly.The alterations in P1NP and osteocalcin were correlated with the changes in miRNA-335-5p.Conclusion:Circulating miRNA-335-5p may serve as an important target of Erxian decoction in the treatment of postmenopausal women.The effect of Erxian decoction on bone formation is significant,but the underlying mechanism requires further investigation.展开更多
BACKGROUND Prion diseases are a group of degenerative nerve diseases that are caused by infectious prion proteins or gene mutations.In humans,prion diseases result from mutations in the prion protein gene(PRNP).Only a...BACKGROUND Prion diseases are a group of degenerative nerve diseases that are caused by infectious prion proteins or gene mutations.In humans,prion diseases result from mutations in the prion protein gene(PRNP).Only a limited number of cases involving a specific PRNP mutation at codon 196(E196A)have been reported.The coexistence of Korsakoff syndrome in patients with Creutzfeldt-Jakob disease(CJD)caused by E196A mutation has not been documented in the existing literature.CASE SUMMARY A 61-year-old Chinese man initially presented with Korsakoff syndrome,followed by rapid-onset dementia,visual hallucinations,akinetic mutism,myoclonus,and hyperthermia.The patient had no significant personal or familial medical history.Magnetic resonance imaging of the brain revealed extensive hyperintense signals in the cortex,while positron emission tomography/computed tomography showed a diffuse reduction in cerebral cortex metabolism.Routine biochemical and microorganism testing of the cerebrospinal fluid(CSF)yielded normal results.Tests for thyroid function,human immunodeficiency virus,syphilis,vitamin B1 and B12 levels,and autoimmune rheumatic disorders were normal.Blood and CSF tests for autoimmune encephalitis and autoantibody-associated paraneoplastic syndrome yielded negative results.A test for 14-3-3 protein in the CSF yielded negative results.Whole-genome sequencing revealed a diseasecausing mutation in PRNP.The patient succumbed to the illness 11 months after the initial symptom onset.CONCLUSION Korsakoff syndrome,typically associated with alcohol intoxication,also manifests in CJD patients.Individuals with CJD along with PRNP E196A mutation may present with Korsakoff syndrome.展开更多
BACKGROUND Myositis ossificans(MO)is a rare disease involving the formation of bone outside the musculoskeletal system.While surgical intervention is the main treatment approach,preventing recurrence and standardized ...BACKGROUND Myositis ossificans(MO)is a rare disease involving the formation of bone outside the musculoskeletal system.While surgical intervention is the main treatment approach,preventing recurrence and standardized rehabilitation are also crucial.Here,we present a surgical strategy to prevent the recurrence of MO.CASE SUMMARY A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon.However,incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification,causing a loss of normal range of motion.The patient was diagnosed with MO based on physical examination,X-ray findings,and clinical presentation.We devised a surgical strategy to remove MO,followed by fixation with an Ilizarov frame,and implemented a scientifically reasonable rehabilitation plan.The surgery lasted for 3 h with an estimated blood loss of 45 mL.A drainage tube was placed after surgery,and fluid was aspirated through ultrasound-guided puncture.The patient experienced a significant reduction in joint stiffness after surgery.In the final follow-up at 9 mouths,there was evident improvement in the range of motion of the elbow joint,and no other symptoms were reported.CONCLUSION The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal.It offers benefits such as passive recovery,individualized treatment,and prompt recovery.展开更多
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...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.展开更多
The hepatitis E virus(HEV),a member of the Hepeviridae family,is a small,non-enveloped icosahedral virus divided into eight distinct genotypes(HEV-1 to HEV-8).Only genotypes 1 to 4 are known to cause diseases in human...The hepatitis E virus(HEV),a member of the Hepeviridae family,is a small,non-enveloped icosahedral virus divided into eight distinct genotypes(HEV-1 to HEV-8).Only genotypes 1 to 4 are known to cause diseases in humans.Genotypes 1 and 2 commonly spread via fecal-oral transmission,often through the consum-ption of contaminated water.Genotypes 3 and 4 are known to infect pigs,deer,and wild boars,often transferring to humans through inadequately cooked meat.Acute hepatitis caused by HEV in healthy individuals is mostly asymptomatic or associated with minor symptoms,such as jaundice.However,in immunosup-pressed individuals,the disease can progress to chronic hepatitis and even escalate to cirrhosis.For pregnant women,an HEV infection can cause fulminant liver failure,with a potential mortality rate of 25%.Mortality rates also rise amongst cirrhotic patients when they contract an acute HEV infection,which can even trigger acute-on-chronic liver failure if layered onto pre-existing chronic liver disease.As the prevalence of HEV infection continues to rise worldwide,highlighting the particular risks associated with severe HEV infection is of major medical interest.This text offers a brief summary of the characteristics of hepatitis developed by patient groups at an elevated risk of severe HEV infection.展开更多
以某台2.25Cr-1Mo-V钢加氢反应器为例,从工程角度介绍现行设计方法与ASME Code Case 2605-3在反应器设计中的应用,说明过去留有一定余量的设计是设备安全运行的原因之一。探讨了压力和温度载荷对蠕变参数的影响,其中压力对三轴度系数影...以某台2.25Cr-1Mo-V钢加氢反应器为例,从工程角度介绍现行设计方法与ASME Code Case 2605-3在反应器设计中的应用,说明过去留有一定余量的设计是设备安全运行的原因之一。探讨了压力和温度载荷对蠕变参数的影响,其中压力对三轴度系数影响较大,而温度对蠕变松弛影响显著。最后提出在业主非强制要求进行完整分析的前提下,ASME Code Case 2605-3在工程上的简化应用。展开更多
BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report...BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain.CASE SUMMARY A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma.Laboratory tests on admission reported a mild elevation of alkaline phosphatase,γ-glutamyl transpeptidase,and total bilirubin in serum.Endoscopic retrograde cholangiography revealed a filling defect in the common bile duct(CBD)extending to the left hepatic duct.Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern.Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis.Therefore,a diagnosis of IPNB cT1N0M0 was established.Left hepatectomy with bile duct reconstruction was performed.Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement.The patient was monitored carefully by regular examinations.However,at 32 mo after the operation,a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level.Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated.In addition to histopathological results,a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer.CONCLUSION This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.展开更多
BACKGROUND Simple hepatic cysts are relatively common in adults, and mostly appear asasymptomatic incidental radiologic findings. Occasionally, a large cyst will causesymptoms. Elevations in the serum biomarkers prote...BACKGROUND Simple hepatic cysts are relatively common in adults, and mostly appear asasymptomatic incidental radiologic findings. Occasionally, a large cyst will causesymptoms. Elevations in the serum biomarkers protein induced by vitamin Kabsence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 are often associatedwith malignant tumors in the liver or bile ducts. This is the first report to describea case of hepatic cyst with elevated levels of PIVKA-II and CA12-5.CASE SUMMARY An 84-year-old Chinese woman was admitted with gradual abdominal distension.Her symptoms started 1 year ago, and she had poor appetite and a weight loss of5 kg within the past 2 wk. She denied any symptoms associated with abdominalpain, fever and chills, nausea and vomiting, etc. The abdomen was enlarged, morein the right upper quadrant, without tenderness. Laboratory examination showedsignificantly increased serum levels of PIVKA-II, CA12-5, and CA19-9. Acomputed tomography scan revealed multiple round cysts in the liver with clearboundaries. The largest cyst was 20.1 cm × 12.2 cm × 19.6 cm in size, located in theright lobe of the liver with mild dilatation of the intrahepatic bile duct, but therewas no contrast enhancement. Percutaneous drainage on the largest hepatic cystand polycinnamol sclerosing agent injection into the cyst cavity were performed.After treatment, the patient’s symptoms relieved and the elevated serum tumormakers reduced to the normal levels dramatically.CONCLUSION The present report identifies an unusual case of a giant hepatic cyst with markedelevation of serum tumor marker levels of PIVKA-II, CA12-5, and CA19-9. Aftertreatment, these three serum markers dramatically decreased to normal levels.The mechanisms for the elevation of these tumor markers may be as follows: (1) Agiant hepatic cyst compresses the liver, causing injury to the hepatocytes, whichmay lead to secretion of a large amount of PIVKA-II;and (2) Some tumorassociatedantigens, such as carcinoembryonic antigen, CA19-9, CA12-5, andCA15-3, are expressed on inflammatory cells.展开更多
In this study,two sandblasting textures,namely,quartz and high-chromium(Cr)stainless steel sands,were used for sandblasting of the internal surface L80-13Cr tubing and casing.The contrastive analysis on the properties...In this study,two sandblasting textures,namely,quartz and high-chromium(Cr)stainless steel sands,were used for sandblasting of the internal surface L80-13Cr tubing and casing.The contrastive analysis on the properties of the pipes before and after abrasive blasting was conducted,including the metallographic phase detection of the internal surface,simulating accelerated corrosion tests,and residual stress tests for the pipe after abrasive blasting.Based on the analysis results,it is explained why the API standard requires that no scale appears on the internal surface of L80-13Cr and iron contamination when internal sandblasting media are applied.The results show that abrasive blasting can effectively remove scales on the internal surface of L80-13Cr tubing and casing and improve corrosion resistance.The abrasive blasting process does not produce obvious residual stress on the internal surface of the tubing and casing.Also,the de-rusting effect of stainless sand is better than that of quartz sand,and the former does not produce iron contamination.展开更多
ASME Code Case 2843(以下简称为“案例”)提供了针对高温工况和交变载荷下承受蠕变和疲劳损伤交互作用的受压元件进行评定的方法。在应用该案例方法的过程中,如不能理解这些方法的技术基础,则可能造成评定结果的不安全。案例中所提出...ASME Code Case 2843(以下简称为“案例”)提供了针对高温工况和交变载荷下承受蠕变和疲劳损伤交互作用的受压元件进行评定的方法。在应用该案例方法的过程中,如不能理解这些方法的技术基础,则可能造成评定结果的不安全。案例中所提出的蠕变-疲劳损伤评定方法主要利用线弹性分析得到的结果对弹塑性材料构成的受压元件进行评定。整套方法包括载荷控制极限的判定、应变控制极限的判定以及蠕变-疲劳损伤极限的判定三个步骤,每个步骤中采用的方法均依据多年来有关研究人员发表文献中的理论和实验结果。拟对案例中所采用方法的技术基础进行分析,为工程中应用案例的方法对承受高温和交变载荷作用的压力容器进行设计提供一定的参考。展开更多
基金Supported by the Guide Project for Key Research and Development Foundation of Liaoning Province,No.2019JH8/10300008the 345 Talent Projectthe Liaoning Baiqianwan Talents Program.
文摘BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEUS)findings are lacking.The diagnosis and imaging modalities for this condition remain challenging.CASE SUMMARY A 53-year-old Chinese man presented with mild signs and symptoms of the digestive tract.He underwent routine examinations after GIST surgery.Magnetic resonance imaging showed a 2.3 cm hepatic space-occupying lesion.All the laboratory test results were within normal limits.For further diagnostic confirmation,we conducted high frame rate CEUS(H-CEUS)and found a malignant perfusion pattern.Heterogeneous concentric hyper-enhancement,earlier wash-in than the liver parenchyma,and two irregular vessel columns could be observed at the periphery of the lesion during the arterial phase.Ultrasound-guided puncture biopsy was used to confirm the diagnosis of the lesion as liver metastasis of duodenal GIST.Imatinib was prescribed after biopsy,and the patient’s clinical course was monitored.CONCLUSION H-CEUS is useful for detecting microcirculation differences,wash-in patterns,and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.
基金supported by Suzhou Special Project for Diagnosis and Treatment Technology of Clinical Key Diseases(No.LCZX202127)。
文摘Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predict the miRNA targets of Erxian decoction for the treatment of postmenopausal osteoporosis,and the results were validated by clinical trials.Methods:In this study,we identified possible targets of Erxian decoction in osteoporosis by means of network pharmacological analysis and bioinformatic prediction.Fifteen cases of postmenopausal osteoporosis with kidney Yin and Yang deficiency(In traditional Chinese medicine,kidney Yin nourishes and moistens the tissues of the internal organs of the body,while kidney Yang promotes and warms the tissues of the internal organs of the body.)were treated with Erxian decoction for four weeks,and serum bone metabolism indices(P1NP,osteocalcin,andβ-CTX)and miRNA-335-5p expression were measured before and after treatment.Results:The constructed miRNA postmenopausal osteoporosis related gene network of the effective compound of the Erxian decoction has 296 points and 981 edges.The 39 postmenopausal osteoporosis related genes regulated by miRNA-335-5p were enriched in ossification,while the signaling pathways were enriched in rheumatoid arthritis,the Toll signaling pathway,the HIF-1 signaling pathway,and the MAPK signaling pathway.After taking Erxian decoction,the expression of the serum bone formation index(P1NP,osteocalcin)and miRNA-335-5p gene expression levels increased significantly.The alterations in P1NP and osteocalcin were correlated with the changes in miRNA-335-5p.Conclusion:Circulating miRNA-335-5p may serve as an important target of Erxian decoction in the treatment of postmenopausal women.The effect of Erxian decoction on bone formation is significant,but the underlying mechanism requires further investigation.
文摘BACKGROUND Prion diseases are a group of degenerative nerve diseases that are caused by infectious prion proteins or gene mutations.In humans,prion diseases result from mutations in the prion protein gene(PRNP).Only a limited number of cases involving a specific PRNP mutation at codon 196(E196A)have been reported.The coexistence of Korsakoff syndrome in patients with Creutzfeldt-Jakob disease(CJD)caused by E196A mutation has not been documented in the existing literature.CASE SUMMARY A 61-year-old Chinese man initially presented with Korsakoff syndrome,followed by rapid-onset dementia,visual hallucinations,akinetic mutism,myoclonus,and hyperthermia.The patient had no significant personal or familial medical history.Magnetic resonance imaging of the brain revealed extensive hyperintense signals in the cortex,while positron emission tomography/computed tomography showed a diffuse reduction in cerebral cortex metabolism.Routine biochemical and microorganism testing of the cerebrospinal fluid(CSF)yielded normal results.Tests for thyroid function,human immunodeficiency virus,syphilis,vitamin B1 and B12 levels,and autoimmune rheumatic disorders were normal.Blood and CSF tests for autoimmune encephalitis and autoantibody-associated paraneoplastic syndrome yielded negative results.A test for 14-3-3 protein in the CSF yielded negative results.Whole-genome sequencing revealed a diseasecausing mutation in PRNP.The patient succumbed to the illness 11 months after the initial symptom onset.CONCLUSION Korsakoff syndrome,typically associated with alcohol intoxication,also manifests in CJD patients.Individuals with CJD along with PRNP E196A mutation may present with Korsakoff syndrome.
基金Supported by Gansu Provincial Science and Technology Program Project,No.008108491108。
文摘BACKGROUND Myositis ossificans(MO)is a rare disease involving the formation of bone outside the musculoskeletal system.While surgical intervention is the main treatment approach,preventing recurrence and standardized rehabilitation are also crucial.Here,we present a surgical strategy to prevent the recurrence of MO.CASE SUMMARY A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon.However,incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification,causing a loss of normal range of motion.The patient was diagnosed with MO based on physical examination,X-ray findings,and clinical presentation.We devised a surgical strategy to remove MO,followed by fixation with an Ilizarov frame,and implemented a scientifically reasonable rehabilitation plan.The surgery lasted for 3 h with an estimated blood loss of 45 mL.A drainage tube was placed after surgery,and fluid was aspirated through ultrasound-guided puncture.The patient experienced a significant reduction in joint stiffness after surgery.In the final follow-up at 9 mouths,there was evident improvement in the range of motion of the elbow joint,and no other symptoms were reported.CONCLUSION The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal.It offers benefits such as passive recovery,individualized treatment,and prompt recovery.
基金Anhui Province Central Guided Local Science and Technology Development Funding Project,No.2017070802D147Anhui Province Key Clinical Specialist Construction Fund.
文摘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.
基金Supported by Interreg V-A Romania-Hungary Programme,No.ROHU339.
文摘The hepatitis E virus(HEV),a member of the Hepeviridae family,is a small,non-enveloped icosahedral virus divided into eight distinct genotypes(HEV-1 to HEV-8).Only genotypes 1 to 4 are known to cause diseases in humans.Genotypes 1 and 2 commonly spread via fecal-oral transmission,often through the consum-ption of contaminated water.Genotypes 3 and 4 are known to infect pigs,deer,and wild boars,often transferring to humans through inadequately cooked meat.Acute hepatitis caused by HEV in healthy individuals is mostly asymptomatic or associated with minor symptoms,such as jaundice.However,in immunosup-pressed individuals,the disease can progress to chronic hepatitis and even escalate to cirrhosis.For pregnant women,an HEV infection can cause fulminant liver failure,with a potential mortality rate of 25%.Mortality rates also rise amongst cirrhotic patients when they contract an acute HEV infection,which can even trigger acute-on-chronic liver failure if layered onto pre-existing chronic liver disease.As the prevalence of HEV infection continues to rise worldwide,highlighting the particular risks associated with severe HEV infection is of major medical interest.This text offers a brief summary of the characteristics of hepatitis developed by patient groups at an elevated risk of severe HEV infection.
文摘以某台2.25Cr-1Mo-V钢加氢反应器为例,从工程角度介绍现行设计方法与ASME Code Case 2605-3在反应器设计中的应用,说明过去留有一定余量的设计是设备安全运行的原因之一。探讨了压力和温度载荷对蠕变参数的影响,其中压力对三轴度系数影响较大,而温度对蠕变松弛影响显著。最后提出在业主非强制要求进行完整分析的前提下,ASME Code Case 2605-3在工程上的简化应用。
文摘BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in situ.In the present study,we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain.CASE SUMMARY A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma.Laboratory tests on admission reported a mild elevation of alkaline phosphatase,γ-glutamyl transpeptidase,and total bilirubin in serum.Endoscopic retrograde cholangiography revealed a filling defect in the common bile duct(CBD)extending to the left hepatic duct.Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern.Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis.Therefore,a diagnosis of IPNB cT1N0M0 was established.Left hepatectomy with bile duct reconstruction was performed.Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement.The patient was monitored carefully by regular examinations.However,at 32 mo after the operation,a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level.Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated.In addition to histopathological results,a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer.CONCLUSION This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.
文摘BACKGROUND Simple hepatic cysts are relatively common in adults, and mostly appear asasymptomatic incidental radiologic findings. Occasionally, a large cyst will causesymptoms. Elevations in the serum biomarkers protein induced by vitamin Kabsence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 are often associatedwith malignant tumors in the liver or bile ducts. This is the first report to describea case of hepatic cyst with elevated levels of PIVKA-II and CA12-5.CASE SUMMARY An 84-year-old Chinese woman was admitted with gradual abdominal distension.Her symptoms started 1 year ago, and she had poor appetite and a weight loss of5 kg within the past 2 wk. She denied any symptoms associated with abdominalpain, fever and chills, nausea and vomiting, etc. The abdomen was enlarged, morein the right upper quadrant, without tenderness. Laboratory examination showedsignificantly increased serum levels of PIVKA-II, CA12-5, and CA19-9. Acomputed tomography scan revealed multiple round cysts in the liver with clearboundaries. The largest cyst was 20.1 cm × 12.2 cm × 19.6 cm in size, located in theright lobe of the liver with mild dilatation of the intrahepatic bile duct, but therewas no contrast enhancement. Percutaneous drainage on the largest hepatic cystand polycinnamol sclerosing agent injection into the cyst cavity were performed.After treatment, the patient’s symptoms relieved and the elevated serum tumormakers reduced to the normal levels dramatically.CONCLUSION The present report identifies an unusual case of a giant hepatic cyst with markedelevation of serum tumor marker levels of PIVKA-II, CA12-5, and CA19-9. Aftertreatment, these three serum markers dramatically decreased to normal levels.The mechanisms for the elevation of these tumor markers may be as follows: (1) Agiant hepatic cyst compresses the liver, causing injury to the hepatocytes, whichmay lead to secretion of a large amount of PIVKA-II;and (2) Some tumorassociatedantigens, such as carcinoembryonic antigen, CA19-9, CA12-5, andCA15-3, are expressed on inflammatory cells.
文摘In this study,two sandblasting textures,namely,quartz and high-chromium(Cr)stainless steel sands,were used for sandblasting of the internal surface L80-13Cr tubing and casing.The contrastive analysis on the properties of the pipes before and after abrasive blasting was conducted,including the metallographic phase detection of the internal surface,simulating accelerated corrosion tests,and residual stress tests for the pipe after abrasive blasting.Based on the analysis results,it is explained why the API standard requires that no scale appears on the internal surface of L80-13Cr and iron contamination when internal sandblasting media are applied.The results show that abrasive blasting can effectively remove scales on the internal surface of L80-13Cr tubing and casing and improve corrosion resistance.The abrasive blasting process does not produce obvious residual stress on the internal surface of the tubing and casing.Also,the de-rusting effect of stainless sand is better than that of quartz sand,and the former does not produce iron contamination.
文摘ASME Code Case 2843(以下简称为“案例”)提供了针对高温工况和交变载荷下承受蠕变和疲劳损伤交互作用的受压元件进行评定的方法。在应用该案例方法的过程中,如不能理解这些方法的技术基础,则可能造成评定结果的不安全。案例中所提出的蠕变-疲劳损伤评定方法主要利用线弹性分析得到的结果对弹塑性材料构成的受压元件进行评定。整套方法包括载荷控制极限的判定、应变控制极限的判定以及蠕变-疲劳损伤极限的判定三个步骤,每个步骤中采用的方法均依据多年来有关研究人员发表文献中的理论和实验结果。拟对案例中所采用方法的技术基础进行分析,为工程中应用案例的方法对承受高温和交变载荷作用的压力容器进行设计提供一定的参考。
