Anti-melanoma differentiation-associated gene 5 and anti-Ro52 antibody-dual positive dermatomyositis accompanied by rapidly lung disease:Three case reports

BACKGROUND Clinically amyopathic deramatomyositis was manifested as the various cutaneous dermatomyositis(DM)manifestations without muscle weakness.Anti-melanoma differentiation-associated gene 5(anti-MDA5)and anti-Ro52 antibody-dual positive clinically amyopathic DM patients are at a high risk of developing rapidly progressive interstitial lung disease,and they exhibit an immensely high half-year mortality.CASE SUMMARY We presented three patients with anti-MDA5 and anti-Ro52 antibody-dual positive DM patients and we reviewed the previous studies on the link between anti-MDA5 and anti-Ro52 antibody-dual positive DM.Although we aggressively treated these patients similarly,but they all exhibited different prognoses.We reviewed the importance of clinical cutaneous rashes as well as the pathogenesis and treatment in the dual positive anti-MDA5 and anti-Ro52 associated DM.CONCLUSION Patients with anti-MDA5 anti-Ro52 antibody-dual positive DM should be accurately diagnosed at an early stage and should be treated aggressively,thus,the patient’s prognosis can be significantly modified.

Erxian decoction potentially prevents postmenopausal osteoporosis by modulating miR-335: a study based on bioinformatics analysis and preliminary clinical case validation

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.

Treatment of refractory anti-melanoma differentiation-associated gene 5 anbibody-positive dermatomyositis complicated by rapidly progressing interstitial pulmonary disease:Two case reports

BACKGROUND Anti-melanoma differentiation-associated gene 5 antibody-positive(anti-MDA5 Ab+)dermatomyositis complicated with rapidly progressive interstitial lung disease(anti-MDA5 Ab+DM-RP-ILD)has an unclear underlying mechanism with no recommended unified treatment plan.Herein,one of the cases that we report(Case 2)was successfully treated with tocilizumab despite having lung infection.CASE SUMMARY Case 1 was a 30-year-old woman who was admitted due to recurrent rash for 5 mo,fever and cough for 1 mo,and chest tightness for 3 d.She was diagnosed with non-myopathic dermatomyositis(anti-MDA5 Ab+)and interstitial pneumonia,and was treated with the combination of hormone therapy and cyclophosphamide followed by oral tacrolimus.Case 2 was a 31-year-old man admitted due to systemic rash accompanied by muscle weakness of limbs for more than 1 mo,and chest tightness and dry cough for 4 d.He was diagnosed with dermatomyositis(anti-MDA5 Ab+)and acute interstitial pneumonia with Pneumocystis jirovecii and Aspergillus fumigatus infections and was treated with hormone therapy(without cyclophosphamide)and the combination of tocilizumab and tacrolimus.The condition of both patients eventually improved and they were discharged and showed clinically stable condition at the latest follow-up.CONCLUSION Tocilizumab could be a salvage treatment for patients with anti-MDA5 Ab+DMRP-ILD who are refractory to intensive immunosuppression.

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.

超声引导下5%葡萄糖注射治疗腰脊神经后支卡压综合征的疗效观察

目的:观察比较超声引导下5%葡萄糖和糖皮质激素注射治疗腰脊神经后支卡压综合征病人的疗效。方法:选择2023年1月至2023年6月徐州医科大学附属医院疼痛科86例腰脊神经后支卡压综合征病人,按随机数字表法分为5%葡萄糖(5%dextrose water,D5W)组(D5W组)和激素组(对照组)。D5W组采用超声下双侧脊神经后支注射30 ml 5%葡萄糖,对照组同样方法注射30 ml复方倍他米松稀释液。观察治疗前和治疗后1、2、4、12周的疼痛数字分级评分法(numerical rating scale,NRS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、镇痛药物使用人数及不良反应;记录治疗前、治疗后第2天和第3天空腹末梢血糖变化。结果:与治疗前相比,两组治疗后1、2、4、12周NRS评分及ODI评分均降低;与对照组相比,D5W组治疗后12周的NRS评分及ODI评分也有所下降,D5W组对住院病人治疗后第2天和第3天空腹末梢血糖影响较小。治疗后2周,D5W组使用镇痛药物人数高于对照组。结论:超声引导下5%葡萄糖注射可缓解腰脊神经后支卡压综合征病人的疼痛,改善腰背功能,是治疗此类病人一种安全有效的方法。

Novel intergenic KIF5B-MET fusion variant in a patient with gastric cancer: A case report

BACKGROUND MET fusion is a key driver mutation,but it is rare in gastric cancer(GC).Several MET(hepatocyte growth factor receptor)inhibitors have been approved for the treatment of MET-positive patients,but the tumor response is heterogeneous.With the development of next-generation sequencing,diverse MET fusion partner genes have been identified.We herein report a fusion variant involving KIF5BMET in GC.CASE SUMMARY After thoracoscopic inferior lobectomy plus lymph node dissection under general anesthesia,a“tumor within a tumor”was found in the lung tumor tissue of a 64-year-old non-smoking male patient.Combining the medical history and the results of enzyme labeling,the focal area was considered to be GC.To seek potential therapeutic regimens,an intergenic region between KIF5B and MET fusion was identified.This fusion contains a MET kinase domain and coil-coiled domains encoded by KIF5B exons 1-25,which might drive the oncogenesis.CONCLUSION Our finding could extend the spectrum and genomic landscape of MET fusions in GC and favor the development of personalized therapy.

网络拍卖的法律适用研究:以指导性案例125号为参照

司法实践中关于《拍卖法》相关条款的涵摄范围,主要存在主体要件和行为要件两种标准。最高人民法院指导性案例125号采用行为要件说,确立了《拍卖法》适用的“委托(拍卖)关系”标准。虽然,指导性案例125号的裁判要旨主要针对作为民事强制措施的网络司法拍卖,但是“委托(拍卖)关系”标准具有适用于普遍意义上的网络拍卖行为、解决其是否适用以及如何适用《拍卖法》的参照意义。即便如此,任意拍卖型网络拍卖领域仍会存在法律漏洞,且难以被解释论的思路所解决:(1)包括网络拍卖合同在内的拍卖合同难以被纳入《民法典》有名合同(比如行纪合同、中介合同)的种类之中;(2)《电子商务法》对电子商务的宽泛规定,使得其难以调整网络拍卖行为。在司法实践中可进一步参照《个人信息保护法》第58条守门人条款,将网络拍卖规范化的“守门人”责任赋予相关的网络交易平台提供者。

Efficacy of bevacizumab-containing chemotherapy in metastatic colorectal cancer and CXCL5 expression: Six case reports

BACKGROUND In metastatic colorectal cancer(mCRC),the anti-vascular endothelial growth factor drug bevacizumab(BVZ)plus chemotherapy significantly improves progression-free survival compared to chemotherapy(CT)alone.This benefit is not,however,observed in all patients.While increased chemokine CXCL5 gene expression promoting angiogenesis has been proposed as a prognostic mCRC biomarker,few studies have examined its relationship with drug efficacy.This study sought to analyze tumor CXCL5 gene expression in six patients with different efficacy of BVZ-containing CT in terms of the tumor response to treatment.CASE SUMMARY We report six cases of stage IV KRAS-mutated mCRC.Patients were given first line treatment with BVZ-containing chemotherapy in University Hospital of Fuenlabrada.The six patients differed in terms of primary tumor location(right/left side),tumor burden(mostly hepatic and peritoneal disease)and clinical disease course.Before treatment onset,total RNA was isolated from paraffinated tumor biopsy specimens and CXCL5 gene expression quantified through conventional RT-qPCR procedures.Our main finding was that CXCL5 expression levels were several times higher in three patients with lower progression free survival(under 6 mo)from the start of treatment.CONCLUSION A higher expression of CXCL5 was observed in the three patients showing worse tumor response to treatment.

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.

Cutaneous Symptoms Revealing M5 Acute Myeloid Leukemia: A Case Report

Cutaneous presentation revealing acute myeloid leukemia (AML) is rare, and the prognosis is poor. We report a case of an 11-month-old male who presented with cutaneous lesions present as diffuse purplish papulo-nodular lesions, revealing M5 acute myeloid leukemia. Skin biopsy and immunohistochemical examination, combined with routine blood analysis and bone marrow examination, contributed to early diagnosis. However, despite intensive chemotherapy treatment, the prognosis was poor and death occurred during the first months of treatment.

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.

Role of colonoscopy in diagnosis of capecitabine associated ileitis:Two case reports

BACKGROUND Capecitabine is considered a first line agent in adjuvant therapy for breast and colorectal cancer. However,cases of severe diarrhea have been reported with increasing frequency in recent years. When diarrhea is severe and prolonged,capecitabine associated ileitis should be considered as a possible etiology.CASE SUMMARY Herein,we present two cases of capecitabine ileitis,specifically involving the terminal ileum and ascending colon. We will demonstrate the disease course and treatment modalities applied to alleviate this condition,as well as discuss the merits of using colonoscopy to aid in diagnosis.CONCLUSION Ultimately our cases demonstrate that symptomatic management with traditional anti-diarrheal medications is largely ineffective. Prompt recognition and discontinuation of capecitabine is an imperative step in proper management of this condition and colonoscopy with biopsy can be helpful when the diagnosis is unclear.

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.

Del(5q) and inv(3) in myelodysplastic syndrome: A rare case report

BACKGROUND Del(5q)is the most common molecular event in myelodysplastic syndrome(MDS),accounting for 10%-15%of cases.Inv(3)is an adverse cytogenetic abnormality observed in less than 1%of MDS patients.Few studies have reported the coexistence of del(5q)and inv(3)in MDS.Therefore,the pathological mechanism,treatment strategy and prognosis of this subtype need to be elucidated.CASE SUMMARY A 66-year-old woman was admitted to the hospital due to chest tightness and shortness of breath.Combining clinical assessments with laboratory examinations,the patient was diagnosed with MDS containing both del(5q)and inv(3).Considering the deletion of chromosome 5q,we first treated the patient with lenalidomide.When drug resistance arose,we tried azacitidine,and the patient had a short remission.Finally,the patient refused treatment with haematopoietic stem cell transplantation and died of severe infection four months later.CONCLUSION MDS patients with del(5)and inv(3)have a poor prognosis.Azacitidine may achieve short-term remission for such patients.

Postoperative jaundice related to UGT1A1 and ABCB11 gene mutations:A case report and literature review

BACKGROUND Patients with obstructive jaundice caused by intrahepatic bile duct stones can be effectively managed by surgery.However,some patients may develop postope-rative complications,liver failure,and other life-threatening situations.Here,we report a patient with mutations in the uridine 5’-diphospho-glucuronosyltrans-ferase 1A1(UGT1A1)and bile salt export pump(adenosine triphosphate-binding cassette subfamily B member 11,ABCB11)genes who presented multiple intrahe-patic bile duct stones and cholestasis,and the jaundice of the patient increased after partial hepatectomy.CASE SUMMARY A 52-year-old male patient admitted to the hospital on October 23,2021,with a progressive exacerbation of jaundice,was found to have multiple intrahepatic bile duct stones with the diagnoses of obstructive jaundice and acute cholecystitis.Subsequently,the patient underwent left hepatectomy with biliary exploration,stone extraction,T-tube drainage,and cholecystectomy without developing any intraoperative complications.The patient had a dark urine color with worsening jaundice postoperatively and did not respond well to plasma exchange and other symptomatic and supportive treatments.Since the progressive increase in postoperative bilirubin could not be clinically explained with any potential reason,including,if not at all,viral infection,cholangitis,autoimmune liver disease,and other causes,the patient underwent whole-exon screening for any genetic diseases,which surprisingly identified UGT1A1 and ABCB11 gene mutations related to glucuronidation of indirect bilirubin as well as bile acid transport in hepatocytes,respectively.Thus,we hypothesized that postoperative refractory cholestasis might result from UGT1A1 and ABCB11 gene mutations and further recommended liver transplantation to the patient,who eventually declined it and died from liver failure six months later.CONCLUSION Surgery may aggravate cholestasis in patients with multiple intrahepatic bile duct stones and cholestasis associated with UGT1A1 and ABCB11 gene mutations.A liver transplant may be the best option if active medical treatment fails.

美国《0~5岁儿童身体活动指南(第3版)》的解读与启示

运用文献资料法和逻辑分析法,从研制背景、研制原则、结构特点、核心内容等方面,对美国《0~5岁儿童身体活动指南(第3版)》进行介绍和解读。发现,该《指南》核心内容主要包括强调基本动作技能的早期干预、落实儿童身体活动的强度、强调通过引导使儿童参加身体活动、注重团队协同干预4个方面。在此基础上,结合我国实际情况,提出坚持政府牵头主导,多元主体共同参与研制指南;基于儿童身心特点,提出引导儿童参与身体活动的具体建议;结合我国儿童身体发育特点,科学安排儿童身体活动的强度;构建家校协同育人的身体活动干预体系。

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.

Mepolizumab induced palmoplantar psoriasis:A case report

BACKGROUND Atopic dermatitis and asthma are two diseases whose pathogenesis is largely attributable to the activation,at least in the initial stages,of T helper(Th)-2 Lymphocytes,the related cytokine axis,and B lymphocytes with antibody production.Psoriasis is conversely a pathology resulting from a recruitment of Th-17 and Th-1 lymphocytes,after an initial role of innate immunity.Mepolizumab is a humanized monoclonal antibody directed against interleukin(IL)-5,a central cytokine in the Th-2 axis,therefore involved in the pathogenesis of asthma.Several authors have described the appearance of psoriatic lesions in patients with asthma or atopic dermatitis following the therapy with dupilumab,a monoclonal antibody that blocks the interleukin(IL)-4,another Th-2 cytokine.CASE SUMMARY We present the case of a 59-year-old patient who developed psoriasiform lesions on the palms after mepolizumab therapy for asthma,for the activation of the parallel cytokine cascade after the blockade of IL-5.We successfully treated the patient with a topical calcipotriol and betamethasone ointment.CONCLUSION We should investigate with further attention the possible impact on the human immunological ecosystem put in place by the inhibition of the activity of individual inflammatory mediators,so as to be able to recognize the initial adverse effects early.

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.