BACKGROUND Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV),PCV may be misdiagnosed as CSC.More attention should be paid to dist...BACKGROUND Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV),PCV may be misdiagnosed as CSC.More attention should be paid to distinguishing these two disorders.CASE SUMMARY A 52-year-old woman presented to our hospital with blurred vision in her left eye for approximately 1 wk.Anterior segment and intraocular pressure findings were normal in both eyes.Fundus photography of the left eye showed a seemingly normal adult oculus fundus without any obvious hard exudate or hemorrhage.Optical coherence tomography exhibited a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer.The late phase of fluorescein angiography revealed increased leakage.The patient was initially diagnosed with CSC.At follow-up,however,the final diagnosis turned out to be PCV.CONCLUSION CSC and PCV are two different retinal entities.Lipid deposition and hemorrhage are the most important elements that lead to confusion between these two entities.Indocyanine green angiography should be performed to make a definitive diagnosis,especially in cases with suspected PCV.展开更多
BACKGROUND Central nervous system(CNS) metastases are a catastrophic complication of nonsmall cell lung cancer(NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis....BACKGROUND Central nervous system(CNS) metastases are a catastrophic complication of nonsmall cell lung cancer(NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis. Despite the continuous development of existing treatments, the therapy of CNS metastases remains challenging.CASE SUMMARY We report a patient who was definitively diagnosed with brain and leptomeningeal metastases from NSCLC with a targeted mutation in epidermal growth factor receptor(EGFR). A standard dosage of icotinib(125 mg three times daily) was implemented but ineffective. CNS lesions developed despite stable systemic control, so pulsatile icotinib(1125 mg every 3 d) was administered. This new strategy for administration has lasted 25 mo so far, and resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival with no notable side effects.CONCLUSION This is the first successful example of pulsatile icotinib for treating isolated CNS progression from EGFR mutation-positive NSCLC, providing a new alternative for the local treatment of CNS metastases.展开更多
BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patient...BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.展开更多
BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have...BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.展开更多
为明确内蒙古中西部地区臭氧(O_(3))污染的天气形势分型及气象要素阈值,采用斜交旋转主成分分析法(obliquely rotated Principal Components in T-mode,PCT)对2015—2021年该地区6个盟市的O_(3)污染过程进行了地面及高空环流形势分析,...为明确内蒙古中西部地区臭氧(O_(3))污染的天气形势分型及气象要素阈值,采用斜交旋转主成分分析法(obliquely rotated Principal Components in T-mode,PCT)对2015—2021年该地区6个盟市的O_(3)污染过程进行了地面及高空环流形势分析,并结合典型O_(3)污染个例,探讨了天气形势、气象要素与O_(3)污染间的关系。结果表明,内蒙古中西部地区O_(3)污染过程在500 hPa环流场中可分为3种类型:脊前西北气流型、平直西风型、高压脊型;在海平面气压场中可分为4种类型:均压场型、低压控制型、高压南部型、低压前部型。环流配置可分为5种类型:高压脊—均压场型、脊前西北气流—低压控制型、平直西风—高压南部型、脊前西北气流—低压南部型、脊前西北气流—均压场型。阿拉善、乌海地区O_(3)超标主要为平直西风—高压南部型,而其他城市多为脊前西北气流—低压控制型。这两种大气环流配置是发生O_(3)污染的主要气象条件。典型区域性O_(3)污染通常发生在特定大气环流形势下,边界层存在逆温层时,逆温强度越强,垂直扩散条件越差,不利于近地面污染物的扩散。气象要素如地面最高气温、日照时数和平均相对湿度对O_(3)污染均有影响。在干燥地区如阿拉善、乌海和巴彦淖尔,O_(3)质量浓度超标时,最高气温通常不低于30℃,日照时数不少于10 h;而相对湿润地区如鄂尔多斯、包头和呼和浩特,O_(3)质量浓度超标时,最高气温通常不低于27℃,日照时数不少于8 h。此外,当风向为西南、南、东南,风速为2.0~5.0 m·s^(-1)时,易发生O_(3)污染。展开更多
文摘BACKGROUND Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV),PCV may be misdiagnosed as CSC.More attention should be paid to distinguishing these two disorders.CASE SUMMARY A 52-year-old woman presented to our hospital with blurred vision in her left eye for approximately 1 wk.Anterior segment and intraocular pressure findings were normal in both eyes.Fundus photography of the left eye showed a seemingly normal adult oculus fundus without any obvious hard exudate or hemorrhage.Optical coherence tomography exhibited a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer.The late phase of fluorescein angiography revealed increased leakage.The patient was initially diagnosed with CSC.At follow-up,however,the final diagnosis turned out to be PCV.CONCLUSION CSC and PCV are two different retinal entities.Lipid deposition and hemorrhage are the most important elements that lead to confusion between these two entities.Indocyanine green angiography should be performed to make a definitive diagnosis,especially in cases with suspected PCV.
基金Supported by the Key Project of Nanjing Health Bureau,No.ZKX16031the Healthcare Project of Nanjing Science and Technology Committee,No.201715020+2 种基金the Medical Key Science and Technology Development Project of Nanjing,No.ZKX18014the Cadre Health Care Project of Jiangsu Province,No.BJ18006the Cancer Research Funding of CSCO-Hausen,No.Y-HS2019-5
文摘BACKGROUND Central nervous system(CNS) metastases are a catastrophic complication of nonsmall cell lung cancer(NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis. Despite the continuous development of existing treatments, the therapy of CNS metastases remains challenging.CASE SUMMARY We report a patient who was definitively diagnosed with brain and leptomeningeal metastases from NSCLC with a targeted mutation in epidermal growth factor receptor(EGFR). A standard dosage of icotinib(125 mg three times daily) was implemented but ineffective. CNS lesions developed despite stable systemic control, so pulsatile icotinib(1125 mg every 3 d) was administered. This new strategy for administration has lasted 25 mo so far, and resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival with no notable side effects.CONCLUSION This is the first successful example of pulsatile icotinib for treating isolated CNS progression from EGFR mutation-positive NSCLC, providing a new alternative for the local treatment of CNS metastases.
基金Young Teacher Foundation of Wuhan University,China,No.2042017kf0142Guidance Fund of Renmin Hospital of Wuhan University,China,No.RMYD2018M19
文摘BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.
文摘BACKGROUND Bacillus subtilis(B. subtilis) is considered a nonpathogenic microorganism of the genus Bacillus and a common laboratory contaminant. Only scarce reports of B. subtilis central nervous system infection have been reported, mainly in the form of pyogenic meningitis,usually in cases of direct inoculation by trauma or iatrogenically.CASE SUMMARY A 51-year-old man, with a free previous medical history, presented to the Emergency Department of our hospital complaining of recurrent episodes of left upper limb weakness, during the last month, which had been worsened the last 48 h. During his presentation in Emergency Department he experienced a generalized tonic-clonic grand mal seizure. Brain magnetic resonance imaging(MRI) scan with intravenous Gadolinium revealed a 3.3 cm × 2.7 cm lesion at the right parietal lobe surrounded by mild vasogenic edema, which included the posterior central gyrus. The core of the lesion showed relatively homogenous restricted diffusion. Post Gadolinium T1 W1 image, revealed a ring-shaped enhancement. Due to the imaging findings, brain abscess was our primary consideration. Detailed examination for clinical signs of infectious foci revealed only poor oral hygiene with severe tooth decay and periodontal disease, but without detection of dental abscess. The patient underwent surgical treatment with right parietal craniotomy and total excision of the lesion. Pus and capsule tissue grew B. subtilis and according to antibiogram intravenous ceftriaxone 2 g bids was administered for 4 wk. The patient remained asymptomatic and follow-up MRI scan two months after operation showed complete removal of the abscess.CONCLUSION This case highlights the ultimate importance of appropriate oral hygiene and dental care to avoid potentially serious infectious complications and second, B. subtilis should not be considered merely as laboratory contaminant especially when cultivated by appropriate central nervous system specimen.
文摘为明确内蒙古中西部地区臭氧(O_(3))污染的天气形势分型及气象要素阈值,采用斜交旋转主成分分析法(obliquely rotated Principal Components in T-mode,PCT)对2015—2021年该地区6个盟市的O_(3)污染过程进行了地面及高空环流形势分析,并结合典型O_(3)污染个例,探讨了天气形势、气象要素与O_(3)污染间的关系。结果表明,内蒙古中西部地区O_(3)污染过程在500 hPa环流场中可分为3种类型:脊前西北气流型、平直西风型、高压脊型;在海平面气压场中可分为4种类型:均压场型、低压控制型、高压南部型、低压前部型。环流配置可分为5种类型:高压脊—均压场型、脊前西北气流—低压控制型、平直西风—高压南部型、脊前西北气流—低压南部型、脊前西北气流—均压场型。阿拉善、乌海地区O_(3)超标主要为平直西风—高压南部型,而其他城市多为脊前西北气流—低压控制型。这两种大气环流配置是发生O_(3)污染的主要气象条件。典型区域性O_(3)污染通常发生在特定大气环流形势下,边界层存在逆温层时,逆温强度越强,垂直扩散条件越差,不利于近地面污染物的扩散。气象要素如地面最高气温、日照时数和平均相对湿度对O_(3)污染均有影响。在干燥地区如阿拉善、乌海和巴彦淖尔,O_(3)质量浓度超标时,最高气温通常不低于30℃,日照时数不少于10 h;而相对湿润地区如鄂尔多斯、包头和呼和浩特,O_(3)质量浓度超标时,最高气温通常不低于27℃,日照时数不少于8 h。此外,当风向为西南、南、东南,风速为2.0~5.0 m·s^(-1)时,易发生O_(3)污染。
