Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

Optimal Control of a Mackerel-Mimicking Robot for Energy Efficient Trajectory Tracking

A robotic fish, BASEMACK1, is designed and fabricated by mimicking the shape of a live mackerel. Three DC servo-motors are serially linked together and actuated to mimic the mackerel＇s Carangiform motion. Hydrodynamic characteristics of a fish-mimetic test model are experimentally identified and utilized in order to numerically simulate fish swimming. The discrete set of kinematic and dynamic parameters are obtained by considering required horizontal and lateral forces and minimum energy consumption. Using the optimized parameter set, optimal control of the robot is studied.

Differentiation of pyogenic hepatic abscesses from malignant mimickers using multislice-based texture acquired from contrast-enhanced computed tomography

BACKGROUND： Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography（CECT）. The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS： This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter（5 filter levels with sigma weighting ranging from 1.0 to 2.5）. We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference（HSD） test. Diagnostic performance was evaluated using the receiver operating characteristic（ROC） curve analysis.RESULTS： There were significant differences in entropy and uniformity at all sigma weightings（P〈0.001） among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings（P=0.002-0.006）. Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers（P=0.000-0.004）. Entropy（at a sigma 2.0 weighting） had the largest area under the ROC curve（0.888） in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION： Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.

IgG4-related sclerosing cholangitis and chronic sclerosing sialadenitis mimicking cholangiocarcinoma and neck malignancy

To the Editor:IgG4-related sclerosing cholangitis（IgG4-SC）has re cently been recognized as a biliary manifestation of IgG4-related disease（IgG4-RD）.Type 3 IgG4-SC pre sented biliary strictures in both the porta hepatis and the distal common bile duct（CBD）.;Its manifestation especially in the absence of autoimmune pancreatitis,is extremely rare and very similar to that of cholangiocarci noma（CC）.

ECG after near-drowning mimicking acute coronary syndrome with left main coronary artery involvement

We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.

A Lazarus effect： A case report of Bupropion overdose mimicking brain death

Dear editor,We report a case of a 47-year-old female who presented with a toxic bupropion ingestion leading to cardiac arrest.She initially exhibited a loss of brainstem reflexes in conjunction with burst-suppression pattern on EEG.Burst suppression is an EEG waveform pattern of alternating isoelectric suppressions and high voltage bursts.^([1])

Lumbar disc sequestration mimicking a tumor:Report of four cases and a literature review

BACKGROUND Disc herniation refers to the displacement of disc material beyond its anatomical space.Disc sequestration is defined as migration of the herniated disc fragment into the epidural space,completely separating it from the parent disc.The fragment can move in upward,inferior,and lateral directions,which often causes low back pain and discomfort,abnormal sensation,and movement of lower limbs.The free disc fragments detached from the parent disc often mimic spinal tumors.Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors,such as lumbar soreness,pain,numbness and weakness of lower limbs,radiation pain of lower limbs,etc.It is usually necessary to diagnose the disease according to the doctor’s clinical experience,and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging(MRI)and contrast-enhanced MRI.However,pathological examination is the gold standard that distinguishes tumoral from non-tumoral status.We report four cases of disc herniation mimicking a tumor,and all the pathological results were intervertebral disc tissue.CASE SUMMARY The first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year,with exacerbation over the last 2 wk.After admission,MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment,with enhancement on contrast-enhanced MRI suggesting neurilemmoma.The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years,with exacerbation over the last 3 mo.MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious peripheral enhancement on contrast-enhanced MRI.Thus,neurilemmoma was suspected.The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk.MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level,with obvious rim enhancement on contrast-enhanced MRI.Thus,a spinal tumor was suspected.The fourth case was a 75-year-old man with right lower extremity pain for 2 wk,with exacerbation over the last week.MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion.There was no obvious enhancement on contrast-enhanced MRI,so a spinal tumor was suspected.All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5,8,8,and 6,respectively.All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSION Disc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor.Examinations and tests should be improved preoperatively.Patients should undergo comprehensive preoperative evaluations,and the lesions should be removed surgically and confirmed by pathological diagnosis.

Metastatic Cervical and Supraclavicular Lymphadenopathy from Prostate Mimicking Lymphoma: A Case Series

Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.

Cholesterol granuloma of the right epididymis mimicking an acute scrotum

Dear Sir, I am B. Spajic, the urologist from Clinical Department of Urology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. Recently, we had a rare case of a cholesterol granuloma of the right epididymis at our department, showing clinical signs of acute scrotum. The case described here appears to be the second reporting cholesterol granuloma in the epididymis and the first one presenting with clinical signs of acute scrotum.

Mycosis fungoides: A mimicker of benign dermatoses

Mycosis fungoides, the most common primary cutaneous lymphoma, may present with a broad spectrum of clinical features. As both clinical and dermatopathological findings in mycosis fungoides occasionally closely imitateother dermatoses, correct diagnosis may be a challenge both for clinicians as well as dermatopathologists. As a consequence, diagnosis of cutaneous lymphoma may be initially missed and, therefore, prompt and adequate therapeutic measures delayed. Hence, the purpose of our article was to give an overview of hitherto published "mimickers" of mycosis fungoides with a review of its diverse clinical features to alert the clinicians about the wide spectrum of this dissimulating disease. By integrating our own encountered atypical cases of mycosis fungoides we provide a comprehensive illustrated histological and moleculargenetic workup thereof and thereby critically revise the different available diagnostic tools of daily routine. Finally, we derive a practical algorithm to obtain the correct diagnosis even in such ambiguous cases of mycosis fungoides.

A case of mimicking left atrial myxoma demanding emergency surgery

尽管有在转移的可观的死亡和病态，心脏的集体、临死前的诊断是不平常的。这里，我们 echocardiographically 报导一个左 atrial 团的一个案例 mimicking 粘液瘤，在有肺癌的一个病人。团病理地被证实是变形的癌，它经由左优异肺的静脉的直接侵略进入了左中庭，说明为散布进心和获得在如此的情况中的织物诊断的重要性的肿瘤的不平常的线路的潜力。

仿生物电刺激联合戊酸雌二醇、地屈孕酮治疗卵巢早衰患者的回顾性研究

目的以回顾性研究方法分析仿生物电刺激联合戊酸雌二醇、地屈孕酮治疗卵巢早衰(POF)效果。方法收集2018年5月至2020年5月郑州市第一人民医院收治的75例POF患者临床资料进行回顾性分析,根据治疗方案分组,对照组37例采取戊酸雌二醇+地屈孕酮,实验组38例基于对照组采取仿生物电刺激。观察两组疗效、月经情况、治疗前后性激素水平、T淋巴细胞亚群水平、卵巢影像学指标、不良反应。结果实验组治疗有效率(86.84%)高于对照组(64.86%),差异有统计学意义(P<0.05)。实验组月经恢复正常时间短于对照组,月经来潮次数、经期持续时间大于对照组,差异有统计学意义(P<0.05)。治疗后,实验组血清抗苗勒管激素(AMH)、黄体生成素(LH)、水平高于对照组,卵泡刺激素(FSH)、黄体生成素(LH)水平低于对照组,收缩期峰值血流速度(PSV)、卵巢体积、子宫内膜厚度、窦卵泡数大于对照组,阻力指数(RI)、搏动指数(PI)小于对照组,差异有统计学意义(P<0.05)。治疗后实验组CD3^(+)、CD4^(+)/CD8^(+)水平高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。实验组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论仿生物电刺激联合戊酸雌二醇、地屈孕酮可调节POF患者性激素水平,改善月经状况及卵巢影像学指标,增强免疫功能,提高治疗效果,且安全性较高。

基于贻贝仿生构建高效抗菌及良好血液相容性的聚胺-酚表面

目的赋予血液接触类材料优异的表面抗菌性能。方法受天然贻贝黏附现象的启发,通过多巴胺(Dopamine,DA)、ε-聚赖氨酸(ε-Poly-L-lysine,ε-PL)、高碘酸钠(Sodium Periodate,NaIO4)构建一种简易、快速的聚胺-酚涂层(ε-PL@PDA),同时利用ε-PL丰富的氨基质子化形成的阳离子,实现表面高效抗菌的目的。其中DA和ε-PL通过共价交联形成酚胺聚合物,酚胺共同介导基底材料黏附形成涂层。通过傅里叶变换红外光谱(FTIR)、X射线光电子能谱(XPS)、场发射扫描电镜(SEM)、椭圆偏光、氨基定量、水接触角(WCA)等材料学表征评价ε-PL@PDA涂层的理化性能;通过菌落计数法、细菌活/死染、液体法等细菌实验评价涂层抗菌性能;通过内皮细胞黏附与增殖实验评价其细胞相容性;通过血小板黏附与激活及半体内血液循环实验验证其血液相容性。结果材料学表征结果证明,ε-PL@PDA富氨基涂层成功制备,同时ε-PL的浓度大小会影响涂层的沉积过程;细菌实验表明,ε-PL@PDA涂层具备优异的抗菌性能,当ε-PL质量浓度为3 mg/mL时,对大肠杆菌和表皮葡萄球菌的抑制率高达91%;细胞实验和血液相容性实验表明,相较于316不锈钢(316L SS),ε-PL的质量浓度为3、30 mg/mL时,涂层均不会促进细胞毒性增强、血小板黏附和激活以及血栓形成。结论ε-PL@PDA涂层能够在不影响细胞相容性和血液相容性的基础上有效提高表面抗菌能力,因此,该高效便捷且适用性强的表面抗菌策略或有助于解决临床血液接触类器械细菌感染等问题。

压电纤维致动柔性结构的仿鱼体波振动特性及流场分布研究

提出利用压电纤维(MFC)致动柔性结构的二阶振动模态来模仿鲹科鱼类的鱼体波运动。基于假设模态法求解智能柔性结构的前三阶振型,实验测得水下柔性结构的二阶振型,验证了智能柔性结构的二阶振型逼近鲹科鲈鱼的鱼体波。采用计算流体动力学(CFD)分析了柔性结构周围流线及压力分布情况,结果表明:二阶振动行为下,柔性结构节点前后流线方向相反;两侧流场始终存在两组高、低压集中区域,且节点前后的压力集中区域分布相反;柔性结构两侧始终存在正压梯度,其中向前的压力分量为柔性结构提供持续的推进力,而节点前后压力分量产生的侧向力方向相反,部分抵消,增强了柔性结构的侧向稳定性。研究结果为水下仿生推进器的设计和性能分析提供了重要参考。

同种抗-C、e伴类同种抗-e、Jk b自身抗体的鉴定及输血治疗

目的应用吸收放散和效价积分法对1例抗-C、e同种抗体合并抗-e、Jk b类同种自身抗体进行鉴别诊断。方法采用试管法对ABO、Rh和Kidd血型抗原进行鉴定;盐水、凝聚胺、微柱凝胶3种方法联用2套谱细胞进行抗体筛查及抗体特异性鉴定;多重吸收放散试验和效价积分原则对抗体进一步确认;多重PCR技术对RHCE基因、JK基因进行测序。结果通过血清学分析,该患者血型为A型、Rh分型ccDEE,直抗阳性。结合不同的Rh和Jk表型细胞吸收放散试验以及效价积分原则得出患者血清中含有抗-C、e同种抗体以及抗-e、Jk b类同种自身抗体,红细胞上有抗-e、Jk b类同种自身抗体。基因测序分析RHCE基因第5外显子676位出现G>C,其余外显子没有发生突变,推断Rh分型ccEE型;JK基因中第9外显子838 G/A杂合,Jk血型表型Jk(a+b+),选择交叉配血相合的A型ccDEE、Jk(a+b-)红细胞给患者输注,输血效果良好。结论应用吸收放散试验和效价积分法对患者血清进行抗体鉴定,以及血清学结合分子生物学对患者红细胞表型鉴定,可综合分析及区分出抗体的类型,为患者精准输血提供方案。

Stable Vertical Takeoff of an Insect-Mimicking Flapping-Wing System Without Guide Implementing Inherent Pitching Stability

We briefly summarized how to design and fabricate an insect-mimicking flapping-wing system and demonstrate how to implement inherent pitching stability for stable vertical takeoff. The effect of relative locations of the Center of Gravity （CG） and the mean Aerodynamic Center （AC） on vertical flight was theoretically examined through static force balance considera- tion. We conducted a series of vertical takeoff tests in which the location of the mean AC was determined using an unsteady Blade Element Theory （BET） previously developed by the authors. Sequential images were captured during the takeoff tests using a high-speed camera. The results demonstrated that inherent pitching stability for vertical takeoff can be achieved by controlling the relative position between the CG and the mean AC of the flapping system.

Graphene oxide as a photocatalytic nuclease mimicking nanozyme for DNA cleavage

Developing nanomaterial-based enzyme mimics for DNA cleavage is an interesting challenge and it has many potential applications.Single-layered graphene oxide(GO)is an excellent platform for DNA adsorption.In addition,GO has been employed for photosensitized generation of reactive oxygen species(ROS).Herein,we demonstrate that GO sheets could cleave DNA as anuclease mimicking nanozyme in the presence of UV or blue light.For various DNA sequences and lengths,well-defined product bands were observed along with photobleaching of the fluorophore label on the DNA.Different from previously reported GO cleavage of DNA,our method did not require metal ions such as Cu^2+.Fluorescence spectroscopy suggested a high adsorption affinity between GO and DNA.For comparison,although zero-dimensional fluorescent carbon dots(C-dots)had higher photosensitivity ir terms of producing ROS,their cleavage activity was much lower and only smeared cleavage products were observed,indicatingthat the ROS acted on the DNA in solution.Based on the results,GO behaved like a classic heterogeneous catalyst following substrate adsorption,reaction,and product desorption steps.This simple strategy may help in the design of new nanozymes by introducing light.

Durable endothelium-mimicking coating for surface bioengineering cardiovascular stents

Mimicking the nitric oxide(NO)-release and glycocalyx functions of native vascular endothelium on cardiovascular stent surfaces has been demonstrated to reduce in-stent restenosis(ISR)effectively.However,the practical performance of such an endothelium-mimicking surfaces is strictly limited by the durability of both NO release and bioactivity of the glycocalyx component.Herein,we present a mussel-inspired amine-bearing adhesive coating able to firmly tether the NO-generating species(e.g.,Cu-DOTA coordination complex)and glycocalyx-like component(e.g.,heparin)to create a durable endothelium-mimicking surface.The stent surface was firstly coated with polydopamine(pDA),followed by a surface chemical cross-link with polyamine(pAM)to form a durable pAMDA coating.Using a stepwise grafting strategy,Cu-DOTA and heparin were covalently grafted on the pAMDA-coated stent based on carbodiimide chemistry.Owing to both the high chemical stability of the pAMDA coating and covalent immobilization manner of the molecules,this proposed strategy could provide 62.4%bioactivity retention ratio of heparin,meanwhile persistently generate NO at physiological level from 5.9±0.3 to 4.8±0.4×10^(-10) mol cm^(-2) min^(-1) in 1 month.As a result,the functionalized vascular stent showed long-term endothelium-mimicking physiological effects on inhibition of thrombosis,inflammation,and intimal hyperplasia,enhanced re-endothelialization,and hence efficiently reduced ISR.

Effect of Wing Kinematics Modulation on Aerodynamic Force Generation in Hovering Insect-mimicking Flapping-wing Micro Air Vehicle

We investigated the effect of wing kinematics modulation, which was achieved by adjusting the location of trailing-edge constraint at the wing-root, i.e., by adjusting the wing-root offset, on the generation of aerodynamic forces in a hovering in- sect-mimicking Flapping-Wing Micro Air Vehicle （FW-MAV） by numerical and experimental studies. Three-dimensional wing kinematics measured using three synchronized high-speed cameras revealed a clear difference in the wing rotation angle of a wing section for different wing-root offsets. The extrapolated wing kinematics were in good agreement with the measured ones for various wing-root offsets. The Unsteady Blade Element Theory （UBET） was used to estimate the forces generated by the flapping wings and validated by comparison with results of measurements performed using a load cell. Although the thrust produced by a flapping wing with a wing-root offset of 0.20 c was about 4% less, its force-to-input-power ratio was about 30% and 10% higher than those with the offsets of 0.10 c and 0.15 c, respectively. This result could be explained by analyzing the effective Angle of Attack （AoA） and the force components computed by the UBET. Thus, a flapping wing with a wing-root offset of 0.20 c can be regarded as an optimal twist configuration for the development of the FW-MAV.

Deposition of bio-mimicking graphene sheets with lotus leaf-like and cell-like structures on the nickel substrate

Bio-mimicking graphene films,deposited on textured nickel substrates,were synthesized by the following method:replicating the surface textures of the lotus leaf by polymer duplication,fabricating textured nickel substrates by electroplating on the polymer coated with a Au film,preparing bio-mimicking graphene oxide films on the nickel substrates by vacuum filtration,and electrochemical reduction.By controlling the vacuum filtration,this replica method can not only replicate the lotus leaf structure by a graphene film,but also can achieve a novel cell-like graphene film.