Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung’s disease: A case report and review of literature

BACKGROUND Madelung’s disease(MD)is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head,neck,shoulders,back,trunk,and nerve roots of the upper and lower limbs.It is relatively rare in Asian individuals and is prone to misdiagnosis.Herein,we report a case of a patient with MD who had undergone surgical management at our hospital,and we discuss the pathogenesis,diagnosis,and treatment of MD.CASE SUMMARY We report a case of MD in a 65-year-old man of Han descent.The patient had multiple,painless progressive masses for more than five years in the neck and more than 30 years in the upper back.Because of neck mobility limitations and progressive cosmetic deformities caused by the masses,he was admitted to our hospital.He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years.Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated,subcutaneous fatty deposits.We prepared a staged operation plan.The patient was diagnosed with MD;he was advised to abstain from alcohol and was followed up regularly.After a 3-month follow-up,no recurrence of fat accumulation was found in the surgical areas.CONCLUSION This report presents a case of surgical treatment for MD to improve clinicians'understanding of the disease.

Kimura’s Disease—A Rare Cause of Head and Neck Swelling

Kimura’s disease (KD) is a chronic inflammatory disorder with unknown etiology, most commonly manifesting as painless unilateral cervical lymphadenopathy or subcutaneous masses in the head or neck region. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. Kimura’s disease is an unusual vascular tumor that typically occurs at 20 to 30 years of age. There has been no documented case of malignant transformation;however, recurrence rates after excision may be as high as 25%. Surgery and medical therapy are useful for treatment. We present a 14 years old male developed a unilateral cervical mass associated with KD. It was a recurrence of disease. As a complete excisional resection of the mass already done 1 year back at some other centre, we decided to give medical treatment for Kimura’s disease.

表现为颈部肿块的Castleman病

目的探讨表现为颈部肿块的Castleman病(Castleman disease,CD)的临床特点和诊治方法。方法报道1例并总结分析39例颈部CD患者的临床资料。结果颈部CD临床极为少见,10岁以下儿童更为罕见。临床主要表现为颈中上部无痛肿块,易与头颈部常见疾病混淆造成误诊甚至误治。该病的CT和MRI影像表现有一定特点。该病穿刺活检一般难以确诊,术中冷冻切片有较高诊断价值,最终确诊依靠术后常规病检。其病理类型多为透明血管型,彻底的手术切除效果良好。结论对于初步排除颈部常见疾病又疑为颈部CD的患者,应该先取活检,如被冷冻切片结果证实,再行彻底手术切除。彻底手术切除是治疗颈部CD最为有效的方法,术后随访极少复发。

脐动脉S/D值联合胎心监护在胎儿脐带缠绕预后的临床价值

目的探讨胎儿脐血流监测与胎心监护在预测胎儿脐带缠绕妊娠结局的临床价值。方法孕晚期B超诊断为胎儿脐带绕颈的孕妇452例行胎心监护、脐血流S/D值测定,并记录分娩方式、产时羊水情况及新生儿Apgar评分。结果胎监异常同时脐血流S/D比值>3在羊水过少发生率、胎盘功能低下发生率、胎儿窘迫发生率、羊水污染发生率、剖宫产率、新生儿窒息率均明显高于胎监及S/D比值正常的孕妇。结论对胎儿脐带缠绕孕妇联合应用胎心监护与脐血流测定,可减少新生儿窒息,改善围产儿预后具有积极的临床意义。

基于T-S模糊模型的混沌控制方法的复杂网络的广义同步

目的基于T-S模糊模型研究了复杂网络的广义同步问题。方法根据仿真试验,给出T-S模糊模型。设计一个基于T-S模糊模型的同步控制器,实现复杂网络的广义同步。结果用Lypapunov稳定性定理证明广义同步。结论给出系统4个分量同步误差数值模拟演化图,进一步验证了所提方案的有效性。

基于YOLOv5s和改进质心跟踪的人员跌倒检测

针对目标检测器检测跌倒时过于依赖卷积网络分类效果、无法利用运动信息的问题,本文设计了一种基于YOLOv5s和改进质心跟踪的跌倒检测模型。为解决耗费资源问题,用MobileNetV3网络和Slim Neck模块对YOLOv5s进行轻量化,同时将MobileNetV3网络中的SE模块替换为更高效的ECA模块,降低网络复杂度的同时保持较高的精度。引入哈希感知算法改进质心跟踪,增加目标关联的依据,提高跌倒检测的准确性。实验结果显示改进YOLOv5s模型大小下降52.2%,计算量下降51.8%,精度高达90.3%。改进质心跟踪的跌倒检测模型准确率提高了4.3%。结果表明了本文提出模型的有效性和优越性。

Benign symmetric lipomatosis (Madelung’s disease) with concomitant incarcerated femoral hernia: A case report

BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.

ESRP1在人头颈部鳞状细胞癌中的表达及其与ZEB1的关系

目的:探讨上皮剪切调控蛋白1(epithelial splicing regulatory protein 1,ESRP1)和在人头颈部鳞状细胞癌(Head and Neck Squamous Cell Carcinoma,HNSCC)发生、发展中的作用及其与锌指E盒结合蛋白1(zinc finger E-box binding homeobox 1,ZEB1)的关系。方法:采用免疫组化S-P染色法检测ESRP1和ZEB1在32例HNSCC组织及其对应的癌旁组织中的表达情况。结果:(1)HNSCC组织中ESRP1表达较癌旁组织低(P<0.05);(2)在HNSCC组织中ESRP1的表达与肿瘤分化及复发/转移密切相关(P<0.05);(3)HNSCC组织中ESRP1高表达者ZEB1表达较低(P<0.05)。结论:(1)ESRP1表达减少或缺失对HNSCC的发生发展可能具有促进作用,与肿瘤分化程度也可能密切相关;(2)ESRP1表达下调与ZEB1高表达密切相关。

Maxillofacial sarcomas: a ugandan epidemiological survey

We reviewed the case notes of 203 patients who were treated for sarcomas of the oral and maxillofacial region over a period of 5 years. There were 98 male cases (mean age 31.4 ± 12.8 years) and 105 female cases (mean age 29.3 ± 10.4). Kaposi’s sarcoma accounted for 82.8% cases, and rhabdomyosarcoma 6.9% followed by osteosarcoma and chondrosarcoma at 2.5% each. Except for Kaposi’s sarcoma, surgery in combination with radiotherapy and/or chemothe- rapy was the main stay of treatment. Survival data was not available for most of our patients.

Diagnostic Sign of Terra Firma-Forme Dermatosis

Background: Terra Firma-Forme Dermatosis (TFFD), a benign skin condition which presents with asymptomatic brown to black plaques which resemble dirty skin. Aim: To document a new case presentation with TFFD in the Arab region which is considered as one of the differential diagnoses of dirty neck. Case presentation: A 15-year-old girl presented with a history of asymptomatic brownish dirt-like lesion on the nape and sides of the neck for 4-years duration, not resolved by wash with water and soap and confused with other dermatoses like acanthosis nigricans or atopic dermatitis. The diagnosis of TFFD was confirmed when the lesions were completely resolved after gentle swabbing with 70% isopropyl alcohol. Conclusion: TFFD is rarely reported in Arab region and should be considered when evaluating cases of dirty neck-like presentation of atopic dermatitis or acanthosis nigricans.

脐动脉血流S/D值临床价值探讨

目的：探讨脐动脉Ｓ／Ｄ值对脐带绕颈、产时胎窘、妊高征、羊水过少的影响。方法：采用多普勒血流测定５００ 例孕妇脐动脉Ｓ／Ｄ值。结果：Ｓ／Ｄ 值≥３ 时，产时胎窘、妊高征、羊水过少的发生率显著高于对照组，而脐带绕颈在剖宫产及阴道分娩时发生产时胎窘显著高于对照组。结论：Ｓ／Ｄ 值在各种产科并发症时异常增高，可以提早发现胎儿宫内缺氧情况。

中国新疆地区21例头颈部IgG4相关性疾病的临床分析

目的:分析头颈部IgG4相关性疾病的临床表现、诊断、治疗和预后。方法:选取2012年1月-2023年3月笔者医院收治的21例头颈部IgG4相关性疾病患者的临床资料,并复习相关文献。结果:头颈部IgG4相关性疾病是一种多器官系统疾病,以受累器官肿胀硬化、组织纤维化、血清IgG4升高、IgG4阳性淋巴细胞和浆细胞浸润为临床特征,CT和MRI也呈现特征性表现。激素为该疾病的一线治疗药物,视病情联合使用免疫抑制剂可控制疾病复发。结论:IgG4相关性疾病临床表现多样,临床医生应警惕该疾病,避免不必要的手术。

程为平教授从伏毒致病角度探讨肌萎缩侧索硬化症辨治思路管窥

程为平教授指出,肌萎缩侧索硬化症病邪始萌,症状隐匿,伏而不觉,迁延尔后,发病则病势暴戾,凶险骤显,颇类伏毒。其伏毒可禀自天资,亦可自外袭及内孳,毒伏于体,潜而不发,暗消气血精津液,损及脏腑、脑及髓,毒邪积聚酝酿,伺机而动,一旦发病,则症状杂合,病来急暴。其病机可概括为毒潜脏腑、损督及脊、毒伏脑髓、毁损元神两端,核心治则可概括为扶正祛毒,通督填髓。程为平教授临证每针药结合,尤善针刺,创新针法,颇重颈项。并附验案一则,以资佐证。

Earth: Review Article

Every year on 22 April, we have celebrated Earth Day and the beautiful planet we call home. Earth Day, established in 1970, has been used to highlight our planet’s environmental challenges and raise awareness of the importance of protecting our world for future generations [1]. To provide the protection of our planet, we should explain Earth’s environmental challenges to the best of our knowledge in frames of contemporary Geophysics. This paper gives a short overview of the developed Hypersphere World-Universe Model (WUM) and pay particular attention to the principal role of Dark Matter (DM) in the Earth’s life. In this manuscript, we discuss different aspects of the Earth: a condition of Young Earth before the Beginning of life on It;Internal Structure;“The 660-km Boundary” that we named Geomagma;Random Variations of Earth’s Rotational Speed on a daily basis;Origin of Moon;Expanding Earth;Internal Heating;Faint Young Sun paradox;Geocorona and Planetary Coronas;High-Energy Atmospheric Physics. WUM proposed principally different ways to solve the problems of Internal Heating, Origin of the Moon, and Faint Young Sun paradox based on DM core of the Earth. The Model revealed the fact that the Sun Activity causes the Geomagma Activity and, as a consequence, Random Variations of Earth’s Rotational Speed by the varying Sun’s magnetic field.

基因工程腺病毒(H101)瘤内注射联合化疗治疗头颈部及食管鳞癌的Ⅲ期临床研究

背景与目的:H101是利用基因重组技术得到的一种删除了E1B部分基因片段的溶瘤腺病毒,其在一定剂量范围内对肿瘤有明显的抑制作用。本研究目的是比较H101瘤内注射联合顺铂(cisplatin,DDP)+5-氟尿嘧啶(5-fluorouracil,5-FU)或阿霉素(adriamycin,ADM)+5-FU方案化疗与单纯化疗对头颈、食管鳞癌的治疗效果及毒副作用。方法:160例入选患者,根据过去化疗史分别选定不同化疗方案。未用过PF方案化疗或用过PF方案有效者采用PF方案化疗,已用过PF方案无效者则采用AF方案化疗。采用多中心随机对照分组,分别加用(A组)或不加用(B组)肿瘤浅表病灶内注射H101。两组均为21天一个周期,所有患者至少接受2个周期的治疗。结果:完全符合方案标准的病例123例,A1组(PF+H101)有效率为78.8%,B1组(PFonly)为39.6%,A2组(AF+H101)为50%(7/14),B2组(AFonly)50%(2/4)。A1、B1组间以及A1+A2、B1+B2组间疗效差异有显著性(P=0.000)。45.7%病例出现轻～中度发热,28.3%出现注射局部反应,9.8%出现流感样症状。结论:H101注射液瘤内局部注射联合化疗的客观有效率比单纯化疗组高,显示H101瘤内注射对于头颈、食管鳞癌具有明确的治疗作用,且具有较高的安全性。

头颈部非霍奇金淋巴瘤68例临床分析

目的探讨头颈部非霍奇金淋巴瘤的诊断方法和治疗措施。方法对68例经病理诊断的非霍奇金淋巴瘤,进行临床分期、病理组织类型分类,采用化疗、放疗及部分结合手术等综合治疗42例,单一化疗20例,单一放疗6例。结果68例患者1、3、5年生存率分别为56%,38%,22%,存活患者以早期者占绝大多数,且多为恶性程度较低者,死亡患者中以晚期为多。结论诊断本病需明确非霍奇金淋巴瘤的类型和判定病变累及的部位及范围,对原因不明的颈部肿大淋巴结应反复活检以明确诊断,治疗效果好坏的关键在于选择治疗方案的正确与否,综合治疗是最为有效的治疗手段,预后与组织类型、临床分期有密切关系。

某斜盘式柱塞泵柱塞颈部结构参数计算及仿真分析

柱塞颈部断裂是柱塞体主要损坏形式之一,其直径值对柱塞强度和寿命有重要影响。目前柱塞颈部直径主要通过文献中经验公式来确定,通过试验进行检验,若发生故障,则重新修正该尺寸值。以某型号斜盘式液压柱塞泵为例,以不影响滑靴转动角度与保证柱塞强度为目标,对柱塞颈部直径进行计算,得到柱塞颈部最小允许直径与最大允许直径,并通过ANSYS进行仿真分析,得到仿真应力结果,对比后得出,柱塞颈部直径与柱塞体直径的比例值与目前文献中的经验公式并不一致。

60岁以下股骨颈头下型骨折50例内固定治疗分析

目的 :探讨股骨颈头下型骨折内固定治疗的适应证、手术时机、内固定物的选择。方法 :分析 5 0例 6 0岁以下股骨颈头下型骨折的治疗及康复过程。结果 :5 0例患者均进行手法复位、3枚螺纹钉内固定治疗 ,经至少 9个月的随访 ,骨折愈合 38例 ,股骨头坏死 6例 ,骨折不愈合 4例 ,同时发生骨折不愈合及头坏死 2例。 38例骨折愈合患者 ,患髋关节功能 Harris评分平均 88分。结论 :对于较年轻的股骨颈头下型骨折患者 ,良好的复位、及早有效的坚强内固定及术中、术后正确的处理 。

章氏正骨手法复位夹板固定和切开复位钢板内固定治疗骨质疏松性肱骨外科颈骨折的比较

目的 比较章氏正骨手法复位夹板固定和切开复位钢板内固定治疗骨质疏松性肱骨外科颈骨折的安全性和临床疗效。方法 回顾性分析2016年10月至2018年10月我科62例骨质疏松性肱骨外科颈骨折患者的临床资料,采用章氏正骨手法复位夹板固定32例,采用切开复位钢板内固定30例。记录并比较两组患者骨折愈合时的Neer评分、骨折愈合后6个月的Neer评分、并发症。结果 手法复位夹板固定组骨折愈合时间稍短于切开复位钢板固定组,差异无统计学意义(P>0.05)。骨折愈合时手法复位夹板固定组Neer评分低于切开复位钢板固定组,差异有统计学意义(P<0.01),主要表现在功能、运动范围、解剖均低于切开复位钢板固定组(P<0.01或P<0.05);骨折愈合后6个月两组患者Neer评分比较,差异无统计学意义(P>0.05)。两组患者并发症的发生率比较,差异无统计学意义(P>0.05)。结论 在骨质疏松性肱骨外科颈骨折在骨折愈合时的肩关节活动功能和能力方面,切开复位钢板内固定法优于手法复位夹板外固定;但在骨折愈合后6个月,章氏手法复位夹板固定与切开复位钢板内固定在恢复肩关节功能方面,疗效差异不大,均可满足老年患者的治疗需求,是临床上治疗骨质疏松性肱骨外科颈骨折较佳的选择。

头颈部原发性淋巴结外非霍奇金氏淋巴瘤临床和细胞免疫学表型分析

目的 :报告原发于头颈部淋巴结外非霍奇金氏淋巴瘤的临床及细胞免疫学表型特点。方法 :回顾近十年来经病理学确诊的 ,原发于头颈部淋巴结外的非霍奇金氏淋巴瘤 115例 ,对其临床和细胞免疫学表型特征进行分析。结果 :本组头颈部淋巴结外非霍奇金氏淋巴瘤发病高峰年龄段为 2 1～ 40岁 ,原发部位鼻腔最多 ,其次为鼻咽、扁桃体和口腔 ,而口咽、下咽和喉较少。临床表现以原发器官症状为主 ,体征以结节状或菜花状肿块型最多 ,其次为肿块伴溃烂型 ,单纯溃烂型较少。细胞免疫学表型结果显示 ,来源于 T细胞者占 5 1.2 % ,来源于 B细胞者占 48.8%。其中鼻腔以 T细胞淋巴瘤为主 ,鼻咽则 T、B细胞淋巴瘤约各占一半 ,扁桃体和口腔则以 B细胞淋巴瘤为多。结论 :头颈部淋巴结外非霍奇金氏淋巴瘤最常原发于鼻腔 ,其次为鼻咽、扁桃体和口腔 ,临床表现缺乏特征性 ,易与原发器官的其他恶性肿瘤相混淆 ,易造成误诊 ,因此必须依据病理学和免疫组化染色进行鉴别和确诊。