Cystic artery pseudoaneurysm:A case report

BACKGROUND Cystic artery pseudoaneurysm is a condition rarely encountered by clinicians;this,its etiology and presentation as well as appropriate treatments are not well studied.Although it is treated by removal of the diseased gallbladder and cystic artery,such surgery can be difficult and risky if acute inflammation with bleeding occurs,and not every patient can tolerate the surgery.CASE SUMMARY An 81-year-old man complained of epigastric pain and tarry stool passage that lasted for 3 d.He had a medical history of poor cardiopulmonary function.The computed tomographic scan of abdomen showed cystic artery pseudoaneurysm and dilatation of gallbladder.Because of high adverse outcomes related to general anesthesia,the patient was successfully managed with endovascular embolization for this cystic artery pseudoaneurysm and percutaneous drainage for the distended gallbladder.CONCLUSION A patient with cystic artery pseudoaneurysm may quickly deteriorate with the occurrence of concurrent arterial bleeding and sepsis.This report presents the case of a patient who did not undergo surgery due to multiple cardiopulmonary comorbidities and whose condition was managed successfully with embolization and biliary drainage.Endovascular embolization and biliary drainage may provide an alternative option to manage this complicated condition.

Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

目的将由帮助录像的 thoracoscopic 外科(大桶) 考察我们双边的主要自发的气胸(PSP ) 的治疗的经验。回顾的图表评论被在诊所上或电话会见跟随的材料和方法。病人们被在乎为由在四个医学中心的一位胸的外科医生或在北、中央的台湾的社区医院。有双边的 PSP 的 13 个病人从 1994 年 7 月同时或顺序经历了双边的大桶到 2005 年 12 月。结果与从 15 ～ 36 年(平均数 23.1 年)的年龄， 12 男性和男性女性同时为双边的 PSP 与大桶被对待，在双边的 pneumothoracis 的指示下面(n=4 ) 或顺序(n=9 ) 。在为非同时的 PSP 病人的第一和第二个相反地侧面的大桶过程之间的间隔从 7 d 到 6 年。13 个病人(84.6%) 中的十一个有突出的肺的 bullae/blebs，并且与机械或化学的 pleurodesis 经历了 bullae 切除术。吝啬的起作用的时间是( 45.6 ±1 8.3 ) min (范围 25 ～9 6 min )并且( 120.6 ±2 8.7 ) min (范围 84 ～1 66 min )分别地为非同时(为在第一个大桶以后的相反地侧面的方面的复发的第二个大桶)并且同时(双边的大桶在里面一操作)过程。没有手术后的死亡。然而，延长了漏气(】7 d ) 在在保守治疗以后恢复了的一个病人(7.7%) 发生了。胸试管排水的吝啬的持续时间是 3.1 d 并且中部在时期上面列在后面是 3.4 年。结论大桶是在双边的 PSP 的治疗的一个安全、有效的过程。因为甚至与可见 bullae，复发的发生不在我的组并且在某以前的文学那么高，双边的大桶仅仅与同时双边的 PSP 为病人被推荐。在一个仰卧的位置的双边的大桶应该仅仅在选择情况中被使用，因为可能的肋膜的粘附或在以后的方面上隐藏 bullae。

Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan: A 15-year population-based cohort study

AIM: To describe the ages at diagnosis and operation of biliary atresia(BA) and its incidence over a 15-year period in Taiwan.METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases,Ninth Revision(ICD-9) code of BA 751.61 plus Kasai operation(ICD-9 procedure code 51.37) or liver transplantation(LT,ICD-9 procedure code 50.5). The patients' characteristics including sex,age at diagnosis,age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts:(1) 1997 to 2001;(2) 2002 to 2006; and(3) 2007 to 2011.RESULTS: There were a total of 540 BA cases(275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9,55.6 and 52.6 d.A linear regression model demonstrated a decreasing trend of the mean age at diagnosis(1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189(35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age,respectively. All patients who did not undergo a Kasai operation eventually required LT.CONCLUSION: The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates,but without certain trend.

Recent upper gastrointestinal panendoscopy increases the risk of pyogenic liver abscess

AIM To investigate the association between a recent gastrointestinal(GI) endoscopy and the subsequent risk of pyogenic liver abscess(PLA).METHODS We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date(when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.RESULTS Patients with a history of diabetes [adjusted odds ratio(a OR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease(a OR = 3.98, 95%CI: 1.45-10.91), biliary tract infection(a OR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis(a OR = 2.19, 95%CI: 1.39-3.46), GI malignancies(a OR = 5.68, 95%CI: 4.23-7.64), appendicitis(a OR = 3.16, 95%CI: 2.27-4.41), diverticulitis(a OR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography(a OR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy(a OR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy(a OR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.CONCLUSION An upper GI panendoscopy performed before 90 d may increase the risk of PLA.

Case Report:Breast metastasis from small cell lung carcinoma

Breast metastases from extramammary neoplasms are very rare. We presented a 66 year-old female with metastasis of small cell lung carcinoma to the breast. She presented with consolidation over the left upper lobe of her lung undetermined after endobronchial or video-assisted thoracoscopic surgery (VATS) biopsy,and this was treated effectively after antibiotic therapy at initial stage. The left breast lumps were noted 4 months later,and she underwent a modified radical mastectomy under the im-pression of primary breast carcinoma. However,the subsequent chest imaging revealed re-growing mass over the left mediastinum and hilum,and cells with the same morphological and staining features were found from specimens of transbronchial brushing and biopsy. An accurate diagnosis to distinguish a primary breast carcinoma from metastatic one is very important because the therapeutic planning and the outcome between them are different.

Case Report:Pulmonary actinomycosis:a case undergoing resection through video-assisted thoracic surgery (VATS)

Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection and related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation and the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient and thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis and treatment of patients with undetermined pulmonary nodule(s).

Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability:A rare case report

BACKGROUND The brisement manipulation is an effective treatment for refractory shoulder stiffness.Rotator cuff tears can sometimes exist in combination with adhesive capsulitis.Arthroscopic capsular release combined with rotator cuff repair has achieved good outcomes in published reports.CASE SUMMARY We report the case of a patient with right shoulder pain for more than 1 year that was suspected to have adhesive capsulitis and a rotator cuff tear that was treated with brisement manipulation and arthroscopic management.An iatrogenic glenoid fracture with shoulder instability occurred during the manipulation.Arthroscopic treatment for fracture fixation,capsular release,and rotator cuff repair was performed,and the functional results are reported.CONCLUSION Arthroscopic fixation for iatrogenic glenoid fracture and repairing coexisting rotator cuff tear can provide the stability needed for early rehabilitation.

预测中国男性前列腺癌切片检查阳性率的视距诺模图：基于台湾地区的研究

Several nomograms for prostate cancer detection have recently been developed. Because the incidence of prostate cancer is lower in Chinese men, nomograms based on other populations cannot be directly applied to Chinese men. We, therefore, developed a model for predicting the probability of a positive initial prostate biopsy using clinical and laboratory data from a Chinese male population. Data were collected from 893 Chinese male referrals, 697 in the derivation set and 196 in the external validation set, who underwent initial prostate biopsies as individual screening. We analyzed age, prostate volume, total prostate-specific antigen （PSA）, PSA density （PSAD）, digital rectal examinations （DRE） and transrectal ultrasound （TRUS） echogenicity. Logistic regression analysis estimated odds ratio, 95% confidence intervals and Pvalues. Independent predictors of a positive biopsy result included advanced age, small prostate volume, elevated total PSA, abnormal digital rectal examination, and hyperechoic or hypoechoic TRUS echogenicity. We developed a predictive nomogram for an initial positive biopsy using these variables. The area under the receiver-operating characteristic curve for the model was 88.8%, which was greater than that of the prediction based on total PSA alone （area under the receiver-operating characteristic curve 74.7%）. If externally validated, the predictive probability was 0.827 and the accuracy rate was 78.1%, respectively. Incorporating clinical and laboratory data into a prebiopsy nomogram improved the prediction of prostate cancer compared with predictions based solely on the individual factors.

Cortex Moutan Inhibits Bladder Cancer Cell Proliferation and Expression of Angiogenic Factors

Metastases are the main cause of death among patients with bladder cancer, which is the second most common malignancy of the genitourinary tract and is highly prevalent in the southwestern region of Taiwan. Angiogenesis plays a critical role in tumor growth and metastasis processes and has relevance in disease recurrence, pelvic lymph node metastasis and poor prognosis. Cancer cells can produce several angiogenesis-stimulating factors involved in vascular growth, including vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and inflammatory cytokines such as interleukin (IL)-8. Common chemotherapeutic drugs for intravesical instillations usually cause major side effects, including urinary frequency, urinary urgency, cystitis, and hematuria. In order to identify a less cytotoxic therapeutic agent that can inhibit tumor cell proliferation, we examined the traditional Chinese herbal medicine Cortex Moutan—reported to have antibacterial, antiviral, anti-inflammatory, antithrombotic, and antitumor properties—for its effects on bladder cancer cell proliferation and expression of angiogenic factors. Our results revealed that Cortex Moutan exhibited high selectivity in inhibiting the growth of bladder cancer cells and also reduced the expression of angiogenesis-stimulating factors in those cells. Thus, we suggest that Cortex Moutan might be used as a cancer therapy drug for bladder’s intravesical chemotherapy in the future.

Cauda equina syndrome caused by the application of DuraSeal^(TM) in a microlaminectomy surgery:A case report

BACKGROUND The management of dural tears is important.While a massive dura can be repaired with absorbable suture lines,cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively.DuraSeal is often used because it can expand to seal tears.This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.CASE SUMMARY A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis.She underwent microlaminectomy,foraminal decompression,and disk height restoration using an IntraSPINE~? device.A tiny incident durotomy occurred intraoperatively and was sealed using DuraSeal ^(TM).However,decreased muscle power,urinary incontinence,and absence of anal reflexes were observed postoperatively.Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression.Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and,consequently,compressed the thecal sac and nerve roots.While we removed all DuraSeal ^(TM) and exposed the nerve root,the patient’s neurological function did not recover postoperatively.CONCLUSION DuraSeal expansion must not be underestimated.Changes in neurological status require investigation for cauda equina syndrome due to expansion.

Pneumatosis intestinalis after systemic chemotherapy for colorectal cancer:A case report

BACKGROUND Pneumatosis intestinalis(PI),also known as intramural gas in the small intestine,is a rare condition encountered by patients with cancer after receiving chemotherapy.CASE SUMMARY A 78-year-old man with a history of colorectal cancer developed epigastric pain and diarrhea after receiving combination chemotherapy of fluorouracil,leucovorin,irinotecan,and cetuximab.Abdomen radiography revealed in-tramural air in the small intestinal wall.A computed tomography scan of the abdomen revealed the features of PI with air expanding into the mesentery.After surgery,the patient remained symptom-free throughout a 9 mo follow-up period during which he received chemotherapy of fluorouracil,leucovorin,and irinotecan.CONCLUSION Although chemotherapy-induced PI is rare among patients with cancer,the differential diagnosis of PI and fulminant complications(such as ischemia,infarction,and perforation of the gastrointestinal tract)should be conducted,in which case an urgent surgical intervention is required.

<i>Survivin</i>promoter rs9904341 polymorphism is associated with tumor stage and grade in patients with bladder cancer

Survivin is an inhibitor of apoptosis protein and also plays a important role in the development of several malignancies. To investigate the association between survivin promoter –31 G/C (rs9904341) polymorphism and bladder cancer (BC) risk. A total of 200 pathologically confirmed BC cases and 200 unrelated cancer-free controls were recruited in Chiayi Christian Hospital from August 2002 to May 2009. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the –31 G/C polymorphism at survivin promoter region. There was a significant difference in the frequency distribution of survivin promoter –31 G/C polymorphism in BC cases as compared to controls. Among BC cases, individuals with the C/C genotype of survivin promoter have a significantly higher prevalence of invasive (T2-T4) or high-grade (G2-G3) tumors as compared to those who carried the G/G genotype. In conclusion, our findings suggest that the survivin promoter –31 G/C polymorphism was not only associated with clinical stage and pathological grade but also involved in the development of bladder cancer.

Telemedicine System Based on Medical Consultation Assistance Integration

With the aging of the global population, how to provide effective telemedicine for the aging population has become a very important issue, especially for the elderly with limited mobility. If there is a complete telemedicine system, it will not only greatly improve medical efficiency. It can reduce the chance of contact between people and avoid the medical risks caused by severe special infectious pneumonia. This paper focuses on the development of a high-efficiency telemedicine system platform that conforms to international standard data exchange formats. This system platform can not only solve the problem of shortage of medical staff but also allow patients to be free from medical outpatient time constraints. Achieve the effect of telemedicine at any time, and digitize the medical process rules to establish a complete online telemedicine system platform.

Real-world effectiveness of direct-acting antivirals in people living with human immunodeficiency virus and hepatitis C virus genotype 6 infections

BACKGROUND Hepatitis C virus(HCV)genotype 6(HCV-6)infection is prevalent predominantly in Southeast Asia,and the data on the virologic response of HCV-6 to direct-acting antivirals(DAAs)are sparse in people living with human immunodeficiency virus(HIV)(PLWH).AIM To assess the virologic response of HCV-6 to DAAs in PLWH.METHODS From September 2016 to July 2019,PLWH coinfected with HCV-6 initiating DAAs were included.Laboratory investigations were performed at baseline,the end of treatment,and 12 wk off-therapy.RESULTS Of the 349 PLWH included(mean age 48.9 years,82.5%men),80.5%comprised people who inject drugs,18.1%men who have sex with men,and 1.4%heterosexuals.Coexistent hepatitis B virus infection was present in 12.3%of the included PLWH,liver cirrhosis 10.9%,hepatocellular carcinoma 0.9%,and previous HCV treatment experience 10.9%.The mean baseline plasma HCV RNA was 6.2 log10 IU/m L.Treatment with glecaprevir/pibrentasvir was initiated in 51.9%,sofosbuvir/ledipasvir 41.5%,sofosbuvir/velpatasvir 6.3%,and sofosbuvir/daclatasvir 0.3%.At DAA initiation,antiretroviral therapy containing tenofovir alafenamide was given in 26.4%,tenofovir disoproxil fumarate 34.4%,non-tenofovir alafenamide/tenofovir disoproxil fumarate 39.3%,non-nucleoside reverse-transcriptase inhibitors 30.4%,protease inhibitors 4.0%,and integrase strand transfer inhibitors 66.8%;94.8%of the included patients had CD4 counts≥200 cells/mm3 and 96.0%had plasma HIV RNA<50 copies/m L.Overall,96.8%achieved undetectable plasma HCV RNA(<30 IU/m L)at end of treatment;and 92.3%achieved sustained virologic response 12 wk off-therapy in the intention-to-treat analysis(93.5%in patients receiving sofosbuvir-based DAAs and 91.2%in those receiving glecaprevir/pibrentasvir).CONCLUSION Similar to the observation made in HIV-negative patients,sustained virologic response 12 wk offtherapy with DAAs is high in PLWH coinfected with HCV-6.

Dust mite allergen-specific immunotherapy increases IL4 DNA methylation and induces Der p-specific T cell tolerance in children with allergic asthma

Allergen-specific immunotherapy(allergen-SIT)is a highly effective treatment for children with allergic asthma(AA),an immune-mediated chronic disease leading to bronchial muscle hypertrophy and airway obstruction in response to specific allergens.T helper cells and secreted cytokines play important roles in the pathogenesis of asthma,and epigenetic modulation controls genes important for T cell development and cytokine expression.This study evaluated T helper cell-secreted cytokines and DNA methylation patterns in children treated with Dermatophagoides pteronyssinus(Der p)allergen-SIT.Our results showed that after Der p challenge,peripheral blood mononuclear cells(PBMCs)from the SIT group,compared with the non-SIT AA group,produced lower levels of IL-4,IL-5 and IL-2.The SIT group,compared with the AA group,exhibited decreased sensitivity to the Der p allergen,concurrent with IL-4 down-modulation due to increased promoter DNA methylation,as estimated in PBMCs.Our results showed that SIT decreased IL-4 and IL-5,and inhibited T cell proliferation,by inhibiting IL-2 production after the specific allergen challenge.These results suggest that decreased IL-2 production and increased IL-4 cytokine promoter methylation is a potential mechanism of Der p-specific allergen desensitization immunotherapy.

Effect of auricular acupuncture on oxygen consumption of boxing athletes

Boxing is an official sport at the 2008 Beijing Olympic Games and the fast development of world-class high strength training and sport science has made a significant impact on scientific training. Boxing needs high cardio-respiratory function, speed, muscle strength, and anaerobic and intensive physical demands including weight control covering the grading of athlete＇s body weight and balancing physical ability and health. Sport training is important even for talented athletes. Weight cycling is a term used to describe rapid weight loss following self food limitation and/or dehydration. Both gradual （seasonal） reduction cycles are used and rapid （weekly） weight by athletes,