Rim^(18)F-fluorodeoxyglucose uptake of hepatic cavernous hemangioma on positron emission tomography/computed tomography:A case report

BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare.Therefore,clinicians should pay close attention to patients with hepatic mass.CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital.A whole body^(18)-Fluordesoxyglucose(PET-FDG)positron emission tomography/computed tomography(PET/CT)was performed to elucidate the source of the fever.However,whole body^(18)-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation(SUVmax 3.5 g/mL)higher than that of the normal liver parenchyma(SUVmax 1.6 g/mL)surrounding a hypoactive area,and no other abnormalities were showed.Subsequently,the patient underwent liver mass resection.Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion.The fever disappeared four days after surgery and the patient did not present any complications during follow-up.CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells.This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.

Overexpression of microRNA-124 promotes the neuronal differentiation of bone marrow-derived mesenchymal stem cells

microRNAs （miRNAs） play an important regulatory role in the self-renewal and differentiation of stem cells. In this study, we examined the effects of miRNA-124 （miR-124） overexpression in bone marrow-derived mesenchymal stem cells. In particular, we focused on the effect of overexpression on the differentiation of bone marrow-derived mesenchymal stem cells into neurons. First, we used GeneChip technology to analyze the expression of miRNAs in bone marrow-derived mesen- chymal stem cells, neural stem cells and neurons, miR-124 expression was substantially reduced in bone marrow-derived mesenchymal stem cells compared with the other cell types. We con- structed a lentiviral vector overexpressing miR-124 and transfected it into bone marrow-derived mesenchymal stem cells. Intracellular expression levels of the neuronal early markers [3-III tu- bulin and microtubule-associated protein-2 were significantly increased, and apoptosis induced by oxygen and glucose deprivation was reduced in transfected cells. After miR-124-transfected bone marrow-derived mesenchymal stem cells were transplanted into the injured rat spinal cord, a large number of cells positive for the neuronal marker neurofilament-200 were observed in the transplanted region. The Basso-Beattie-Bresnahan locomotion scores showed that the motor function of the hind limb of rats with spinal cord injury was substantially improved. These re- sults suggest that miR-124 plays an important role in the differentiation of bone marrow-derived mesenchymal stem cells into neurons. Our findings should facilitate the development of novel strategies for enhancing the therapeutic efficacy of bone marrow-derived mesenchymal stem cell transplantation for spinal cord injury.

Clinical characteristics and prognosis of young patients with colorectal cancer in Eastern China

AIM:To explore the clinical characteristics and prognosis of young patients with colorectal cancer patients in Eastern China.METHODS:A total of 1335 patients with colorectal cancer treated from December 1985 to December 2005at the Second Affiliated Hospital of Zhejiang University School of Medicine were studied retrospectively.The patients were divided into two groups,a younger group(aged≤30 years)and an older group(aged>30 years),and comparison was made in the clinical characteristics and prognosis between the two groups.Chisquare test was used for data analysis of all categorical variables,and overall survival(OS)was calculated by the Kaplan-Meier method.A multivariate analysis was performed using the Cox model.RESULTS:There were 42(3.1%)and 1293(96.9%)cases in the younger group and older group,respectively.Univariate analysis showed that the 5-and10-year OS in the younger group were 33.9%and26.1%,respectively,and those in the older group were60.1%and 52.2%,respectively.Younger group had poor survival(χ2=14.146,P=0.000).Multivariate analysis revealed that age was not a dependent factor for prognosis(OR=0.866,95%CI:0.592-1.269,P=0.461).Stratified analysis indicated that in stageⅢandⅣdisease,the 5-and 10-year OS were 24.6%and14.8%in the younger group,and 40.4%and 33.3%in the older group,respectively,with a significant difference between the two groups(χ2=5.101,P=0.024).In the subgroup of radical surgery,the 5-and 10-year OS were 44.3%and 34.2%in the younger group,and69.6%and 60.5%in the older group,with a difference being significant between the two groups(χ2=7.830,P=0.005).CONCLUSION:Compared with older patients,the younger patients have lower survival,especially in the subgroups of stageⅢandⅣdisease and radical surgery.

Laparoscopic pancreatic duct incision and stone removal and T-type tube drainage for pancreatic duct stone: A case report and review of literature

To study a more micro-invasive procedure for patients having pancreatic duct stones(PDS).Till now,there has been no report of laparoscopic pancreatic duct incision and stone removal and T-type tube drainage for PDS in the English literature.An 82-year-old man suffered from subxiphoid pain associated with a dilated pancreatic duct(7 mm)containing one stone,but without a mass in the head of the pancreas.Laparoscopic pancreatic duct incision,stone removal,and T-type tube drainage were successfully performed without intraoperative or postoperative complications.An uneventful operation was performed with laparoscopically completed procedures in 160 min.The intraoperative loss of blood was around 50 mL.After patient a discharge on day 11,complete relief from the subxiphoid pain was reported at a follow-up visit 15 mo later.Laparoscopic pancreatic duct incision with stone removal and T-type tube drainage is applicable in carefully selected patients and can be effectively and safely used for the treatment of the abdominal pain of chronic pancreatitis.

Smoking, alcohol consumption, and the risk of extrahepatic cholangiocarcinoma:A meta-analysis

AIM:To assess the association between smoking and alcohol consumption and extrahepatic cholangiocarcinoma(ECC)through a meta-analysis of clinical observational studies.METHODS:A literature search was conducted using Embase and MEDLINE databases from inception to 31May 2013 without language limitations,and by manually searching the references of retrieved articles.Casecontrol and cohort studies that investigated the association between smoking or alcohol consumption and ECC were included.The quality of these studies was assessed using the Newcastle-Ottawa quality assessment scale.Summary relative risks and corresponding95%CI were calculated using a random-effects model.Publication bias was assessed by Begg’s funnel plot and Egger’s test.RESULTS:A total of 12 eligible articles(11 case-control studies and one cohort study)were included in this meta-analysis.Eleven studies reported the association between smoking and ECC.Pooled analysis indicated that smokers had an increased risk of ECC development as compared with non-smokers(summary RR=1.23;95%CI:1.01-1.50).This correlation was present in population-based studies(n=5;summary RR=1.47;95%CI:1.06-2.05)but not in hospital-based studies(n=6;summary RR=1.10;95%CI:0.88-1.37)and in non-Asian regions(n=7;summary RR=1.39;95%CI:1.03-1.87)but not in Asia(n=4;summary RR=1.08;95%CI:0.85-1.38).Seven studies reported an association between consuming alcohol and ECC.Pooled analysis indicated that alcohol drinkers had a similar risk of ECC development as did individuals who did not drink alcohol(summary RR=1.09;95%CI:0.87-1.37).There was moderate heterogeneity among the studies and no evidence of publication bias.CONCLUSION:Smoking is associated with an increased risk of ECC,but alcohol consumption is not.Further population-based studies,particularly cohort studies,are warranted to enable definitive conclusions.

Mesenteric phlebosclerosis with amyloidosis in association with the long-term use of medicinal liquor: A case report

BACKGROUND Mesenteric phlebosclerosis(MP)is a rare disease of the colon.The clinical manifestations of this disease are nonspecific and it may easily be misdiagnosed.We report a case of MP with amyloidosis in the colonic vessel walls in a patient with hypertension who had been consuming Chinese medicinal liquor for 10 years.We also review the relevant literature and summarize the characteristics of MP in patients in China's Mainland.CASE SUMMARY A 64-year-old man was referred to our department from his primary hospital because of abdominal pain,diarrhea,and fever for almost 10 d.Computed tomography showed colon wall thickening,with threadlike calcifications in the mesenteric vein in the transverse colon.Colonoscopy revealed purple-blue mucosa with multiple ulcers in the ascending and transverse colon.Biopsy showed thickening and calcification of the vein walls,perivascular and mucosal collagen degeneration,and amyloidosis.The patient had been consuming Chinese medicinal liquor,mainly that made from gardenia fruit,for 10 years.Based on these results,a diagnosis of MP with amyloidosis was made.After conservative treatment,the patient’s discomfort subsided and he was followed closely.The use of Chinese herbal medicine was suspected to play a role in the pathogenesis of MP.CONCLUSION The clinical manifestations of MP are nonspecific.Recognition of its typical imaging findings,including multiple calcifications on computed tomography and purple-blue mucosal discoloration on colonoscopy,is vital.

Shrinking lung syndrome in autoimmune inflammatory diseases:A case series and review of literature

Dear editor,Shrinking lung syndrome(SLS),a rare complication of autoimmune inflammatory diseases,is mainly associated with systemic lupus erythematosus(SLE),with an occurrence in 1%-2%of cases.^([1])It is characterized by restrictive defects on pulmonary function tests(PFTs)associated with reduced lung volume.SLS has also been reported in cases of primary Sjogren syndrome(pSS),^([2,3])scleroderma,^([4])rheumatoid arthritis,^([5])mixed connective tissue disease,⑹and undifferentiated connective tissue disease.Herein,we present three case reports of SLS,including two patients with SLE and one patient with adultonset StilFs disease(AOSD)(Table 1).

AME证据系列001--转化医学协会:脓毒症诊断和早期识别的临床实践指南

脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。

Predictive analytics with ensemble modeling in laparoscopic surgery:A technical note

Predictive analytics have been widely used in the literature with respect to laparoscopic surgery and risk stratification.However,most predictive analytics in this field exploit generalized linearmodels for predictive purposes,which are limited by model assumptionsdincluding linearity between response variables and additive interactions between variables.In many instances,such assumptions may not hold true,and the complex relationship between predictors and response variables is usually unknown.To address this limitation,machine-learning algorithms can be employed to model the underlying data.The advantage of machine learning algorithms is that they usually do not require strict assumptions regarding data structure,and they are able to learn complex functional forms using a nonparametric approach.Furthermore,two or more machine learning algorithms can be synthesized to further improve predictive accuracy.Such a process is referred to as ensemble modeling,and it has been used broadly in various industries.However,this approach has not been widely reported in the laparoscopic surgical literature due to its complexity in both model training and interpretation.With this technical note,we provide a comprehensive overview of the ensemble-modeling technique and a step-by-step tutorial on how to implement ensemble modeling.

Segmental small bowel necrosis associated with antiphospholipid syndrome:A case report

Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid(anticardiolipin Ig M) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient's condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

Comparative effect of electroacupuncture and moxibustion on the expression of substance P and vasoactive intestinal peptide in patients with irritable bowel syndrome

OBJECTIVE: To compare the impacts of electroacupuncture(EA) and moxibustion(Mox) on the primary gastrointestinal symptoms and the expressions of colonic mucosa-associated neuropeptide substance P(SP) and vasoactive intestinal peptide(VIP)in patients with either diarrhea-predominant or constipation-predominant irritable bowel syndrome(IBS-D and IBS-C,respectively).METHODS: Eighty-five IBS patients were randomly allocated to the EA and Mox groups. Zusanli(ST 36)and Shangjuxu(ST 37) were selected as acupoints for electroacupuncture or warm moxibustion treatment once a day for 14 consecutive days. Before and after the treatment sessions,a Visual Analog Pain Scale and the Bristol Stool Form Scale were used to evaluate gastrointestinal symptoms. There were four dropout cases,leaving 81 participants(41 with IBS-D and 40 with IBS-C) who volunteered to undergo colonoscopy before and after the treatment sessions. During colonoscopy,sigmoid mucosa were collected to detect SP and VIP expression using immunohistochemistry assay.RESULTS: Both EA and Mox treatments were effective at relieving abdominal pain in IBS-D and IBS-C patients. However,Mox was more effective at reducing diarrhea in IBS-D patients,whereas EA was more effective at improving constipation in IBS-C patients. EA and Mox treatments both down-regulated the abnormally increased SP and VIP expression in the colonic mucosa,with no significant difference shown between the two treatments.CONCLUSION: Both EA and Mox treatments are effective at ameliorating gastrointestinal symptoms by reducing SP and VIP expression in the colonic mucosa of IBS patients.

The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma:a retrospective cohort study

Background:Pancreatic signet ring cell carcinoma(SRCC)is an exceedingly rare histological subtype of pancreatic cancer.Previous studies have focused on the trends of incidence and independent predictors of pancreatic SRCC.Our objectives of the study were to analyze the prognostic value of the lymph node ratio(LNR)and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic SRCC.Method:We analyzed 120 patients diagnosed from January 1,1990,to December 31,2016,constituted the study cohort from the Surveillance,Epidemiology,and End Results(SEER)registry.We calculated the overall survival(OS)of these patients by using a Kaplan–Meier analysis.The Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate analysis.The multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic SRCC.Receiver-operating characteristic curve(ROC)analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE)relative to whether lymph node metastasis was present.Results:The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14(interquartile range:6.25–20.0).According to the univariate analysis of OS,age,grade,chemotherapy,LNR,and TNLE were significantly different(P<.05).We demonstrated the prognostic benefit of chemotherapy in resected pancreatic SRCC,whereas radiotherapy was not associated with improved survival.The multivariate survival analysis showed that LNR and grade were independent prognostic indicators after pancreatic SRCC resection for OS.TNLE≥8 showed the highest discriminatory power for evaluating lymph node metastasis(Area under curve(AUC):0.656,95%confidence interval:0.564–0.741,Youden index:0.2533,sensitivity:78.67%,specificity:46.67%,P=.003).Conclusion:Our study indicated that the LNR was a valuable independent prognostic factor for resected pancreatic SRCC.Regional lymphadenectomy of at least 8 lymph nodes was necessary to accurately stage patients.An adequate number of lymph nodes examined are necessary for clinicians to accurately predict the significance of the LNR in resected pancreatic SRCC.

DOCK8 deficiency with mediastinal lymph node tuberculosis

A 12-year-old girl presented with a history of unexplained persistent fever,accompanied by paroxysmal dry cough,skin ulceration.The patient had a past medical history of recurrent fever,pneumonia(at least four times per year),eczema,accompanied by diarrhea,repeated skin Staphylococcus aureus infection since 6 months of age.Physical examination revealed broad nasal bridge and scoliosis,and chest computed tomography(CT)showed pneumonia,partial bronchiectasis of the right lung,and multiple mediastinal lymph node enlargement with confluence(Fig.1).Laboratory studies demonstrated significantly increased blood eosinophils and serum level of total IgE.The biopsy of the rashes on the buttocks suggested eosinophil infiltration.

Trichobezoar and Rapunzel syndrome

A 12-year-old girl without a history of psychiatric disorders presented to the emergency department with abdominal pain and mass in epigastric and left upper quandrant.The vital signs and laboratory studies were unremarkable.

Colon carcinoma treated with oxaliplatin and capecitabine in a 12-year-old child

Background:XELOX(oxaliplatin 130mg/m^(2)iv,capecitabine 1000mg/m^(2)bid oral d1–14,q3w)chemotherapy has never been used in children.In this report,we present a case of a 12-year-old girl with colon adenocarcinoma,treated with surgery and XELOX chemotherapy.Methods:On admission,the girl complained of abdominal pain and intestinal obstruction.Physical examination revealed a distended abdomen with tenderness on the left upper quadrant.Barium enema revealed a stenotic lesion at the distal end of the transverse colon,and abdominal computed tomography showed acute obstruction and a colonic mass.Laparotomy was performed after the failure of conservative treatment.Results:The mass was originated from the transverse colon.Frozen sections of the specimens revealed an adenocarcinoma.Transverse colectomy was performed and regional lymph nodes were removed.Pathological examination confirmed that the mass was a poorly differentiated adenocarcinoma,and XELOX chemotherapy was used.No evidence of recurrent or metastatic tumor was found after 18 months.Conclusion:Although complete resection is the most effective treatment,XELOX chemotherapy is beneficial to the improvement of clinical outcome of patients with colon adenocarcinoma.