A case of secretory breast carcinoma with ETV6-NTRK3 fusion gene during childhood

Secretory carcinoma is a rare breast cancer.We report a case of secretory carcinoma occurred in childhood.A 7-year-old girl had a history of a mass in the breast for 4 years.The tumor grew slowly and well circumscribed,mimicking benign lesions on imaging.After breast lumpectomy,a diagnosis of secretory carcinoma was made based on its histological morphology,immunohistochemical reaction,and molecular profile.Herein,we report the process of diagnosis,and treatment of this rare case.

Peripheral corneal ulcer secondary to acquired eyelash trichomegaly following treatment with erlotinib in Asia:a case report

Dear Editor,Erlotinib is an epidermal growth factor receptor (EGFR)inhibitor used in the treatment of non-small cell lung cancer.Common side effects of erlotinib include rash and diarrhea,while eyelash trichomegaly and hair disorder are rarely reported,and corneal ulcer is less than 0.1%^([1]).

Comprehensive integrated analysis of MR and DCE-MR radiomics models for prognostic prediction in nasopharyngeal carcinoma

Although prognostic prediction of nasopharyngeal carcinoma (NPC) remains a pivotal research area, the role of dynamic contrast-enhanced magnetic resonance (DCE-MR) has been less explored. This study aimed to investigate the role of DCR-MR in predicting progression-free survival (PFS) in patients with NPC using magnetic resonance (MR)- and DCE-MR-based radiomic models. A total of 434 patients with two MR scanning sequences were included. The MR- and DCE-MR-based radiomics models were developed based on 289 patients with only MR scanning sequences and 145 patients with four additional pharmacokinetic parameters (volume fraction of extravascular extracellular space (ve), volume fraction of plasma space (vp), volume transfer constant (Ktrans), and reverse reflux rate constant (kep) of DCE-MR. A combined model integrating MR and DCE-MR was constructed. Utilizing methods such as correlation analysis, least absolute shrinkage and selection operator regression, and multivariate Cox proportional hazards regression, we built the radiomics models. Finally, we calculated the net reclassification index and C-index to evaluate and compare the prognostic performance of the radiomics models. Kaplan-Meier survival curve analysis was performed to investigate the model’s ability to stratify risk in patients with NPC. The integration of MR and DCE-MR radiomic features significantly enhanced prognostic prediction performance compared to MR- and DCE-MR-based models, evidenced by a test set C-index of 0.808 vs 0.729 and 0.731, respectively. The combined radiomics model improved net reclassification by 22.9%-52.6% and could significantly stratify the risk levels of patients with NPC (p = 0.036). Furthermore, the MR-based radiomic feature maps achieved similar results to the DCE-MR pharmacokinetic parameters in terms of reflecting the underlying angiogenesis information in NPC. Compared to conventional MR-based radiomics models, the combined radiomics model integrating MR and DCE-MR showed promising results in delivering more accurate prognostic predictions and provided more clinical benefits in quantifying and monitoring phenotypic changes associated with NPC prognosis.

Long-term remission by secukinumab in erythrodermic psoriasis with metabolic syndrome:report of two cases

Introduction Psoriasis is a chronic inflammatory systemic disorder which is strongly associated with metabolic syndrome.Erythrodermic psoriasis(EP)is a severe type of psoriasis that causes severe physical and mental impairment.Evidence-based data on EP treatment are limited in recent years.Although conventional systemic treatments such as acitretin,cyclosporine,methotrexate and steroids show efficacy in patients with EP,these treatments have many limitations and intolerance[1].Improvement of this syndrome can seriously affect patients’quality of life(DLQI).Secukinumab is an interleukin-17A inhibitor human monoclonal antibody which has been approved for the treatment of moderate to severe plaque psoriasis[2].There has been no research on the use of secukinumab in EP patients with metabolic syndrome.We present two EP patients with metabolic syndrome who achieved and maintained successful treatment and remission for more than 52 weeks with secukinumab.

Prevention and Treatment of Diabetic Foot Ulcer by Health Education of Specialized Nurses

Objective:To analyze the preventive effect of specialized nurse health education on diabetic foot ulcers.Methods:From January 2022 to December 2022,90 diabetic high-risk foot patients that were admitted to the Endocrinology Department of a general hospital in Macao that met the inclusion criteria were selected as the research subjects.The research subjects were randomly divided into an intervention group and a control group,with 45 cases in each group by mechanical sampling method.The foot care knowledge of the patients one month and three months after the intervention were evaluated and analyzed.Results:The scores of foot care knowledge in the intervention group were higher than those in the control group at one month and three months after the intervention,and the dift'ercncc was statistically significant(P<0.05).Conclusion:Health education by specialized nurses are essential in preventing and treating diabetic foot ulcers.Effective prevention and management of diabetic foot ulcers can be achieved through guidance on diet control,exercise,foot care,blood sugar monitoring,infection prevention,stress reduction,appropriate medication,and regular follow-up.

Comparative study on artificial intelligence systems for detecting early esophageal squamous cell carcinoma between narrow-band and white-light imaging

BACKGROUND Non-magnifying endoscopy with narrow-band imaging(NM-NBI)has been frequently used in routine screening of esophagus squamous cell carcinoma(ESCC).The performance of NBI for screening of early ESCC is,however,significantly affected by operator experience.Artificial intelligence may be a unique approach to compensate for the lack of operator experience.AIM To construct a computer-aided detection(CAD)system for application in NMNBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging(WLI).METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions(Zhongshan Hospital of Fudan University,Xuhui Hospital,and Kiang Wu Hospital)as the training dataset,and 316 pairs of images,each pair including images obtained by WLI and NBI(same part),were collected for validation.Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems.The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value.RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761.For the validation dataset,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CAD-NBI were 91.0%,96.7%,94.3%,95.3%,and 93.6%,respectively,while those of CAD-WLI were 98.5%,83.1%,89.5%,80.8%,and 98.7%,respectively.CAD-NBI showed superior accuracy and specificity than CAD-WLI(P=0.028 and P≤0.001,respectively),while CAD-WLI had higher sensitivity than CAD-NBI(P=0.006).By using both CAD-WLI and CAD-NBI,the endoscopists could improve their diagnostic efficacy to the highest level,with accuracy,sensitivity,and specificity of 94.9%,92.4%,and 96.7%,respectively.CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI.Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.

Relationship between Myopia and Optical Components - A Study among Chinese Hong Kong Student Population

Purpose: To establish the prevalence and severity of myopia among the Chinese Hong Kong students and to study the relationship between myopia and optical components.Methods;One thousand and seventy-five freshmen of the 1993-1994 academic year in the Chinese University of Hong Kong underwent the eye examination including evaluation of refractive error, keratometry, and A-scan ultrasonic biometry. The data were analyzed with the SPSS/PC+4. 01 statistical package. Results: The prevalence of myopia was 91. 7% with the mean refraction being -4. 00 ± 2. 64D in this young adult population. The statistical analyses demonstrated a significant correlation between refractive value and axial length of the globe (r=-0. 78), vitreous length (r=-0. 76), anterior chamber depth (r=-0. 33), lens thickness (r = 0. 13) and corneal curvature (r = 0. 19). Conclusion: The refractive status is mainly dependent on the axial length. In general, the higher the myopia was, the longer the eyeball, the deeper the anterior chamber,

Antidiarrheal properties of different extracts of Chinese herbal medicine formula Bao-Xie-Ning

OBJECTIVE： Bao-Xie-Ning （BXN）, a traditional Chinese herbal medicine （CHM） formula composed of Fructus Evodiae, Flos Caryophylli and Cortex Cinnamomi, and used for the treatment of infant diarrheal illness, was subject to systematic assessment for its putative multiple pharmacodynamic effects and pharmacological antidiarrheal mechanisms. METHODS： High-performance liquid chromatography-diode array detector-electrospray ionization- mass spectrometric/mass spectrometry was developed and validated for identification and quantification of the main constituents in different extracts of BXN. Male Kunming mice weighing 20 to 25 g were used for detecting the antidiarrheal activity of the extracts. Ethanolic extract （EE）, volatile oil extract （VOE）, and aqueous extract （AE） of BXN were respectively subjected to pharmacodynamic and pharmacological comparison in assessing antidiarrheal effects with senna-induced diarrhea, castor oil-induced diarrhea, acetic acid-induced writhing assay, and isolated duodenum test. RESULTS： The highest yields of three detected components of BXN, rutaecarpine, eugenol and cinnamaldehyde were observed in EE. EE showed the most remarkable antidiarrheal activity in dose-dependent and time-dependent manners in both senna- and castor oil-induced diarrhea models, and presented dose-dependent analgesic activity in acetic acid-induced algesthesia model. In addition, EE extract of BXN also exhibited strong antimobility action on the intestine and strongest depression on spontaneous contraction of isolated duodenum. CONCLUSION： Ethanol extraction is an efficient method to extract the active constituents of BXN. BXN extract demonstrated multiple pharmacological activities affecting the main mechanisms of diarrhea, which validated BXN＇s usage in the comprehensive clinical treatment of diarrhea.

Deep learning based radiomics for gastrointestinal cancer diagnosis and treatment:A minireview

Gastrointestinal(GI)cancers are the major cause of cancer-related mortality globally.Medical imaging is an important auxiliary means for the diagnosis,assessment and prognostic prediction of GI cancers.Radiomics is an emerging and effective technology to decipher the encoded information within medical images,and traditional machine learning is the most commonly used tool.Recent advances in deep learning technology have further promoted the development of radiomics.In the field of GI cancer,although there are several surveys on radiomics,there is no specific review on the application of deep-learning-based radiomics(DLR).In this review,a search was conducted on Web of Science,PubMed,and Google Scholar with an emphasis on the application of DLR for GI cancers,including esophageal,gastric,liver,pancreatic,and colorectal cancers.Besides,the challenges and recommendations based on the findings of the review are comprehensively analyzed to advance DLR.

Longest survival with primary intracranial malignant melanoma:A case report and literature review

BACKGROUND Primary intracranial malignant melanoma(PIMM)is rare,and its prognosis is very poor.It is not clear what systematic treatment strategy can achieve long-term survival.This case study attempted to identify the optimal strategy for long-term survival outcomes by reviewing the PIMM patient with the longest survival following comprehensive treatment and by reviewing the related literature.CASE SUMMARY The patient is a 47-year-old Chinese man who suffered from dizziness and gait disturbance.He underwent surgery for right cerebellum melanoma and was subsequently diagnosed by pathology in June 2000.After the surgery,the patient received three cycles of chemotherapy but relapsed locally within 4 mo.Following the second surgery for total tumor resection,the patient received an injection of Newcastle disease virus-modified tumor vaccine,interferon,andβ-elemene treatment.The patient was tumor-free with a normal life for 21 years before the onset of the recurrence of melanoma without any symptoms in July 2021.A third gross-total resection with adjuvant radiotherapy and temozolomide therapy was performed.Brain magnetic resonance imaging showed no residual tumor or recurrence 3 mo after the 3rd operation,and the patient recovered well without neurological dysfunction until the last follow-up in June 2022,which was 22 years following the initial treatment.CONCLUSION It is important for patients with PIMM to receive comprehensive treatment to enable the application of the most appropriate treatment strategies.Long-term survival is not impossible in patients with these malignancies.

Clinical Application of PES Membrane Dialyzer

Objective The dialysate membrane can be classified into acetate membrane and synthetic membrane,while the latter can be further divided into polysulfone,polyacrylonitrile,etc.Polyethersulfone membrane is high molecular membrane material with excellent biocompatibility,stable mechanical properties,high temperature and pressure resistance,and good cleaning performance,which has been applied for more than 10 years.This trial is to assess the safety and efficacy of hollow polysulfone membrane fiber dialyzer with pattern number Enttex^(TM)-16LF(E60)for hemodialysis in patients with acute or chronic renal failure due to multiple factors.Methods Totally 76 patients receiving maintenance hemodialysis were included in a two-site,random,open label,two-stage,positive crossover and non inferiority validation study.The clinical efficacy and safety of the test device were observed,which was a hollow fiber dialyzer produced by Guangzhou Enttex Medical Products Co.,Ltd.,with polyethersulfone membrane imported from Germany.It was a low flux dialyzer with the pattern number of EnttexTM-16LF(E60).Inclusion criteria:①patients with acute or chronic renal failure due to various reasons who needed hemodialysis;②18 to 80 years old,gender unlimited;③patients who received stable dialysis for more than 3 months,regular hemodialysis 3 times a week,4 h at each time,blood flow rate of 200~350ml/min;④using bicarbonate dialysate at a flow rate of 500ml/min;⑤patients with arteriovenous fistula or who received artificial blood vessel puncture dialysis;received anticoagulation by heparin or low molecular weight heparin.Exclusion criteria:①patients needing heparin free dialysis for severe anemia,tumor and active bleeding;②patients with severe cardiac(gradeⅢcardiac function),hepatic(severe hepatitis and cirrhosis)and pulmonary diseases(severe respiratory failure).Results Comparison of parameters,including the changes of Kt/V,general creatinine and urea clearance rates and URR(urea reduction rate)shows no statistical significance in differences between the two devices,indicating that the test and control devices can equally and effectively eliminate toxins including creatinine and urea,etc.PPP and MITTP results are consistent.Comparison of ultrafiltration rates between two groups of patients shows no statistical difference.PPP and MITTP results are consistent,indicating that both the test device and control device can effectively eliminate water.In MITTP,electrolytes including K^+,Na^+,Cl^-,Ca^2+,HCO3^-,etc.show no statistical significance in difference between the test and control devices before and after dialysis(P>0.05).After treating by using test and control devices,body weight,serum potassium and phos-phorus all significantly decrease(P<0.001);serum Ca^2+,PO2,PCO2and HCO3^-all significantly increase(P<0.001).These results indicate that both the test and control devices can effectively eliminate serum potassium and phosphorus,and eliminate excess water in body,maintain the balance between liquid and electrolytes in patients.PPP and MITTP results are consistent.Conclusion This clinical trial confirms that hollow polyethersulfone membrane fiber dialyzer can be safely and effectively used in hemodialysis therapy.

Radiotherapy for Brain Metastases

Radiotherapy for Brain Metastases Brain metastases are common in patients with malignant tumors.According to the reports from autopsy,surgery and imaging investigations,the incidence of brain metastases is approximately 20%~40%[1].The main symptoms are headache,dementia and motor dysfunction.The most common primary sites are lung,breast,colorectal,melanoma and kidney.

Kawasaki disease complicated with macrophage activation syndrome:a case report and literature review

Kawasaki disease(KD)is an acute self-limited febrile systemic vasculitis of unknown cause and often occurs in children under 5 years old[1].Macrophage activation syndrome(MAS),also known as secondary hemophagocytic lymphohistiocytosis(HLH),is a life-threatening complication associated with autoimmune and/or inflammatory disorders including KD[2].The incidence of MAS in pediatric patients with KD has been reported to range 1.1~1.9%[3,4].KD-MAS has never been reported in Macao.In this article,we presented the clinical features,laboratory characteristics,and treatment outcomes of a patient with KD complicated with MAS.

鉤端螺旋體致急性腎損傷1例分析

INTRODUCTION Leptospirosis is a zoonotic infection of worldwide distribution caused by Leptospira interrogans,a pathogenic spirochete.The most important reservoirs are rodents,predominantly rats.Urinary shedding of organisms from infected animals is the most significant source of Leptospira spp.The majority of patients presented with a mild,febrile illness similar with common cold,but a subgroup of patients develops a severe form with multiorgan involvement characterized by fever,jaundice,hemorrhagic manifestation such as pulmonary hemorrhage,renal failure,or even multiple organ dysfunction[1].

澳門地區丙型肝炎病毒基因型分析

應用逆轉錄——DNA聚合酶鏈反應(RT-PCR)及DNA序列分析,對採自澳門地區的43例抗——丙型肝炎病秦(HCV)抗體陽性的慢性肝炎患者及55例血液透析患者血清進行了HCV RNA檢測及基因型分析。結果顯示,15例慢性肝炎患者中,8例為Ⅱ/Ⅰb基因型,7例為6a型。在11例HCV RNA陽性的血液透析患者中,1例為Ⅰ/Ⅰa型,5例為Ⅱ/Ⅰb型,1例為6a型。這種基因型分佈與在中國内地城市所得結果明顯不同,提示丙型肝炎病毒在中國内地及相鄰地區的廣泛傅播可能僅是近半個多世紀的事件。

Echocardiography in Diagnosis and Prevention of the Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (muco-cutaneous lymph node syndrome, MCLS) was first reported by Kawasaki in 1967. It was characteried by nonvascular polymorphous rash, fever, ulcer in oral mucosa, edema of hands of feet, cervix lymphadenopathy and desquamations in peripheral extremities. Because of unknown pathogens, no lab examination was available as a single easily recognized diagnostic marker; the diagnosis is

Pain control with Methadone and Ketamine in Morphine nonresponsive terminal cancer pain

Pain management remains one of the major challenges in the practice of palliative medicine.Approximately 80%-90%of pain due to cancer can be relieved relatively simply with oral analgesics and adjuvant drugs in accordance with the WHO guidelines.Nevertheless,there remains a small percentage of patients who experience severe pain despite rapid upward titration of opioid analgesics in their last days.Therefore,a comprehensive assessment and specialized management are needed in such cases.Methadone and ketamine in these cases with intractable neuropathic pain proved their efficacy.

successful Thrombolytic Therapy in a Child with Kawasaki Disease and Acute Myocardial Infarction

CLINICAL MATERIALSThe patient was 7 year - old boy, body weight 20 kg. He was admitted on May 10th , 2002 because of fever, rashes, enlarged lymphnodes, conjunctivae injection, strawberry tongue, edema and erythema of the hands and feet. Laboratory data as follow: 1. Promine nt increase in white blood cell(WBC) 14. 3 - 22. 7×109 . 2. Anemia, hemoglobin (Hb) 121→103 g/L.

Artificial intelligence system for outcome evaluations of human in vitro fertilization-derived embryos

Background:In vitro fertilization(IVF)has emerged as a transformative solution for infertility.However,achieving favorable live-birth outcomes remains challenging.Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods,including static images and temporal videos.However,traditional embryo selection methods,primarily reliant on visual inspection of morphology,exhibit variability and are contingent on the experience of practitioners.Therefore,an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable.Methods:We employed artificial intelligence(AI)for embryo morphological grading,blastocyst embryo selection,aneuploidy prediction,and final live-birth outcome prediction.We developed and validated the AI models using multitask learning for embryo morphological assessment,including pronucleus type on day 1 and the number of blastomeres,asymmetry,and fragmentation of blastomeres on day 3,using 19,201 embryo photographs from 8271 patients.A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5,and predict live-birth outcomes.Additionally,a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing(PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes.Results:These two approaches enabled us to automatically assess the implantation potential.By combining embryo and maternal metrics in an ensemble AI model,we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists(46.1%vs.30.7%on day 3,55.0%vs.40.7%on day 5).Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians(area under the curve:0.769,95%confidence interval:0.709-0.820).These findings could potentially provide a noninvasive,high-throughput,and low-cost screening tool to facilitate embryo selection and achieve better outcomes.Conclusions:Our study underscores the AI model’s ability to provide interpretable evidence for clinicians in assisted reproduction,highlighting its potential as a noninvasive,efficient,and cost-effective tool for improved embryo selection and enhanced IVF outcomes.The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.

Epidemiological Characteristics of Influenza A and B in Macao,2010–2018

Influenza is one of the major respiratory diseases in humans.Macao is a tourist city with high density of population and special population mobility.The study on the epidemiological characteristics of influenza in Macao should bring great value for preventing influenza in tourist cities like Macao in the world.In this study,we collected a total of 104,874 samples with influenza-like illness(ILI)in Macao from 2010 to 2018.Chi-square test and binary multivariable logistic regression were used to investigate the epidemiological characteristics of influenza A and B in Macao.Among these ILI samples,the overall positive rate is 17.17%for influenza A and 6.97%for influenza B.The epidemics of influenza in three years(i.e.,2012,2017 and 2018)differ from the remaining years(i.e.,normal years).In a normal year,influenza A occurs year-round whereas influenza B is seasonal.Our research shows significant differences in influenza infections between different age groups in normal years.Interestingly,our analysis shows no significant difference between locals and tourists in influenza A and B infection in a normal year,whereas the odds of influenza A in tourists were significantly higher than those in locals in July 2017 and the odds of influenza B in tourists were significantly higher than those in locals in January–February 2012 and January–February 2018.This is possibly attributed by the policy of free vaccination to everyone in Macao.These findings should be valuable for preventing influenza in not only Macao but also the world.