简介：AbstractSevere acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.

简介：Complicationsaremorefrequentinelderlypatientswithcoronaryheartdisease(CHD),suchasimpairedglucosetoleranceandconstipations.Itisalwaysdifficulttocurethesecomplicationsinclinicalpractice.Inthiscasewehadsuccessfullycuredaneighty-threeyearsoldmanwithCHDcomplicatingimpairedglucosetoleranceandconstipationbyintegratedChinese-Westernmedicine.

简介：Objectiveandbackground:Althoughp21rashasbeenreportedtobeupregulatedinhepatocellularcarcinomacomplicatingchronichepatitisCtypeI,p21rashasadifferentroleinadvancedstages,asithasbeenfoundtobedownregulated.Thegoalofthisstudywastoinvestigatethestatusofp21rasinearly-stage/low-gradeandlate-stage/high-gradehepatocellularcarcinomaanditspossiblelinktoapoptosis.Materialandmethods:Thirty-fivecaseseachofchronicHCVhepatitistype4(groupI)andcirrhosiswithhepatocellularcarcinoma(HCC)complicatingchronicHCVhepatitis(groupsIIandIII)wereimmunohistochemicallyevaluatedusingap21raspolyclonalantibody.Theapoptoticindexwasdeterminedinhistologicsectionsusingtheterminaldeoxynucleotidyltransferase-mediatedd-UTPbiotinnickendlabeling(TUNEL)assay.Results:Significantdifferences(P=0.001)weredetectedinp21rasproteinexpressionbetweenthethreegroups.Anear2-foldincreaseinp21rasstainingwasobservedinthecirrhoticcasescomparedtothehepatitiscases,andp21rasexpressionwasdecreasedintheHCCgroup.p21rasexpressioncorrelatedwithstage(r=0.64,P=0.001)andgrade(r=-0.65,P=0.001)intheHCCgroupandgradeintheHCVgroup(r=0.44,P=0.008).Bothp21rasexpressionandTUNEL-LIweresignificantlylowerinlargeHCCscomparedtosmallHCCs(P=0.01each).TheTUNELvalueswerenegativelycorrelatedwithstageintheHCCgroup(r=-0.85,P=0.001).TheTUNELvalueswerealsonegativelycorrelatedwithgradeinboththeHCVandHCCgroups(r=0.89,P=0.001andr=-0.53,P=0.001,respectively).Thep21rasscoresweresignificantlycorrelatedwiththeTUNEL-LIvaluesintheHCCgroup(r=0.63,P=0.001)andHCVgroup(r=0.88,P=0.001).Conclusions:p21rasactsasaninitiatorinHCCcomplicatingtype4chronicHCVandisdownregulatedwithHCCprogression,whichmostlikelypromotestumorcellsurvivalbecauseitfacilitatesthedownregulationofapoptosiswithtumorprogression.