简介：Breastmetastasisfromextra-mammarymalignancyisrare.Anincidenceof0.4%to1.3%hasbeenreportedinliterature.Theprimarymalignanciesthatmostcommonlymetastasizetothebreastareleukemia,lymphoma,andmalignantmelanoma.Inthisreport,twocasesofpulmonarymetastasistothebreastwerepresented.A40-year-oldfemalemanifestedarightbreastmassof2-monthduration.Afterphysicalexaminationwasperformed,apoorlydefinedmasswasnotedintheupperouterquadrantoftherightbreast.Another49-year-oldfemalemanifestedrightbreastmassof5-dayduration.Apoorlydefinedmasswasnotedinthelowerinnerquadrantoftherightbreast.Mammographyresultsalsorevealedbreastcancer.Thepatientsunderwentlocalexcision.Afterhistologicalandimmunohistochemicalanalyseswereconducted,aprimarylungcarcinomathatmetastasizedtothebreastwasdiagnosed.Anaccuratedifferentiationofmetastasistothebreastfromprimarybreastcancerisveryimportantbecausethetreatmentandprognosisofthetwodiffersignificantly.

简介：双边的肩膀脱臼arerare并且几乎总是发生在以后的方向。同时的双边的前面的肩膀脱臼甚至更稀罕，仅仅一些案例在文学被说。当同步、同时的力量被需要导致它，双边的肩膀脱臼的最有趣的部分关于它的损害机制。在癫痫或电刑的情况下，机制是不同的，肌肉的选择的组的有力的收缩导致脱臼。这篇文章报导在一个癫痫的病人发生在一个道路方面事故以后并且在骚动的一个事件以后的双边的同时的前面的肩膀关节脱臼的二个案例。脱臼早被诊断并且与合适的postreduction康复立即减少了。在他们的后续期间，bothpatients有令人满意的功能的结果。这篇文章在道路方面事故牺牲品和癫痫的病人在肩膀检查的重要性上强调。所有矫形surgeonsand紧急情况医生应该知道如此的不平常的可能性有早诊断和治疗。早减小和适当康复能提供令人满意的功能的结果。这篇文章简短也讨论损害机制，诊断并且在文学报导了的双边的肩膀脱臼的治疗。

简介：AIMEndothelin1(ET-1),apotentvasoconstrictorpeptide,isalsoregardedasanimportantetiologicalfactorinvolvedinmanycardiacdiseaseslikeheartfailureandcardiachypertrophy.Itmediatespathologicchangesbyformingan""""ETaxis""""attheupstreamtoionchannels,suchasstimulatingoxidantstress,elicitingcardiacremodelingbyproliferationofcardiomyocytes,inducingapoptosis,affectingsignaltransductionpathway,andmodulatingintranucleargenetranscription.ThepurposeofthisstudywastoinvestigatethepivotalrolebyETaxisinworseningarrhythmiasandcardiacfunctioninexperimentalhypertrophiccardiomyopathy(HCM)andheartfailure(HF)models.METHODSTheratHCMmodelwasinducedbys.cL-thyroxin(L-thy,0.2mg/Kg/d)for10d,

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简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.

简介：Interactivepickingisafundamentaltaskforprocessingdigitalgraphicsandimages.Combiningtwo-dimensional(2D)andthree-dimensional(3D)viewsisanimportanttrendinprocessingmedicalsliced-geometries.Withthegoalofaccuratelypickingpointsinsliced-geometries,wepresentamethodtopickpointsinteractivelybycombining2Dand3Dviewsofsliced-geometries.Fourviewwindowsareconstructedtorendersliced-geometriesusingmedicalimaginginteractiontoolkit(MITK):threefor2DslicesparalleltotheXY,YZ,andXZplanesandoneforsurfacerendering.Pointspickedinaviewwindowcanberenderedandmodifiedinanywindow.Afterapointispicked,itisimmediatelyconvertedintoaworldcoordinateandstored.Pointsareonlyrenderedandmodifiedbasedontheirworldcoordinates.Thispickingmethodcanbeusedforfitting,observing,andmeasuringlocalregions.Thismethodcanalsobeusedforinteractivesegments.Ourexperimentshowsthatthepickingmethodisaccurateandhasareal-timepickingeffect.

简介：Aim:TocomparetherecoveryrateofmorphologicallynormalandchromatincondensedspermatozoafromnativesemensamplesusingtheSpermPrepTMfiltrationcolumnsandPercollgradientcentrifugationandtodeterminetheinfluenceofthetwoprocessingtechniquesonfertilizationandpregnancyratesinanIVF-ETprogram.Methods:Sixteensemensamplesobtainedfrompatient'shusbandwereincludedinthisstudy.Eachwasdividedintotwoaliquots.ThefirstaliquotwasprocessedwithSpermPrepTMfiltrationcolumnsandthesecond,Percollgradientcentrifugation.Smearsweremadebeforeandaftersemenprocessingwithbothmethodsfortheevaluationofchromatincondensation(chromomycineCMA3)aswellasmorphology(strictcriteria)ofspermatozoa.Onehundredandseventyoocyteswereretrievedfromthepatientsandtheoocytesfromeachpatientweresubdividedintotwosets:onesetwasinseminatedusingspermatozoaprocessedwithSpermPrepTMandtheotherinseminatedaftersemenprocessingwithPercollgradientcentrifugation.Resuits:ThePercollmethodyieldedasignificantlyhigherpercentageofchromatincondensed(90.8±6.5%vs82.3±8.8%,P=0.017)andmorphologicallynormalspermatozoa(12.9±7.4%vs6.9±4.8%,P=0.001)incomparisontoSpermPrepTM.Whereas,spermcountrecoveryratewassignificantlyhigheraftertheuseofSpermPrepTMthanafterthePercollgradientcentrifugation.Thefertilizationratewassimilarbetweenthetwomethods.Conclusion:SemenprocessingwithPercollshouldberecommendedforintracytoplasmicsperminjectionasthenaturalselectionisbypassedandtheSpermPrepTMtechniquecouldberecommendedfor1VFandIUIprogramsasthespermconcentrationplaysamoresignificantroleintheseprocedures.

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简介：关于为心脏性的吃惊的处理的levosimendan的使用的编辑的一封信被介绍。

简介：Acupunctureiswidelyusedtotreatfunctionaldyspepsiawithsatisfactoryoutcomes.CombinationoftheHeandMuacupointsiscommonlyusedandhasasynergisticeffectonfunctionaldyspepsia;however,itsunderlyingmechanismsremainunclear.Therefore,arandomizedcontrolledparallelclinicaltrialiscurrentlyunderwayatChengduUniversityofTraditionalChineseMedicine,China.ThistrialisdesignedtoexploretheefficacyofandcentralresponsestotheHe-Mupointcombinationinpatientswithfunctionaldyspepsiausingfunctionalmagneticresonanceimaging.Atotalof105patientswithfunctionaldyspepsiawillbeallocatedinto3groups:thelow-Hepointgroup(puncturingatZusanli(ST36)),Mupointgroup(puncturingatZhongwan(CV12)),andHe-Mupointcombinationgroup(puncturingatST36andCV12).Everyparticipantwillreceive20sessionsofmanualacupuncturefor4weeks.Theneedleswillbeinsertedperpendicularlytoadepthof1to2cun.Theangleofrotationandtwistingwillrangefrom90to180degrees,whileliftingandthrustingwillrangefrom0.3to0.5cm.Thevariousmanipulationswillbeperformed60to90timesperminute.Theneedleswillremaininplacefor30minutes,duringwhichmanipulationwillbeappliedevery10minutes.Magneticresonanceimagingwillbeperformedbeforeandafter20sessionsofacupuncture.TheprimaryoutcomeissymptomimprovementaccordingtotheChineseversionoftheNepeanDyspepsiaIndex.SecondaryoutcomesincludetheLeedsdyspepsiaquestionnaire,Self-RatingAnxietyScale,Self-RatingDepressionScale,BeckAnxietyInventory,BeckDepressionInventory,andvisualanaloguescalescoresbeforeandafter10and20sessionsofacupuncture.Needlesensationandadverseeventswillbeusedtoassessthetherapeuticeffects.ThisstudywillpromotemorewidespreadawarenessofthebenefitsofacupointcombinationintheclinicalsettingandprovideafurtherexplanationoftheneuromechanismbywhichacupunctureattheHe-Mupointcombinationforfunctio

简介：Totreat30casesofdiarrheaofinsufficiencyofthespleen-yangtypebymoxibustionwithsaltatShenque(CV8).Thetotaleffectiveratewas93.3%.

简介：AbstractIntroduction:Scarring and non-scarring alopecias have rarely been described to occur together in the same patient. Distinguishing these two different types of alopecia is important as treatment and prognosis can be different.Case presentation:Here, we report the first case of simultaneous alopecia areata (AA) and central centrifugal cicatricial alopecia (CCCA) in a 35-year-old woman. New alopecic patches were noted on her frontal and vertex scalp. Biopsy of the frontal scalp revealed miniaturized hair follicles and dense lymphocytic infiltrate surrounding the hair bulbs, consistent with AA; while biopsy of the vertex scalp revealed decreased hair follicles, perifollicular fibroplasia with eccentric atrophy of the follicular epithelium, and premature desquamation of the inner root sheath at the level of the lower isthmus, consistent with CCCA.Discussion:Proposed mechanisms of these two alopecia types occurring together include loss of immune privilege, genetic predisposition, as well as unknown external factors that trigger an autoimmune lymphocytic response. Most recently, the peptidylarginine deiminase type III gene has been implicated in both diseases. Although treatment options can overlap between the two diseases, treatment response can differ and CCCA tends to have a worse prognosis.Conclusion:Awareness of this concomitant presentation of two alopecic types is important for appropriate treatment and prognostication.

简介：AbstractTwo cases of type II odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type II odontoid fracture and a 42-year-old man with fracture end hardened type II odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior C1-C2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type II odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type II odontoid fractures.

简介：AbstractPurpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017. Patients with (1) intra-articular fractures of the distal third of the tibia and fibula, (2) pathological fracture resulting in bone loss or (3) neurological and vascular pathologies of the limbs were excluded. The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone. Functional & radiographic results and complications were evaluated according to Paley's criteria.Results:The patients comprised 14 males and 5 females with a mean age of 37.4 years (range, 21-52 years). Patients were followed up for an average of 27 months (range, 15-38 months). The microorganisms produced from these patients were Staphylococcus aureus in 13 patients, Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients. After the first stage operation, superficial skin necrosis developed in 1 patient. In another patient, there was a persistent infection, although union was achieved. For the entire patient group, union was observed at the end of 7.44 months (range, 7-11 months). Based on Paley's criteria, there were 16 (84.2%) patients with excellent scores, 2 (10.5%) good scores and 1 (5.3%) fair scores radiologically; while regarding the tibial function, 15 (78.9%) patients had excellent scores, 3 (15.8%) good scores, and 1 (5.3%) fair scores. No patients had poor radiological or functional score.Conclusion:Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications, such as the tibia. This technique has the advantages of short operation time, minimal blood loss, no excessive tissue damage and not very technique-demanding (a short learning curve with no requirement for an experienced team).

简介：AbstractBackground:Zoonotic schistosomiasis, caused by Schistosoma japonicum, remains a major public health problem in the Philippines. This study aimed to evaluate the commercially available rapid diagnostic point-of-care circulating cathodic antigen (POC-CCA) test in detecting individuals infected with S. japonicum in a human cohort from an endemic area for schistosomiasis japonica in the Philippines.Methods:Clinical samples were collectedin 18 barangays endemic for S. japonicum infection in Laoang and Palapag municipalities, Northern Samar, the Philippines, in 2015. The presence of CCA in filter-concentrated urine samples (n = 412) was evaluated using the commercial kits and the results were converted to images, which were further analyzed by ImageJ software to calculate R values. The diagnostic performance of the immunochromatographic POC-CCA test was compared using the Kato-Katz (KK) procedure, in-house enzyme-linked immunosorbent assays (ELISAs) and droplet digital (dd) PCR assays as reference.Results:The POC-CCA test was able to detect S. japonicum-infected individuals in the cohort with an eggs per gram of faeces (EPG) more than or equal to 10 with sensitivity/specificity values of 63.3%/93.3%. However, the assay showed an inability to diagnose schistosomiasis japonica infections in all cohort KK-positive individuals, of which the majority had an extremely low egg burden (EPG: 1-9). The prevalence of S. japonicum infection in the total cohort determined by the POC-CCA test was 12.4%, only half of that determined by the KK method (26.2%). When compared with the ELISAs and ddPCR assays as a reference, the POC-CCA assay was further shown to be a test with low sensitivity. Nevertheless, the assay exhibited significant positive correlations with egg burden determined by the KK technique and the target gene copy number index values determined by the ddPCR assays within the entire cohort.Conclusions:By using in silico image analysis, the POC-CCA cassette test could be converted to a quantitative assay to avoid reader-variability. Because of its low sensitivity, the commercially available POC-CCA assay had limited potential for determining the status of a S. japonicum infection in the target cohort. The assay should be applied with caution in populations where schistosome parasites (especially S. japonicum) are present at low infection intensity.

简介：AbstractIntroduction:Postherpetic neuralgia (PHN) is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month. PHN is usually difficult to treat.We herein present two cases of PHN comorbid with spinal metastasis of a malignant tumor. Both patients responded well to an epidural block.Case presentation:Patient 1 was a 54-year-old woman who had PHN for 35 days. Patient 2 was a 74-year-old woman who had PHN for 65 days. Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor.Discussion:The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects. Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs. Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease. Computed tomography or magnetic resonance imaging of the spine is recommended for such patients, and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded.Conclusion:Epidural block treatment provides a new approach for patients of herpes zoster or PHN, but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.

简介：Type2cytokinesareusuallypredominantintumorpatientsandassociatedwithtumorprogression.Toexplorewhetherreversingoftype2predominancecouldbeapromisingstrategyintumorimmunotherapy,PBMCsof35lungcancerpatientsand19healthysubjectswerepreparedandsubjectedtobeexaminedforcytokinesecretionandgeneexpression.Tetra-Methylpyrazine(TTMP),extractedfromatraditionalChinesemedicinalherbwhichhasbeenusedinclinictoreversetheTh2statusofcancerpatientsinChina,wasaddedtoPBMCculture.DeterminedbyRT-PCR,thepositivepercentagesofmRNAexpressionoftype1cytokines(8.6%forIFN-γand11.4%forIL-2)werelowerthanthoseoftype2cytokines(71.4%forIL-4,60%forIL-6and80%forIL-10)inpatients'PBMCs.Thepotentialofgeneexpressing(measuredasrelativeintensitytotheratioofβ-actin)inthepatientsfortype1cytokineswasalsoinalowlevel(0.111forIFN-γ,0.119forIL-2)incomparisonwitharelativehighlevelfortype2cytokines(0.319forIL-4,0.303forIL-6and0.377forIL-10).Meanwhile,bothpositivepercentageandrelativeintensityofgeneexpressionwerelowerforatype1cytokine-relatedtranscriptionfactorT-bet(31.4%and0.142,respectively)thanthosefortype2cytokine-relatedGATA3(85.7%and0.378,respectively).ThebloodserumlevelsofIFN-γandIL-2inthepatientswereslightlylowerbutnotsignificantlywhencomparedwithhealthycontrol.Incontrast,thelevelsIL-4andIL-6inpatientsweresignificantlyhigherthanthoseinhealthysubjectsbyELISAanalysis.TTMPcouldenhancesupernatantconcentrationandgeneexpressionlevelsofIFN-γ,IL-2andT-bet,butreducedthoseoftype2cytokines.Theseresultsdemonstratethatthelungcancerpatientshadapredominantexpressionoftype2cytokinesandTTMPcouldreversethetype2dominantstatus,whichmightofferanalternativetherapeuticregimeforlungcancerpatients.Cellular&MolecularImmunology.2004;1(1):63-70.