BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlan...BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.展开更多
At present, internal rural tourism is at the stage of upgrading and renewing, and ecotourism has been considered to be the main direction. This paper discussed the concepts and criteria of rural tourism and ecotourism...At present, internal rural tourism is at the stage of upgrading and renewing, and ecotourism has been considered to be the main direction. This paper discussed the concepts and criteria of rural tourism and ecotourism, analyzed a typical case of Nongke Village of Chengdu City-being considered to be the first rural tourism site in China, went deep into the problems of the contents and criteria of the development of rural ecotourism, and tried to probe into the principles of the development of rural ecotourism both theoretically and practically so as to understand the rules of the development of rural ecotourism .展开更多
Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor...Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor nutrition, thus affecting the prognosis. This study aims to introduce a typical case to explore the whole-course</span><span style="font-family:""> </span><span style="font-family:Verdana;">(started at admission and ended 5 years after surgery)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and Multidisciplinary Teams (MDTs)</span><span style="font-family:""> </span><span style="font-family:Verdana;">(comprising physician, primary nurse, case manager, nutrition liaison and nutrition specialist nurse)</span><span style="font-family:""> </span><span style="font-family:Verdana;">nutritional management mode of breast cancer patients. The patient successfully completed the scheduled treatment by implementing the whole-course and multidisciplinary nutrition management. The mode can prospectively and dynamically estimate the changes </span><span style="font-family:Verdana;">in</span><span style="font-family:Verdana;"> patients’ nutritional status, and provide timely nutritional intervention to promote patient outcomes.展开更多
Dear editor, Isopropanol, also named 2-propanol or isopropyl alcohol(IPA), is a colorless, volatile liquid found in numerous household chemicals, such as cleaners and disinfectants, which typically contain a 70% solut...Dear editor, Isopropanol, also named 2-propanol or isopropyl alcohol(IPA), is a colorless, volatile liquid found in numerous household chemicals, such as cleaners and disinfectants, which typically contain a 70% solution of IPA in water. IPA is also extensively used in industry and laboratories as a solvent.展开更多
BACKGROUND After vaccination was mandated worldwide,various adverse effects associated with the coronavirus disease 2019(COVID-19)vaccination,including shoulder pain,have been reported.Here,we report a case of new-ons...BACKGROUND After vaccination was mandated worldwide,various adverse effects associated with the coronavirus disease 2019(COVID-19)vaccination,including shoulder pain,have been reported.Here,we report a case of new-onset shoulder pain after BNT162b2(Comirnaty,Pfizer-BioNTech)mRNA vaccination.CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion(ROM)limitation that had persisted for more than 5 mo.The history included no specific noteworthy events,except vaccination.The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain.The patient self-administered aspirin,with which the pain subsided immediately,whereas ROM limitation persisted.At the first visit,the patient complained of dull pain and ROM restriction of the left shoulder(flexion 130°,abduction 110°,and external rotation 40°).Among the diagnostic studies conducted for the evaluation of the shoulder,magnetic resonance imaging showed a thickened coracohumeral ligament.Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities.The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment,the exact cause and mechanism of pain are unclear.However,the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.展开更多
BACKGROUND Zollinger–Ellison syndrome(ZES)results from hypersecretion of gastrin from pancreatic or duodenal neuroendocrine tumors,commonly referred to as gastrinomas.The high levels of gastrin lead to a typical pres...BACKGROUND Zollinger–Ellison syndrome(ZES)results from hypersecretion of gastrin from pancreatic or duodenal neuroendocrine tumors,commonly referred to as gastrinomas.The high levels of gastrin lead to a typical presentation involving watery diarrhea and multiple ulcers in the duodenum.Here,we have presented the rare case of a patient with ZES and absence of hypergastrinemia as well as an atypical location of gastrinoma.CASE SUMMARY A 72-year-old woman presented with the typical clinical manifestations of ZES,including upper abdominal pain,significant watery diarrhea,and acidic liquid vomitus.Surprisingly,however,she did not have an increased level of serum gastrin.In addition,there was no evidence of gastrinoma or any other ulcerogenic tumor.Esophagogastroduodenoscopy was conducted to examine the upper digestive tract.Revised diagnoses were considered,and an individualized treatment plan was developed.The patient responded to antacid medication while experiencing intermittent,recurring bouts of ZES.18F-AlF-NOTAoctreotide positron emission tomography(18F-OC PET)/computed tomography(CT)helped locate the tumor.Postoperative pathology and immunohistochemistry results suggested that the tumor was a gastrinoma located at an unconventional site.CONCLUSION This present case study demonstrates the possibility of ZES-like manifestation in patients with absence of hypergastrinemia.18F-OC PET/CT is a relatively new imaging technique that can be applied for diagnosing even tiny gastrinomas that are atypical in terms of location.展开更多
BACKGROUND Congenital agenesis of the gallbladder(CAGB)is a rare condition often misdiagnosed as cholecystolithiasis,leading to unnecessary surgeries.Accurate diagnosis and surgical exploration are crucial in patients...BACKGROUND Congenital agenesis of the gallbladder(CAGB)is a rare condition often misdiagnosed as cholecystolithiasis,leading to unnecessary surgeries.Accurate diagnosis and surgical exploration are crucial in patients with suspected CAGB or atypical gallbladder stone symptoms.Preoperative imaging,such as magnetic resonance cholangiopancreatography(MRCP),plays a vital role in confirming the diagnosis.Careful intraoperative dissection is necessary to avoid iatrogenic injuries and misdiagnosis.Multidisciplinary consultations and collaboration,along with the use of various diagnostic methods,can minimize associated risks.CASE SUMMARY We present the case of a 34-year-old female with suspected gallbladder stones,ultimately diagnosed with CAGB through surgical exploration.The patient underwent laparoscopic examination followed by open exploratory surgery,which confirmed absence of the gallbladder.Subsequent imaging studies supported the diagnosis.The patient received appropriate postoperative care and experienced a successful recovery.CONCLUSION This case highlights the rarity of CAGB and the importance of considering this condition in the differential diagnosis of patients with gallbladder stone symptoms.Accurate diagnosis using preoperative imaging,such as MRCP,is crucial to prevent unnecessary surgeries.Surgeons should exercise caution and conduct meticulous dissection during surgery to avoid iatrogenic injuries and ensure accurate diagnosis.Multidisciplinary collaboration and utilization of various diagnostic methods are essential to minimize the risk of misdiagnosis.Selection of the optimal treatment strategy should prioritize minimizing trauma and maintaining open communication with the patient and their family members.展开更多
BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy.It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide.Eclampsia is characterised by classic signs such...BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy.It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide.Eclampsia is characterised by classic signs such as elevated blood pressure,proteinuria,and seizures.However,it may occur in the absence of hypertension and/or proteinuria.The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it.In addition,the occurrence of this case in a remote area makes it more challenging to handle.The objective of this case report is to increase awareness of uncommon manifestations of eclampsia,particularly in limited-resource settings.CASE SUMMARY A young primigravida experienced a generalised seizure without hypertension and/or proteinuria.Sudden hearing loss,blurred vision,and vomiting were complained about before the seizure attack.The patient was diagnosed with eclampsia.A loading dose of magnesium sulphate was administered immediately.The patient was referred from community healthcare to a hospital and discharged without any complications.CONCLUSION Atypical eclampsia may be a diagnostic challenge.However,other symptoms may be beneficial,such as awareness of eclampsia signs.展开更多
BACKGROUND Brucellosis is endemic in India with seropositivity rates as high as 10%in children in the eastern states,yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin(PUO)i...BACKGROUND Brucellosis is endemic in India with seropositivity rates as high as 10%in children in the eastern states,yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin(PUO)is being considered,especially in children in urban set-up.This may be because of the non-specific multitude of systemic symptoms seen in this disease and the lack of awareness among clinicians.CASE SUMMARY We present a case of a 13-year-old boy,who came with a history of undulating fever for the past three and a half months,loss of appetite,and abdominal pain.The child had visited several pediatricians and was even admitted to a tertiary care hospital for PUO evaluation,but to no avail.He presented to us after three and half months of suffering and weight loss of more than 10%of body weight.His ultrasonography revealed thickening of the terminal ileum.His blood culture grew Brucella melitensis.A diagnosis of Brucellosis with terminal ileitis was made.Brucella serology by enzyme-linked immunoassay(ELISA)was positive for both IgG and IgM.He was treated with doxycycline and Rifampicin along with syrup multivitamin and zinc,for 6 wk.There was remarkable improvement with gain in 4 kg body weight within 2 mo of completing treatment.History revealed consumption of unpasteurized milk and contact with cattle.CONCLUSION Clinical suspicion,detailed history,appropriate laboratory investigations are the three pillars for diagnosing Brucellosis in patients presenting with vague symptoms.展开更多
BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of ear...BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of earlier hematopoietic progenitors and impaired productivity of mature blood cells.An increased percentage of myeloblasts and the presence of unfavorable somatic mutations are signs of leukemic hematopoiesis and indicators of entrance into an advanced stage.Bone marrow cellularity and myeloblasts usually increase with disease progression.However,aplastic crisis occasionally occurs in advanced MDS.CASE SUMMARY A 72-year-old male patient was definitively diagnosed with MDS with excess blasts-1(MDS-EB-1)based on an increase in the percentages of myeloblasts and cluster of differentiation(CD)34+hematopoietic progenitors and the identification of myeloid neoplasm-associated somatic mutations in bone marrow samples.The patient was treated with hypomethylation therapy and was able to maintain a steady disease state for 2 years.In the treatment process,the advanced MDS patient experienced an episode of progressive pancytopenia and bone marrow aplasia.During the aplastic crisis,the bone marrow was infiltrated with sparsely distributed atypical lymphocytes.Surprisingly,the leukemic cells disappeared.Immunological analysis revealed that the atypical lymphocytes expressed a high frequency of CD3,CD5,CD8,CD16,CD56 and CD57,suggesting the activation of autoimmune cytotoxic T-lymphocytes and natural killer(NK)/NKT cells that suppressed both normal and leukemic hematopoiesis.Elevated serum levels of inflammatory cytokines,including interleukin(IL)-6,interferon-gamma(IFN-γ)and tumor necrosis factor-alpha(TNF-α),confirmed the deranged type I immune responses.This morphological and immunological signature led to the diagnosis of severe aplastic anemia secondary to large granule lymphocyte leukemia.Disseminated tuberculosis was suspected upon radiological examinations in the search for an inflammatory niche.Antituberculosis treatment led to reversion of the aplastic crisis,disappearance of the atypical lymphocytes,increased marrow cellularity and 2 mo of hematological remission,providing strong evidence that disseminated tuberculosis was responsible for the development of the aplastic crisis,the regression of leukemic cells and the activation of CD56+atypical lymphocytes.Reinstitution of hypomethylation therapy in the following 19 mo allowed the patient to maintain a steady disease state.However,the patient transformed the disease phenotype into acute myeloid leukemia and eventually died of disease progression and an overwhelming infectious episode.CONCLUSION Disseminated tuberculosis can induce CD56+lymphocyte infiltration in the bone marrow and in turn suppress both normal and leukemic hematopoiesis,resulting in the development of aplastic crisis and leukemic cell regression.展开更多
Grassland biomass is an important parameter of grassland ecosystems.The complexity of the grassland canopy vegetation spectrum makes the long-term assessment of grassland growth a challenge.Few studies have explored t...Grassland biomass is an important parameter of grassland ecosystems.The complexity of the grassland canopy vegetation spectrum makes the long-term assessment of grassland growth a challenge.Few studies have explored the original spectral information of typical grasslands in Inner Mongolia and examined the influence of spectral information on aboveground biomass(AGB)estimation.In order to improve the accuracy of vegetation index inversion of grassland AGB,this study combined ground and Unmanned Aerial Vehicle(UAV)remote sensing technology and screened sensitive bands through ground hyperspectral data transformation and correlation analysis.The narrow band vegetation indices were calculated,and ground and airborne hyperspectral inversion models were established.Finally,the accuracy of the model was verified.The results showed that:(1)The vegetation indices constructed based on the ASD FieldSpec 4 and the UAV were significantly correlated with the dry and fresh weight of AGB.(2)The comparison between measured R^(2) with the prediction R^(2) indicated that the accuracy of the model was the best when using the Soil-Adjusted Vegetation Index(SAVI)as the independent variable in the analysis of AGB(fresh weight/dry weight)and four narrow-band vegetation indices.The SAVI vegetation index showed better applicability for biomass monitoring in typical grassland areas of Inner Mongolia.(3)The obtained ground and airborne hyperspectral data with the optimal vegetation index suggested that the dry weight of AGB has the best fitting effect with airborne hyperspectral data,where y=17.962e^(4.672x),the fitting R^(2) was 0.542,the prediction R^(2)was 0.424,and RMSE and REE were 57.03 and 0.65,respectively.Therefore,established vegetation indices by screening sensitive bands through hyperspectral feature analysis can significantly improve the inversion accuracy of typical grassland biomass in Inner Mongolia.Compared with ground monitoring,airborne hyperspectral monitoring better reflects the inversion of actual surface biomass.It provides a reliable modeling framework for grassland AGB monitoring and scientific and technological support for grazing management.展开更多
Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-establish...Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.展开更多
Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the s...Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.展开更多
Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmati...Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.展开更多
Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Pe...Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Peritoneal dialysis (PD) is an effective, albeit invasive, therapy for neonatal renal failure. We report a case of neonatal obstruction with severe renal failure treated by PD to highlight our hospital practice and possible remedies in a context of limited resources. Case Presentation: This was a female neonate of moderate prematurity admitted on day 4 of life for management of a flat neonatal obstruction. Radiological diagnosis suggested small bowel atresia. Biological tests revealed severe renal failure with creatinine levels of 416 micromoles per liter and blood urea of 27.1 micromoles per liter. Management consisted of preoperative peritoneal dialysis for 48 hours followed by laparotomy. The intraoperative diagnosis was GROSFELD type IIIa digestive atresia. The postoperative course was favourable, transit was resumed on day 5 and the patient returned home on day 12. Progress at 3 months was satisfactory. Conclusion: Neonatal intestinal obstruction with renal failure in premature infants is associated with a poor prognosis, even more so if there is a delay in treatment. Peritoneal dialysis seems to be a suitable alternative for this management in our working conditions with limited resources.展开更多
Edge devices,due to their limited computational and storage resources,often require the use of compilers for program optimization.Therefore,ensuring the security and reliability of these compilers is of paramount impo...Edge devices,due to their limited computational and storage resources,often require the use of compilers for program optimization.Therefore,ensuring the security and reliability of these compilers is of paramount importance in the emerging field of edge AI.One widely used testing method for this purpose is fuzz testing,which detects bugs by inputting random test cases into the target program.However,this process consumes significant time and resources.To improve the efficiency of compiler fuzz testing,it is common practice to utilize test case prioritization techniques.Some researchers use machine learning to predict the code coverage of test cases,aiming to maximize the test capability for the target compiler by increasing the overall predicted coverage of the test cases.Nevertheless,these methods can only forecast the code coverage of the compiler at a specific optimization level,potentially missing many optimization-related bugs.In this paper,we introduce C-CORE(short for Clustering by Code Representation),the first framework to prioritize test cases according to their code representations,which are derived directly from the source codes.This approach avoids being limited to specific compiler states and extends to a broader range of compiler bugs.Specifically,we first train a scaled pre-trained programming language model to capture as many common features as possible from the test cases generated by a fuzzer.Using this pre-trained model,we then train two downstream models:one for predicting the likelihood of triggering a bug and another for identifying code representations associated with bugs.Subsequently,we cluster the test cases according to their code representations and select the highest-scoring test case from each cluster as the high-quality test case.This reduction in redundant testing cases leads to time savings.Comprehensive evaluation results reveal that code representations are better at distinguishing test capabilities,and C-CORE significantly enhances testing efficiency.Across four datasets,C-CORE increases the average of the percentage of faults detected(APFD)value by 0.16 to 0.31 and reduces test time by over 50% in 46% of cases.When compared to the best results from approaches using predicted code coverage,C-CORE improves the APFD value by 1.1% to 12.3% and achieves an overall time-saving of 159.1%.展开更多
AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a tota...AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.展开更多
BACKGROUND Gigantic epidermal cysts(GECs)are rare benign skin appendicular tumours also known as keratinocysts.GECs have a high incidence and their wall is made up of epidermis.Epidermal cysts can occur in any part of...BACKGROUND Gigantic epidermal cysts(GECs)are rare benign skin appendicular tumours also known as keratinocysts.GECs have a high incidence and their wall is made up of epidermis.Epidermal cysts can occur in any part of the skin;clinical manifestations include skin colour hemispherical swelling;cystic;mobile;0.5 cm to several centimetres in diameter;and slow growth.CASE SUMMARY Herein,we report a case involving a 56-year-old female with a GEC in the occipitalia.On July 25,2023,a patient with a GEC was admitted to the neurosurgery Department of the Second Affiliated Hospital of Xi'an Medical University.The phyma was shown to be a solid mass during the operation and was confirmed to be a GEC based on pathological examination.CONCLUSION Epidermal cysts are common cystic nodules on the surface of the body,the aetiology is unclear,the clinical manifestations can vary,and the misdiagnosis rate is high.However,giant epidermal cysts are rare.In most cases,however,the prognosis is satisfactory.This paper analyses and summarizes the population,location,clinical and pathological characteristics and pathogenesis of the disease to strengthen the understanding of this disease and improve the accuracy of clinical diagnosis.展开更多
BACKGROUND Paramyotonia congenita(PMC)stands as a rare sodium channelopaty of skeletal muscle,initially identified by Eulenburg.The identification of PMC often relies on electromyography(EMG),a diagnostic technique.Th...BACKGROUND Paramyotonia congenita(PMC)stands as a rare sodium channelopaty of skeletal muscle,initially identified by Eulenburg.The identification of PMC often relies on electromyography(EMG),a diagnostic technique.The child’s needle EMG unveiled trains of myotonic discharges with notably giant amplitudes,alongside irregular wave trains of myotonic discharges.This distinctive observation had not surfaced in earlier studies.CASE SUMMARY We report the case of a 3-year-old female child with PMC,who exhibited la-ryngeal stridor,muffled speech,myotonia from birth.Cold,exposure to cool water,crying,and physical activity exacerbated the myotonia,which was relieved in warmth,yet never normalized.Percussion myotonia was observable in bilateral biceps.Myotonia symptoms remained unchanged after potassium-rich food consumption like bananas.Hyperkalemic periodic paralysis was excluded.Cranial magnetic resonance imaging yielded normal results.Blood potassium remained within normal range,while creatine kinase showed slight elevation.Exome-wide genetic testing pinpointed a heterozygous mutation on chromosome SCN4A:c.3917G>A(p.G1306E).After a six-month mexiletine regimen,symptoms alleviated.CONCLUSION In this case revealed the two types of myotonic discharges,and had not been documented in other studies.We underscore two distinctive features:Giant-amplitude potentials and irregular waves.展开更多
文摘BACKGROUND In bow hunter’s syndrome(BHS),also known as rotational vertebral artery(VA)syndrome,there is dynamic/rotational compression of the VA producing verte-brobasilar insufficiency.Most occurrences involve atlantoaxial rather than mid-cervical VA compromise,the latter being rarely reported.Herein,we detail successful VA decompression at mid-cervical spine,given a departure from its usual course.CASE SUMMARY The patient,a 45-year-old man,presented to our hospital with occipital headache and vertigo.Computed tomography angiography showed anomalous C4 entry of right VA,with compression upon head rotation to that side.Thyroid cartilage and anterior tubercle of C5 transverse process were visibly at fault.We opted for sur-gery,using an anterior cervical approach to remove the anterior tubercle.Patient recovery was uneventful and brought resolution of all preoperative symptoms.CONCLUSION BHS is an important consideration where aberrant coursing of VA and neurologic symptoms coexist.
文摘At present, internal rural tourism is at the stage of upgrading and renewing, and ecotourism has been considered to be the main direction. This paper discussed the concepts and criteria of rural tourism and ecotourism, analyzed a typical case of Nongke Village of Chengdu City-being considered to be the first rural tourism site in China, went deep into the problems of the contents and criteria of the development of rural ecotourism, and tried to probe into the principles of the development of rural ecotourism both theoretically and practically so as to understand the rules of the development of rural ecotourism .
文摘Breast cancer patients face different nutritional problems at each stage. However, the nutrition of breast cancer patients has not been taken seriously. As a result, some patients cannot tolerate treatment due to poor nutrition, thus affecting the prognosis. This study aims to introduce a typical case to explore the whole-course</span><span style="font-family:""> </span><span style="font-family:Verdana;">(started at admission and ended 5 years after surgery)</span><span style="font-family:""> </span><span style="font-family:Verdana;">and Multidisciplinary Teams (MDTs)</span><span style="font-family:""> </span><span style="font-family:Verdana;">(comprising physician, primary nurse, case manager, nutrition liaison and nutrition specialist nurse)</span><span style="font-family:""> </span><span style="font-family:Verdana;">nutritional management mode of breast cancer patients. The patient successfully completed the scheduled treatment by implementing the whole-course and multidisciplinary nutrition management. The mode can prospectively and dynamically estimate the changes </span><span style="font-family:Verdana;">in</span><span style="font-family:Verdana;"> patients’ nutritional status, and provide timely nutritional intervention to promote patient outcomes.
文摘Dear editor, Isopropanol, also named 2-propanol or isopropyl alcohol(IPA), is a colorless, volatile liquid found in numerous household chemicals, such as cleaners and disinfectants, which typically contain a 70% solution of IPA in water. IPA is also extensively used in industry and laboratories as a solvent.
文摘BACKGROUND After vaccination was mandated worldwide,various adverse effects associated with the coronavirus disease 2019(COVID-19)vaccination,including shoulder pain,have been reported.Here,we report a case of new-onset shoulder pain after BNT162b2(Comirnaty,Pfizer-BioNTech)mRNA vaccination.CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion(ROM)limitation that had persisted for more than 5 mo.The history included no specific noteworthy events,except vaccination.The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain.The patient self-administered aspirin,with which the pain subsided immediately,whereas ROM limitation persisted.At the first visit,the patient complained of dull pain and ROM restriction of the left shoulder(flexion 130°,abduction 110°,and external rotation 40°).Among the diagnostic studies conducted for the evaluation of the shoulder,magnetic resonance imaging showed a thickened coracohumeral ligament.Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities.The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment,the exact cause and mechanism of pain are unclear.However,the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.
基金National Natural Science Foundation of China,No.82100612Zhejiang Medical Health Science and Technology Plan Project,No.2021KY1116。
文摘BACKGROUND Zollinger–Ellison syndrome(ZES)results from hypersecretion of gastrin from pancreatic or duodenal neuroendocrine tumors,commonly referred to as gastrinomas.The high levels of gastrin lead to a typical presentation involving watery diarrhea and multiple ulcers in the duodenum.Here,we have presented the rare case of a patient with ZES and absence of hypergastrinemia as well as an atypical location of gastrinoma.CASE SUMMARY A 72-year-old woman presented with the typical clinical manifestations of ZES,including upper abdominal pain,significant watery diarrhea,and acidic liquid vomitus.Surprisingly,however,she did not have an increased level of serum gastrin.In addition,there was no evidence of gastrinoma or any other ulcerogenic tumor.Esophagogastroduodenoscopy was conducted to examine the upper digestive tract.Revised diagnoses were considered,and an individualized treatment plan was developed.The patient responded to antacid medication while experiencing intermittent,recurring bouts of ZES.18F-AlF-NOTAoctreotide positron emission tomography(18F-OC PET)/computed tomography(CT)helped locate the tumor.Postoperative pathology and immunohistochemistry results suggested that the tumor was a gastrinoma located at an unconventional site.CONCLUSION This present case study demonstrates the possibility of ZES-like manifestation in patients with absence of hypergastrinemia.18F-OC PET/CT is a relatively new imaging technique that can be applied for diagnosing even tiny gastrinomas that are atypical in terms of location.
文摘BACKGROUND Congenital agenesis of the gallbladder(CAGB)is a rare condition often misdiagnosed as cholecystolithiasis,leading to unnecessary surgeries.Accurate diagnosis and surgical exploration are crucial in patients with suspected CAGB or atypical gallbladder stone symptoms.Preoperative imaging,such as magnetic resonance cholangiopancreatography(MRCP),plays a vital role in confirming the diagnosis.Careful intraoperative dissection is necessary to avoid iatrogenic injuries and misdiagnosis.Multidisciplinary consultations and collaboration,along with the use of various diagnostic methods,can minimize associated risks.CASE SUMMARY We present the case of a 34-year-old female with suspected gallbladder stones,ultimately diagnosed with CAGB through surgical exploration.The patient underwent laparoscopic examination followed by open exploratory surgery,which confirmed absence of the gallbladder.Subsequent imaging studies supported the diagnosis.The patient received appropriate postoperative care and experienced a successful recovery.CONCLUSION This case highlights the rarity of CAGB and the importance of considering this condition in the differential diagnosis of patients with gallbladder stone symptoms.Accurate diagnosis using preoperative imaging,such as MRCP,is crucial to prevent unnecessary surgeries.Surgeons should exercise caution and conduct meticulous dissection during surgery to avoid iatrogenic injuries and ensure accurate diagnosis.Multidisciplinary collaboration and utilization of various diagnostic methods are essential to minimize the risk of misdiagnosis.Selection of the optimal treatment strategy should prioritize minimizing trauma and maintaining open communication with the patient and their family members.
文摘BACKGROUND Eclampsia is a generalized tonic-clonic seizure induced by pregnancy.It contributes to a high rate of maternal and neonatal morbidity and mortality worldwide.Eclampsia is characterised by classic signs such as elevated blood pressure,proteinuria,and seizures.However,it may occur in the absence of hypertension and/or proteinuria.The uncommon appearance of eclampsia makes it difficult to immediately assess and treat it.In addition,the occurrence of this case in a remote area makes it more challenging to handle.The objective of this case report is to increase awareness of uncommon manifestations of eclampsia,particularly in limited-resource settings.CASE SUMMARY A young primigravida experienced a generalised seizure without hypertension and/or proteinuria.Sudden hearing loss,blurred vision,and vomiting were complained about before the seizure attack.The patient was diagnosed with eclampsia.A loading dose of magnesium sulphate was administered immediately.The patient was referred from community healthcare to a hospital and discharged without any complications.CONCLUSION Atypical eclampsia may be a diagnostic challenge.However,other symptoms may be beneficial,such as awareness of eclampsia signs.
文摘BACKGROUND Brucellosis is endemic in India with seropositivity rates as high as 10%in children in the eastern states,yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin(PUO)is being considered,especially in children in urban set-up.This may be because of the non-specific multitude of systemic symptoms seen in this disease and the lack of awareness among clinicians.CASE SUMMARY We present a case of a 13-year-old boy,who came with a history of undulating fever for the past three and a half months,loss of appetite,and abdominal pain.The child had visited several pediatricians and was even admitted to a tertiary care hospital for PUO evaluation,but to no avail.He presented to us after three and half months of suffering and weight loss of more than 10%of body weight.His ultrasonography revealed thickening of the terminal ileum.His blood culture grew Brucella melitensis.A diagnosis of Brucellosis with terminal ileitis was made.Brucella serology by enzyme-linked immunoassay(ELISA)was positive for both IgG and IgM.He was treated with doxycycline and Rifampicin along with syrup multivitamin and zinc,for 6 wk.There was remarkable improvement with gain in 4 kg body weight within 2 mo of completing treatment.History revealed consumption of unpasteurized milk and contact with cattle.CONCLUSION Clinical suspicion,detailed history,appropriate laboratory investigations are the three pillars for diagnosing Brucellosis in patients presenting with vague symptoms.
基金Supported by The Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University,No.YLJT20201002.
文摘BACKGROUND Myelodysplastic syndrome(MDS)is caused by malignant proliferation and ineffective hematopoiesis.Oncogenic somatic mutations and increased apoptosis,necroptosis and pyroptosis lead to the accumulation of earlier hematopoietic progenitors and impaired productivity of mature blood cells.An increased percentage of myeloblasts and the presence of unfavorable somatic mutations are signs of leukemic hematopoiesis and indicators of entrance into an advanced stage.Bone marrow cellularity and myeloblasts usually increase with disease progression.However,aplastic crisis occasionally occurs in advanced MDS.CASE SUMMARY A 72-year-old male patient was definitively diagnosed with MDS with excess blasts-1(MDS-EB-1)based on an increase in the percentages of myeloblasts and cluster of differentiation(CD)34+hematopoietic progenitors and the identification of myeloid neoplasm-associated somatic mutations in bone marrow samples.The patient was treated with hypomethylation therapy and was able to maintain a steady disease state for 2 years.In the treatment process,the advanced MDS patient experienced an episode of progressive pancytopenia and bone marrow aplasia.During the aplastic crisis,the bone marrow was infiltrated with sparsely distributed atypical lymphocytes.Surprisingly,the leukemic cells disappeared.Immunological analysis revealed that the atypical lymphocytes expressed a high frequency of CD3,CD5,CD8,CD16,CD56 and CD57,suggesting the activation of autoimmune cytotoxic T-lymphocytes and natural killer(NK)/NKT cells that suppressed both normal and leukemic hematopoiesis.Elevated serum levels of inflammatory cytokines,including interleukin(IL)-6,interferon-gamma(IFN-γ)and tumor necrosis factor-alpha(TNF-α),confirmed the deranged type I immune responses.This morphological and immunological signature led to the diagnosis of severe aplastic anemia secondary to large granule lymphocyte leukemia.Disseminated tuberculosis was suspected upon radiological examinations in the search for an inflammatory niche.Antituberculosis treatment led to reversion of the aplastic crisis,disappearance of the atypical lymphocytes,increased marrow cellularity and 2 mo of hematological remission,providing strong evidence that disseminated tuberculosis was responsible for the development of the aplastic crisis,the regression of leukemic cells and the activation of CD56+atypical lymphocytes.Reinstitution of hypomethylation therapy in the following 19 mo allowed the patient to maintain a steady disease state.However,the patient transformed the disease phenotype into acute myeloid leukemia and eventually died of disease progression and an overwhelming infectious episode.CONCLUSION Disseminated tuberculosis can induce CD56+lymphocyte infiltration in the bone marrow and in turn suppress both normal and leukemic hematopoiesis,resulting in the development of aplastic crisis and leukemic cell regression.
基金This study was supported by the Basic Research Business Fee Project of Universities Directly under the Inner Mongolia Autonomous Region(JY20220108)the Inner Mongolia Autonomous Region Natural Science Foundation Project(2022LHMS03006)+1 种基金the Inner Mongolia University of Technology Doctoral Research Initiation Fund Project(DC2300001284)the Inner Mongolia Autonomous Region Natural Science Foundation Project(2021MS03082).
文摘Grassland biomass is an important parameter of grassland ecosystems.The complexity of the grassland canopy vegetation spectrum makes the long-term assessment of grassland growth a challenge.Few studies have explored the original spectral information of typical grasslands in Inner Mongolia and examined the influence of spectral information on aboveground biomass(AGB)estimation.In order to improve the accuracy of vegetation index inversion of grassland AGB,this study combined ground and Unmanned Aerial Vehicle(UAV)remote sensing technology and screened sensitive bands through ground hyperspectral data transformation and correlation analysis.The narrow band vegetation indices were calculated,and ground and airborne hyperspectral inversion models were established.Finally,the accuracy of the model was verified.The results showed that:(1)The vegetation indices constructed based on the ASD FieldSpec 4 and the UAV were significantly correlated with the dry and fresh weight of AGB.(2)The comparison between measured R^(2) with the prediction R^(2) indicated that the accuracy of the model was the best when using the Soil-Adjusted Vegetation Index(SAVI)as the independent variable in the analysis of AGB(fresh weight/dry weight)and four narrow-band vegetation indices.The SAVI vegetation index showed better applicability for biomass monitoring in typical grassland areas of Inner Mongolia.(3)The obtained ground and airborne hyperspectral data with the optimal vegetation index suggested that the dry weight of AGB has the best fitting effect with airborne hyperspectral data,where y=17.962e^(4.672x),the fitting R^(2) was 0.542,the prediction R^(2)was 0.424,and RMSE and REE were 57.03 and 0.65,respectively.Therefore,established vegetation indices by screening sensitive bands through hyperspectral feature analysis can significantly improve the inversion accuracy of typical grassland biomass in Inner Mongolia.Compared with ground monitoring,airborne hyperspectral monitoring better reflects the inversion of actual surface biomass.It provides a reliable modeling framework for grassland AGB monitoring and scientific and technological support for grazing management.
文摘Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.
文摘Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.
文摘Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.
文摘Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Peritoneal dialysis (PD) is an effective, albeit invasive, therapy for neonatal renal failure. We report a case of neonatal obstruction with severe renal failure treated by PD to highlight our hospital practice and possible remedies in a context of limited resources. Case Presentation: This was a female neonate of moderate prematurity admitted on day 4 of life for management of a flat neonatal obstruction. Radiological diagnosis suggested small bowel atresia. Biological tests revealed severe renal failure with creatinine levels of 416 micromoles per liter and blood urea of 27.1 micromoles per liter. Management consisted of preoperative peritoneal dialysis for 48 hours followed by laparotomy. The intraoperative diagnosis was GROSFELD type IIIa digestive atresia. The postoperative course was favourable, transit was resumed on day 5 and the patient returned home on day 12. Progress at 3 months was satisfactory. Conclusion: Neonatal intestinal obstruction with renal failure in premature infants is associated with a poor prognosis, even more so if there is a delay in treatment. Peritoneal dialysis seems to be a suitable alternative for this management in our working conditions with limited resources.
文摘Edge devices,due to their limited computational and storage resources,often require the use of compilers for program optimization.Therefore,ensuring the security and reliability of these compilers is of paramount importance in the emerging field of edge AI.One widely used testing method for this purpose is fuzz testing,which detects bugs by inputting random test cases into the target program.However,this process consumes significant time and resources.To improve the efficiency of compiler fuzz testing,it is common practice to utilize test case prioritization techniques.Some researchers use machine learning to predict the code coverage of test cases,aiming to maximize the test capability for the target compiler by increasing the overall predicted coverage of the test cases.Nevertheless,these methods can only forecast the code coverage of the compiler at a specific optimization level,potentially missing many optimization-related bugs.In this paper,we introduce C-CORE(short for Clustering by Code Representation),the first framework to prioritize test cases according to their code representations,which are derived directly from the source codes.This approach avoids being limited to specific compiler states and extends to a broader range of compiler bugs.Specifically,we first train a scaled pre-trained programming language model to capture as many common features as possible from the test cases generated by a fuzzer.Using this pre-trained model,we then train two downstream models:one for predicting the likelihood of triggering a bug and another for identifying code representations associated with bugs.Subsequently,we cluster the test cases according to their code representations and select the highest-scoring test case from each cluster as the high-quality test case.This reduction in redundant testing cases leads to time savings.Comprehensive evaluation results reveal that code representations are better at distinguishing test capabilities,and C-CORE significantly enhances testing efficiency.Across four datasets,C-CORE increases the average of the percentage of faults detected(APFD)value by 0.16 to 0.31 and reduces test time by over 50% in 46% of cases.When compared to the best results from approaches using predicted code coverage,C-CORE improves the APFD value by 1.1% to 12.3% and achieves an overall time-saving of 159.1%.
基金Supported by the Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.YNZD2201903)the Scientific Research Foundation of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.KYQD20180306)the Nursing Project of the Eye Hospital of Wenzhou Medical University(No.YNHL2201908).
文摘AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
文摘BACKGROUND Gigantic epidermal cysts(GECs)are rare benign skin appendicular tumours also known as keratinocysts.GECs have a high incidence and their wall is made up of epidermis.Epidermal cysts can occur in any part of the skin;clinical manifestations include skin colour hemispherical swelling;cystic;mobile;0.5 cm to several centimetres in diameter;and slow growth.CASE SUMMARY Herein,we report a case involving a 56-year-old female with a GEC in the occipitalia.On July 25,2023,a patient with a GEC was admitted to the neurosurgery Department of the Second Affiliated Hospital of Xi'an Medical University.The phyma was shown to be a solid mass during the operation and was confirmed to be a GEC based on pathological examination.CONCLUSION Epidermal cysts are common cystic nodules on the surface of the body,the aetiology is unclear,the clinical manifestations can vary,and the misdiagnosis rate is high.However,giant epidermal cysts are rare.In most cases,however,the prognosis is satisfactory.This paper analyses and summarizes the population,location,clinical and pathological characteristics and pathogenesis of the disease to strengthen the understanding of this disease and improve the accuracy of clinical diagnosis.
文摘BACKGROUND Paramyotonia congenita(PMC)stands as a rare sodium channelopaty of skeletal muscle,initially identified by Eulenburg.The identification of PMC often relies on electromyography(EMG),a diagnostic technique.The child’s needle EMG unveiled trains of myotonic discharges with notably giant amplitudes,alongside irregular wave trains of myotonic discharges.This distinctive observation had not surfaced in earlier studies.CASE SUMMARY We report the case of a 3-year-old female child with PMC,who exhibited la-ryngeal stridor,muffled speech,myotonia from birth.Cold,exposure to cool water,crying,and physical activity exacerbated the myotonia,which was relieved in warmth,yet never normalized.Percussion myotonia was observable in bilateral biceps.Myotonia symptoms remained unchanged after potassium-rich food consumption like bananas.Hyperkalemic periodic paralysis was excluded.Cranial magnetic resonance imaging yielded normal results.Blood potassium remained within normal range,while creatine kinase showed slight elevation.Exome-wide genetic testing pinpointed a heterozygous mutation on chromosome SCN4A:c.3917G>A(p.G1306E).After a six-month mexiletine regimen,symptoms alleviated.CONCLUSION In this case revealed the two types of myotonic discharges,and had not been documented in other studies.We underscore two distinctive features:Giant-amplitude potentials and irregular waves.
