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Sarcomatoid intrahepatic cholangiocarcinoma mimicking liver abscess: A case report

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World Journal of Clinical Cases 2020年第1期8卷 208-216页

作者： Yan Wang Jia-Lei ming Xing-Yu Ren Lu Qiu Li-Juan Zhou Shu-Dong Yang xiang-ming fang Department of Radiology The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina Department of Pathology The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina

BACKGROUND Sarcomatoid intrahepatic cholangiocarcinoma(SICC) is an extremely rare and highly invasive malignant tumor of the liver. To our knowledge, the imaging findings of sarcomatous cholangiocarcinoma have been rarely reported; and radiological features of this tumor mimicking liver abscess have not yet been *** SUMMARY We present a case of SICC mimicking liver abscess. The patient, a 43-year-old male, complained of repeated upper right abdominal discomfort and intermittent distension over a period of one month. Radiology examination revealed a huge focal lesion in the right liver. The lesion was hypointense on computed tomography with honeycomb enhancement surrounded by enhanced peripheral areas. It showed a hypo-signal on non-contrast T1-weighted images and a hypersignal on non-contrast T2-weighted images. Radiologists diagnosed the lesion as an atypical liver abscess. The patient underwent a hepatectomy. After surgery, he survived another 2.5 mo before passing away. A search of Pub Med and Google revealed 43 non-repeated cases of SICC reported in 20 published studies. The following is a short review in order to improve the diagnostic and therapeutic skills in cases of *** This report presents the clinical and radiological features of SICC and imaging features which showed hypovascularity and progressive enhancement. SICC can present as a multilocular cyst on radiological images and it is necessary to distinguish this lesion from an atypical abscess. Simple surgical treatment is not the best treatment option for this disease.

关键词： Sarcomatoid intrahepatic cholangiocarcinoma Liver abscess Radiological features Case report

Lateral position intubation followed by endoscopic ultrasoundguided angiotherapy in acute esophageal variceal rupture: A case report

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World Journal of Clinical Cases 2021年第2期9卷 372-378页

作者： Ting-Ting Wen Zheng-Lv Liu Min Zeng Yu Zhang Bao-Li Cheng xiang-ming fang Department of Anesthesiology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina Department of Anesthesiology The Second Hospital of YinzhouNingbo 315100Zhejiang ProvinceChina

BACKGROUND Massive esophageal variceal bleeding can be catastrophic,leading to high morbidity and *** experiencing massive esophageal variceal bleeding are at high risk of aspiration and hemorrhagic shock in acute *** and bleeding control are the two essential steps for resuscitation of these *** SUMMARY A 47-year-old male patient was admitted to our hospital with upper digestive tract *** was diagnosed with alcohol-induced liver cirrhosis and consequent esophagogastric *** he did not show a good response to somatostatin and Sengstaken-Blakemore tube placement,the patient was scheduled for endoscopic angiotherapy under *** assessment showed an ASA physical status of III and Child-Pugh classification ***,massive hemorrhage occurred just after induction of *** by video-guided laryngoscopy in the lateral decubitus position was attempted twice and was *** that,an experienced endoscopic ultrasound(EUS)specialist performed angiotherapy and occluded the culprit *** ultra-thin gastroscope was then inserted into the endotracheal tube to extract the blood observed in the lobar *** patient suffered hemorrhagic shock with an estimated blood loss of 1500 mL in 20 min and remained in the intensive care unit for two *** patient was discharged from our hospital eight days later without major *** Intubation in the lateral decubitus position and EUS-guided treatment can be lifesaving procedures in patients with massive upper gastrointestinal hemorrhage.

关键词： Intubation in the lateral position Endoscopic ultrasound Esophageal varices Angiotherapy Ultra-thin gastroendoscope Case report

Persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple surgery:A case report

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World Journal of Clinical Cases 2023年第24期11卷 5817-5822页

作者： Kang-Mei Zhao Jia-Sheng Hu Sheng-Mei Zhu Ting-Ting Wen xiang-ming fang Department of Anesthesiology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina Department of Anesthesiology Sanmen People’s HospitalSanmen 317100Zhejiang ProvinceChina

BACKGROUND Empty sella is an anatomical and radiological finding of the herniation of the subarachnoid space into the pituitary fossa leading to a flattened pituitary *** with empty sella may present with various symptoms,including headache due to intracranial hypertension and endocrine symptoms related to the specific pituitary hormones ***,we report a female patient who developed persistent postoperative hypotension caused by subclinical empty sella syndrome after a simple *** SUMMARY A 47-year-old woman underwent vocal cord polypectomy under general anesthesia with endotracheal *** denied any medical history,and her vital signs were normal before the *** and surgery were ***,she developed dizziness,headache and persistent hypotension in the ***,intravenous dopamine was started to maintain normal blood pressure,which improved her ***,she remained dependent on dopamine for over 24 h without any obvious anesthesia-and surgery-related *** endocrine etiology was then suspected,and further examination showed a high prolactin level,a low normal adrenocorticotropic hormone level and a low cortisol *** resonance imaging of the brain revealed an empty ***,she was diagnosed with empty sella syndrome and secondary adrenal *** symptoms disappeared one week later after daily glucocorticoid *** Endocrine etiologies such as pituitary and adrenal-related dysfunction should be considered in patients showing persistent postoperative hypotension when anesthesia-and surgery-related factors are excluded.

关键词： Empty sella syndrome Perioperative hypotension Secondary adrenal insufficiency Adrenocorticotropic hormone Cortisol Case report

indfulness Meditation for Primary Headache Pain： A Meta-Analysis

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Chinese Medical Journal 2018年第7期131卷 829-838页

作者： Qiang Gu Jin-Chao Hou xiang-ming fang School of Medicine Zhejiang University Hangzhou Zhejiang 210029 China Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang 210029 China

Background： Several studies have reported that mindfulness meditation has a potential effect in controlling headaches, such as migraine and tension-type headache; however, its role remains controversial. This review assessed the evidence regarding the effects of mindfulness meditation for primary headache pain. Methods： Only English databases （PubMed, Cochrane Central Register of Controlled Trials [the Cochrane Library], PsyclNFO, Psychology and behavioral science collection, PsyArticles, Web of Science, and Scopus） were searched from their inception to November 2016 with the keywords （＂meditation＂ or ＂mindfulness＂ or ＂vipassana＂ or ＂dzogchen＂ or ＂zen＂ or ＂integrative body-mind training＂ or ＂IBMT＂ or ＂mindfulness-based stress reduction＂ or ＂MBSR＂ or ＂＇mindfulness-based cognitive therapy＂ or ＂MBCT＂ and ＂Headache＂ or ＂Head pain＂ or ＂Cephalodynia＂ or ＂Cephalalgia＂ or ＂Hemicrania＂ or ＂Migraine＂）. Titles, abstracts, and full-text articles were screened against study inclusion criteria： controlled trials of structured meditation programs for adult patients with primary headache pain. The quality of studies included in the meta-analysis was assessed with the Yates Quality Rating Scale. The meta-analysis was conducted with Revman 5.3. Results： Ten randomized controlled trials and one controlled clinical trial with a combined study population of 315 patients were included in the study. When compared to control group data, mindfulness meditation induced significant improvement in pain intensity （standardized mean difference, -0.89; 95% confidence interval, 1.63 to 0.15; P - 0.02） and headache frequency （-0.67; - 1.24 to -0.10; P - 0.02）. In a subgroup analysis of different meditation forms, mindfulness-based stress reduction displayed a significant positive influence on pain intensity （P 〈 0.000）. Moreover, 8-week intervention had a significant positive effect （P 〈 0.000）. Conclusions： Mindfulness meditation may reduce pain intensity and is a promising treatment option tbr pa

关键词： Headache Pain Meta-Analysis Mindfulness Meditation

Single-lung transplantation for pulmonary alveolar microlithiasis: A case report

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World Journal of Clinical Cases 2019年第22期7卷 3851-3858页

作者： Xing-Yu Ren xiang-ming fang Jing-Yu Chen Hao Ding Yan Wang Qiu Lu Jia-Lei ming Li-Juan Zhou Hong-Wei Chen Department of Radiology Wuxi People’s Hospital-Nanjing Medical UniversityWuxi 214000Jiangsu ProvinceChina Lung Transplantation Center Wuxi People’s Hospital-Nanjing Medical UniversityWuxi 214000Jiangsu ProvinceChina

BACKGROUND Pulmonary alveolar microlithiasis(PAM)is a rare idiopathic lung disease characterized by the accumulation of innumerable ***,effective therapeutics for PAM are not available,and the only treatment for end-stage lung disease is lung transplantation(LuTx).Further,there are few reports that focus on LuTx for the treatment of PAM,and the follow-up reports of postoperative imaging are even *** SUMMARY A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and *** patient was diagnosed with PAM and referred for single-LuTx(SLuTx)on March 14,*** imaging results from a chest X-ray demonstrated bilateral,diffuse,symmetrical,sandstorm-like radiopaque micronodules,and pneumothorax and a computed tomography scan revealed minute,calcified military nodules in both *** performed a left SLuTx,and intraoperative pathology was consistent with *** week after surgery,a chest X-ray revealed slight exudation of the left lung,and one month later,the left transplanted lung exhibited good dilation,mild pulmonary perfusion injury with local infection,and left pleural *** bronchoscopy revealed left hyperplastic granulation at the left bronchial *** sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter *** last follow-up was conducted in April 2019;the patient recovered *** This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.

关键词： Pulmonary alveolar microlithiasis Lung transplantation Complications Chest X-ray Computed tomography Case report

Sepsis-induced immunosuppression:mechanisms,diagnosis and current treatment options

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Military Medical Research 2023年第2期10卷 242-261页

作者： Di Liu Si-Yuan Huang Jian-Hui Sun Hua-Cai Zhang Qing-Li Cai Chu Gao Li Li Ju Cao fang Xu Yong Zhou Cha-xiang Guan Sheng-Wei Jin Jin Deng xiang-ming fang Jian-Xin Jiang Ling Zeng Department of Trauma Medical Center Daping HospitalState Key Laboratory of TraumaBurns and Combined InjuryArmy Medical UniversityChongqing 400042China Department of Respiratory Disease Daping HospitalArmy Medical UniversityChongqing 400042China Department of Laboratory Medicine the First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Department of Critical Care Medicine the First Affiliated Hospital of Chongqing Medical University400016 ChongqingChina Department of Physiology School of Basic Medicine ScienceCentral South UniversityChangsha 410078China Department of Anesthesia and Critical Care the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityZhejiang 325027 WenzhouChina Department of Emergency the Affiliated Hospital of Guizhou Medical UniversityGuizhou Medical University550001 GuiyangChina Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310052China.

Sepsis is a common complication of combat injuries and trauma,and is defined as a life-threatening organ dysfunction caused by a dysregulated host response to *** is also one of the significant causes of death and increased health care costs in modern intensive care *** use of antibiotics,fluid resuscitation,and organ support therapy have limited prognostic impact in patients with *** its pathophysiology remains elusive,immunosuppression is now recognized as one of the major causes of septic ***-induced immunosuppression is resulted from disruption of immune *** is characterized by the release of antiinflammatory cytokines,abnormal death of immune effector cells,hyperproliferation of immune suppressor cells,and expression of immune *** targeting immunosuppression,especially with immune checkpoint inhibitors,preclinical studies have demonstrated the reversal of immunocyte dysfunctions and established host ***,we comprehensively discuss recent findings on the mechanisms,regulation and biomarkers of sepsis-induced immunosuppression and highlight their implications for developing effective strategies to treat patients with septic shock.

关键词： Sepsis Immunosuppression Immune monitoring Immunomodulatory therapy

Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning

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World Journal of Pediatrics 2023年第11期19卷 1094-1103页

作者： Wen‑Yuan Zhang Zhong‑Hua Chen Xiao‑Xia An Hui Li Hua‑Lin Zhang Shui‑Jing Wu Yu‑Qian Guo Kai Zhang Cong‑Li Zeng xiang‑ming fang Department of Anesthesiology and Intensive Care School of MedicineThe First Affiliated HospitalZhejiang UniversityQingChun Road 79Hangzhou 310003China Department of Anesthesiology Shaoxing People’s Hospital(Shaoxing HospitalZhejiang University School of Medicine)Shaoxing 312000China Department of Anesthesiology Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNYUSA

Background Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in *** is associated with high rates of morbidity and mortality,and rapid detection and administration of antimicrobials have been *** objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this *** Three gene expression datasets were available from the Gene Expression Omnibus ***,the differentially expressed genes(DEGs)were found with the use of the R program,and then gene set enrichment analysis was carried ***,the DEGs were combined with the major module genes chosen using the weighted gene co-expression *** hub genes were identified by the use of three machine-learning algorithms:random forest,support vector machine-recursive feature elimination,and least absolute shrinkage and selection *** receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub *** addition,the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts(CIBERSORT).The relationship between the diagnostic markers and infiltrating immune cells was further *** Overall,after overlapping key module genes and DEGs,we detected 402 overlapping *** pediatric sepsis diagnostic indicators,CYSTM1(AUC=0.988),MMP8(AUC=0.973),and CD177(AUC=0.986)were investigated and demonstrated statistically significant differences(P<0.05)and diagnostic efficacy in the validation *** indicated by the immune cell infiltration analysis,multiple immune cells may be involved in the development of pediatric ***,all diagnostic characteristics may correlate with immune cells to varying *** The candida

关键词： Paediatric sepsis Bioinformatics Machine-Learning Biomarkers Immune cell infiltration

Inadvertent perioperative hypothermia and surgical site infections after liver resection

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Hepatobiliary & Pancreatic Diseases International 2024年第6期23卷 579-585页

作者： Yi-De Zhou Wen-Yuan Zhang Guo-Hao Xie Hui Ye Li-Hua Chu Yu-Qian Guo Yi Lou xiang-ming fang Department of Anesthesiology and Intensive Care Medicine the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Background:In the overall surgical population,inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection(SSI).However,recent clinical trials did not validate this *** study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver ***:This retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital,Zhejiang University School of *** temperature managements were implemented for all patients included in the *** propensity score matching(PSM)was performed to reduce the baseline imbalances between the normothermia and hypothermia *** and after PSM,univariate analyses were performed to evaluate the correlation between hypothermia and *** regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major *** analyses were performed for diabetes mellitus,age>65 years,and major liver ***:Among 4000 patients,2206 had hypothermia(55.2%),of which 150 developed SSI(6.8%).PSM yielded 1434 individuals in each *** PSM,the hypothermia and normothermia groups demonstrated similar incidence rates of SSI(7.0%vs.6.3%,P=0.453),postoperative transfusion(13.7%vs.13.3%,P=0.743),and major complications(10.1%vs.9.0%,P=0.309).Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure[odds ratio(OR)=1.25,95%confidence interval(CI):0.84-1.87,P=0.266],the group with moderate exposure(OR=1.00,95%CI:0.65-1.53,P=0.999),or the group with the lowest exposure(OR=1.11,95%CI:0.73-1.65,P=0.628).The subgroup analysis revealed similar *** liver function,patients in the hypothermia group demonstrated l

关键词： Surgical site infection Perioperative hypothermia Liver resection Postoperative complications Intraoperative care

Plasma gelsolin level predicts acute kidney injury after cardiopulmonary bypass in infants and young children

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World Journal of Pediatrics 2018年第2期14卷 143-150页

作者： Shan-Shan Shi Xiao-Jie Yue Dong-Yan Zhao Jia-Jie Fan Jian-Guo Xu Xi-Wang Liu Bao-Li Cheng xiang-ming fang Jie Fan Qiang Shu Cardiac Intensive Care Unit The Children's Hospital of Zhejiang University School of MedicineHangzhouChina The Key Laboratory for Diagnosis and Therapy of Neonatal Diseases The Children's Hospital of Zhejiang University School of MedicineHangzhouChina Department of Thoracic and Cardiovascular Surgery The Children's Hospital of Zhejiang University School of MedicineHangzhouChina Department of Anesthesiology The First Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina Department of Surgery University of Pittsburgh School of MedicinePittsburghPAUSA

Background Acute kidney injury(AKI)after cardiopulmonary bypass(CPB)is a common complication especially in pedi-atric *** gelsolin(pGSN)is an anti-inflammatory factor through binding with actin and pro-inflammatory cytokines in *** in pGSN has been reported in some pathologic *** purpose of the study was to determine the alterations of pGSN level in infants and young children after CPB and the role of pGSN as a predictor for the morbidity and severity of post-CPB *** Sixty-seven infants and young children at age≤3 years old undergoing CPB were prospectively *** levels were measured during peri-operative period with enzyme-linked immuno-sorbent assay and normalized with plasma total protein *** clinical characteristics of the patients were also *** In patients developing AKI,the normalized pGSN(pGSN_(N))levels significantly decreased at 6 h post-operation and remained low for 24 h post-operation as compared to the patients with *** at 6 h post-operation combining with CPB time presents an excellent predictive value for *** Decreased pGSN_(N)identifies post-CPB AKI in the patients≤3 years old,and is associated with adverse clini-cal *** findings suggest that circulating GSN in post-CPB patients may have beneficial effects on diminishing inflammatory responses.

关键词： Acute kidney injury Cardiopulmonary bypass Infants Plasma gelsolin Young children