Intra-abdominal Hernia with Bowel Obstruction Triggering Multi-organ Failure: The Role of Preoperative Enteritis This report details the clinical course of a 41-year-old male who developed fulminant multiple organ dysfunction syndrome following emergency surgery for a strangulated intra-abdominal hernia. Preoperative manifestations, including diarrhea and marked leukocytosis, pointed towards an underlying infectious enteritis. We posited that surgical release of the obstructed, ischemic bowel segment precipitated a massive systemic influx of endotoxins and inflammatory mediators, triggering septic shock and rapid sequential organ failure. This case underscored the critical need to suspect concomitant gastrointestinal infection in patients presenting with mechanical bowel obstruction accompanied by infectious signs. Aggressive perioperative sepsis management encompassing early empiric antimicrobial therapy, vigilant hemodynamic monitoring, and preparedness for advanced organ support is essential to mitigate this severe complication.

OBJECTIVE: To observe the efficacy of chimeric antigen receptor T cell (CAR-T) in the treatment of children with refractory/recurrent B acute lymphocytic leukemia (B-ALL). METHODS: Thirty-two patients with r/r B-ALL were treated by CAR-T, the recurrence and death respectively were the end point events to evaluate the efficacy and safety of CAR-T. RESULTS: The median age of the patients was 7.5 (2-17.5) years old; 40 times CAR-T were received in all patients and the median number of CAR-T was 0.9×107/kg; efficacy evaluation showed that 2 cases died before the first evaluation. Thirty patients showed that 3, 6, and 9-moth RFS was (96.3±3.6)%, (81.4±8.6)% and (65.3±12.5)%, respectively, while 3, 6, and 9-month OS was all 100%, and 12, 24-month OS was (94.7±5.1)% and (76±12.8)%. BM blasts≥36% before reinfusion and ferritin peak≥2 500 ng/ml within two weeks of CAR-T cell reinfusion were associated with recurrence. Adverse reactions mainly included cytokine release syndrome (CRS) and CART-cell-related encephalopathy syndrome (CRES), CRS appeared in 26 patients within a week of CAR-T cell reinfusion. CRES reaction was detected in 12 patients. Eighteen patients received intravenous drip of tocilizumab, among them, 12 combined with glucocorticoid. CRS and CRES reactions were relieved within one week after treatment. Hormone dosage was related to the duration of remission in patients, and the cumulative dose of methylprednisolone≥8 mg/kg showed a poor prognosis. CONCLUSION CAR-T is a safe and effective treatment for r/r B-ALL, most CRS and CRES reactions are reversible. BM blasts ≥36% before reinfusion and cumulative dose of methylprednisolone ≥8 mg/kg after reinfusion both affect the therapeutic effect. Ferritin≥2 500 ng/ml within two weeks after reinfusion is related to disease recurrence and is an independent prognostic risk factor.
Adolescent ; Antigens, CD19 ; Child ; Child, Preschool ; Chronic Disease ; Ferritins ; Humans ; Immunotherapy, Adoptive ; Methylprednisolone ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy* ; Receptors, Antigen, T-Cell ; Receptors, Chimeric Antigen/metabolism* ; Recurrence ; T-Lymphocytes

Objective To identify the environmental factors affecting the geographical distribution of Rhipicephalus microplus in China, and to examine the impact of climate changes on the distribution of R. microplus in China. Methods The national and international publications pertaining to the geographical distribution of R. microplus in China were retrieved, and the geographical location was extracted. The suitable habitats of R. microplus and the dominant environmental factors affecting the distribution of suitable habitats of R. microplus were predicted in China based on the geographical data and environmental variables using the ArcGIS 10.7 software and the maximum entropy model. Results Among the main climatic factors affecting the geographical distribution of R. microplus in China, the factors contributing more than 10% to the suitable habitats of R. microplus mainly include the annual mean precipitation (38.2%), the average temperature of the coldest quarter (28.4%) and the precipitation of the driest month (14.2%). The current suitable habitats of R. microplus were mainly found in southern China, and the high-, medium- and low-suitable areas accounted for 8.6%, 13.1% and 10.5% of the total land area of China, respectively. The suitable habitats of R. microplus were predicted to increase by 399 800 km² in China using the maximum entropy model under the RCP 4.5 emissions scenario in 2070, and the emerging suitable habitats were mainly distributed in Gansu Province, Ningxia Hui Autonomous Region, Qinghai Province, Hebei Province, Shaanxi Province, Liaoning Province, Inner Mongolia Autonomous Region, Shandong Province, Sichuan Province and Tibeten Autonomous Region. In addition, the suitable habitats of R. microplus were predicted to show an overall expansion towards northward from present to 2070. Conclusions Climate changes affect the distribution of suitable habitats of R. microplus in China, and annual mean precipitation may be a key factor affecting the distribution of suitable habitats of R. microplus.

Objective To evaluate the effect of an integrated control strategy and to quantify the spatial-temporal variation of infected snails in the bottomland areas after the strategy was implemented.Methods Based on the geographic database of infected snail distribution at the village level during 2004-2010 in Anxiang county,Hunan province,spatial autocorrelation analysis and spatial scan statistics were applied to analyze the spatial-temporal characteristics on the distribution of infected snails.Results The number of embankments with infected snails in Anxiang county decreased from 23 in 2004 to 10 in 2010,while the rate of frame with infected snail in embankments decreased from 4.32‰ in 2004 to 0.12‰ in 2010.The spatial distribution of infected snails was nonrandom,only in 2004 and 2005 with Moran's I=0.21 (P＜0.10) and Moran's I=0.13 (P＜0.10) respectively.Data from the local spatial auto-correlation analysis showed that the number of villages with H-H types of auto-correlation model had been gradually decreasing.The results of SaTScan statistics appeared the same as from the local spatial auto-correlation analysis,showing that the number of areas with increased risk was decreasing.Conclusion The comprehensive measures with emphasis on infectious source control seemed effective for schistosomiasis control program.The current distribution characteristics provided us with evidence that the resource assignment could be more reasonably implemented so as to control schistosomiasis in a more effective way.

Objective To investigate the effects of hyperbaric oxygen (HBO) on cerebral hemodynamics and ambulatory electroencephalogram(AEEG) of patients with moderate and severe brain trauma and to analyze its therapeutic efficiency. Methods One hundred and forty-two patients with moderate and severe brain trauma were randomly divided into the conventional therapy group (71 cases) and the HBO plus conventional therapy group (71 cases). The conventional therapy group received surgical treatment and conventional drug treatment, while the HBO group received the same treatment as the conventional therapy group and plus 3 courses of HBO treatment, following stabilization of the illness. Thirty normal healthy people who received physical check-ups were used as control. All the patients received Transcranial Doppler (TCD)detection, before treatment and on the 10th and 30th day after treatment. Ambulatory electroencephalogram (AEEG) was detected and the scores of Glasgow coma scale (GCS) were evaluated before treatment and on the 30th day after treatment. The scores of Glasgow outcome scale (GOS) were again measured in a clinical followup, following 6 months of brain trauma. Results Before treatment, Vs, Vm, Vd, PI and RI of the middle cerebral artery (MCA) in all the patients of both the conventional therapy group and HBO plus conventional therapy group were significantly higher than those of the normal control group ( P ＜ 0. 05 ) and the abnormal rates of AEEG accounted for 94. 4％ and 95.8％ respectively. On the 10th day after treatment, Vs, Vm, PI and RI in the conventional therapy group decreased significantly (P ＜ 0. 05), but were still higher than those of the normal control group ( P ＜ 0. 05 ). Vs, Vm, PI and RIin the HBO plus conventional therapy group decreased more significantly, when compared with those of the conventional therapy group ( P ＜ 0. 05 ),however, Vs, Vm and PI were still higher than those of the normal control group ( P ＜ 0. 05 ). On the 30th day after treatment, Vs and Vm in the conventional therapy group were lower than those of the normal control group (P＜0. 05), but, PI and RI were still higher than those of the normal control group (P ＜0.05). No significant differences in Vs, Vm, Vd, PI and RIcould be noted between the HBO plus conventional therapy group and the normal control group (P ＞0. 05 ). On the 30th day after treatment, abnormal rates of AEEG of both groups decreased significantly than those before treatment ( P ＜ 0. 05 ), while scores of GCS increased significantly than those before treatment ( P ＜ 0. 05 ) and more significant differences could be noticed in the HBO plus conventional therapy group, when compared with those of the conventional therapy group (P ＜ 0. 05). Six months after brain trauma, GOS scores indicated that the number of patients with good prognosis in the HBO plus conventional therapy group increased, and mortality rate decreased obviously, when compared with those of the conventional therapy group (P ＜ 0. 05 ). Conclusions HBO therapy could alleviate cerebral vascular spasms, regulate cerebral blood flow and promote the electrophysiological activity and function of neurons, thus enhancing therapeutic efficiency of the patients with moderate and severe traumatic brain injury.

Objective To investigate the effects of hyperbaric oxygen (HBO) on cerebral hemodynamics and ambulatory electroencephalogram(AEEG) of patients with moderate and severe brain trauma and to analyze its therapeutic efficiency. Methods One hundred and forty-two patients with moderate and severe brain trauma were randomly divided into the conventional therapy group (71 cases) and the HBO plus conventional therapy group (71 cases). The conventional therapy group received surgical treatment and conventional drug treatment, while the HBO group received the same treatment as the conventional therapy group and plus 3 courses of HBO treatment, following stabilization of the illness. Thirty normal healthy people who received physical check-ups were used as control. All the patients received Transcranial Doppler (TCD)detection, before treatment and on the 10th and 30th day after treatment. Ambulatory electroencephalogram (AEEG) was detected and the scores of Glasgow coma scale (GCS) were evaluated before treatment and on the 30th day after treatment. The scores of Glasgow outcome scale (GOS) were again measured in a clinical followup, following 6 months of brain trauma. Results Before treatment, Vs, Vm, Vd, PI and RI of the middle cerebral artery (MCA) in all the patients of both the conventional therapy group and HBO plus conventional therapy group were significantly higher than those of the normal control group ( P ＜ 0. 05 ) and the abnormal rates of AEEG accounted for 94. 4％ and 95.8％ respectively. On the 10th day after treatment, Vs, Vm, PI and RI in the conventional therapy group decreased significantly (P ＜ 0. 05), but were still higher than those of the normal control group ( P ＜ 0. 05 ). Vs, Vm, PI and RIin the HBO plus conventional therapy group decreased more significantly, when compared with those of the conventional therapy group ( P ＜ 0. 05 ),however, Vs, Vm and PI were still higher than those of the normal control group ( P ＜ 0. 05 ). On the 30th day after treatment, Vs and Vm in the conventional therapy group were lower than those of the normal control group (P＜0. 05), but, PI and RI were still higher than those of the normal control group (P ＜0.05). No significant differences in Vs, Vm, Vd, PI and RIcould be noted between the HBO plus conventional therapy group and the normal control group (P ＞0. 05 ). On the 30th day after treatment, abnormal rates of AEEG of both groups decreased significantly than those before treatment ( P ＜ 0. 05 ), while scores of GCS increased significantly than those before treatment ( P ＜ 0. 05 ) and more significant differences could be noticed in the HBO plus conventional therapy group, when compared with those of the conventional therapy group (P ＜ 0. 05). Six months after brain trauma, GOS scores indicated that the number of patients with good prognosis in the HBO plus conventional therapy group increased, and mortality rate decreased obviously, when compared with those of the conventional therapy group (P ＜ 0. 05 ). Conclusions HBO therapy could alleviate cerebral vascular spasms, regulate cerebral blood flow and promote the electrophysiological activity and function of neurons, thus enhancing therapeutic efficiency of the patients with moderate and severe traumatic brain injury.

OBJECTIVETo investigate the prognostic significance of Her-2 expression in node-positive and node-negative breast cancer in Chinese women.

METHODSThe Her-2 expression in breast cancers from 981 patients was detected by immunohistochemistry with anti-Her-2 (CB11) monoclonal antibody. The survival curves were analyzed by Kaplan-Meier method, and Cox regression model was applied to determine whether this factor is an independent predictor of survival in multivariate analysis.

RESULTSNineteen point seven percent of the patients showed positive Her-2 expression in their tumors. Patients with Her-2-positive tumors tended to be younger. The high level Her-2 expression was significantly associated with negative estrogen receptor and progesterone receptor status in their tumors (P < 0.05). Among 387 patients with node-positive disease, the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were significantly lower in patients with Her-2-positive tumors than in patients with Her-2-negative tumors (DFS: 48.8% vs. 66.9%, P = 0.009; OS: 55.2% vs. 76.4%, P = 0.001), and Her-2 expression was an independent unfavorable prognostic factor for OS, but not for DFS in patients with node-positive disease. Among 591 patients with node-negative disease, Her-2 expression was not significantly associated with DFS and OS (P > 0.05).

CONCLUSIONHer-2 expression is an important prognostic factor in patients with node-positive disease, but not for patients with node-negative disease in Chinese women.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Breast Neoplasms ; metabolism ; pathology ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Receptor, ErbB-2 ; metabolism ; Receptors, Progesterone ; metabolism ; Survival Rate

Objective To investigate effects of hyperbaric oxygen (HBO) on brainstem auditory evoked potential (BAEP) and somatic evoked potential (SEP)of patients with moderate and severe trauma tic brain injury and to analyze its therapeutic efficiency. Methods One hundred and thirty-four patients with moderate and severe trauma brain injury were randomly divided into the control group (67 cases) and the HBO adjunctive therapy group (HBO group, 67 cases). The control group received essential neurosurgical treatment and conventional drug treatment, and the HBO group was given HBO therapy for three sessions in addition to the same treatment received by the control group. BAEP and SEP were detected and the scores of Glasgow coma scale (GCS) were measured before and after treatment. Glasgow outcome scale (GOS) were evaluated in follow - ups 6 months after injury. Results Abnormality of BAEP, SEP and GCS for the patients of both groups showed no statistical difference before treatment (P > 0.05). After treatment, significant improvement could be seen in BAEP of the control group(P <0. 05), and more significant improvement was noted in SEP (P <0.01), GCS also increased significantly in the control group (P <0.05). For the HBO group, BAEP and SEP all improved

Objective To investigate effects of hyperbaric oxygen (HBO) on brainstem auditory evoked potential (BAEP) and somatic evoked potential (SEP)of patients with moderate and severe trauma tic brain injury and to analyze its therapeutic efficiency. Methods One hundred and thirty-four patients with moderate and severe trauma brain injury were randomly divided into the control group (67 cases) and the HBO adjunctive therapy group (HBO group, 67 cases). The control group received essential neurosurgical treatment and conventional drug treatment, and the HBO group was given HBO therapy for three sessions in addition to the same treatment received by the control group. BAEP and SEP were detected and the scores of Glasgow coma scale (GCS) were measured before and after treatment. Glasgow outcome scale (GOS) were evaluated in follow - ups 6 months after injury. Results Abnormality of BAEP, SEP and GCS for the patients of both groups showed no statistical difference before treatment (P > 0.05). After treatment, significant improvement could be seen in BAEP of the control group(P <0. 05), and more significant improvement was noted in SEP (P <0.01), GCS also increased significantly in the control group (P <0.05). For the HBO group, BAEP and SEP all improved

BACKGROUNDBifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high (> or = 60 degrees ) with low (< 60 degrees ) bifurcation angle in patients who underwent either classical or double kissing (DK) crush stenting for bifurcation lesions from the DKCRUSH-1 data base.

METHODSThere were 212 patients with 220 lesions, some with low-angle (n = 138) and some with high-angle (n = 74). Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as cardiac death, myocardial infarction and target lesion revascularization (TLR). Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation (FKBI).

RESULTSAt 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group (91.43%) and the low-angle group (82.39%). In the high angle group, there was a significant difference in contrast volume used (P = 0.005) but no significant difference in acute gain, minimum lumen diameter (MLD), late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with-(n = 133) and without-FKBI (n = 42), significant side-branch late loss was seen in the group without-FKBI ((0.65 +/- 0.49) mm vs (0.47 +/- 0.62) mm, P = 0.02), with a resultant greater restenosis rate (37.68% vs 18.32%, P = 0.001). No difference was detected in the MACE free survival rate between the high and low angle groups (82.39% vs 82.36%, P = 0.84). The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference (P = 0.38). The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group (P = 0.001). Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting (hazard ratios (HR) 1.028, 95% CI 2.357 - 16.233, P = 0.002), lack of FKBI (HR 4.910, 95% CI 4.706 - 8.459, P = 0.001) and unsatisfactory kissing (HR 3.120, 95% CI 2.975 - 5.431, P = 0.001).

CONCLUSIONSBifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Asian Continental Ancestry Group ; ethnology ; Coronary Angiography ; methods ; Coronary Stenosis ; ethnology ; pathology ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; ethnology ; pathology ; therapy ; Stents ; Treatment Outcome