Objective:To explore the clinical manifestations of IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland, the diagnostic criteria for IgG4-related diseases and parotid malignant tumors, treatment regimens, and the application of fine-needle aspiration in disease diagnosis, so as to reduce clinical misdiagnosis and missed diagnosis. Methods:A retrospective analysis was conducted on the case data of a patient with IgG4-related diseases（IgG4-RD） complicated with moderately differentiated adenosquamous carcinoma of the parotid gland admitted to our department in March 2024. The clinical characteristics, imaging findings, preoperative puncture results, and postoperative pathological features were analyzed, and relevant literatures on both diseases were reviewed and summarized. Results:The elderly male patient was admitted due to "a mass in the parotid area in front of the right ear for more than 3 months". Through clinical examination, imaging examination, laboratory examination, and preoperative needle biopsy, the diagnosis of "right parotid moderately differentiated adenosquamous carcinoma complicated with IgG4-related disease" was considered. It was also considered that IgG4-related disease did not involve other organs before surgery, so no systemic hormone therapy was given before or after surgery. After surgery combined with postoperative radiotherapy, follow-up showed that neither the parotid tumor nor IgG4-related disease recurred. Conclusion:"IgG4-related disease complicated with moderately differentiated adenosquamous carcinoma"is a rare clinical disease. Both lack typical clinical manifestations and specific imaging features, and the diagnosis is mostly unclear before surgery. Pathological examination is of great significance in the diagnosis of the disease, while fine-needle aspiration has limited value in the diagnosis, which should attract the attention of clinicians. In addition, for patients with both diseases, individualized treatment plans should be formulated.
Humans ; Parotid Neoplasms/pathology* ; Male ; Carcinoma, Adenosquamous/pathology* ; Immunoglobulin G4-Related Disease/complications* ; Parotid Gland/pathology* ; Retrospective Studies ; Aged ; Biopsy, Fine-Needle ; Immunoglobulin G

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Objective:To evaluate the efficacy of gadolinium ethoxybenzyl- diethy-lenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI features in the preoperative prediction of tertiary lymphoid structures (TLS) within hepatocellular carcinoma (HCC) lesions.Methods:This retrospective cross-sectional study included clinical and pathological data from 297 HCC patients treated at the Southwest Hospital, Army Medical University between June 2021 and November 2022. Based on postoperative pathology, patients were categorized into TLS-negative ( n=93) and TLS-positive ( n=204) groups. MRI features of HCC lesions using Gd-EOB-DTPA enhancement and relevant clinical data were analyzed. Intergroup comparisons of imaging features and laboratory findings were performed using independent sample t-test, Mann-Whitney U test, χ2 test, or Fisher exact test, as appropriate. The logistic regression analysis was conducted to identify independent predictors of TLS positivity. A predictive model was constructed and visualized using a nomogram. The model′s predictive performance and clinical utility were assessed using the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The area under the ROC curve (AUC) was compared using the DeLong test. Results:Significant differences were observed between the TLS-negative and TLS-positive groups in alpha-fetoprotein (AFP) levels, intratumoral hemorrhage, and peritumoral satellite nodules in the hepatobiliary phase ( P<0.05). Multivariate logistic regression identified intratumoral hemorrhage ( OR=0.123, 95% CI 0.070-0.216, P<0.001) and peritumoral satellite nodules in the hepatobiliary phase ( OR=0.236, 95% CI 0.093-0.596, P=0.002) as independent predictive factors for TLS-positivity. The imaging model based on these two features yielded an AUC of 0.764 (95% CI 0.709-0.809) for predicting TLS-positivity. When combined with AFP levels, the resulting clinical-imaging model achieved a superior AUC of 0.784 (95% CI 0.732-0.829), which was significantly higher than that of the imaging model alone ( Z=2.20, P=0.028). A nomogram was constructed based on the clinical-imaging model. The calibration curve demonstrated good predictive performance of the nomogram, and the DCA showed that the curve remained above the default line across a range of reasonable threshold probabilities, indicating that patients could derive clinical benefit. Conclusion:A nomogram model based on Gd-EOB-DTPA enhanced MRI features combined with AFP levels can effectively predict the presence of TLS in HCC.

Objective To observe the value of singular value decomposition(SVD)combined with block-matching and three-dimensional(BM3D)filtering for improving imaging quality of contrast-enhanced ultrasound(CEUS).Methods Three subject who would undergo liver,kidney and ovarian CEUS examination respectively were prospectively enrolled,and 250 images unaffected by respiratory movements were acquired in each one.SVD filtering was performed alone and combined with BM3D filtering,and contrast-to-tissue ratio(CTR),contrast-to-noise ratio(CNR)and signal-to-noise ratio(SNR)of the obtained CEUS images were calculated and compared.Results Compared with original CEUS images,CTR,CNR and SNR of SVD alone filtered CEUS images improved,which all further improved after combining with BM3D filtering.Conclusion SVD combined with BM3D filtering could significantly suppress the background tissue signals and remove noise,improving imaging quality of CEUS.

OBJECTIVE To systematically evaluate the efficacy and safety of different induction regimens for AIDS complicated with cryptococcal meningitis.METHODS PubMed,Embase,Cochranre library,Web of science,CNKI,Wanfang,Weipu and other databases were systematically searched to collect randomized controlled trials related to the induction treatments of AIDS complicated with cryptococcal meningitis.The search was limited to Oct.2024.The Cochrane risk of bias evaluation system was used to evaluate the quality of the literature,and Stata 15.1 and Revman 5.3 software were used for network meta-analysis.RESULTS A total of 17 randomized controlled trials involving 3,281 patients were included.The result of network meta-analysis showed that the treatment regi-men with the lowest early mortality was the short-course of amphotericin B+fluconazole+flucytosine;the regi-men with the lowest late mortality was a single high-dose amphotericin B liposome;the regimen with the highest 14-day fungal clearance rate was amphotericin B+flucytosine;the regimen with the lowest incidence of grade 3+4 anemia was a single high-dose amphotericin B liposome;the regimen with the lowest incidence of grade 3+4 re-nal injury was amphotericin B liposome;the regimen with the lowest incidence of grade 3-4 hypokalemia was flu-conazole+flucytosine.CONCLUSION According to the comprehensive analysis of various indices,there is good efficacy and safety for the inclusion of short-course amphotericin B regimen and single high-dose amphotericin B li-posome as induction period therapy for AIDS complicated with cryptococcal meningitis.

Objective:To evaluate the efficacy of gadolinium ethoxybenzyl- diethy-lenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI features in the preoperative prediction of tertiary lymphoid structures (TLS) within hepatocellular carcinoma (HCC) lesions.Methods:This retrospective cross-sectional study included clinical and pathological data from 297 HCC patients treated at the Southwest Hospital, Army Medical University between June 2021 and November 2022. Based on postoperative pathology, patients were categorized into TLS-negative ( n=93) and TLS-positive ( n=204) groups. MRI features of HCC lesions using Gd-EOB-DTPA enhancement and relevant clinical data were analyzed. Intergroup comparisons of imaging features and laboratory findings were performed using independent sample t-test, Mann-Whitney U test, χ2 test, or Fisher exact test, as appropriate. The logistic regression analysis was conducted to identify independent predictors of TLS positivity. A predictive model was constructed and visualized using a nomogram. The model′s predictive performance and clinical utility were assessed using the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The area under the ROC curve (AUC) was compared using the DeLong test. Results:Significant differences were observed between the TLS-negative and TLS-positive groups in alpha-fetoprotein (AFP) levels, intratumoral hemorrhage, and peritumoral satellite nodules in the hepatobiliary phase ( P<0.05). Multivariate logistic regression identified intratumoral hemorrhage ( OR=0.123, 95% CI 0.070-0.216, P<0.001) and peritumoral satellite nodules in the hepatobiliary phase ( OR=0.236, 95% CI 0.093-0.596, P=0.002) as independent predictive factors for TLS-positivity. The imaging model based on these two features yielded an AUC of 0.764 (95% CI 0.709-0.809) for predicting TLS-positivity. When combined with AFP levels, the resulting clinical-imaging model achieved a superior AUC of 0.784 (95% CI 0.732-0.829), which was significantly higher than that of the imaging model alone ( Z=2.20, P=0.028). A nomogram was constructed based on the clinical-imaging model. The calibration curve demonstrated good predictive performance of the nomogram, and the DCA showed that the curve remained above the default line across a range of reasonable threshold probabilities, indicating that patients could derive clinical benefit. Conclusion:A nomogram model based on Gd-EOB-DTPA enhanced MRI features combined with AFP levels can effectively predict the presence of TLS in HCC.

Objective To observe the value of singular value decomposition(SVD)combined with block-matching and three-dimensional(BM3D)filtering for improving imaging quality of contrast-enhanced ultrasound(CEUS).Methods Three subject who would undergo liver,kidney and ovarian CEUS examination respectively were prospectively enrolled,and 250 images unaffected by respiratory movements were acquired in each one.SVD filtering was performed alone and combined with BM3D filtering,and contrast-to-tissue ratio(CTR),contrast-to-noise ratio(CNR)and signal-to-noise ratio(SNR)of the obtained CEUS images were calculated and compared.Results Compared with original CEUS images,CTR,CNR and SNR of SVD alone filtered CEUS images improved,which all further improved after combining with BM3D filtering.Conclusion SVD combined with BM3D filtering could significantly suppress the background tissue signals and remove noise,improving imaging quality of CEUS.

OBJECTIVE To systematically evaluate the efficacy and safety of different induction regimens for AIDS complicated with cryptococcal meningitis.METHODS PubMed,Embase,Cochranre library,Web of science,CNKI,Wanfang,Weipu and other databases were systematically searched to collect randomized controlled trials related to the induction treatments of AIDS complicated with cryptococcal meningitis.The search was limited to Oct.2024.The Cochrane risk of bias evaluation system was used to evaluate the quality of the literature,and Stata 15.1 and Revman 5.3 software were used for network meta-analysis.RESULTS A total of 17 randomized controlled trials involving 3,281 patients were included.The result of network meta-analysis showed that the treatment regi-men with the lowest early mortality was the short-course of amphotericin B+fluconazole+flucytosine;the regi-men with the lowest late mortality was a single high-dose amphotericin B liposome;the regimen with the highest 14-day fungal clearance rate was amphotericin B+flucytosine;the regimen with the lowest incidence of grade 3+4 anemia was a single high-dose amphotericin B liposome;the regimen with the lowest incidence of grade 3+4 re-nal injury was amphotericin B liposome;the regimen with the lowest incidence of grade 3-4 hypokalemia was flu-conazole+flucytosine.CONCLUSION According to the comprehensive analysis of various indices,there is good efficacy and safety for the inclusion of short-course amphotericin B regimen and single high-dose amphotericin B li-posome as induction period therapy for AIDS complicated with cryptococcal meningitis.

Objective To observe the value of ultrasound vector flow imaging(VFI)combined with singular value decomposition(SVD)filtering for depicting deep microvasculature flow velocity of liver.Methods Grayscale ultrasound,CDFI and contrast-enhanced ultrasound(CEUS)were prospectively performed in a patient with suspected liver hemangioma.Images of CEUS were dealt with SVD filtering.Cross-correlation algorithm was used to obtain images of VFI based on grayscale ultrasound,original CEUS and SVD filtered CEUS,respectively,and the ability of the above images for depicting liver microvascular flow direction and velocity were compared.Results The signal-to-noise ratio(SNR)of liver grayscale ultrasound,original CEUS and SVD filtered CEUS images was 7.56,17.65 and 22.43 dB,respectively,while their contrast-to-issue ratio(CTR)was 1.12,7.56 and 16.34 dB,respectively.Compared with VFI based on grayscale ultrasound and original CEUS,VFI based on SVD filtered CEUS could display faster velocity and more uniform direction of blood flow.Before and after SVD filtering,liver microvascular flow velocity measured with VFI was 1.91(0.81,4.11)and 6.83(4.25,9.41)mm/s,respectively,which were significantly different(Z=-10.671,P＜0.001).Conclusion Combined with SVD filtering could significantly improve the efficiency of VFI for depicting liver deep microvasculature flow velocity.

Objective To construct and validate a risk prediction model for delayed healing of venous leg ulcer(VLU),so as to provide a reference basis for early identification of people at high risk of delayed healing.Methods Using a convenience sampling method,331 VLU patients attending vascular surgery departments in 2 tertiary A hospitals in Sichuan Province from January 2018 to December 2022 were selected as a modeling group and an internal validation group,and 112 patients admitted to another tertiary A hospital were selected as an external validation group.Risk factors for delayed healing in VLU patients were screened using univariate analysis,LASSO regression,and multivariate logistic regression analysis,and a risk prediction model was constructed using R software,and the predictive effects of the models were examined using the area under the receiver operating characteristic curve,the Hosmer-Lemeshow test,decision curve,and the bootstrap resampling for internal validation and spatial external validation were performed,respectively.Results The predictors that ultimately entered the prediction model were diabetes(OR=4.752),deep vein thrombosis(OR=4.104),lipodermatosclerosis(OR=5.405),ulcer recurrence(OR=3.239),and ankle mobility(OR=5.520).The model had good discrimination(AUC:0.819 for internal validation and 0.858 for external validation),calibration(Hosmer-Lemeshow test:χ2=13.517,P=0.095 for internal validation and χ2=3.375,P=0.909 for external validation)and clinical validity.Conclusion The model constructed in this study has good differentiation and calibration,and it can effectively predict people at high risk of delayed healing of VLU,which facilitates targeted clinical interventions to improve ulcer outcomes and reduce the risk of delayed ulcer healing.