To investigate the clinical value of endoscopic ultrasound-guided puncture drainage in the treatment for liver abscess and abdominal and pelvic abscess with difficulty in conventional puncture drainage. Data of 12 such patients in the Second Affiliated Hospital of Soochow University from January 2015 to November 2023 were retrospectivly analyzed. Results showed liver abscess in 4 cases, abdominal and pelvic abscess in 8 cases. All patients had fever with varying degrees of abdominal pain. Twelve patients with liver abscess and abdominal and pelvic abscess received 13 times of endoscopic ultrasound-guided puncture (1 patient with a large abdominal and pelvic cyst complicated with infection received transgastric and transrectal puncture of 2 times). The puncture needle was successfully penetrated into the pus cavity. Four patients with liver abscess underwent endoscopic ultrasound-guided suction and irrigation, and the abscess was almost completely aspirated. Seven patients with abdominal and pelvic abscess underwent endoscopic ultrasound-guided suction and irrigation, of which 5 cases were almost completely aspirated, and 2 cases had poor drainage effect due to the viscous pus (1 case returned to normal temperature after anti-infection treatment; 1 case had recurrent fever after the operation, and septic shock and death occurred 2 weeks after the operation). A patient with recurrent abdominal and pelvic sclerosis after the operation had multiple abscesses in the abdomen and pelvis, and percutaneous CT-guided drainage was performed for abdominal abscess, but the fever was still repeated. Endoscopic ultrasound-guided balloon dilation plus double pig tail and nasobiliary duct drainage were performed. The patient's temperature returned to normal and abdominal pain was relieved 48 hours after the operation. The total effective rate of abscess drainage was 83.3% (10/12), and the effective rate of suction combined with irrigation for abscess drainage was 81.8% (9/11), and no operation-related complications were observed in all patients. After 3 months of follow-up, no recurrence occurred in 10 patients with effective drainage of abscess, and abscess was self-absorbed in 1 patient with pelvic abscess without effective drainage and no recurrence was observed. Endoscopic ultrasound-guided puncture drainage is of certain clinical value for some liver abscesses and abdominal and pelvic abscesses that are difficult to be drained by conventional puncture, and can reduce the secondary trauma caused by surgical operations.

To investigate the clinical value of endoscopic ultrasound-guided puncture drainage in the treatment for liver abscess and abdominal and pelvic abscess with difficulty in conventional puncture drainage. Data of 12 such patients in the Second Affiliated Hospital of Soochow University from January 2015 to November 2023 were retrospectivly analyzed. Results showed liver abscess in 4 cases, abdominal and pelvic abscess in 8 cases. All patients had fever with varying degrees of abdominal pain. Twelve patients with liver abscess and abdominal and pelvic abscess received 13 times of endoscopic ultrasound-guided puncture (1 patient with a large abdominal and pelvic cyst complicated with infection received transgastric and transrectal puncture of 2 times). The puncture needle was successfully penetrated into the pus cavity. Four patients with liver abscess underwent endoscopic ultrasound-guided suction and irrigation, and the abscess was almost completely aspirated. Seven patients with abdominal and pelvic abscess underwent endoscopic ultrasound-guided suction and irrigation, of which 5 cases were almost completely aspirated, and 2 cases had poor drainage effect due to the viscous pus (1 case returned to normal temperature after anti-infection treatment; 1 case had recurrent fever after the operation, and septic shock and death occurred 2 weeks after the operation). A patient with recurrent abdominal and pelvic sclerosis after the operation had multiple abscesses in the abdomen and pelvis, and percutaneous CT-guided drainage was performed for abdominal abscess, but the fever was still repeated. Endoscopic ultrasound-guided balloon dilation plus double pig tail and nasobiliary duct drainage were performed. The patient's temperature returned to normal and abdominal pain was relieved 48 hours after the operation. The total effective rate of abscess drainage was 83.3% (10/12), and the effective rate of suction combined with irrigation for abscess drainage was 81.8% (9/11), and no operation-related complications were observed in all patients. After 3 months of follow-up, no recurrence occurred in 10 patients with effective drainage of abscess, and abscess was self-absorbed in 1 patient with pelvic abscess without effective drainage and no recurrence was observed. Endoscopic ultrasound-guided puncture drainage is of certain clinical value for some liver abscesses and abdominal and pelvic abscesses that are difficult to be drained by conventional puncture, and can reduce the secondary trauma caused by surgical operations.

Contrast-induced encephalopathy(CIE)is a rare neurological complication of the intravascular application of a contrast media.The clinical manifestation of CIE which is easily misdiagnosed in clinical is not specific.Recently,with the extensive development of interventional diagnosis and therapy in different disciplines,case report of CIE patient is increasing yearly.At present,there is not a uniform diagnosis and treatment standard for CIE in China and abroad.Chinese Federation of Interventional Clinical Neurosciences organized relevant experts in China and developed the expert consensus,to provide suggestions and references for clinicians at all levels to prevent,identify and treat CIE.

Humans ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Pancreatic Neoplasms ; Pancreas ; Needles

A 11-year old female patient with severe thalassemia, receipt a lentivirus-based cell and gene therapy (CGT) therapy in Shenzhen Children′s Hosptial on July 27th, 2021. At the two follow-up visits after discharge, patient were continuously tested positive for HIV screening through HIV Ag/Ab Combo assay (chemiluminescence Immunoassay), and the viral load results of HIV-1 nucleic acid testing (NAT) were both>5 000 copies/ml. The patient can be diagnosed with HIV infection according to the National Guideline for Detection of HIV/AIDS(2020 Revised Edition). The thorough investigation findings and supplementary experiment results indicated that the false-positive HIV-1 NAT results was caused by cross-reactivity between the target sites detected by conventional HIV-1 NAT reagents and the lentiviral vectors fragments integrated into the genome of patient′s hematopoietic stem/progenitor cells. In conclusion, it is important for laboratories to select appropriate HIV-1 NAT testing platforms which won′t cause cross-reactivity for the testing of samples from patients who have been treated with HIV-derived vectors. It is also recommended to design and develop NAT testing platforms with multiple target regions labeled by different fluorescents for HIV NAT supplementation experiment to reduce the risk of false-positive diagnoses of HIV infection.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Objective:To describe the clinical features of a patient of anti-neurofascin 186 (NF186) antibody associated acute immune sensory polyradiculopathy (AISP), and enhance understanding of AISP/chronic immune sensory polyradiculopathy (CISP).Methods:The clinical characteristics, diagnosis and treatment of a domestic AISP patient with NF186 antibody positive admitted to the First Hospital of Shanxi Medical University in December 2021 were summarized, and the previously reported cases of AISP/CISP were systematically reviewed.Results:The patient was a 62-year-old male with acute onset. The clinical manifestations included severe sensory ataxia, increased protein in cerebrospinal fluid, no response to stimulation of the central segment of somatosensory evoked potentials (SEP), normal sensory and motor nerve conduction, and positive serum anti-NF186 antibody (1∶32). After glucocorticoid treatment, the clinical symptoms and SEP were significantly improved. The drug was stopped for 2 months, and there was no recurrence. There were 23 cases of AISP and CISP with complete data reported in the literature (including this patient). The age of onset was (54.7±17.7) years, and the ratio of male to female was 1.88. Three patients with acute onset were classified as AISP. A total of 95.7% (22/23) of patients showed sensory ataxia without limb weakness, 95.0% (19/20) of patients showed prolonged cortical potential latency or even no response, and 95.5% (21/22) of patients showed increased cerebrospinal fluid protein in varying degrees, and nerve root thickening or abnormal enhancement was not common. All 10 patients receiving immunotherapy responded to corticosteroids or intravenous immune globulin. Only 6 AISP/CISP articles reported screening for anti-ganglioside antibodies or Ranvier′s node-paranodal region-related antibodies, and no positive NF186 antibodies were reported. All the 3 patients with AISP had some characteristics of CISP/chronic inflammatory demyelinating polyradiculoneuropathy, and there was no significant difference between AISP and CISP patients in clinical features except the mode of onset.Conclusions:NF186 antibody could cause AISP, which presents as acute onset sensory ataxia. AISP is responsive to glucocorticoid therapy. Except for the mode of onset, AISP and CISP are difficult to distinguish from clinical, electrophysiological, pathological aspects and pathogenic antibodies, so they may be two different manifestations of the same disease.

To compare the efficacy, safety and economic cost of endoscopic ultrasound (EUS)-guided puncture sclerotherapy and laparoscopic decapitation decompression for the renal cysts in the upper pole, data of patients with renal cysts in the upper pole who received EUS-guided puncture sclerotherapy (the EUS group, n=9) or laparoscopic decapitation decompression (the laparoscopy group, n=16) in the Second Affiliated Hospital of Soochow University from January 2021 to August 2022 were analyzed retrospectively. The effective rate, operation time, intraoperative blood loss, incidence of complications, hospital stay and treatment cost of the EUS group and the laparoscopy group were compared. Results showed that the effective rate was comparable in the EUS group and laparoscopy group (9/9 VS 14/16, P=0.520). The operation time was shorter (29.8±4.8 min VS 70.1±11.1 min, t=10.207, P<0.001), intraoperative blood loss less (0 mL VS 26.1±5.9 mL, t=13.089, P<0.001), postoperative hospital stay shorter (3.5±0.7 days VS 5.4±2.0 days, t=2.663, P=0.014), and total cost lower (10 547.85±2 388.19 yuan VS 15 316.09±5 352.45 yuan, t=2.517, P=0.019) in the EUS group compared with those in the laparoscopy group. There was no significant difference in the total hospital stay (8.1±2.0 days VS 9.3±3.1 days, t=1.019, P=0.319) or operation cost (3 946.79±490.82 yuan VS 3 860.18±857.42 yuan, t=-0.277, P=0.784) between the EUS group and laparoscopy group. There was 1 case of puncture bleeding, 1 case of hematuria, and 1 case of lumbago in the laparoscopy group, while no complication occurred in the EUS group. In conclusion, it is preliminarily believed that EUS-guided puncture sclerotherapy for renal cysts in the upper pole has similar clinical effects with higher safety, shorter postoperative hospital stay and lower total hospitalization cost compared with those of laparoscopic decapitation decompression, which is worth of clinical promotion.

Objective:To evaluate the preoperative localization value of endoscopic ultrasound guided fine needle tattooing (EUS-FNT) for laparoscopic distal pancreatectomy in pancreatic lesions with a maximum diameter ≤3 cm.Methods:From November 2017 to October 2022, at the Second Affiliated Hospital of Soochow University, the data of patients with pancreatic lesions ≤3 cm who underwent laparoscopic distal pancreatectomy were retrospectively analyzed. Eight patients who underwent EUS-FNT assisted laparoscopic distal pancreatectomy were included in the fine needle tattooing (FNT) combined laparoscopic group. And 14 patients who underwent simple laparoscopic distal pancreatectomy were taken as the simple laparoscopic group. The success rate and complications of EUS-FNT were observed. The differences in operation time, surgery-related complications and complete resection rate of lesions between the two groups were compared. Mann-Whitney U test and descriptive analysis were used for statistical analysis. Results:In the FNT combined laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 4 cases in the pancreatic tail. In the simple laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 10 cases in the pancreatic tail. There was a significant difference in lesion size between the two groups (14.5 mm (10.8 mm, 16.5 mm) vs. 27.0 mm (23.5 mm, 30.0 mm), Z=-3.09, P=0.001). In the FNT combined laparoscopic group, EUS-FNT was successfully performed in all 8 patients. The average time of laparoscopy after EUS-FNT was (98.4±8.8) min. The marks were clearly visible under the laparoscopic field of view, and no complications such as abdominal hemorrhage and hematoma were observed. Laparoscopic pancreaticocaudectomy was performed in 5 cases and pancreaticocaudectomy plus splenectomy in 3 cases. The median operation time was 192.5 min (176.3 min, 203.8 min). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. The lesions were one-time completely resected in all 8 patients. The postoperative pathology were 6 cases of pancreatic neuroendocrine neoplasm, 1 case of intraductal papillary mucinous neoplasm (IPMN), and 1 case of solid pseudopapilloma. In the simple laparoscopic group, laparoscopic pancreaticocaudectomy was performed in 2 cases and pancreaticocaudectomy plus splenectomy in 12 cases. The median operation time was 202.5 min (192.8 min, 235.0 min), which was longer than that of FNT combined laparoscopic group, but the difference was not statistically significant ( P>0.05). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. In 1 patient with pancreatic body lesions, no lesion was found in the specimen examination after the first pancreatectomy, and the lesions were completely resected after the second partial pancreatectomy. Active abdominal hemorrhage occurred in 1 patient on the second day after operation, and underwent interventional embolization for hemostasis. Two weeks after surgery, 1 patient was found to have a encapsulated fluid with a long diameter of 6 cm around the pancreas by computed tomography re-examination 2 weeks after surgery. The postoperative pathology were 5 cases of pancreatic neuroendocrine neoplasm, 2 cases of IPMN, 1 case of solid pseudopapilloma, 1 case of pancreatic cyst with glandular low-grade intraepithelial neoplasia, 1 case of ectopic spleen, and 4 cases of pancreatic ductal adenocarcinoma. Conclusion:EUS-FNT can effectively localize small pancreatic lesions before laparoscopic distal pancreatectomy, shorten the operation time and improve the complete resection rate under laparoscopy.