Pheochromocytoma is a neuroendocrine tumor that produces catecholamines, leading to elevated blood pressure and metabolic changes in patients. It can result in serious complications affecting the heart, brain, kidneys, and blood vessels, potentially becoming a primary cause of death. Most pheochromocytoma patients present with atypical symptoms, making misdiagnosis or missed diagnosis common. This article reports a case of pheochromocytoma crisis misdiagnosed as severe viral myocarditis and includes a review of the relevant literature.

Pheochromocytoma is a neuroendocrine tumor that produces catecholamines, leading to elevated blood pressure and metabolic changes in patients. It can result in serious complications affecting the heart, brain, kidneys, and blood vessels, potentially becoming a primary cause of death. Most pheochromocytoma patients present with atypical symptoms, making misdiagnosis or missed diagnosis common. This article reports a case of pheochromocytoma crisis misdiagnosed as severe viral myocarditis and includes a review of the relevant literature.

Pediatric malocclusion is common in dentistry.Some children with malocclusion combined with obstruc-tive sleep apnea-hypopnea syndrome(OSAHS)often fail to receive appropriate treatment due to a lack of multidisci-plinary diagnosis and treatment.It can cause abnormal ventilation during sleep,affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems.Pediatric OSAHS is caused by the narrowing of the upper respiratory tract,characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion.Due to its diverse clinical manifestations and etiology,the diagnosis and treatment of pediatric OSAHS require an interdisciplinary,personalized,and specialized approach.Questionnaires and physical ex-aminations can be used for preliminary screening.Moreover,children's stomatology and otorhinolaryngology examina-tions are the basis for disease diagnosis.Polysomnography(PSG)is currently the direct diagnostic method.There are var-ious treatment methods for OSAHS in children,and for OSAHS caused by adenoid tonsil hypertrophy,adenoidectomy and tonsillectomy are the main treatments.Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion.Currently,there is limited research on the cor-relation between childhood malocclusion and OSAHS,and multidisciplinary combination therapy may improve the cure rate,but there is a lack of sufficient evidence.In the future,the pathogenesis of OSAHS should be further elucidated,and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.

To investigate the alleviating effect of glycyrrhizic acid(GA)on chronic toxicity of afla-toxin B1(AFB1)in ducklings.Eighty 4-day-old ducklings were randomly divided into 4 groups,with 20 ducklings in each group,including a blank group,a model group(100 μg/kg AFB1),a high-concentration GA group(100 μg/kg AFB1+100 mg/kg GA),and a low-concentration GA group(100 μg/kg AFB1+50 mg/kg GA),with a trial period of 18 days.At the end of the experi-ment,the body weight of the ducklings in each group,AFB1-DNA content in the liver and liver tis-sues index,the biochemical indicators of liver function,and the pathological changes in liver tissues were examined.Additionally,the oxidative damage status of the liver tissues was eval-uated,and the mRNA expression levels of mitochondria-related apoptosis genes was detected.Com-pared with the control group,the body weight of ducklings in the model group decreased signifi-cantly(P＜0.01),AFB1-DNA content in the tissues increased significantly(P＜0.05),liver swell-ing and yellowing were observed,the liver index increased significantly(P＜0.01),as did the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)(P＜0.01).The AST/ALT levels also increased significantly(P＜0.01),while the serum total protein(TP)content de-creased significantly(P＜0.01).The liver tissues showed a large amount of inflammatory cell infil-tration,vacuolar degeneration,fibrotic changes and apoptosis.The activities of catalase(CAT),glutathione S-transferase(GST),the total antioxidant capacity(T-AOC)of the duckling liver all decreased significantly(P＜0.01)and the mRNA expression of mitochondria-related apoptosis genes Bax,Cyt-c,Caspase-3,and Caspase-9 significantly increased(P＜0.01).Compared with the model group,GA treatment significantly increased the body weight of the model ducklings(P＜0.01),reduced AFB1-DNA content in the tissue,significantly reduced their liver index(P＜0.05),visibly restored the liver's apparent status,effectively reversed the abnormal changes in serum liver function indicators,improved the pathological changes in liver tissue histology,enhanced liver an-tioxidant function,significantly decreased expression of Bax,Cyt-c,Caspase-3,and Caspase-9 mR-NA(P＜0.05).Further correlation analysis showed that mRNA expression levels of Bax,Cyt-c,Caspase-3,and Caspase-9 in duck liver tissues were positively correlated with liver index,AFB1-DNA content,AST content,ALT content,AST/ALT ratio,and MDA content,and negatively cor-related with body weight,TP content,SOD activity,CAT activity,GST activity,and T-AOC activi-ty in ducklings.In conclusion,GA may alleviate liver damage to relieve duckling AFB1 chronic tox-icity by inhibiting the mitochondrial pathway of apoptosis.

To investigate the alleviating effect of glycyrrhizic acid(GA)on chronic toxicity of afla-toxin B1(AFB1)in ducklings.Eighty 4-day-old ducklings were randomly divided into 4 groups,with 20 ducklings in each group,including a blank group,a model group(100 μg/kg AFB1),a high-concentration GA group(100 μg/kg AFB1+100 mg/kg GA),and a low-concentration GA group(100 μg/kg AFB1+50 mg/kg GA),with a trial period of 18 days.At the end of the experi-ment,the body weight of the ducklings in each group,AFB1-DNA content in the liver and liver tis-sues index,the biochemical indicators of liver function,and the pathological changes in liver tissues were examined.Additionally,the oxidative damage status of the liver tissues was eval-uated,and the mRNA expression levels of mitochondria-related apoptosis genes was detected.Com-pared with the control group,the body weight of ducklings in the model group decreased signifi-cantly(P＜0.01),AFB1-DNA content in the tissues increased significantly(P＜0.05),liver swell-ing and yellowing were observed,the liver index increased significantly(P＜0.01),as did the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)(P＜0.01).The AST/ALT levels also increased significantly(P＜0.01),while the serum total protein(TP)content de-creased significantly(P＜0.01).The liver tissues showed a large amount of inflammatory cell infil-tration,vacuolar degeneration,fibrotic changes and apoptosis.The activities of catalase(CAT),glutathione S-transferase(GST),the total antioxidant capacity(T-AOC)of the duckling liver all decreased significantly(P＜0.01)and the mRNA expression of mitochondria-related apoptosis genes Bax,Cyt-c,Caspase-3,and Caspase-9 significantly increased(P＜0.01).Compared with the model group,GA treatment significantly increased the body weight of the model ducklings(P＜0.01),reduced AFB1-DNA content in the tissue,significantly reduced their liver index(P＜0.05),visibly restored the liver's apparent status,effectively reversed the abnormal changes in serum liver function indicators,improved the pathological changes in liver tissue histology,enhanced liver an-tioxidant function,significantly decreased expression of Bax,Cyt-c,Caspase-3,and Caspase-9 mR-NA(P＜0.05).Further correlation analysis showed that mRNA expression levels of Bax,Cyt-c,Caspase-3,and Caspase-9 in duck liver tissues were positively correlated with liver index,AFB1-DNA content,AST content,ALT content,AST/ALT ratio,and MDA content,and negatively cor-related with body weight,TP content,SOD activity,CAT activity,GST activity,and T-AOC activi-ty in ducklings.In conclusion,GA may alleviate liver damage to relieve duckling AFB1 chronic tox-icity by inhibiting the mitochondrial pathway of apoptosis.

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in the patients after neoadjuvant treatment. Methods From January 2019 to February 2021, the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Comprehensive Breast Health Center, Department of General Surgery, Ruijin Hospital were collected. Comparison of clinicopathological features was done between neoadjuvant treatment group and control group. Univariate analysis was used to compare the rate of surgical complications between two groups. Results A total of 110 patients were enrolled with 23 cases (20.9%) in neoadjuvant treatment group and 87 cases (79.1%) in control group. None of carcinoma in situ (0 vs. 19.5%, P=0.003) and higher pTNM stage (P<0.001) was present in neoadjuvant treatment group compared with those in control group. However, there were no significant differences in the number of flap perforator of DIEP (P=0.472), the proportion of bipedicled flaps (P=0.489), operative time (P=0.651) and hospital length of stay (P=0.275) between two groups. No significant difference was found in the incidence of postoperative complications between two groups. Breast seroma was the most common recipient complication (13.0%, 3 cases) without donor complication in neoadjuvant treatment group. The most common complication was fat necrosis (12.6%, 11 cases) in recipient site and abdominal seroma (3.4%, 3 cases) in donor site of control group. Reoperation was done in one case (4.3%) of neoadjuvant treatment group and 4 cases (4.6%) of control group. DIEP flap necrosis with total flap loss occurred in 2 cases (2.3%) in control group, but none in neoadjuvant treatment group. Conclusions The imme-diate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.

Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer. This study aimed to evaluate the prognostic significance of the 21-gene recurrence score (RS) in Chinese patients with pN0-1, estrogen receptor-positive (ER
Biomarkers, Tumor/genetics* ; Breast Neoplasms/pathology* ; Female ; Humans ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Prognosis ; Receptor, ErbB-2/genetics* ; Receptors, Estrogen

Purpose: This retrospective study aimed to evaluate the distribution pattern and prognostic value of 21-gene recurrence score (RS) in Chinese patients with mucinous breast cancer (MC) and compared with infiltrating ductal carcinoma (IDC). Materials and Methods: Patients diagnosed with MC or IDC from January 2010 to January 2017 were retrospectively recruited. Reverse transcriptase–polymerase chain reaction assay of 21 genes was conducted to calculate the RS. Univariate and multivariate analyses were performed to assess the association between RS and clinicopathological factors. Survival outcomes including disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared by log-rank test. Results: The MC cohort included 128 patients and the IDC cohort included 707 patients. The proportions of patients with a low (RS < 18), intermediate (18-30), or high risk (RS > 30) were 32.0%, 48.4%, and 19.5% in MC cohort, and 26.9%, 46.8% and 26.3% in IDC cohort. The distribution of RS varied significantly according to different Ki-67 index and molecular subtype in both cohorts. Moreover, the receipt of chemotherapy was associated with RS in both cohorts. Among patients with MC, tumor stage was related to the DFS (p=0.040). No significant differences in DFS and OS were found among MC patients in different RS risk groups (OS, p=0.695; DFS, p=0.926). Conclusion RS was significantly related to Ki-67 index and molecular subtypes in MC patients, which is similar in IDC patients. However, RS was not able to predict DFS and OS in patients with MC.

PURPOSE: The purpose of this study was to investigate the changes of tumor infiltrating lymphocytes (TILs) between core needle biopsy (CNB) and surgery removed sample (SRS) in early stage breast cancer patients and to identify the correlating factors and prognostic significance of TILs changes. MATERIALS AND METHODS: A retrospective study was carried out on 255 patients who received CNB and underwent surgical resection for invasive breast cancer. Stromal TILs levels of CNB and SRS were evaluated respectively. Tumors with ≥50% stromal TILs were defined as lymphocyte-predominant breast cancer (LPBC). Clinicopathological variables were analyzed to determine whether there were factors associated with TILs changes. Log-rank tests and Cox proportional hazards models were used to analyze the influences of TILs and TILs changes on survival. RESULTS: SRS-TILs (median, 10.0%) were significant higher than CNB-TILs (median, 5.0%; p<0.001). Younger age (<60 years, p=0.016) and long surgery time interval (STI, ≥4 days; p=0.003) were independent factors correlating with higher TILs changes. CNB-LPBC patients showed better breast cancer-free interval (BCFI, p=0.021) than CNB-non-LPBC (CNB-nLPBC) patients. Patients were categorized into four groups according to the LPBC change pattern from CNB to SRS: LPBC→LPBC, LPBC→nLPBC, nLPBC→LPBC, and nLPBC→nLPBC, with estimated 5-year BCFI 100%, 100%, 69.7%, and 86.0% (p=0.016). nLPBC→LPBC pattern was an independent prognostic factor of worse BCFI (hazard ratio, 2.19; 95% confidence interval, 1.06 to 4.53; p=0.035) compared with other patterns. CONCLUSION: TILs were significantly higher in SRS than in CNB. Higher TILs changes were associated with younger age and long STI. Changing from nLPBC to LPBC after CNB indicated a worse BCFI, which needs further validation.
Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast ; Humans ; Lymphocytes, Tumor-Infiltrating ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Sexually Transmitted Diseases

Objective To compare the safety of octogenarian patients receiving non-cardiac surgery within 1 week versus within 1-3 weeks after coronary computed tomographic angiography(CTA).Methods Octogenarian patients who underwent non-cardiac surgery after coronary CTA in Fujian Medical University Union Hospital,were retrospectively analyzed.All patients were divided into two groups:those received surgery within 1 week after coronary CTA as group 1 (n =73),those within 1-3 week after coronary CTA as group 2,(n =35).The baseline clinical characteristics,the changes in pre-and postoperative serum creatinine levels (Scr)and estimated glomerular filtration rate(eGFR),and the incidence of acute kidney injury(AKI)were compared between two groups.The revised cardiac risk index(RCRI)score was evaluated for each octogenarian inpatient,and the RCRI sum score for different types of non-cardiac surgery were calculated.Finally,the RCRI sum score of the preoperative risk factors were compared between different types of non-cardiac surgery so as to assess their specifically safety.Results In 108 patients who performed coronary CTA,only one patients developed palpitation and three had injection site pain.All patients receiving different types of non-cardiac operation had low revised cardiac risk index(RCRI ≤ 2).Death was not found.The serum levels of Scr and eGFR were similar between two groups before coronary CTA and after operation(all P＞0.05).Conclusions Octogenarian patients with low preoperative cardiac risk index(RCRI ≤ 2) are safe for performing non-cardiac surgery within 1 week after coronary CTA.