Hepatosplenic candidiasis (HSC) is a rare type of candidiasis that can occur in patients with hematologic malignancies, hematopoietic stem cell transplantation. At present, there is still a lack of studies on HSC in patients with hematologic disorders. Based on The Chinese Guidelines for the Diagnosis and Treatment of Invasive Fungal Disease in Patients with Hematological Disorders and Cancers (the 6th revision), We retrospectively analyzed the clinical characteristics and prognosis of patients with HSC treated in Peking University Institute of Hematology from 2008 to 2022. Finally, eighteen patients were included, with 1 (5.6%) proven, 2 (11.1%) probable, and 15 (83.3%) possible HSC. Among them, 3 (16.7%) patients occurred after haploid hematopoietic stem cell transplantation and 15 (83.3%) patients occurred after chemotherapy. 6 (33.3%) patients had positive blood cultures, including 4 cases of Candida tropicalis and 2 cases of Candida albicans. At 4 weeks of antifungal therapy, 10 (58.8%) patients achieved partial response (PR), At 8 weeks, 1 (6.3%) patients achieved complete response and 10 (62.5%) patients achieved PR. At 6 months after diagnosis, 3 (16.7%) patients died of hematopoietic recurrence, and none of them died of HSC. As a rare fungal infection disease, HSC has a low positive rate of microbiological and histological examinations, a persistent treat cycle, and has difficulty in remission, reminding us of the need for vigilance in patients with hematopoietic disorders and persistent fever.

Objective:To study the relationship between circulating inflammatory proteins and liver cancer by Mendelian randomization.Methods:Data from the genome-wide association study (GWAS) of 91 circulating inflammatory proteins were sourced from the GWAS Catalog, involving 14 824 participants of European ancestry from 11 cohorts. Summary statistics for liver cancer were obtained from the GWAS database, encompassing a total sample of 197 611 cases, a two-sample Mendelian randomization analysis was conducted to evaluate the relationship between 91 circulating inflammatory proteins and liver cancer. Among them, inverse variance weighting, weighted median method, MR-Egger, simple mode, and weighted mode were the main analysis methods. Using odds ratio (OR) values to evaluate the causal relationship between them. Cochran Q-test, MR-PRESSO, MR-Egger intercept, and "leave-one-out" analyses were used for sensitivity analysis. Reverse MR, MR-Steiger tests were employed to rule out the influence of reverse causality.Results:Among the circulating 91 inflammatory proteins, C-C motif chemokine 20 ( OR=1.28, 95% CI: 1.01-1.62), CD40 receptor ( OR=1.31, 95% CI: 1.00-1.28), fibroblast growth factor 21 ( OR=1.47, 95% CI: 1.18-1.83), glial cell line-derived neurotrophic factor ( OR=1.29, 95% CI: 1.08-1.54), interleukin-13 (IL-13) ( OR=1.24, 95% CI: 1.02-1.50), IL-20 levels ( OR=1.78, 95% CI: 1.30-2.44), IL-20 receptor subunit alpha ( OR=1.43, 95% CI: 1.06-1.93), and matrix metalloproteinase-10 ( OR=1.21, 95% CI: 1.04-1.39) have positive causal relationship with the occurrence of liver cancer. And IL-1 alpha ( OR=0.83, 95% CI: 0.71-0.96), IL-24 ( OR=0.68, 95% CI: 0.47-0.99), leukemia inhibitory factor ( OR=0.77, 95% CI: 0.60-0.98) and stem cell factor ( OR=0.87, 95% CI: 0.78-0.97) showed negative causal relationship with the occurrence of liver cancer. Heterogeneity tests for all 12 circulating inflammatory proteins revealed no outliers. Sensitivity analyses consistently demonstrated robustness, with no evidence of pleiotropy observed. Neither reverse MR nor MR-Steiger tests supported the existence of a reverse causal relationship between inflammatory proteins and liver cancer. Conclusion:The C-C motif chemokine 20, CD40L receptor, fibroblast growth factor 21, glial cell line-derived neurotrophic factor, IL-13, IL-20, IL-20 receptor subunit alpha, MMP-10, IL-1 alpha, IL-24, leukemia inhibitory factor, and stem cell factor may be causally related to the development of liver cancer.

Objective:To investigate the significance and mechanism of ten-eleven translocation (Tet1) against Mycobacterium marinum ( Mm) infection in mice. Methods:SPF wild-type C57BL/6 and Tet1-knockout (Tet1KO) mice were injected intravenously with Mm. All mice were monitored and the abscesses formed in tail were observed and quantified. Pathological changes in mouse tail tissues were observed using hematoxylin and eosin (HE) staining and transmission electron microscopy and the differences between the two groups were analyzed. Immunohistochemistry staining was used to detect the expression and distribution of TNF-α and TGF-β in mouse tail tissues. Moreover, mouse tail tissues were cultured on 7H10 plates for bacterial counting. The expression of NF-κBp65 and TGF-β was detected by Western blot. Results:Obvious lesions including abscesses and ulcers were formed in the Mm-infected C57BL/6, but only scattered small abscesses were observed in Mm-infected Tet1KO mice. During Mm infection, the bacterial load was gradually increased in C57BL/6 mice, but decreased in Tet1KO mice. Histopathological examination showed that obvious inflammatory cell infiltration and typical granulomatous lesions were found in Mm-infected C57BL/6 mice, while no significant inflammatory cell infiltration was detected in Mm-infected Tet1KO mice. Immunohistochemistry staining demonstrated that the expression of TNF-α and TGF-β was lower in Mm-infected Tet1KO mice than in Mm-infected C57BL/6 mice. Moreover, the expression of phosphorylated NF-κBp65 and TGF-β was significantly reduced in Mm-infected Tet1KO mice as compared with that in Mm-infected C57BL/6 mice. Conclusions:Deletion of Tet1 could alleviate the inflammatory damage mediated by Mm and enhance the host immune response to bacteria.

Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.There were 26 males and 13 females,aged (60±7)years,with a range of 41-75 years.All the 39 patients underwent PD,using Child method to reconstruct digestive tract.Of 39 patients,19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group,respectively.Observation indicators:(1)surgical situations;(2) postoperative complications;(3) follow-up.Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence,main pancreatic duct dilatation,survival,and discomfort (abdominal pain,bloating,indigestion,etc.) of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as M (P25,P75) or M (range),and comparison between groups was analyzed by Mann Whitney U test.Count data were expressed as absolute numbers,and comparison between groups was analyzed by chi-square test or Fisher exact probability.Results (1) Surgical situations:operation time,volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay of the innovative group were (342±47) minutes,400 mL (300 mL,400 mL),10,9,3.1 cm (2.9 cm,3.4 cm),37 days (32 days,63 days),17,18 days (15 days,22 days),respectively,versus (392±95)minutes,400 mL (300 mL,525 mL),6,14,3.6 cm (2.6 cm,4.2 cm),43 days (34 days,49 days),18,and 24 days (15 days,27days) of the traditional group;there was no significant difference in the volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay between the two groups (Z=-0.775,x2 =2.063,Z=-1.155,Z=-0.295,x2 =0.003,Z=-1.286,P＞0.05);but a significant difference in operation time between the two groups (t =-2.114,P＜0.05).(2) Postoperative complications:6 patients in the innovative group had complications,including 1 of delayed gastric emptying,1 of wound infection,1 of pulmonary infection,1 of acute respiratory failure,1 of perihepatic effusion,and 3 of grade A pancreatic leakage;11 patients in the traditional group had postoperative complications,including 1 of bile leakage,2 of delayed gastric emptying,4 of abdominal infection,4 of wound infection,2 of pulmonary infection,1 of ascites,1 of abdominal hemorrhage,1 of pleural effusion,2 of grade A pancreatic leakage,5 of grade B and C pancreatic leakage;the same patient had multiple complications.There was no significant difference in postoperative complications between the two groups (x2=2.174,P＞0.05),but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P＜O.05).Patients with postoperative complications were improved after symptomatic support treatment,and no patient died during the perioperative period.(3) Follow-up:of the 39 patients,33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months,with a median follow-up time of 17 months.Of the 18 patients receiving follow-up in the innovative group,5 died of tumor recurrence and metastasis,with a survival time of 5-24 months,1 had tumor recurrence at 34 months after operation,1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,5 had indigestion,1 had back pain,and 5 had good recovery.Of 15 patients receiving follow-up in the traditional group,10 died of tumor recurrence and metastasis,with a survival time of 3-57 months,2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,2 had indigestion,1 had good recovery.Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy,modified invagination for pancreaticojejunostomy in the PD is safe and feasible,which can simplify the operation,reduce the requirements for the operator's operation skills,shorten the operation time,and reduce incidence of postoperative grade B and C pancreatic leakage.

Objective To evaluate the diagnostic value of gray-scale ultrasound combined with contrast-enhanced ultrasound (CEUS) in thyroid imaging and reporting system ( TI-RADS) 3-5 nodules of American College of Radiology ( ACR) . Methods The 208 patients( 216 nodules) who underwent thyroid contrast-enhanced ultrasound examination from April 2014 to December 2016 were retrospectively analyzed . The ACR TI-RADS classification and contrast-enhanced mode of thyroid ultrasound were evaluated . The benign and malignant thyroid lesions were constructed through the analysis of contrast-enhanced mode of thyroid benign and malignant lesions in the past literature and the preliminary study of our group . Prediction model of gray scale combined with contrast-enhanced ultrasound for lesions were established . Besides ,the sensitivity ,specificity and accuracy of gray scale ultrasound combined with contrast-enhanced ultrasound prediction model for differential diagnosis of benign and malignant thyroid lesions were calculated based on the results of puncture biopsy or surgical pathology as the gold standard . Results Compared with pathological results , the positive predictive value , negative predictive value , accuracy , sensitivity and specificity of gray scale combined with contrast-enhanced ultrasound in evaluating thyroid nodules were 90 .8％ ,93 .3％ ,91 .2％ ,98 .8％ and 62 .2％ ,respectively . Conclusions Gray-scale ultrasound combined with contrast-enhanced ultrasound can provide clinical value in differential diagnosis of benign and malignant TI-RADS 3-5 thyroid nodules .

Objective To investigate the features of computed tomography (CT) and magnetic resonance imaging (MRI) of regional portal hypertension (RPH).Methods The retrospective cohort study was conducted.The clinicopathological data of 31 patients with PHR in the RPH group and 31 patients with liver cirrhotic portal hypertension (CPH) in the CPH group who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between February 2014 and February 2018 were collected.Etiologies of patients in the RPH group included 21 of chronic pancreatitis complicated with pancreatic pseudocyst,5 of carcinoma of pancreatic body and tail,1 of solid pseudopapillary tumor of the pancreas,1 of pancreatic serotls cystoadenoma,1 of gastric stromal tumor,1 of retroperitoneal metastatic tumor and 1 of left renal carcinoma.Etiologies of patients in the CPH group included 27 of liver cirrhosis after viral hepatitis type B (4 complicated with liver metastasis),3 of alcoholic cirrhosis and 1 of cholestatic cirrhosis.All the patients underwent CT and MRI examinations.Patients in the RPH group were mainly treated the primary diseases and patients in the CPH group were decreased portal vein pressure.Observation indicators:(1) imaging features of patients in the two groups;(2) treatment and follow-up situations.Follow-up using outpatient examination and telephone interview were performed to detect management of portal hypertension after treatment up to February 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed by the t test.Measurement data were represented as M (range) and comparison between groups was analyzed by the Mann-Whitney rank sum test.Count data were compared with chi-square test.Results (1) Imaging features of patients in the two groups:of 31 patients in the RPH group,12 underwent CT examination,2 underwent MRI examination,and 17 underwent CT combine with MRI examination.Of 31 patients in the CPH group,12 underwent CT examination and 19 underwent CT combined with MRI examination.The number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,diameter of splenic vein,liver volume,splenic volume,hepatosplenic volume ratio were 11,1,49,(13.9±2.9) mm,(12.0±2.8) mm,1 383 cm3 (range,1 005-1 637 cm3),271 cm3(range,199-311 cm3) and 5.5±2.0 in the RHP group and 24,21,33,(16.3±1.7)mm,(10.5±3.2)mm,1 087 cm3(range,916-1 536 cm3),603 cm3(range,415-869 cm3) and 2.2±0.9 in the CHP group,with statistically significant differences in the number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,splenic volume,hepatosplenic volume ratio between the two groups (x2=11.088,28.182,8.940,t=4.430,Z=6.205,t=8.544,P＜0.05) and with no statistically significant differences in the diameter of splenic vein and liver volume between the two groups (t=1.974,Z=1.162,P＜0.05).Of 31 patients in the RPH group,2 with pancreatic pseudocyst were misdiagnosed as pancreatic cancer and 29 were diagnosed accurately by imaging examinations.Of 31 patients in the CPH group,3 with liver metastasis were undetected by CT examination and the other 28 were diagnosed accurately by imaging examinations.Splenic vein occlusion,severe splenic vein stenosis,moderate splenic vein stenosis and mild splenic vein stenosis were detected in 2,17,10 and 2 of 31 patients in the RHP group.All the 31 patients in the CHP group mainly had dilation in splenic veins,with no clear stenosis.(2) Treatment and follow-up situations:patients in the two groups were followed up for 6-48 months,with a median time of 21 months.Of 21 patients with chronic pancreatitis complicated with pancreatic pseudocyst in the RPH group,7 underwent pancreatic pseudocyst puncture and drainage,6 of them had poor control on portal hypertension and 1 had moderate control;4 underwent pancreaticoenteric drainage,1 of them underwent pancreaticojejunostomy 4 years later and 3 of them had good control on portal hypertension;3 undergoing splenectomy combined with perigastrectomy had good control on portal hypertension;7 undergoing conservative treatment had good control on portal hypertension.Of 5 patients with carcinoma of pancreatic body and tail in the RHP group,2 undergoing distal pancreatectomy combined with splenectomy had good control on portal hypertension and 3 undergoing non-operative combined therapy died of primary disease one year later.One,1 and 1 patient with solid pseudopapillary tumor of the pancreas,pancreatic serotls cystoadenoma and gastric stromal tumor respectively in the RHP group underwent relative surgical treatments and had good control on portal hypertension.One and 1 patient with retroperitoneal metastatic tumor and left renal carcinoma respectively in the RHP group underwent non-operative combined therapy and had good control on portal hypertension.All the 31 patients in the CHP group were mainly treated with protection of liver function,8 of them were encounted with medusa head,7 with upper gastrointestinal rehemorrhage within one year,5 with subcutaneous varicose vein of abdominal wall,3 with continuing increase of spleen volume and 8 had good control on portal hypertension.Conclusions RHP are existed in pancreatic,splenic or peritoneal diseases,especially the pancreatic primary diseases.The main imaging features of RHP include isolated gastric varices,perigastric varices and splenic vein occlusion without normal main portal vein and liver function.Surgical resection of primary tumor and reasonable splenectomy are effective therapy.

Currently,the BCG is used to prevent tuberculosis,but the immune effect is not ideal due to varied reasons.The existence of drug-resistant strains of tuberculosis and the increased prevalence and incidence of AIDS have leaded to the increased incidence of TB year by year.Therefore,the development of new tuberculosis vaccine is imminent In this paper,the latest research results in recent years for tuberculosis live vector vaccines were summarized,which provide a theoretical reference for further research and development of new TB vaccines.

OBJECTIVETo evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy(LPD).

METHODSData of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of (58.7±10.3) years and mean body mass index of (23.5±3.9)kg/m(2). Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery.

RESULTSOf 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was (367±49) minutes. The mean blood loss was(193±126)ml. The rate of overall postoperative complications was 36.4%(24/66), with 4.5%(3/66) of B or C pancreatic fistula and 7.6% (5/66) of bleeding. The mean postoperative hospital stay was (18.9±12.1) days. Mean tumor size was (3.8±2.3) cm, and the mean number of lymph nodes harvested was (20.3±10.9). Forty-severn patients were diagnosed as pancreatic adenocarcinoma(n=18), cholangiocarcinoma(n=7), ampullary adenocarcinoma(n=21), and gastric cancer(n=1), respectively.

CONCLUSIONLPD is feasible and safe under the skilled hand.

Adenocarcinoma ; surgery ; Aged ; Anastomosis, Surgical ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pancreatectomy ; Pancreatic Fistula ; pathology ; Pancreatic Neoplasms ; surgery ; Pancreaticoduodenectomy ; Postoperative Complications

OBJECTIVETo evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.

METHODSTo analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.

RESULTSThe lesions (benign=28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7). The tumors showed heterogeneous density on unenhanced CT (n=25). Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast. The enhancement patterns included whole enhancement (n=9), solid area enhancement (n=12), peripheral enhancement (n=1), and spotted enhancement (n=1). The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement. The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3). Besides that the morphology had statistical significance (P=0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.

CONCLUSIONSRetroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes. Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.

Adrenal Gland Neoplasms ; diagnostic imaging ; pathology ; Calcinosis ; Diagnosis, Differential ; Humans ; Hypertension ; Image Enhancement ; Pheochromocytoma ; diagnostic imaging ; pathology ; Retroperitoneal Space ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To evaluate the CT and MR findings of retroperitoneal ectopic pheochromocytoma.Methods To analyze retrospectively the CT and MR images of 32 patients with retroperitoneal ectopic pheochromocytoma proved by pathology.Results The lesions ( benign =28, malignant=4) were located in the anterior pararenal space (ARS) (n=12), the perirenal space (PS) (n=13) and the posterior pararenal space (PRS) (n=7).The tumors showed heterogeneous density on unenhanced CT (n=25).Among the 23 cases with enhanced CT imaging, 19 cases had marked contrast and 4 had mild contrast.The enhancement patterns included whole enhancement ( n =9 ) , solid area enhancement ( n=12 ) , peripheral enhancement ( n=1 ) , and spotted enhancement ( n=1 ) .The tumors had heterogeneous signal on unenhanced MR (n=23), and usually showed enhancement at arterial, portal and delayed phases on 22 enhanced MR, while cystic area with no enhancement.The lesions usually had cystic changes (n=18), septa (n=16), vessels inside (n=9), hemorrhage (n=3), and calcification (n=3).Besides that the morphology had statistical significance (P =0.013), other indexes had no statistical significance (P>0.05) in differential diagnosis of benign and malignant retroperitoneal ectopic pheochromocytomas.Conclusions Retroperitoneal ectopic pheochromocytomas have some CT and MR features, usually revealed as an oval mass, growing along the paravertebral axis, and often with cystic changes.Those signs combined with hypertension and elevated catecholamine level may lead to a correct diagnosis.