This article reports a diagnostically and therapeutically challenging case of small intestinal marginal zone lymphoma. The patient presented with recurrent abdominal pain as the chief complaint, and imaging revealed multifocal small bowel wall thickening with high uptake, multisegmental luminal stenosis, and proximal dilation. Initial diagnostic workup, including gastroscopy, colonoscopy, and enteroscopy with biopsy, failed to establish a definitive diagnosis. Empirical anti-tuberculosis therapy was ineffective. A repeat enteroscopic biopsy performed over eight months after symptom onset eventually confirmed the diagnosis of mucosa-associated lymphoid tissue (MALT) extranodal marginal zone lymphoma. Despite three different chemotherapy regimens, the patient's intestinal obstruction symptoms persisted, with imaging still showing multifocal bowel wall thickening and hypermetabolic activity. A critical diagnostic dilemma arose regarding whether the PET/CT-positive lesions represented residual lymphoma or fibrotic scarring, whether further chemotherapy adjustments were warranted, and whether surgical resection was necessary. Multidisciplinary discussion concluded that imaging had limited discriminatory value in this scenario and that surgical intervention should be pursued if feasible. The patient successfully underwent partial small bowel resection, with postoperative pathology confirming no residual lymphoma but significant fibrotic changes. The patient has since resumed a normal diet, with body weight nearly restored to pre-illness levels. This case highlights that fibrotic transformation is a common sequela of treated marginal zone lymphoma and that PET/CT may misleadingly suggest residual disease, potentially leading to unnecessary chemotherapy. Timely surgical intervention is crucial in such scenarios.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

Objective To investigate the effects of dexmedetomidine on sedation and inflammatory response in patients undergoing brachial plexus anesthesia, to provide a reference for the selection of sedative drugs in forearm traumatic patients undergoing brachial plexus block anesthesia .Methods 80 forearm traumatic patients underwent trauma surgery with brachial plexus nerve block from July 2015 to June 2016 were selected and randomly divided into two groups of dexmedetomidine group (dexmedetomidine group, D group) and normal saline group (control group, C group), each group of 40 cases.The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were recorded before operation (T0), incision (T1), 15 min (T2), 30 min (T3).Interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) were measured at different time points. At the same time, the Ramsay sedation score and the degree of amnesia after operation were measured.Results There were no significant differences in MAP, HR and SpO2 before anesthesia between the two groups.In group D, MAP and HR were significantly lower than those in group C at T1, T2, T3 and T4, the difference was statistically significant (P<0.05).There was no statistical difference in SpO2 between the two groups.The Ramsay sedation score of group D at T1 to T4 was significantly higher than that of group C, the difference was statistically significant (P<0.05).The levels of IL-1β, IL-6 and TNF-αin group D were significantly lower than those in group C at T1 to T4, the difference was statistically significant (P<0.05).Conclusion Dexmedetomidine has good curative effect on forearm traumatic patients with brachial plexus block and less hemodynamics changes , which is beneficial to patients'forgotten of operation and inhibition of inflammatory reaction in forearm traumatic patients.

Objective To explore the safety and efficacy of dezocine combined with flurbiprofen axetil in postoperative analgesia in elderly patients undergoing upper abdominal surgery.Methods 80 patients underwent abdominalsurgery were selected.They were divided into study group(T group) and control group(C group) according to the random number table,40 cases in each group.The visual analogue scale(VAS) and Ramsay sedation score were recorded at 2h,6h,12h,24h,48h after operation,respectively.The anesthesia-related complications such as sleepiness,chills,postoperative nausea and vomiting (PONV),and pulmonary infection in 48 hours were also recorded.Results There were no statistically significant differences in the VAS score between the two groups in the resting state and the active state(t =0.287,0.436,all P ＞ 0.05).The VAS scores of T group were significantly lower than those of C group at 2h,6h,12h,24h and 48h after operation (t =4.096,4.241,5.510,6.121,5.752,3.542,3.866,4.948,5.542,4.030,all P ＜ 0.05).There were no statistically significant differences in Ramsay sedation scores between the two groups at postoperative 2h,6h,12h,24h and 48h (t =0.323,0.226,0.541,0.297,0.771,0.795,all P ＞ 0.05).There were no statistically significant differences in the incidence of drowsiness,chills,PONV,skin itching and pulmonary infection in the two groups (4 cases vs.6 cases,6 cases vs.5 cases,5 cases vs.3 cases,1 case vs.3 cases,5 cases vs.1 case,P =0.499,0.712,0.745,0.615,0.201).Conclusion The postoperative analgesic compatibility of dezocine combined with flurbiprofen axetil can effectively relieve the postoperative pain in elderly patients with upper abdominal surgery and provide good postoperative analgesic effect and does not increase the incidence of drug related complications.It is worth to promote in clinical.

Objective To determine the prevalent herpes simplex virus (HSV) strain in patients with genital herpes (GH),and to evaluate the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of anti-herpes simplex virus type 2 (HSV2) IgG and IgM antibodies in the diagnosis of genital herpes (GH) before in vitro fertilization (IVF).Methods Totally,193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology,First Affiliated Hospital,Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate (FITC)-labelled anti-HSV monoclonal antibodies.Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands (clinical observation group),68 HSV culture-positive patients diagnosed with GH (positive control group),and 120 children aged 8-12 years (negative control group).Enzyme-linked immunosorbent assay (ELISA) was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples.Statistical analysis was carried out using chi-square test.Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG (89.71％ (61/68) vs.40.80％ (49/120),P ＜ 0.01) and anti-HSV2 IgG (91.18％ (62/68) vs.0,P ＜ 0.01),but not in that of anti-HSV1 IgM (20.59％ (14/68) vs.21.70％ (26/120),P ＞ 0.05) or anti-HSV2 lgM (13.24％ (9/68)vs.13.30％ (16/120),P ＞ 0.05).In the clinical observation group,the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies,anti-HSV1 and anti-HSV2 IgG antibodies was 80.70％ (46/57),91.23％ (52/57),84.21％ (48/57) and 14.04％ (8/57) respectively in the females,19.30％ (11/57),8.77％ (5/57),87.71％ (50/57),12.28％ (7/57)respectively in the males,with significant differences in the positivity rate of anti-HSV1 and-HSV2 IgM antibodies (both P ＜ 0.01),but not in that of anti-HSV 1 or-HSV2 IgG antibodies (both P ＞ 0.05).The sensitivity,specificity,PPV and NPV were 13.24％ (9/68),86.67％ (104/120),36.00％ (9/25) and 63.80％ (104/163) respectively for anti-HSV2 IgM antibody in the diagnosis of GH,91.18％ (62/68),100.00％ (120/120),100.00％ (62/62),and 95.24％ (120/126) respectively for anti-HSV2 IgG antibody.Conclusions HSV2 prevails in the patients with GH in this region,while HSV1 only amounts to 5.18％.The type-specific anti-HSV2 IgG antibody shows a higher specificity,sensitivity,PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody,hence,the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction.

Objective To study the appearances and early fetures of sacroiliac joints(SIJ) in ankylosing spondylitis on X-ray film and CT,and to valuate the CT examination of sacroiliac joints in the same groups.Methods The plain X-ray film of 73 cases of SIJ of ankylosing spondylitis which had been proved clinicalhy were studied.All the patients had been examed with CT at the same time.The appearances presented by the two methods were concluded compared and graded,the relationship between them was analyzed with statistics.Results The erosion,cystic lesions of bone and swollen of soft tissues were the early features of sacroiliac joints in ankylosing spondylitis,but the detection rate of them by X-ray was 73%,38%,0.6%,by CT was 86%,72%,3%.They can find on CT and conventional radiography,but the detection rate of them by CT was much higher than that by X-ray plain film(?

Objective: To reconstruct three dimension (3D) model of a rtificial tooth and to establish standardized 3D artificial teeth graphic datab ase. Methods: Artificial teeth were incised with CGI autom atic cross section scanning instrument, then data points were picked up from e ach parallel layer contour of incised tooth, and 3D stereo models of artificia l tooth were retrieved using 3D reconstruction techniques. Results: 3D graphic models of 28 artificial teeth were established.The models may represent the graphic feature of the teeth. Conclusion: The present technic is feasible in the establishment of 3D graphic models of artificial tooth.