Left Cavity Research Articles

Stromal-vascular fraction and adipose-derived stem cell therapies improve cartilage regeneration in osteoarthritis-induced rats

This study aimed to evaluate the effects of the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) on cartilage injury in an osteoarthritis (OA) rat model. Sodium iodoacetate (3 mg/50 μL) was used to induce OA in the left knee joint of rats. On day 14 after OA induction, 50 μL of SVF (5 × 106cells), ADSCs (1 × 106 cells), or 0.9% normal saline (NS) was injected into the left knee-joint cavity of each group. The macroscopic view and histological sections revealed that the articular cartilage in the NS group was damaged, inflamed, uneven and thin, and had hyperchromatic cell infiltration. Notably, the cartilage surface had recovered to nearly normal and appeared smooth and bright on day 14 in the SVF and ADSC groups. Additionally, the white blood cell counts in the SVF and ADSC groups were higher than those in the NS group on day 14. Plasma IL-1β levels on days 7 and 14 were reduced in the SVF and ADSC groups. These results indicated that both SVF and ADSC treatments may assist in articular cartilage regeneration after cartilage injury. Cell therapy may benefit patients with OA. However, clinical trials with humans are required before the application of SVF and ADSC treatments in patients with OA.

High-grade transformation of low-grade biphenotypic sinonasal sarcoma: Radiological, morphophenotypic variation and confirmatory molecular analysis

Biphenotypic sinonasal sarcoma (BSNS) is a recently described spindle cell sarcoma with neural and myogenic differentiation which arises exclusively in the sinonasal region.A man presented with swelling of left eyelid, and history of resection of a low-grade spindle cell mesenchymal tumor of left sinonasal cavity performed 15 years before. The original diagnosis was synovial sarcoma. Current MRI showed left supraorbital mass with intracranial extension. IR biopsy confirmed recurrence, and a left orbital craniotomy was done. NGS identified PAX3-MAML3 fusion in both, current and original tumor. The sarcoma was reclassified as BSNS, recurrent, with higher grade transformation. While the morphology, phenotype and molecular signature were in keeping with BSNS, the tumor showed biological progression towards a high-grade sarcoma.High-grade transformation of low-grade BSNS has not been described so far. High-grade transformation was not appreciated at the time of initial diagnosis, and it occurred in the local recurrence 15 years after.

Development of an apparatus and procedure for evaluating the efficiency of nasal irrigation.

Although different methods of nasal irrigation have been utilized, irrigation efficiency in nasal cavities has not been well assessed. The objective of this study was to develop an apparatus and procedure for evaluating the irrigation efficiency and to explore the optimal head position during irrigation. Casts of the left sinonasal cavity from a healthy volunteer were made from high-resolution-computed tomography data using 3D printing with composite materials. An adjustable apparatus that allowed cast fixation at the different head positions was built. The yogurt was used to simulate mucus. The cast with 5ml yogurt filled around the superior, middle, and inferior turbinate was fixed in six head positions including head tilt 10°, 45°, and 60° forward with or without leaning 30° to the right. The cast was irrigated with 120ml, 175ml, and 240ml dyed water and was video recorded. The irrigation efficiency was calculated based on the weight difference of the cast before and after the irrigation. Most residual yogurt was located around the superior meatus after the irrigation under different volumes and head positions. The irrigation efficiency of the rinse bottle or the pulsatile device was volume dependent, with the highest irrigation efficiency under 240ml water. When the left sinonasal cavity was irrigated, the head position of tilt 45° forward with leaning 30° to the right was the optimal head position for these two devices when compared to other positions. The pulsatile device with 240ml water performed better than the rinse bottle with 240ml water regarding the irrigation efficiency under the optimal head position (0.8700 ± 0.0138 vs 0.7536 ± 0.0099, p = 0.003). The developed apparatus provided a potential method for evaluating the irrigation efficiency. The head position of tilt 45° forward with leaning 30° was suitable for patients to perform the nasal irrigation.

Percutaneous closure of the persistent ductus arteriosus in adults

Persistent ductus arteriosus (PDA) is defined by the persistence of the DA beyond the first 3 months of life. Natural closure normally occurs 24 to 48 hours after birth. Discovery is rare in adulthood. This was a retrospective study of patients with PDA discovered in adulthood and who underwent percutaneous closures (PC) of PDA. Patients were collected over a period from 2009 to 2018. Eleven PC of PDA in adults were performed. The average age of discovery of PDA was 22 years. While the average age for percutaneous treatment was 25 years (18 to 33 years). There was a female predominance (9 women). All the patients were symptomatic. The circumstances of discovery of PDA were as follows: NYHA stage II dyspnea in 9 patients and bronchopulmonary infections in 2 patients. On the chest x-ray, 4 patients had cardiomegaly. On ECG, 10 patients had a left axis. Six patients had electrical LVH. On TTE, the left cavities were dilated in 10 patients. The pulmonary artery (PA) was dilated in 3 patients. LVEF was preserved in 100% of cases. At the TTE the averaged channel diameter was 5.2 mm (from 3 to 8 mm). The maximum average gradient between the aorta and the PA was 78.6 mmHg. The average SPAP was 32.5 mmHg. There were 4 patients who had PAH. No other heart disease was associated. The most common type of PDA was type A (8 patients). The average size of the prosthesis (amplatzer) put in was 8/7 mm. The 11 PDAs were closed successfully, without immediate complications. Angiographic and TTE in the KT room showed minimal residual shunt in 4 patients, and eliminated an aortic and pulmonary obstacle. In the short-term (3 months), all patients were asymptomatic. On TTE LV measurements normalized, SPAP were normal, all prostheses were in place, and there is no residual shunt. The duration of follow-up was 26 months. PDA is a common congenital heart disease. It can remain asymptomatic for a long time and does not appear until adulthood. PC is the treatment of choice.

SURG-09. SUCCESSFUL SAFETY AND EFFICACY OF GAMMATILE INTRACRANIAL BRACHYTHERAPY IMPLANTED DURING AWAKE CRANIOTOMY

Abstract INTRODUCTION GammaTile intracranial brachytherapy utilizing cesium-131 seeds has demonstrated encouraging safety and local control results in a single-arm precommercial study, and recently received Food and Drug Administration clearance. The authors report the first case of GammaTile intraoperative brachytherapy performed during an awake craniotomy. METHODS A 50-year-old man suffered a generalized tonic-clonic seizure while a vehicle passenger. MRI revealed a 2.8 cm left lateral frontal lesion nearing his Broca’s area. Open brain biopsy revealed IDH-wildtype MGMT unmethylated GBM. Unfortunately, despite several interventions (awake craniotomy, adjuvant chemoradiation with temozolomide, Avastin, tumor treating fields) he suffered tumor progression near the left parietal resection cavity. Due to the location of this tumor, re-resection was planned with awake craniotomy and language mapping. A preoperative planning session involving Radiation Oncology and Neurosurgery identified the area of the expected postoperative bed, and consequently five GammaTiles were ordered, each containing 4 cesium-131 3.5 U seeds. RESULTS During surgery, once the tumor was mapped, bipolar stimulation was performed while the patient spoke in complete sentences until going into speech arrest on the posterior edge of the gyrus, indicative of language cortex. Following this mapping, microsurgical maximal safe resection occurred, after which areas at risk for tumor residual/recurrence were determined in consultation with Radiation Oncology. Subsequently, Neurosurgery placed all five GammaTiles (20 cesium-131 seeds total) in customized forward fashion to optimally cover the dosimetric needs of these areas. Following GammaTile placement, closure was completed and radioactive surveys of the room remained within state statue. Postoperative dosimetry yielded excellent coverage, and speech function was maintained. CONCLUSIONS The first reported case of GammaTile intraoperative brachytherapy during awake craniotomy supports the safety and feasibility of this treatment strategy. This case indicates that for patients with tumors adjacent to eloquent cortex, awake craniotomy can allow for maximum safe resection and implantation of intraoperative brachytherapy.

Excision of an Occult, Obstructed Hemivagina Under Laparoscopic Ultrasound Guidance in a Patient with Ohvira Syndrome

<h3>Study Objective</h3> To demonstrate the use of laparoscopic ultrasound guidance for identification and excision of an oblique vaginal septum in a patient with a congenital uterine anomaly. <h3>Design</h3> Case presentation. <h3>Setting</h3> Academic-affiliated tertiary care center. <h3>Patients or Participants</h3> A 27-year-old P0000 who presented to an outside facility with 7 months of abnormal uterine bleeding, pelvic pain, and increased vaginal discharge. A complex left adnexal mass was seen on ultrasound. The patient was taken to the OR and found to have a uterine didelphys, pelvic wall adhesions, and a 3cm left ovarian cyst. Three months later, when the patient had persistent LLQ pain, MRI demonstrated presence of a double cervix, obstructed and dilated left hemivagina, and left renal agenesis. Referral to a tertiary center was made for further evaluation. <h3>Interventions</h3> At the tertiary center, diagnostic hysteroscopy through the single visible cervix demonstrated a right uterine cavity and ostium. Transvaginal ultrasound did not identify the hematocolpos in a way that aided surgical exploration. During diagnostic laparoscopy, a BK 4-way 10mm OD articulated laparoscopic ultrasound transducer (I12C4F) was attached to the BK 5000 imaging system. The transducer was directed toward the pelvic floor revealing the minimally dilated hematocolpos allowing for image-guided positioning of a needle and injection of sterile water making the mass adequately tense to allow easy identification via the vagina. A portion of the oblique vaginal septum was removed, the opening was secured with interrupted absorbable sutures, and hysteroscopy was performed on the left side through the exposed left cervix demonstrating a left uterine cavity and ostium. <h3>Measurements and Main Results</h3> The patient did well postoperatively. Both cervices were readily seen and the area of resection healed appropriately. No further interventions anticipated. <h3>Conclusion</h3> This video demonstrates the utility of laparoscopic ultrasound to assist with the management of selected Müllerian anomalies, particularly when important features may not be palpable or visible vaginally, hysteroscopically, or laparoscopically.

Remodeling Process in the Right and Left Atria and Ventricles Following Percutaneous Closure of the Atrial Septal Defect in Children and Adolescents: A Mid-term Study

Background: Atrial septal defect and its closure can lead to changes in the right and left cardiac cavities' function and size. In this study, Z-scores of the cardiac chambers and the heart function were assessed, and the important complications were mentioned. Methods: This interventional cross-sectional study was done on patients who had atrial septal defect closure aged younger than 18 years. All patients were recruited for transthoracic echocardiography. About half of the patients were randomly selected. The information of angiography and its side effects belong to all patients, but the echocardiographic parameters and Z-scores belong only to the selected group. Results: A total of 370 patients underwent the atrial septal defect closure, of whom 150 patients participated in the study. The patients' average age and weight were 9.25 ± 3.44 years and 15.12 ± 11.83 kg, respectively, and the mean follow-up time was 2.56 years. Z-scores of the interventricular septal dimension in diastole, the left ventricular posterior wall dimension in diastole, the left ventricular internal dimension in systole, and Z-scores of the size of the right atrium, right ventricle, pulmonary valve annulus, and the main pulmonary artery were more than Z-scores of the normal population. Furthermore, Z-scores of the E/A and the Eat/Aat of the tricuspid valve were less than their peers. Besides, the correlation between Z-scores and the atrial septal defect size and weight of the patients was assessed, which was statistically significant, and patients who underwent atrial special defect closure at the age of fewer than three years and less than 15 kg had more normal cardiac Z-scores. Conclusions: Z-scores of the cardiac chambers and pulmonary artery were more than normal after successful closure of the atrial septal defect in the mid-term follow-up.

Safety and efficacy of GammaTile intracranial brachytherapy implanted during awake craniotomy

GammaTile intracranial brachytherapy (cesium-131 seeds) has demonstrated encouraging safety and local control results, and recently received Food and Drug Administration clearance for newly diagnosed and recurrent brain tumors. The authors present the first reported case of GammaTile intraoperative brachytherapy performed during an awake craniotomy. A 50-year-old man had a biopsy-proven, 2.8 cm left lateral frontal glioblastoma lesion nearing Broca's area on MRI. Despite several interventions (craniotomy, adjuvant chemoradiation, tumor treating fields) tumor progression occurred near the left parietal resection cavity. Re-resection was planned with awake craniotomy and language mapping. A preoperative planning session involving Radiation Oncology and Neurosurgery identified the area of the expected postoperative bed, and consequently five GammaTiles were ordered, each containing 4 cesium-131 3.5 U seeds. During surgery, tumor mapping and bipolar stimulation were performed while the patient spoke in complete sentences. Speech arrest occurred upon stimulation at the posterior edge of the gyrus, indicative of language cortex. Microsurgical maximal safe resection subsequently occurred, and areas at risk for residual/recurrence disease were determined in consultation with Radiation Oncology. Subsequently, Neurosurgery placed all five GammaTiles (20 cesium-131 seeds total) after which closure was completed and radioactive surveys of the room remained within state statue. Postoperative dosimetry yielded excellent coverage. The first reported case of GammaTile intraoperative brachytherapy during awake craniotomy supports the safety and feasibility of this treatment strategy. This case indicates that for patients with tumors adjacent to eloquent cortex, awake craniotomy can allow for custom implantation of intraoperative brachytherapy following maximum safe resection.

Photothermally induced transparency in coupled-cavity system

We aim to study the properties of the output probe field (OPF) in a system composed of two coupled-optical cavities. A strong pump and a weak probe field drives the left cavity whereas the right-side cavity is coupled to mechanical oscillation via photothermal effect. The two cavities are coupled with optical coupling strength J. Single photothermally induced transparency (PTIT) in a single cavity is realized via thermal effect (2020, Sci. Adv. 6, eaax8256). Following the idea, we report double PTIT in coupled-cavities system. The control of single to double PTIT is realized in the proposed system by properly adjusting the coupling strength J. We further show the enhancement of slow light by adjusting the coupling strength (J) between the cavities. Our proposed scheme facilitates experiments to investigate photothermal effects in an array of optomechanical systems.

Sudden death after being in a bounce house: a late complication of congenital diaphragmatic hernia.

A 3-year-old white female with no significant past medical history was found unresponsive and apneic after several hours of vomiting. The patient had reportedly felt unwell since jumping in a bounce house at a festival earlier in the day. After one hour of attempted resuscitation by EMS and hospital staff, the patient was pronounced deceased. On autopsy there was a 3 cm opening in the left posterolateral hemidiaphragm with the spleen, the stomach, and portions of the small and large bowel displaced into the left chest cavity, resulting in compression of both lungs and the heart to the right side of the chest. The right lung weighed 295g while the left lung weighed 73g. Histologic examination revealed atelectasis in the left lung and congestion in the right lung, the spleen, the stomach, and the bowel. The cause of death was ultimately ruled to be respiratory compromise and associated gastrointestinal complications due to diaphragmatic herniation of abdominal contents into the chest cavity. It is hypothesized that herniation occurred in this case secondary to increased intra-abdominal pressure from jumping in a bounce house, an etiology that we were unable to find elsewhere despite a thorough literature search.

Rupture colmatée d'un anévrisme de valsalva d’évolution favorable après chirurgie

Aneurysm of the sinus of Valsalva is a rare cardiac condition, which could be either acquired or congenital. The most frequent complication is a rupture into right cavities or more rarely into left cavities or pericardium.Rupture could be either asymptomatic or poorly tolerated with hemodynamic instability, acute heart failure or sudden death.We report the case of a 24-year-old patient with no past medical history presenting with a partially ruptured sinus of Valsalva into the pericardium and in whom the initial diagnosis was idiopathic pericardial effusion; we describe diagnostic modalities and management

Inhalation and deposition of spherical and pollen particles after middle turbinate resection in a human nasal cavity

Middle turbinate resection significantly alters the anatomy and redistributes the inhaled air. The superior half of the main nasal cavity is opened up, increasing accessibility to the region. This is expected to increase inhalation dosimetry to the region during exposure to airborne particles. This study investigated the influence of middle turbinate resection on the deposition of inhaled pollutants that cover spherical and non-spherical particles (e.g. pollen). A computational model of the nasal cavity from CT scans, and its corresponding post-operative model with virtual surgery performed was created. Two constant flow rates of 5 L/min, and 15 L/min were simulated under a laminar flow field. Inhaled particles including pollen (non-spherical), and a spherical particle with reference density of 1000 kg/m3 were introduced in the surrounding atmosphere. The effect of surgery was most prominent in the less patent cavity side, since the change in anatomy was proportionally greater relative to the original airway space. The left cavity produced an increase in particle deposition at a flow rate of 15 L/min. The main particle deposition mechanisms were inertial impaction, and to a lesser degree gravitational sedimentation. The results are expected to provide insight into inhalation efficiency of different aerosol types, and the likelihood of deposition in different nasal cavity surfaces.

Cardiovascular phenotypes predict clinical outcomes in sickle cell disease: An echocardiography-based cluster analysis.

This study sought to link cardiac phenotypes in homozygous Sickle Cell Disease (SCD) patients with clinical profiles and outcomes using cluster analysis. We analyzed data of 379 patients included in the French Etendard Cohort. A cluster analyses was performed based on echocardiographic variables, and the association between clusters, clinical profiles and outcomes was assessed. Three clusters were identified. Cluster 1 (n=123) patients had the lowest cardiac output, mild left cardiac cavities remodeling, mild diastolic dysfunction, and higher tricuspid regurgitation velocity (TRV). They were predominantly female and displayed the most altered functional limitation. Cluster 2 (n=102) patients had the highest cardiac output and the most remodeled cardiac cavities. Diastolic function and TRV were similar to cluster 1. These patients had a higher blood pressure and a severe hemolytic anemia. Cluster 3 (n=154) patients had mild left cardiac cavities remodeling, normal diastolic function and lowest TRV values. They were younger with the highest hemoglobin value. Right heart catheterization was performed in 94 patients. Cluster 1 (n=33) included the majority of pre-capillary PH whilst cluster 2 (n=34) included post-capillary PH. No PH was found in cluster 3 (n=27). After a follow-up of 11.4 ± 2 years, death occurred in 41 patients (11%). Cluster 2 patients had the worst prognosis with a 19% mortality rate versus 12% in cluster 1 and 5% in cluster 3 (p log-rank=0.003). Cluster analysis of echocardiography variables identified three hemodynamic and clinical phenotypes among SCD patients, each predicting a different prognosis.

CLINICAL FEATURES OF THE REHABILITATION PERIOD AFTER THE PREVIOS MYOCARDIAL INFARCTION AND DECOMPENSATED HEART FAILURE WITH ACCOUNT OF CARDIOVASCULAR RISK FACTORS

Cardiovascular diseases (CVD) are known to account for one-third of all deaths worldwide. According to the American Heart Association, 18% of men and 35% of women with prior acute myocardial infarction (AMI) developed recurrent AMI within 6 years after initial MI; 22% of men and 46% of women were disabled due to the development of chronic heart failure (CHF).&#x0D; The purpose of the research: to analyse clinical features of recovering period after myocardial infarction taking into account cardiovascular risk factors.&#x0D; Materials and methods of the research. 175 persons with myocardial infarction and related risk factors were examined. Study groups were homogenous by age, gender, disease severity, clinical signs of decompensation, that served as a basis for inclusion of the patients in the research.&#x0D; All patients underwent the general-clinical examination (pain syndrome analysis, medical history, objective signs), clinical and instrumental (electrocardiography, echocardioscopy, 6-minute walk test, in a quiet 30-50-m long hospital corridor in the morning) and laboratory tests (lipidogram, leptin level). Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation. All patients were divided into groups according to the presence of risk factors: group 1 of MI with HF (74 patients), group 2 – MI with AH (76 patients), group 3 – MI and obesity (72 patients); group 4 consisted of patients with all risk factors (78 patients) together. The obtained results were statistically processed on the personal computer by means of an advanced analytics software package STATISTICA-7 and a statistical software package “Microsoft-Excel” using the statistical variation analysis.&#x0D; Research results and their discussion. The most important cardiovascular risk factors, which aggravate the post infarction period are age, arterial hypertension, diabetes mellitus, heart failure, congenital and acquired valvular defects, obesity. In patients with heart failure, recovering period is characterized by stabile heartbeat, reduced exercise tolerance combined with progressing dilatation of left ventricular chambers in 83.78% of patients. Patients with arterial hypertension have stable anginal pain syndrome and reduced exercise tolerance (89.47% of cases). In obese patients, consistent fatigue, general weakness, dyspnoea, high levels of total cholesterol and leptin in blood serum (81.94% of patients) are mostly observed. In patients with combined heart failure, arterial hypertension, obesity, the recovery period clinics after myocardial infarction is characterized by significantly reduce of exercise tolerance (92.30% of patients). Shortness of breath, which was accompanied by heart palpitations, was prevalent in the group of patients with HF (89.1%) and was the least manifested in the group of patients with obesity (52.7%).&#x0D; Conclusions. Changes in cardiac hemodynamics in patients who had undergone the myocardial infarction with concomitant heart failure and with a combination of risk factors were accompanied by the eccentric hypertrophy onset, characterized by a combination of the left venricle cavities dilation with hypertrophy of its walls and the decreased contractility. The presence of decompensated heart failure significantly degrades the performance of six-minute walk test.

Abstract 422: Sequential targeted therapy and immunotherapy of a BRAF positive metastatic melanoma patient with BRAF inhibitor vemurafenib, MEK inhibitor cobimetnib and a novel PD-1 antibody Sintilimab

Abstract Targeted therapy has dramatically improved the outcome of BRAF mutated melanoma patients. However, its response is usually brisk and lacks the durability of immunotherapy. Decisions about targeted therapy alone, immunotherapy alone, targeted therapy/immunotherapy combination or immunotherapy after targeted therapy require an oncologist to comprehensively evaluate multiple clinical factors. Here we report the sequential treatment of a BRAF positive metastatic melanoma patient with non-standard regimes due to practical reasons. A 75-year old male patient presented a black cauliflower-like mass on back and bilateral axillary lymph nodes enlargement. Postoperative pathologic examination confirmed a nodular malignant melanoma of 1.6 cm in diameter and 0.7 cm thick. NGS sequencing of the tumor revealed the canonical BRAF V600E mutation. As vemurafenib was the only approved melanoma targeted therapy drug in China at the time of diagnosis, it was administered (960 mg bid) as first-line therapy since September 2019 and the patient's response was confirmed by the significant reduction and softening of the left axillary node. One month later the node rapidly enlarged to 15 cm, and the blood scab fell off followed by pulsatile massive hemorrhage (~1000 mL). We performed an emergent angiograph and a transarterial embolization (TAE), aimed at selectively occluding the tumor artery by using gelatin sponge particle and coils. The hemorrhage was significantly reduced after TAE therapy and a left axillary residual cavity was formed. When the patient presented a progression of lymph node metastases, BRAF/MEK inhibitor combination was selected as the second-line therapy from December 2019. He received vemurafenib at a dose of 480 mg bid combined with cobimetinib 60mg qd (3 consecutive weeks every 28 days), the treatment was ongoing till disease progression in April 2020. Immunohistochemical analysis of the biopsy specimen demonstrated PD-L1 expression in 4% of tumor cells and immunotherapy was chosen as the third-line therapy. Sintilimab, a PD-1 antibody approved in China for the treatment of classical Hodgkin lymphoma, is undergoing clincial trials for multiple solid tumors including melanoma. Given the high cost of immunotherapy and the fact that Sintilimab is the only PD-1 inhibitor included in China's National Reimbursement Drug List, the patient started off-label use of Sintilimab and achieved partial response. In summary, our patient had an unconventional timeline of multiple therapies including surgery, TAE, targeted therapy and immunotherapy. His case demonstrated that meaningful clinical responses can be achieved with sequential targeted therapy/immunotherapy in BRAF-mutated metastatic melanoma and the novel PD-1 antibody Sintilimab is worth further investigation for its efficacy in metastatic melanoma. Citation Format: Yu Zhang, Xiaomo Li, Tonghui Ma, Baoshan Cao. Sequential targeted therapy and immunotherapy of a BRAF positive metastatic melanoma patient with BRAF inhibitor vemurafenib, MEK inhibitor cobimetnib and a novel PD-1 antibody Sintilimab [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 422.

Клинические особенности тубоовариальных образований в препубертатном периоде (на примере клинического случая)

Aim. To analyze the clinical features of subacute purulent salpingoophoritis, saktosalpinx, pyovar in a 9-year-old girl. Materials and methods. A retrospective analysis of the medical history of a patient born in 2001, who was treated in the gynecological department of the Novourengoy Central City Hospital, was carried out. Results. The article presents complaints, anamnesis of the disease and life, the results of a clinical, laboratory, and instrumental study of a 9-year-old girl who was admitted to the hospital in an emergency with a diagnosis of Tuboovarial formation of the left appendages. Mild anemia. According to urgent indications, diagnostic laparoscopy, ovariosalpingoviscerolysis on the left, salpingectomy on the left, drainage of the piovar on the left, and sanitation of the left ovarian cavity were performed. Postoperative diagnosis: Subacute purulent salpingoophoritis with the formation of sactosalpinx. Piovar on the left. Adhesive process of the small pelvis of the first degree. The analysis of the clinical features of the course of the disease, possible pathogenetic mechanisms of its development was carried out. Conclusion. The clinical picture of tubovarial formations in the prepubertal period can be characterized by an erased course and inconsistency of the clinical picture of the disease with the severity of the purulent-inflammatory process in the uterine appendages, which must be taken into account when conducting a diagnostic examination.

Heart damage in patients with cirrhosis of the liver

The review outlines the current understanding of the clinical syndrome of heart disease in patients with liver cirrhosis and the development of cirrhotic cardiomyopathy. Patients with cirrhosis of the liver often notice chest pain, palpitations, complaints of arterial hypotension and rapid fatigue. Echocardiography shows that the left ventricular ejection fraction in cirrhosis is preserved at rest and decreases under stress. In some patients with viral liver cirrhosis, there is a decrease in global myocardial deformation (the presence of latent systolic dysfunction). More pronounced impairment of left ventricular diastolic function is recorded in patients with ascites and patients with ChildPugh class B and C. In patients with ascites, unfavorable left ventricular remodeling, left heart cavities enlargement, dilatation of the pulmonary artery and its branches are more common. There is an increase in pulmonary artery pressure, the development of portopulmonary hypertension and hepatopulmonary syndrome in patients with liver cirrhosis. Тhe development of these syndromes leads to a sharp decrease in the quality of life of patients with relatively preserved liver function and a worsening of the prognosis for orthotopic liver transplantation. Аpproximately half of patients with liver cirrhosis have electrophysiological disorders: prolongation of the QT interval, tachycardia, supraventricular and ventricular extrasystoles. To date, there are no clinical guidelines for the management of cirrhotic cardiomyopathy. If a patient with liver cirrhosis develops clinically significant heart failure, then general principles of management of such patients are necessary. It is necessary to limit the use of angiotensin-converting enzyme inhibitors and cardiac glycosides. The combined use of nonselective beta-blockers and nitrates reduce cardiac output and QT interval. The use of potassium canrenoate, lisinopril helps reverse the development of structural and functional changes in left ventricle. The positive effect of antiviral therapy on cardiac hemodynamics in patients with viral cirrhosis was noted. Liver transplantation is known to be an effective treatment for cirrhotic cardiomyopathy, but this treatment may worsen latent heart failure. Thus, in patients with liver cirrhosis, heart damage occurs with the development of cirrhotic cardiomyopathy, while the mechanisms of the development of myocardial dysfunction are not fully understood. Further studies of the development of the syndrome are required for timely diagnosis and clinical intervention to improve the survival of patients.

Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

BackgroundSpontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations.Case presentationWe report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.ConclusionsSpontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.

Block-like and cast-like hyperdense areas in the right heart cavities on post-mortem CT strongly suggest the presence of intracardiac blood clots at autopsy.

To classify the types of hyperdense areas in the heart cavities on post-mortem CT (PMCT) and compare them according to the presence of blood clots in the heart cavities at forensic autopsy. One hundred and twelve cases with CT images taken before forensic autopsy were evaluated. The presence and shape of hyperdense areas in the right or left heart cavities were retrospectively evaluated on PMCT images and were classified into four types (block-like, cast-like, fluid level-like, and unclear). The presence of blood clots was confirmed when there were clots in the heart cavities at forensic autopsy. Of the 112 cases, 57 exhibited blood clots in the heart cavities at forensic autopsy. The hyperdense areas in the right heart cavities on PMCT in 57 cases exhibiting blood clots at forensic autopsy were classified as follows: block-like, 32; fluid level-like, 4; cast-like, 17; and unclear, 4. The sensitivity of block-like and cast-like hyperdense areas in the right heart cavities on PMCT for the presence of clots in the heart cavities at forensic autopsy was 86% (95% confidence interval [CI]: 74-94%); the corresponding specificity, PPV, and NPV were 95% (95% CI: 85-99%), 94% (95% CI: 84-99%), and 87% (95% CI: 75-94%), respectively. Block-like and cast-like hyperdense areas in the right heart cavities on PMCT predicted the presence of intracardiac blood clots at forensic autopsy. • Clinical radiologists likely have no experience of interpreting findings of blood clots on post-mortem CT (PMCT). • The appearance of blood clots on PMCT provides important clues for diagnosing the cause and process of death. • The shapes of the hyperdense areas in the heart cavities were classified into four types, and two of these types could be used to predict the presence of blood clots in the heart cavities at forensic autopsy.

Cathepsin-B involved in effect of electroacupuncture by inhibiting the activation of NLRP3 inflammasome in rats with acute gouty arthritis

To observe the effect of electroacupuncture (EA) on Cathepsin-B in the synovium of the knee joint of acute gouty arthritis(AGA) rats, so as to explore the mechanism of EA in the treatment of AGA. A total of 60 male Wistar rats were randomly divided into normal control,model, medication and EA groups, with 15 rats in each group. Rat model of AGA was established by injection of 0.2 mL sodium urate crystal suspension into the left knee joint cavity. The rats in the medication group were treated with colchicine by gavage(0.3 mg·kg-1·d-1), and the rats in the EA group were treated with EA at the left "Sanyinjiao" (SP6) and "Zusanli"(ST36) for 10 min each time, once a day for a week. The Coderre gait grading standard was used to score the gait of rats. The pathological morphology of synovial tissue of the left knee joint was observed by H.E. staining. The expression levels of Cathepsin-B protein and Nod-like receptor pyrin domain 3(NLRP3), apoptosis-associated speck-like protein containing CARD (ASC),Caspase-1, interleukin-1β(IL-1β) and IL-18 mRNAs were detected by Western blot and real-time fluorescence quantitative PCR, respectively. Compared with the normal control group, the degree of synovitis infiltration in the model group was more serious. And the gait score，the protein expression level of Cathepsin-B and the mRNA expression levels of NLRP3,ASC,Caspase-1, IL-1β,IL-18 were significantly increased (P<0.01).After the interventions, the degree of inflammatory infiltration was mild, The gait score, the protein expression level of Cathepsin-B and the mRNA expression levels of NLRP3 and ASC,Caspase-1，IL-1β,IL-18 were significantly decreased in both medication and EA groups in contrast to the model group (P<0.01, P<0.05). Compared with medication group, the mRNA expression levels of Caspase-1 and IL-18 in the EA group were increased (P<0.05). EA may inhibit the activation of NLRP3 inflammasome by reducing the activity of Cathepsin-B in the synovium of the knee joint, so as to treat AGA.