Local Thickening Research Articles

Total Hip Arthroplasty in Hip Osteoarthritis with Subtrochanteric Localized Periosteal Thickening: Preoperative Planning Using Finite Element Analysis to Determine the Optimal Stem Length

Background: Owing to the risk of atypical femoral fractures, total hip arthroplasty presents unique challenges for patients with ipsilateral osteoarthritis and localized periosteal thickening in the femoral subtrochanteric region. Stem length selection is critical for minimizing stress concentration in the thickened cortex to avoid such fractures. Herein, we report the case of a 78-year-old woman with ipsilateral hip osteoarthritis and localized subtrochanteric periosteal thickening. Methods: Preoperative planning included a finite element analysis to assess the stress distribution across various stem lengths. A simulation was conducted to determine the optimal stem length to span the cortical thickening and reduce the risk of postoperative complications. Results: The finite element analysis indicated that a stem length of >150 mm was required to effectively reduce the stress at the site of cortical thickening. A 175 mm stem was selected for total hip arthroplasty, which provided a favorable stress distribution and avoided the risk of stress concentration. Conclusions: In cases of ipsilateral osteoarthritis with localized subtrochanteric periosteal thickening, finite element analysis can be valuable for preoperative planning to determine the optimal stem length, thereby reducing the risk of atypical femoral fractures. Further studies with multiple cases are recommended to validate these findings and improve surgical outcomes.

Expansion of a hole in a thin plate considering arbitrary smooth pressure-independent yield criterion and work-hardening law

A solution for arbitrary smooth pressure-independent yield criterion and work-hardening law is obtained for the expansion of a hole in an initially uniform infinite plate under plane stress conditions. It is then specialized to widely used yield criteria and work-hardening laws. It is shown that both yield criterion and work-hardening law affect the qualitative behavior of the solution, especially near the hole's surface. In particular, local thickening or thinning may occur there. It is due to the fact that the thickness and yield stress contribute to sustaining the pressure applied to the hole's surface. Therefore, the higher hardening rate requires a smaller thickness. A criterion for the solution's validity applies, and a procedure for using this criterion is developed. Numerical examples illustrate the solution for von Mises and Hosford's yield criteria and Swift's and Voce's hardening laws.

Coupled crystal plasticity-phase field simulation of twin-twin interaction in magnesium

Twin-twin interactions significantly influence the mechanical properties of magnesium and its alloys. A thorough understanding of the underlying mechanisms governing these interactions is essential for designing Mg alloys with enhanced strength and toughness. In this work, a crystal plasticity-twin coupled phase field (CP-TPF) model incorporating multiple extension twin variants and considering the role of dislocation slipping is proposed to investigate the interactions between/among the same twin variants and those between co-zone twin variants in Mg single crystals. The model incorporates an additional energy term to represent the interaction among different twin variants and couples the CP and TPF models through order parameters and stress tensor. The simulated results show that the interaction between the same twin variants can either promote or inhibit the twin propagation, and multiple twins tend to generate concurrently in Mg single crystal to minimize the free energy associated with the accumulation of elastic strain. During co-zone twin-twin interaction, localized thickening of the recipient twin occurs due to the concentrated stresses induced by the intrusion twin, and the mutual extrusion of the two twins leads to blunting of the intrusion twin tip. Both the coalescence of the same twin variants and the formation of twin-twin boundaries between the co-zone twin variants contribute to the effective mechanism of twinning-induced hardening. Moreover, local dislocation accommodation plays a crucial role in twin-twin interactions. It relaxes the stress concentration near the twin tips and twin-twin boundaries and significantly contributes to the uneven migration of the twin boundary.

A novel Osteoarthritis scoring system to separate typical OA joint degeneration from non-typical lesions in male Sprague Dawley rats

ObjectiveTo develop a novel scoring system to characterize osteoarthritis-related degeneration distinct from spontaneous subchondral bone lesions observed in the tibia and femur of male Sprague Dawley rats. MethodKnee joints from male rats following 12 weeks of a diet-induced obesity model of osteoarthritis (OA) were assessed. OA histopathological changes (OAHC) were assessed in the knee joints. All scores were evaluated using a modified Mankin score and a modified Osteoarthritis Research Society International histological score. OAHC were divided into 3 categories: (I) Typical OA score evaluating the changes in cartilage structure, cellularity, proteoglycan depletion, and tidemark integrity, (II) A novel Non-typical OA score evaluating cartilage integrity, and the size of local thickening, fragmentation and degeneration along the tidemark and the size and severity of the subchondral bone lesion, and (III) Total OA score comprised of both, the Typical and the Non-typical scores. ResultsRats exposed to a high fat/high sucrose diet had higher Typical OA score compared to a control group (Chow). Non-typical and Total OA scores revealed no differences in the severity of the lesions between the HFS and the Chow group animals. All scoring systems had excellent intra- and inter-examiner reliability. ConclusionThe spontaneous bone lesions observed in male Sprague Dawley rats can obscure the effect of the diet-induced obesity if the classical scoring system is used to assess joint degeneration. The newly proposed scoring method provides a reliable method to distinguish classical OA joint degeneration from spontaneous Non-typical lesions occurring in these rats.

Obesity and atherosclerosis in children

<p>Atherosclerosis, one of the leading causes of death in developed countries is characterized by lumen reduction of blood vessels due to local thickening of internal blood vessels caused by plaque/atheroma. It begins in childhood, goes for a long time without manifesting symptoms, increasing with age it begins to seriously threaten health. The most important risk factors for the development of atherosclerotic disease are: hyperlipidemia, hypertension, smoking, diabetes, high fibrinogen, excessive weight, increased level of homocysteine, physical inactivity, heredity and immune response in some diseases. The primary intention of prevention is to preclude the occurrence of risk factors for atherosclerosis, and the secondary is to prevent the development or aggravation of the illness along with the reduction or control of existing risks. There is an increasing number of studies that show that children are overweight, which in adolescence is certainly a risk factor for the onset of many chronic diseases, namely: cardiovascular, type 2 diabetes, orthopedic, and psychological diseases. The obesity epidemic is one of the most serious health problems of today affecting individuals of all ages. Atherosclerosis demands action with the aim of early detection and treatment as well as the reduction of development of risk factors for coronary artery diseases. Finding the most effective preventive measures for obesity in each country requires precise epidemiological data on the number of obese children and youth, as well as on their eating and activity habits.</p>

A Dynamic Thickening Strategy for High-Fidelity CFD Analyses of Multi-Regime Combustion

Abstract In this study, a dynamic thickening strategy for DTFLES application to multi-regime combustion is proposed. The main idea lies in using the numerical solution of an Ordinary Differential Equation (ODE) as a thickening factor. The equation relates the time derivative of the local thickening factor to its production and destruction rates, which are proportional to the gap between the instantaneous value and optimal target values. The smoothness of the thickening factor in time is ensured by the ODE solution, while in space it is achieved through a mathematical function defined in a continuous flame index space. The equation is numerically integrated with a semi-implicit scheme by making use of the backward Euler formula. The strategy has been implemented in a commercial Computational Fluid Dynamics (CFD) solver and it has been tested by performing Large Eddy Simulations of the hydrogen/air flame produced by the HYLON injector, which has been individuated as an interesting test case for the proposed dynamic strategy. Turbulence-chemistry interactions are recovered by means of a well-assessed subgrid efficiency model. Numerical results are compared with the experimental ones obtained at Institut de Mécanique des Fluides de Toulouse (IMFT).

Effect of micron/nano Nb particles on high-temperature oxidation behavior of TiAl alloy/thermal barrier coating system

In this study, the effect of NiCoCrAlY bond coating modified by micron- and nano-sized Nb particles on the oxidation behavior of a TiAl alloy/thermal barrier coating (TBC) system was investigated. The results show that the addition of micron-sized Nb particles slightly decreased the oxidation resistance of the TNM/TBC system, while the addition of nano-sized Nb particles significantly increased the oxidation resistance. The growth stress from the oxidation of micron-sized Nb particles and the Kirkendall effect lead to localized thickening (tumor effect) of the thermally grown oxide (TGO). Severe internal oxidation occurs in the bond coating modified by micron-sized Nb particles, greatly reducing the mechanical properties and antioxidant properties of the TNM/TBC system. However, these micron-sized Nb particles are deposited at the bond coating/TiAl matrix interface, acting as an in-situ diffusion barrier and partially hindering element interdiffusion. Conversely, nano-sized Nb particles induce the formation of fine columnar crystals in the TGO and promote the external diffusion of Al elements, thereby maintaining a low growth rate and excellent continuity of the TGO. Additionally, the Nb element dissolves into the matrix phase, and the formation of nano Nb-Al₂O₃ core-shell structures effectively improves the deformation resistance and failure resistance of the bond coating.

Coronary periarteritis and pericarditis are rare but distinct manifestations of heart involvement in IgG4-related disease: a retrospective cohort study

BackgroundThe heart can be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to summarize the clinical features and efficacy of treatment for IgG4-RD patients with heart involvement.MethodsWe conducted a retrospective study enrolling 42 IgG4-RD patients with heart involvement from the IgG4-RD cohorts of the Peking Union Medical College Hospital and Beijing An Zhen Hospital, from 2010 to 2022. Clinical, laboratory, radiological data were collected, and treatment responses to glucocorticoids and immunosuppressants were analyzed.ResultsIgG4-related cardiac involvement is a rare part of the IgG4-RD spectrum. The incidences of coronary periarteritis and pericarditis were 1.2%(13/1075) and 3.1%(33/1075), respectively in our cohort. Valvular disease possibly related to IgG4-RD was detected in two patients. None of the patients with myocardial involvement were identified. The average age was 58.2 ± 12.8 years, with a male predominance (76.7%). Coronary artery CT revealed that mass-like and diffuse wall-thickening lesions were the most frequently observed type of coronary periarteritis. Pericarditis presented as pericardial effusion, localized thickening, calcification and mass. After treatment with glucocorticoid and immunosuppressants, all patients achieved a reduced IgG4-RD responder index score and achieved radiological remission. Two patients with coronary peri-arteritis experienced clinical relapses during the maintenance period.ConclusionsCardiac involvement in IgG4-RD is rare and easily overlooked since many patients are asymptomatic, and the diagnosis relies on imaging. Patients showed a satisfactory response to glucocorticoid based treatment.

Incidence and clinical course of femoral localized periosteal thickening and atypical femoral fracture over a 10-year period in patients with autoimmune inflammatory rheumatic disease.

Atypical femoral fracture (AFF) is generally a rare complication of long-term use of bisphosphonate (BP); glucocorticoid (GC) use and Asian race are also risk factors. Femoral localized periosteal thickening (LPT, also termed "beaking") of the lateral cortex often precedes AFF. This cohort study investigated the incidence of LPT and AFF and their clinical courses over 10yr in patients with autoimmune inflammatory rheumatic diseases (AIRDs) treated with BP and GC. The study population consisted of 121 patients with AIRDs taking BP and GC. LPT was screened by X-ray, and the LPT shape was evaluated. Prednisolone (PSL) dose was 10 (8-12) mg/d at enrollment and 9 (6-10) mg/d at the last observation. LPT was evident in 10 patients at enrollment and increased linearly to 31 patients (26%) at the last observation. AFF occurred in 9 femurs of 5 patients with LPT. All patients with AFF had bilateral LPT, and the prevalence of pointed type and LPT height were higher in the AFF-positive group than in the AFF-negative group. AFF occurred before BP discontinuation in 2 patients, 1yr after BP discontinuation in 1, after BP discontinuation followed by 7yr of alfacalcidol use in 1, and after switching from alfacalcidol to denosumab in 1. The prevalence rates of AFF and LPT associated with long-term BP use with concomitant use of GC (mostly PSL ≥ 6mg/d) in Japanese patients with AIRD increased over time. The selection of long-term osteoporosis treatment for LPT-positive patients is difficult in some cases.

Progress of Clinical Research on the Treatment of Chronic Eczema by Chinese Medicine

Chronic eczema is a common skin disease, which can occur in any part of the body, patients often consciously itch intensely, the skin appears to be local thickening, mossy changes and other manifestations, and is easy to recur, which seriously affects the patient's mental health and quality of life. Chinese medicine has a long history and rich experience in the treatment of chronic eczema. This paper summarises the progress of Chinese medicine clinical research in the treatment of chronic eczema, with a view to providing clinical reference.

Ultrasound semiotics of solitary rectal ulcer

AIM: to develop ultrasound semiotics of solitary rectal ulcer (SRU).PATIENTS AND METHODS: fifty-eight patients with a histologically verified SRU were included in the retrospective study. All patients underwent colonoscopy and transrectal ultrasound (TRUS). Changes in rectal wall detected by TRUS were compared with colonoscopy data.RESULTS: On TRUS SRU is represented by a significantly thickened rectal wall (median thickness of the rectal wall in the region of SRU is 9 (7–10) mm and 5 (4–6) mm outside, p < 0.001), most often with a predominance of muscular and submucosal layers (46/58, 79%). The structure and echogenicity of these layers are changed: the connective tissue layer is visualized in muscular layer (51/58, 88%), submucosal layer is hypoechogenic (47/58, 81%), boundaries between rectal wall layers are faded (50/58, 86%). Ulcers in SRU are characterized by presence of areas where the mucous layer cannot be traced (sensitivity 100%, specificity 95%), its extent is comparable to extent of ulcers detected on colonoscopy (p = 0.528). Polypoid SRU is characterized by local thickening of the mucosa (sensitivity 89%, specificity 95%). TRUS location of the SRU in height (p = 0.644) is comparable with colonoscopy data.CONCLUSION: the study determined general ultrasound signs of SRU and made it possible to differentiate macroscopic forms of SRU from each other with TRUS.

Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases.

Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms.MRI is the reference examination, allowingnot onlythe early diagnosis of pachymeningitisbut alsothe assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaginghad revealed the presence ofpachymeningitis.The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13cases,and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsyconductedon an individual patient revealed non-diagnostic results. The etiological investigationwas dominatedby tuberculosis, which was detectedin 33.3% of cases.Idiopathic origin was identifiedin 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.

Clinical characteristics and literature review of ectopic gastric mucosa in the small intestine

The study aims to summarize the clinical characteristics of patients with ectopic gastric mucosa in the small intestine, comparing clinical presentation differences between domestic and foreign patients through literature review. The clinical characteristics of cases diagnosed with ectopic gastric mucosa in the small intestine at Peking Union Medical College Hospital from January 2000 to January 2024 were retrospectively analyzed. By searching databanks, such as PubMed, EMBASE, the Cochrane Library, Wanfang, VIP, CNKI, and etc (the inclusion period was from the establishment of the database to January 1, 2024). The literature review was conducted on ectopic gastric mucosa in the small intestine. A total of 10 cases were included, all male, age [M (Q1, Q3)] was 27 (13-69) years old. Gastrointestinal bleeding was the first manifestation in most cases, with severe cases leading to hemorrhagic shock. Abdominal CT indicated local intestinal wall thickening and luminal narrowing in 3 cases. Four cases lesions were located at the beginning of the jejunum and 6 lesions were located in the end segment of ileum. All cases underwent local lesion resection, with postoperative pathology confirming ectopic gastric mucosa. Symptoms disappeared postoperatively, with a follow-up period of 0.5-3.0 years. Literature review indicates that the main clinical manifestation of gastric mucosa ectopia in the small intestine in China is gastrointestinal bleeding, while foreign patients are often complicated with intestinal duplication and intussusception, with abdominal pain and vomiting as the primary and main symptoms. The occurrence rate of intestinal obstruction in female patients, both domestically and abroad, is higher than that in male patients. The occurrence rate of ileal lesions with intestinal obstruction and small intestinal duplication is higher than that of duodenal lesions in both domestic and foreign patients. Local small intestine resection is an effective treatment method with generally good prognosis. Ectopic small intestinal mucosa is relatively rare, with symptoms of gastrointestinal bleeding and intestinal obstruction being common presentations, which can serve as one of the differential diagnoses for unexplained gastrointestinal bleeding.

The Impact of Radiation Therapy in Patients with Systemic Sclerosis and Head and Neck Cancer

ObjectiveSystemic sclerosis (SSc) is considered a relative, or in some cases, absolute contraindication for radiation therapy for various cancers; however, radiation is standard of care and the best option for tumor control for locally advanced head and neck (H&N) cancer. We present a case series to document the post-radiation outcomes in patients with SSc and H&N cancer. MethodsPatients with SSc and H&N cancer treated with radiation were identified from two large Scleroderma Center research registries. Through chart review, we identified whether patients developed pre-determined acute and late side effects or changes in SSc activity from radiation. We further describe therapies used to prevent and treat radiation-induced fibrosis. ResultsThirteen patients with SSc who received radiation therapy for H&N cancer were included. Five-year survival was 54%. Nine patients (69%) developed local radiation-induced skin thickening and seven (54%) developed reduced neck range of motion. Two patients required long-term percutaneous endoscopic gastrostomy use due to radiation therapy complications. No patients required respiratory support related to radiation therapy. Regarding SSc disease activity among the patients with established SSc prior to radiation therapy, none experienced interstitial lung disease progression in the post-radiation period. Following radiation, one patient had worsening skin disease outside the radiation field, however, this patient was within the first year of SSc when progressive skin disease is expected. Treatment strategies to prevent radiation fibrosis included pentoxifylline, amifostine and vitamin E, while intravenous immunoglobulin (IVIG) was used to treat it. ConclusionWhile some patients with SSc who received radiation for H&N cancer developed localized skin thickening and reduced neck range of motion, systemic flares of SSc were uncommon. This observational study provides evidence to support the use of radiation therapy for H&N cancer in patients with SSc when radiation is the best treatment option.

Spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma: a rare case

BackgroundGastric intramural hematoma is a rare disease. Here we report a case of spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma.Case presentationA 75-years-old man was admitted to our department with complaints of abdominal pain. He underwent a whole abdominal computed tomography (CT) scan in the emergency department, which showed extensive thickening of the gastric wall in the gastric body and sinus region with enlarged surrounding lymph nodes, localized thickening of the intestinal wall in the transverse colon, localized indistinct demarcation between the stomach and transverse colon, and a small amount of fluid accumulation in the abdominal cavity. Immediately afterwards, he was admitted to our department, and then we arranged a computed tomography with intravenously administered contrast agent showed a spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma. Therefore, we treated him with anticoagulation and conservative observation. During his stay in the hospital, he was given low-molecular heparin by subcutaneous injection for anticoagulation therapy, and after discharge, he was given oral anticoagulation therapy with rivaroxaban. At the follow-up of more than 4 months, most of the intramural hematoma was absorbed and became significantly smaller, and the intermural hematoma of the superior mesenteric artery was basically absorbed, which also confirmed that the intramural mass was an intramural hematoma.ConclusionA gastric intramural hematoma should be considered, when an intra-abdominal mass was found to be attached to the gastric wall. Proper recognition of gastric intramural hematoma can reduce the misdiagnosis rate of confusion with gastric cancer.

Exploring transvaginal sonographic characteristics of the levator ani muscle in women with postpartum pelvic floor myofascial pain.

Pelvic floor myofascial pain is one of the pelvic floor dysfunction diseases disturbing women after delivery. There is a lack of objective standardization for the diagnosis of pelvic floor myofascial pain due to the various symptoms and the dependence on the palpating evaluation. Ultrasound imaging has the advantages of safety, simplicity, economy and high resolution, which makes it an ideal tool for the assistant diagnosis of pelvic floor myofascial pain and evaluation after treatment. This is a retrospective case-control study including women accepting evaluation of pelvic floor function at 6 weeks to 1 year postpartum. They were divided into pelvic floor myofascial pain group and normal control group. A BCL 10-5 biplane transducer was applied to observed their puborectalis. The length, minimum width, area, deficiency, deficiency length, deficiency width, deficiency area, rate of deficiency area, local thickening,angle between the tendinous arch of levator ani muscle and puborectalis of corresponding puborectalis in different groups were observed and measured. A total of 220 postpartum women participated in the study, with 77 in the pelvic floor myofascial pain group and 143 in the normal control group. The Intraclass correlation coefficient value was over 0.750, and Kappa ranged from 0.600 to 0.800. puborectalis deficiency (adjusted odds ratio = 11.625, 95% confidence interval = 4.557-29.658) and focal thickening (adjusted odds ratio = 16.891, 95% confidence interval = 1.819-156.805) were significantly associated with higher odds of having postpartum pelvic floor myofascial pain. Grayscale or the angle between the arch tendineus levator ani and puborectalis measurements on the pain side tended to be smaller than on the non-pain side in patients with unilateral puborectalis or iliococcygeus pain (P < 0.05). This study demonstrated that transvaginal ultrasound was a potentially efficient technique for evaluating postpartum pelvic floor myofascial pain due to its ability to assess various sonographic characteristics of the levator ani muscles.

CORRELATION RATIO OF CHRONIC ENDOMETRITIS WITH ANAMNESTIC FACTORS AND ULTRASOUND CHARACTERISTICS OF THE ENDOMETRIUM IN WOMEN OF REPRODUCTIVE AGE

The diagnosis of chronic endometritis is problematic because of its asymptomatic course and the need for invasive uterineprocedures to confi rm the diagnosis histologically. Therefore, it is important to identify factors that indicate a high risk of this condition. Aim: The aim of this study is to identify factors that have a statistically signifi cant correlation with the presence of CE in women of reproductive age and to validate them by histologic examination of the endometrium.Material and Methods. A retrospective analysis of 400 histories of women of reproductive age who underwent hysteroscopyand endometrial biopsy for histologic examination was performed. Histologically, 154 women (38.5 %) were found to havechronic endometritis (the group of women with chronic endometritis), while 246 women (61.5 %) were found to have otherconditions unrelated to chronic endometritis (the group of women without chronic endometritis). Analysis of anamnestic factors and ultrasound criteria associated with an increased likelihood of chronic endometritis was performed when comparing data from women in these groups. The strength of the relationship between these factors on the one hand and the development of chronic endometritis on the other hand was assessed by calculating the Kendall’s τ (tau) rank correlation coeffi cient. The strength of the relationship between the mentioned factor and CE was considered strong (+++) with a τ coeffi cient of 0.5 or higher, moderate (++) with a τ coeffi cient in the range of 0.2 to 0.499, weak (+) with a τ coeffi cient in the range of 0.1 to 0.199. A τ-coeffi cient value between 0 and 0.099 indicated no correlation between the factor and chronic endometritis.The study was conducted in accordance with the principles of patient- centered care, the requirements of the Tokyo Declaration of the World Medical Association, the international recommendations of the Helsinki Declaration of Human Rights, the Convention of the Council of Europe on Human Rights and Biomedicine, the laws of Ukraine, and the Code of Ethics of the Ukrainian Physician.The paper is an excerpt from the initiative scientifi c research project of the Department of Obstetrics and Gynecology No.2 at Poltava State Medical University, entitled «Optimization of approaches to the management of pregnancy in women at high risk of obstetric and perinatal pathology» (State registration number 0122U201228, duration: 10.2022-09.2027) in collaboration with the Department of Pathological Physiology at Poltava State Medical University.Results and Discussion. The determination of the correlation coeffi cient allowed us to identify the factors with the strongestassociation with chronic endometritis. Among them are 5 infectious factors: cervicitis in the past medical history (τ coeffi cient 0.625245229; p&lt;0.0000000001); chronic infl ammation of the uterine appendages (τ coeffi cient 0.522536031; p&lt;0.0000000001); sexually transmitted diseases in the past medical history (τ coeffi cient 0.547218916; p&lt;0.0000000001); chronic urogenital infl ammatory diseases in the sexual partner (τ coeffi cient 0. 529314979; p&lt;0.0000000001); previous multiple use of intrauterine contraception (τ-coeffi cient 0.502383401; p&lt;0.0000000001); 4 symptomatic consequential factors: infertility in past medical history (τ-coeffi cient 0.683492482; p&lt;0.0000000001); missed miscarriages in past medical history (τ-coeffi cient 0. 644489429; p&lt;0.0000000001); recurrent early pregnancy loss (τ-coeffi cient 0.625942138; p&lt;0.0000000001); abnormal uterine bleeding (τ-coeffi cient 0.650850348; p&lt;0.0000000001); and 4 ultrasound criteria, such as the presence of local endometrial thickening in the form of a polyp (τ-coeffi cient 0.641820318; p&lt;0. 0000000001); increased echogenicity of the endometrium (τ-coeffi cient 0.665249637; p&lt;0.0000000001); heterogeneity of the endometrial echo structure with areas of increased and decreased echogenicity (τ-coeffi cient 0.693152163; p&lt;0.0000000001); hyperechogenic structures in the basal layer of the endometrium (τ-coeffi cient 0.521658745; p&lt;0.0000000001). In our opinion, the combination of an infectious or symptomatic factor with an ultrasound criterion indicates a high probability of chronic endometritis. In the absence of ultrasound signs, the combination of 1 infectious and 1 symptomatic- consequential factor indicates a high risk of chronic endometritis. To confirm the representativeness of this method, we analyzed endometrial biopsies obtained by curettage in 100 women with this combination of factors. The diagnosis was confi rmed histologically in 87 women. Conclusion. Our proposed assessment of high-risk criteria for chronic endometritis, based on the combination of infectious,symptomatic- consequential, and ultrasound criteria, allows predicting the presence of this pathology in 87 % of patients withoutтthe need for invasive interventions. This helps to improve patient selection for hysteroscopy and avoid unnecessary uterine interventions in the diagnosis of chronic endometritis in women planning pregnancy.

Non-traumatic gallbladder hemorrhage with shock in Asia: A case report

Gallbladder hemorrhage, rare due to trauma, iatrogenic factors, or conditions like liver/kidney dysfunction or cancer, presents with symptoms such as right upper abdominal pain and fever. In severe cases, gallbladder blood may enter the gastrointestinal tract, causing melena or hematemesis, necessitating surgical intervention. Delay can lead to life-threatening hemorrhagic shock. Diagnosing in the emergency room is challenging, with delayed recognition risking severe outcomes. Ultrasound is vital for diagnosis. A 64-year-old female presented with three days of epigastric pain and nausea, denying trauma, fever, respiratory or chest symptoms. Unstable vital signs were noted. Blood tests showed no abnormalities; ultrasound revealed a distended gallbladder without stones. Post-cholecystectomy confirmed acute hemorrhagic cholecystitis, highlighting ultrasound’s pivotal role. Gallbladder hematoma, rare with vague symptoms, poses diagnostic challenges linked to trauma, tumors, anticoagulant use, or liver/renal disease. Initial symptoms include right upper quadrant pain, tenderness, nausea, and vomiting, resembling cholecystitis. Persistent bleeding may result in dark or bloody stools. Laboratory tests may reveal abnormalities, but sensitivity is limited. Diagnosis is complex, delayed recognition in the emergency department can lead to severe shock and increased mortality. The literature review emphasizes the association with liver/kidney dysfunction and anticoagulant use, presenting symptoms akin to gallbladder inflammation and occasional gastrointestinal bleeding. Ultrasound is pivotal for diagnosis, showcasing features like uneven echoes and localized wall thickening. Treatment approaches vary, with some cases opting for deferred surgical intervention after conservative treatment. Non-traumatic gallbladder hematoma is linked to risk factors like liver/kidney diseases and chronic anticoagulant use. Gallbladder inflammation and gastrointestinal bleeding symptoms coexist, underscoring ultrasound’s crucial role. This study establishes early detection and diagnosis protocols for emergency room settings.

Single large enterolith in a cat with chronic inflammatory enteropathy

AbstractA 3‐year‐old, male, neutered, domestic shorthair cat with a history of chronic intermittent vomiting, diarrhoea and constipation was referred for abdominal ultrasound of a mid‐abdominal mass identified on palpation. Findings included a densely shadowing structure within the distal ileum with severe local muscularis thickening, mild diffuse small intestinal muscularis thickening, and an enlarged right ileocolic lymph node. Abdominal radiographs showed the structure to be most consistent with an enterolith. Enterolithiasis is a rare condition in companion animals, but common in horses and selected populations of human patients. Enterectomy was performed, and histopathology results of intestinal biopsies were consistent with chronic inflammatory enteropathy. Chemical analysis of the enterolith revealed a predominantly calcium phosphate composition. At the 3‐month follow‐up, the cat had gained weight and showed marked improvement in gastrointestinal signs. Screening for underlying structural intestinal disease may be beneficial in cats diagnosed with enteroliths.

Optimization Design of Insulation Materials and Thickness Based on Box Insulation Performance

To ensure that the air inside the box does not fall below -20 °C after cooling for four hours, With the help of CFD numerical simulation technology, the composition materials and thickness have been optimized and designed in this paper. In this paper, there are two kinds of materials for box wall panel, one is insulation material 1 with smaller specific heat capacity and steel, the other is insulation material 2 with larger specific heat capacity. The simulation analysis results of two types of box wall panels show that the air temperature at edges and corners is difficult to meet the requirements. By using local thickening, this situation can be greatly improved.