Objective To investigate the treatment strategy of giant high cervical extracranial internal carotid artery aneurysm(EICAA).Methods The clinical data,surgical strategy and follow-up of one case were retrospectively ana-lyzed,and the relevant literature was reviewed.Results A 52-year-old male was admitted to hospital due to"intermit-tent cough for 1 year,aggravation and headache for 2 months".DSA showed a giant right high cervical EICAA.An external carotid artery-radial artery graft-internal carotid artery petrous segment bypass combined with aneurysm trapping was performed.There was no new cerebral ischemia or cerebral infarction after surgery,no new neurological dysfunction,and the original symptoms were significantly improved.Conclusion Cerebrovascular bypass surgery is still one of the effective treatment strategies for large internal carotid artery aneurysms with high cervical segments,and internal carotid artery bypass grafting in the external carotid artery-radial artery-petrosal segment can effectively deal with such lesions.
Objective: To determine the predictive value of dynamic changes of neutrophil/lymphocyte ratio (NLR) combined with the model of end-stage liver disease (MELD) score in patients with acute-on-chronic hepatitis B liver failure. Methods: Patients with acute-on-chronic hepatitis B liver failure who were hospitalized in the Department of Hepatology of Qilu Hospital of Shandong University from January 2010 to July 2023 were retrospectively enrolled. According to the clinical outcomes of patients within 30 days of admission, they were divided into the survival group and the death group. The dynamic changes in NLR and initial values on day 3, 5, 8, and 12 in two groups were analyzed for the diagnostic value of 30-day prognosis in patients with acute-on-chronic hepatitis B liver failure. Logistic regression analysis and machine learning XGBoost algorithm were used to evaluate the risk factors influencing the prognosis of patients at 30 days. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of NLR and initial value change combined with MELD score on day 12 of admission in patients with chronic acute hepatitis B liver failure. Results: A total of 243 patients were enrolled in the study, including 145 patients in the survival group [115 males, 30 females, aged 25-74 (47±11)] and 98 patients in the death group [80 males, 18 females, aged 22-80 (49±13) ]. The median initial NLR of survival group and death group were 3.5 (2.1, 5.3) and 4.9 (2.9, 8.3), respectively, and the difference was statistically significant (P=0.003). The variation of NLR from the initial value on day 3, 5, 8, and 12 in the survival group [1.6 (0, 4.3), 1.9 (-0.2, 4.1), 2.0 (-0.1, 4.3) and 2.9 (0.3, 7.0), respectively] were lower than that in the death group [3.2 (0.9, 7.5), 5.1 (1.8, 7.6), 5.8 (2.0, 10.6) and 9.6 (3.5, 16.4), respectively] (all P<0.001). Logistic regression multivariate analysis showed that the changes in NLR on the 12th day and initial value (OR=1.07,95%CI:1.01-1.14, P=0.014), the changes in NLR on the 3rd day and initial value (OR=2.71, 95%CI: 1.32-5.55, P=0.007), the initial value of NLR (OR=1.18,95%CI:1.01-1.37,P=0.035) and fibrinogen (OR=0.21,95%CI:0.05-0.96,P=0.044) were related factors for death within 30 days. Machine learning XGBoost algorithm showed that the weight of the change between the NLR on the 12th day and the initial value was the highest. The area under the ROC curve of the combined MELD score was 0.812 (95%CI: 0.728-0.895), the specificity was 67.78%, and the sensitivity was 82.35%. Conclusion: Dynamic change of NLR combined with MELD score has high predictive value for the short-term prognosis of patients with acute-on-chronic hepatitis B liver failure.
Objective To explore the clinicopathological features of SMARCA2-deficient undifferentiated bowel cancer.Methods Clinical data of patients with undifferentiated bowel cancer and negative SMARCA2 expression diagnosed in Weihai Municipal Hospital during Jan.2016 and Dec.2020 were collected.The sections of HE staining were re-exam-ined,the histological morphology was re-observed,and the undifferentiated morphology was re-determined by senior pathologists.The representative sections extracted from paraffin-embedded formalin-fixed tissue blocks were stained with automatic immunohistochemical staining machine.Results All four patients died within 1 year.HE staining showed highly malignant morphology.Conclusion SMARCA2 depletion is an indicator of poor prognosis and may be involved in tumor dedifferentiati
Objective To observe the three-dimensional(3D)changes of the dentition between sliding straight wire technique and double keyhole loops with heat-induced Typodont system and scanner,and to explore the effects of loading forces on the dentition under the same methodology.Methods Brackets were bonded onto a standard Typodont maxillary model,with the first premolar extracted.The sliding technique group was divided into two subgroups:straight arch group and cruve arch group.The double keyhole group was also divided into two subgroups:tip-forward group and tip-back group.The initial and post-experiment digital models were overlapped,and 3D changes were analyzed using crown marker points.Results ①Sagittal Changes:in the straight arch group,at 250 g force value,there was signifi-cant difference in U1 between the curve arch group and tip-forward group,and in U3 and U7 between tip-back group(P<0.05).At 300 g force value,only U7 in the curve arch group and U1-U6 in the tip-back group had statistical differences(P<0.05).When the force was increased,there was no significant increase in the anterior teeth retrusion,and the advancement of posterior teeth increased accordingly in all groups.However,there were no significant differ-ences between posterior tooth changes,except for U6 in the curve arch group and U7 in the tip-back group(P<0.05).②Crown inclination lip(cheek)tongue degree:the amount of anterior lingual displacement in the straight arch group was more significant than that in the curve arch group.Crown lingual displacement increased in both groups with in-creasing force.Under two force values,only the tip-forward group's anterior teeth showed lip inclination displacement.The tip-back group anterior teeth were close to overall movement at 250 g.Under 250 g at the posterior tooth region,only the curve arch group shifted to the inclination of crown tongue,while the remaining three groups showed buccal displacement.Under 300 g,U5 and U6 in the sliding technique group showed crown tongue inclination,and U7 tooth showed crown buccal inclination.All posterior teeth in the double keyhole group showed buccal inclination.③Vertical changes:at 250 g,the straight arch group elongated all anterior and posterior teeth except U7.At 300 g,the posterior tooth elongation significantly increased(U6,U7:P<0.05).At 250 g,the curve arch group achieved a certain degree of intrusion in anterior and posterior teeth.At 300 g,anterior teeth showed elongation,and posterior teeth intrusion decreased.The tip-forward group significantly lowered the anterior teeth and slightly elongated the posterior teeth.When the force was increased,the anterior tooth intrusion reduced,while posterior tooth elongation increased significantly(P<0.05).The tip-back group exhibited significant posterior tooth intrusion and minor anterior tooth extrusion.The chan-ges in anterior and posterior teeth were not statistically significant with increasing force(P>0.05).Conclusion ①The sliding technique group using the rocking chair reduces the degree of anterior tooth tongue inclination,posterior tooth advancement and elongation to some extent.The double keyhole group with a preset backward inclination provides relatively firm posterior tooth anchorage,while the preset forward inclination provides relatively firm anterior tooth anchorage.The double keyhole group effectively controls anterior and posterior teeth independently and prevents anterior crown tongue inclination during adduction due to front and back tilts.②Using larger forces does not lead to an increase in anterior tooth retrusion,but it adversely affects posterior tooth anchorage and anterior tooth torque.
桥本甲状腺炎(Hashimoto's thyroiditis, HT)是自身免疫性甲状腺炎中的经典类型,多表现为甲状腺肿大,50％的患者伴有甲状腺激素( thy-roid hormone, TH)合成和分泌减少而导致甲状腺功能减退(简称甲减).
