Clinical Manifestation and Multidisciplinary Treatment Approaches for Primary Tracheal Carcinoma in Bangladesh: A Clinical and Therapeutic Review of 13 Patients.

BACKGROUND: Primary tracheal carcinoma is an exceptionally rare and life-threatening disease that presents significant diagnostic and therapeutic challenges. Delayed diagnosis due to misinterpretation of airway obstruction symptoms often leads to poorer prognoses for patients. This study aimed to explore the clinical manifestations and multidisciplinary treatment approaches for primary tracheal carcinoma in Bangladesh, with a focus on recent advancements in diagnosis and treatment. METHODS: A retrospective observational study was conducted at Bangladesh Specialized Hospital Limited, involving patients aged over 30 who were diagnosed with tracheal carcinoma and underwent multidisiplinary treatment from July 2018 to June 2019. Data were collected through patient interviews and medical record reviews. Descriptive and inferential statistical analyses were performed to examine demographic characteristics, histological variations, tumor locations, clinical signs and symptoms, treatment approaches, and outcomes. RESULTS: The study illuminated varied clinical presentations and the successful application of multidisciplinary approaches among the 13 patients. Invasive squamous cell carcinoma and adenoid cystic carcinoma were the predominant histological subtypes. Symptomatology, including dyspnea, cough, and hemoptysis, highlighted the challenge of early detection. Despite the rarity and intricacies associated with primary tracheal carcinoma, the multidisciplinary strategy yielded generally positive outcomes, as evidenced by a 1-year survival rate of 92.31% and a 5-year survival rate of 76.92%. Kaplan-Meier survival curves underscored the superior efficacy of surgical interventions over non-surgical approaches. CONCLUSION: Despite some limitations, this study contributes crucial insights into the nuanced management of primary tracheal carcinoma in the Bangladeshi context. The demonstrated success of the multidisciplinary strategy, especially surgical interventions, accentuates the importance of definitive resection. The lone case of local recurrence emphasizes the necessity for vigilant follow-up.

A Rare Presentation of Malignant Melanoma of the Face: A Case Report.

Melanoma is a malignant neoplasm of melanoblasts, which are the precursors of the melanocytes arising from the neural crest cells. Melanomas can occur at various sites like the skin, eyes, upper esophagus, and meninges due to the migration of neural crest cells. Usually, the prognostic factors are decided based on the Breslow index. This case report describes a 61-year-old female who presented with the complaint of pinkish irregular swelling over the left side of her face for six months. The patient had a surgical resection, and the condition was determined to be invasive melanoma following confirmation by magnetic resonance imaging (MRI) and histological examination. Through our case report, we aim to shed light on the existing protocol for managing malignant melanoma while also exploring new aspects of presentation and multidisciplinary action.

A Tele-detection and referral pAthways model for early childhood cariEs control- a protocol for a randomized factorial study: the TRACE study.

BACKGROUND: Early childhood caries (ECC) is one of the most common childhood diseases affecting the primary teeth of children younger than 6 years of age. ECC progression can be reversed in the early stages although these lesions often go undetected. New approaches are needed to detect oral diseases at an early stage when they can be better controlled. The aim of the study is to assess the effectiveness of ECC tele-detection methods combined with referral pathways with and without user fee removal in controlling ECC. METHODS: A randomized factorial trial will be used to compare two tele-dentistry detection methods for ECC (intraoral camera and smartphone camera) and two referral pathways (user fee removal versus conventional care). The study will recruit children younger than 6 years of age in marginalized communities in Alexandria, Egypt. The primary outcome is the percentage of teeth receiving indicated care, while the secondary outcomes are the oral health-related quality of life, acceptance of teledentistry by dentists, procedure time, and child cooperation. Two-way analysis of variance will be used to assess the effect of the two factors as between group variables on the outcomes after 6 and 12 months. The interaction between detection methods and referral pathways will also be assessed, and the effect of confounders will be controlled in a multivariable linear regression model. DISCUSSION: The findings of this study have the potential to inform clinical practice and oral healthcare policies for ECC management. Successful tele-detection and referral pathways could be integrated into oral healthcare systems, leading to improved oral health outcomes for children. TRIAL REGISTRATION: The trial has been registered on ClinicalTrials.gov in August 2023 (initial release) ID: NCT06019884.

C-Reactive Protein: An Important Inflammatory Marker of Coronary Atherosclerotic Disease.

Cardiovascular disease (CVD) is the most common cause of death worldwide, with coronary atherosclerotic heart disease (CHD) accounting for the majority of events. Evidence demonstrates that inflammation plays a vital role in the development of CHD. The association between C-reactive protein (CRP), a representative inflammatory biomarker, and atherosclerosis (AS), CHD, and inflammation has attracted attention. Therefore, we conducted an extensive search on PubMed using the aforementioned terms as search criteria and identified a total of 1246 articles published from January 2000 to April 2024. Both review and research-based articles consistently indicate CRP as a risk enhancer for CVD, contributing to the refinement of risk stratification and early identification of apparently healthy at-risk populations. Additionally, CRP reflects disease progression and predicts the prognosis of recurrent cardiovascular events. Anti-inflammatory therapeutic strategies targeting CRP also provide new treatment options for patients. This review focuses on the link between CRP and CHD, highlighting how CRP is involved in the pathological progression of AS and its potential value for clinical applications.

The current diagnosis and treatment strategy of breast cancer based on multicentre retrospective data in Shaanxi province.

BACKGROUND: Breast cancer is a common malignancy, and early detection coupled with standardized treatment is crucial for patient survival and recovery. This study aims to scrutinize the current state of breast cancer diagnosis and treatment in Shaanxi province, providing valuable insights into the local practices and outcomes. METHODS: We selected 25 hospitals that typically represent the current diagnosis and treatment strategy of breast cancer in Shaanxi (a province in northwest China). The questionnaire comprised sections on fundamental information, outpatient consultations, breast-conserving surgery, neoadjuvant and adjuvant therapy, sentinel lymph node biopsy, breast reconstruction surgery. RESULTS: A total of 6665 breast cancer operations were performed in these 25 hospitals in 2021. The overall proportion of breast-conserving surgery (BCS) is 23.6%. There was a statistically significant positive correlation between the annual volume of breast cancer surgery and the implementation rate of BCS (P = 0.004). A total of 2882 cases of neoadjuvant treatment accounted for 43.24% of breast cancer patients treated with surgery in 2017. Hospitals in Xi'an performed more neoadjuvant therapy for patients with breast cancer compared to other districts (P = 0.008). There was a significantly positive correlation between outpatient visits and the implementation rate of sentinel lymph node biopsy (SLNB) (P = 0.005). 14 hospitals in Shaanxi performed reconstructive surgery. CONCLUSIONS: Breast conserving surgery, adjuvant and neoadjuvant therapy and sentinel lymph node biopsy in Shaanxi province have reached the China's average level. Moreover, hospitals in Xi 'an have surpassed this average. However, a disparity is observed in the development of breast reconstruction surgery when compared to top-tier hospitals.

Evolving concepts in the treatment of posterior shoulder instability with glenohumeral bone loss.

Posterior shoulder instability is an increasingly recognized phenomenon and comprises approximately 5% of all shoulder instability cases. Posterior shoulder instability presents a complex clinical challenge, particularly when associated with bone loss. Bone loss may be present in up to 25% of patients with posterior shoulder instability. Understanding its etiology, diagnosis, and treatment options is crucial for optimal patient outcomes. Young athletic individuals, especially football linemen and throwing athletes, are commonly affected, with symptoms ranging from insidious onset pain to noticeable changes in athletic performance. History, physical examination, and imaging, including radiographs and advanced three-dimensional imaging, play pivotal roles in diagnosis, with specific tests like the Jerk, Kim, and load and shift tests aiding in provocation. Posterior glenoid bone loss (pGBL), whether dysplastic, attritional, or acute, significantly impacts management decisions. When pGBL exceeds critical thresholds, soft tissue repair alone may be insufficient, necessitating glenoid reconstruction with bone block procedures. Both iliac crest autograft and distal tibial allograft (DTA) offer viable options, with considerations including donor site morbidity and graft integration. Surgical techniques for reverse Hill-Sachs lesions vary from subscapularis transfers to arthroscopic balloon osteoplasty, each aiming to restore native anatomy and prevent engagement. Bipolar bone loss, involving both glenoid and humeral head defects, presents additional challenges and may require combined soft tissue and bony procedures. Quantifying bone loss and understanding its implications are essential for surgical planning. While various techniques show promise, further research is needed to elucidate their long-term outcomes and refine treatment algorithms for posterior shoulder instability with bone loss.

Insights into Theileria transmission-blocking vaccines for East Coast fever control: A disease with an "outdated vaccination approach".

Instead of using the Infection and Treatment Method (ITM)-based vaccine, is it possible to control East Coast Fever (ECF) through blocking Theileria parva transmission in ticks and cattle? This review pursues this question. It's over 100 years since Arnold Theiler (1912) first illustrated the natural ITM as a vaccination approach against ECF-cattle disease. The approach entails infecting cattle with live Theileria sporozoites and co-treatment with long-acting tetracycline. Building on the ITM principle, the "Muguga"-cocktail ECF vaccine was developed in the 1970s and it remains the only commercially available-one. Although the vaccine induces cattle-protection, the vaccination approach still raises several drawbacks. Of those, the most outstanding is the vaccine-safety. This is implied because after ITM vaccination, cattle revert to T. parva pathogen reservoirs, therefore, during blood meal-acquisition, the ticks co-ingest T. parva pathogens. Ultimately, the pathogens are further transmitted transstadial; from larvae to nymph and nymph-adults and later re-transmitted to cattle during blood-meal acquisition. Consequently, the vaccine-constituting T. parva strains are introduced and (re) spread in non-endemic/ endemic areas. Precisely, rather than eradicating the disease, the ITM vaccination-approach promotes ECF endemicity. With advent of novel vaccination approaches toward vector and vector-borne disease control, ECF-control based on ITM of vaccination is considered outdated. The review highlights the need for embracing a holistic integrative vaccination approach entailing blocking Theileria pathogen-development and transmission both in the ticks and cattle, and/or the tick-population.

Upper airway dimensions and craniofacial morphology: A correlation study using cone beam computed tomography.

Objective: To determine the correlation between dentoskeletal parameters related to craniofacial morphology and the upper airway (UA) volume. Methods: Cone-beam computed tomography images of 106 randomly selected orthodontic patients were analyzed using NemoFab Ortho software. The dentoskeletal variables assessed were anterior facial height (AFH), posterior facial height (PFH), PFH/AFH ratio, hyoid position, maxillary width (MW), and palatal depth. The UA volume (evaluation in anatomical regions and as a whole) was also assessed using the same software. We also evaluated potential differences in UA variables between age and sex groups. The correlation between the dentoskeletal parameters and UA volume was calculated using the Pearson correlation coefficient (R). Analysis of variance and Student's t test were performed to assess differences between age and sex for UA variables. Statistical analyses were performed using SPSS software (version 26 for Windows). Results: This study found that PFH, AFH, and MW were the dentoskeletal parameters most strongly correlated with UA volume. However, the ANB angle did not show any significant correlation with UA volume. Additionally, differences in UA volumes were observed between age groups. Sex differences were found in both the "8-12" and "≥ 16" age groups for oropharyngeal and pharyngeal volumes. Conclusions: In conclusion, our findings indicate a significant correlation between UA volume and dentoskeletal parameters, particularly those related to facial height and MW.

Prussian Blue Nanohybridized Multicellular Spheroids as Composite Engraftment for Antioxidant Bone Regeneration and Photoacoustic Tomography.

Regulating the complex microenvironment after tooth extraction to promote alveolar bone regeneration is a pressing challenge for restorative dentistry. In this study, through modulating the mechanical properties of the cellular matrix, we guided various types of cells by self-organizing to form multicellular spheroids (MCSs) and hybridized MCSs with Prussian Blue nanoparticles (PBNPs) in the process. The constructed Prussian Blue nanohybridized multicellular spheroids (PBNPs@MCSs) with empowered antioxidant functions effectively reduced cell apoptosis under peroxidative conditions and exhibited enhanced ability to regulate the microenvironment and promote bone repair both in vitro and in vivo. In addition, the PBNPs@MCSs exhibited enhanced photoacoustic imaging ability to trace low doses of PBNPs. Therefore, the constructed PBNPs@MCSs based on the biomimetic hydrogel can be used as a form of an engraftment building block, with a greater potential for pro-bone repair application in the complex microenvironment of the oral cavity.

Progression of Quality of Life in Patients with Plaque Psoriasis Who Achieved Three or More Years of Complete Skin Clearance with Guselkumab Treatment: a Post hoc Analysis of the VOYAGE 1 Clinical Trial.

INTRODUCTION: The interleukin-23p19 subunit inhibitor, guselkumab, has demonstrated improvements in clinical and patient-reported outcome (PRO) measures in patients with moderate-to-severe psoriasis. Understanding the relationship among clinical response, PRO measures and baseline characteristics could help clinicians individualize treatment plans. The objective of this analysis was to examine changes in signs, symptoms and quality-of-life (QoL) PRO measures in patients who maintained complete skin clearance through ≥ 3 years in the phase 3 VOYAGE 1 trial. METHODS: A descriptive post hoc analysis of data from VOYAGE 1 was conducted to compare baseline characteristics of patients who maintained complete skin clearance (Psoriasis Area and Severity Index [PASI] = 0 for ≥ 156 consecutive weeks) versus patients who did not. Mean scores for individual domains of the Dermatology Life Quality Index (DLQI) and Psoriasis Symptom and Sign Diary (PSSD) were evaluated in patients who maintained complete skin clearance, and baseline characteristics of patients who achieved PRO scores of DLQI = 0/1 and PSSD = 0 were compared with those who did not. RESULTS: Of the 329 patients included in this post hoc analysis, 73 (22.2%) maintained PASI = 0 for ≥ 156 weeks. This group had a numerically lower proportion of patients at baseline with obesity, depression or previous biologic treatment and a higher proportion who had never smoked. Patients who maintained PASI = 0 generally achieved positive DLQI and PSSD outcomes, though some impact of residual disease was observed, largely related to the DLQI "Symptoms and feelings" sub-scale and PSSD components "Dryness," "Redness" and "Itch." Patients reporting continued disease impact (despite sustaining PASI = 0) had greater disease severity at baseline versus those achieving DLQI = 0/1 and PSSD = 0. CONCLUSION: Clinical measures alone do not capture the full patient experience. While both QoL and clinical symptoms are responsive to highly effective treatment, a subset of patients with complete clinical response is still impacted by their psoriasis. Further investigation into this population is warranted. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02207231.

Mixed glandular neuroendocrine carcinoma of the endometrium with hypercalcemic crisis.

OBJECTIVE: To explore the ideas and research progress in diagnosing and treating hypercalcemic crisis in patients with cancer. METHODS: We reviewed the clinical data, diagnosis and treatment of hypercalcemic crisis in a patient with mixed glandular neuroendocrine carcinoma of the endometrium. RESULTS: The patient had gastrointestinal symptoms and acute renal impairment as the main manifestations, and the blood biochemical indexes suggested a hypercalcemic crisis with elevated parathyroid hormone (PTH). No lesions were seen in the parathyroid glands on imaging and nuclide imaging, but an abnormal pelvic mass was seen in the pelvis and the biopsy of the uterine cervix tissue suggested that it was an adenocarcinoma. Surgery was performed to remove the mass, and postoperative findings suggested endometrial large-cell neuroendocrine carcinoma with endometrioid adenocarcinoma. The calcium and PTH decreased to normal after surgery and chemotherapy. CONCLUSIONS: The condition of the hypercalcemia crisis is dangerous, so it is necessary to think from different aspects of the clinical diagnosis and treatment.

[Chinese Expert Consensus on the Standardized Diagnosis and Treatment of 
Non­small Cell Lung Cancer with EGFR Exon 20 Insertion Mutations (2024 Edition)].

The standard clinical practice of managing the non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations was elaborated in Chinese expert consensus on non­small cell lung cancer with EGFR exon 20 insertion mutations (2023 edition), and this rare subset has gradually attracted attention recently. With the deepening of treatment area exploration and the approval of new targeted drugs, there are more options for the diagnosis and treatment of EGFR ex20ins positive NSCLC patients. Therefore, based on the previous version of consensus, the expert panel has updated this consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience. The updated recommendations includes disease congnition, testing methods, therapy and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide better medication reference for clinical physicians.
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Comprehensive insights into oral squamous cell carcinoma: Diagnosis, pathogenesis, and therapeutic advances.

Oral squamous cell carcinoma (OSCC) is considered the most common type of head and neck squamous cell carcinoma (HNSCC) as it holds 90 % of HNSCC cases that arise from multiple locations in the oral cavity. The last three decades witnessed little progress in the diagnosis and treatment of OSCC the aggressive tumor. However, in-depth knowledge about OSCC's pathogenesis, staging & grading, hallmarks, and causative factors is a prime requirement in advanced diagnosis and treatment for OSCC patients. Therefore present review was intended to comprehend the OSCCs' prevalence, staging & grading, molecular pathogenesis including premalignant stages, various hallmarks, etiology, diagnostic methods, treatment (including FDA-approved drugs with the mechanism of action and side effects), and theranostic agents. The current review updates that for a better understanding of OSCC progress tumor-promoting inflammation, sustained proliferative signaling, and growth-suppressive signals/apoptosis capacity evasion are the three most important hallmarks to be considered. This review suggests that among all the etiology factors the consumption of tobacco is the major contributor to the high incidence rate of OSCC. In OSCC diagnosis biopsy is considered the gold standard, however, toluidine blue staining is the easiest and non-invasive method with high accuracy. Although there are various therapeutic agents available for cancer treatment, however, a few only are approved by the FDA specifically for OSCC treatment. The present review recommends that among all available OSCC treatments, the antibody-based CAR-NK is a promising therapeutic approach for future cancer treatment. Presently review also suggests that theranostics have boosted the advancement of cancer diagnosis and treatment, however, additional work is required to refine the role of theranostics in combination with different modalities in cancer treatment.

[Thinking on the application of reinforcing and reducing techniques of moxibustion in the staged differentiation and treatment of prostate cancer].

The effect of reinforcing and reducing techniques of moxibustion depends on types of moxibustion, operation methods and characteristics of acupoints. According to the ups and downs of pathogenic factors and healthy qi during the occurrence and development of prostate cancer, three stages are divided, namely, the stage of initial accumulation of cancer toxicity, the stage of the deficiency of healthy qi and toxin retention, and the stage of yang deficiency and cold stagnation. In the stage of initial accumulation of cancer toxicity, zangfu function is impaired and the dampness, heat and stasis toxin are accumulated in the body; due to which, the reducing technique of moxibustion should be dominant and the healthy qi be supported in combination. In treatment, the wheat-grain sized cone moxibustion, suppurative moxibustion and garlic-isolated moxibustion are applicable. The reducing purpose of moxibustion is obtained by delivering an appropriate increased number of moxa cones, large dosage and strong stimulation at acupoints. In the stage of the deficiency of healthy qi and toxin retention, qi movement is weakened and cancer toxin consumes yin; the reinforcing healthy qi and removing pathogenic factors should be operated simultaneously. In treatment, mild moxibustion and suppurative moxibustion can be used. The reduced number of moxa cones, moderate dosage of moxibustion and mild stimulation at acupoints should be considered to gently adjust the conditions of deficiency and excess. In the stage of yang deficiency and cold stagnation, spleen and kidney yang is deficient, and the meridians are blocked by cold and damp pathogens. In treatment, the reinforcing technique of moxibustion should be used specially and eliminating pathogenic factors be combined. Monkshood cake-insulated moxibustion, salt-insulated moxibustion and wheat-grain sized cone moxibustion can be adopted. The less number of moxa cones, small dosage and appropriately increased frequency of treatment should be considered to produce the gentle and sustained stimulation at acupoints so as to excite the healthy qi and promote the transformation of qi and blood.

Doctor AI? A pilot study examining responses of artificial intelligence to common questions asked by geriatric patients.

Introduction: AI technologies have the potential to transform patient care. AI has been used to aid in differential diagnosis and treatment planning for psychiatric disorders, administer therapeutic protocols, assist with interpretation of cognitive testing, and patient treatment planning. Despite advancements, AI has notable limitations and remains understudied and further research on its strengths and limitations in patient care is required. This study explored the responses of AI (Chat-GPT 3.5) and trained clinicians to commonly asked patient questions. Methods: Three clinicians and AI provided responses to five dementia/geriatric healthcare-related questions. Responses were analyzed by a fourth, blinded clinician for clarity, accuracy, relevance, depth, and ease of understanding and to determine which response was AI generated. Results: AI responses were rated highest in ease of understanding and depth across all responses and tied for first for clarity, accuracy, and relevance. The rating for AI generated responses was 4.6/5 (SD = 0.26); the clinician s' responses were 4.3 (SD = 0.67), 4.2 (SD = 0.52), and 3.9 (SD = 0.59), respectively. The AI generated answers were identified in 4/5 instances. Conclusions: AI responses were rated more highly and consistently on each question individually and overall than clinician answers demonstrating that AI could produce good responses to potential patient questions. However, AI responses were easily distinguishable from those of clinicians. Although AI has the potential to positively impact healthcare, concerns are raised regarding difficulties discerning AI from human generated material, the increased potential for proliferation of misinformation, data security concerns, and more.

Nanomaterials that Aid in the Diagnosis and Treatment of Alzheimer's Disease, Resolving Blood-Brain Barrier Crossing Ability.

As a form of dementia, Alzheimer's disease (AD) suffers from no efficacious cure, yet AD treatment is still imperative, as it ameliorates the symptoms or prevents it from deteriorating or maintains the current status to the longest extent. The human brain is the most sensitive and complex organ in the body, which is protected by the blood-brain barrier (BBB). This yet induces the difficulty in curing AD as the drugs or nanomaterials that are much inhibited from reaching the lesion site. Thus, BBB crossing capability of drug delivery system remains a significant challenge in the development of neurological therapeutics. Fortunately, nano-enabled delivery systems possess promising potential to achieve multifunctional diagnostics/therapeutics against various targets of AD owing to their intriguing advantages of nanocarriers, including easy multifunctionalization on surfaces, high surface-to-volume ratio with large payloads, and potential ability to cross the BBB, making them capable of conquering the limitations of conventional drug candidates. This review, which focuses on the BBB crossing ability of the multifunctional nanomaterials in AD diagnosis and treatment, will provide an insightful vision that is conducive to the development of AD-related nanomaterials.

Clinical characteristics and treatment compounds of obesity-related kidney injury.

Disorders in energy homeostasis can lead to various metabolic diseases, particularly obesity. The obesity epidemic has led to an increased incidence of obesity-related nephropathy (ORN), a distinct entity characterized by proteinuria, glomerulomegaly, progressive glomerulosclerosis, and renal function decline. Obesity and its associated renal damage are common in clinical practice, and their incidence is increasing and attracting great attention. There is a great need to identify safe and effective therapeutic modalities, and therapeutics using chemical compounds and natural products are receiving increasing attention. However, the summary is lacking about the specific effects and mechanisms of action of compounds in the treatment of ORN. In this review, we summarize the important clinical features and compound treatment strategies for obesity and obesity-induced kidney injury. We also summarize the pathologic and clinical features of ORN as well as its pathogenesis and potential therapeutics targeting renal inflammation, oxidative stress, insulin resistance, fibrosis, kidney lipid accumulation, and dysregulated autophagy. In addition, detailed information on natural and synthetic compounds used for the treatment of obesity-related kidney disease is summarized. The synthesis of detailed information aims to contribute to a deeper understanding of the clinical treatment modalities for obesity-related kidney diseases, fostering the anticipation of novel insights in this domain.

Challenges in the diagnosis and treatment of pure non-gestational uterine choriocarcinoma in a child: a case report.

BACKGROUND: Diagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy. CASE PRESENTATION: A 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient's luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m2 IV), etoposide (120 mg/m2 IV), and bleomycin (15 mg/m2 IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again. CONCLUSIONS: Although pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient's response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.

Dual-Drug Loaded Nanobubbles Combined with Sonodynamic and Chemotherapy for Hepatocellular Carcinoma Therapy.

Purpose: Chemotherapy remains the primary therapeutic approach for advanced Hepatocellular Carcinoma (HCC). The therapeutic effect of chemotherapy is limited and the toxic side effects are serious. The aim of this study is to develop a nanobubble that is ultrasonically responsive to reduce the toxic side effects of direct chemotherapy. Methods: We developed curcumin/doxorubicin-cis-aconitic anhydride-polyethylene glycol nanobubble (C/DCNB) surface modified with acid-sensitive polyethylene glycol (PEG). And it is loaded with curcumin (CUR) and doxorubicin (DOX), as liposomes at the nanoscale for diagnosis and therapy of tumors. Results: In this study, the acid-sensitive PEG on the surface layer of nanobubbles serves to stabilize them in the blood circulatory system and in normal tissues, while peeling off in the acidic tumor microenvironment (pH 6.8). C/DCNB can identify tumor sites through contrast-enhanced ultrasound (CEUS). And ultrasound-mediated nanobubbles promote permeability of the tumor vascular, thus improving the enhanced permeability and retention (EPR) effects in the tumor, leading to the accumulation of nanobubbles in the tumor. After endocytosis of nanobubbles, drugs are released and curcumin generates reactive oxygen species (ROS) under ultrasound conditions. CUR can enhance the sensitivity of tumor cells to DOX by inhibiting the expression of P-glycoprotein. In vitro and vivo experiments demonstrate that C/DCNB can facilitate contrast-enhanced ultrasound imaging while simultaneously delivering drugs, enabling both imaging and treatment. Conclusion: The combination of C/DCNB and ultrasound provides an effective strategy for improving the efficiency of HCC therapy and imaging.