Ultrasound-guided superior laryngeal nerve block: a randomized comparison between parasagittal and transverse approach.

BACKGROUND: Different approach ultrasound-guided superior laryngeal nerve block was used to aid awake intubation, but little is known which approach was superior. We aimed to compare the parasagittal and transverse approaches for ultrasound-guided superior laryngeal nerve block in adult patients undergoing awake intubation. METHODS: Fifty patients with awake orotracheal intubation were randomized to receive either a parasagittal or transverse ultrasound-guided superior laryngeal nerve block. The primary outcome was patient's quality of airway anesthesia grade during insertion of the tube into the trachea. The patients' tube tolerance score after intubation, total procedure time, mean arterial pressure, heart rate, Ramsay sedation score at each time point, incidence of sore throat both 1 h and 24 h after extubation, and hoarseness before intubation, 1 h and 24 h after extubation were documented. RESULTS: Patients' quality of airway anesthesia was significantly better in the parasagittal group than in the transverse group (median grade[IQR], 0 [0-1] vs. 1 [0-1], P = 0.036). Patients in the parasagittal approach group had better tube tolerance scores (median score [IQR],1[1-1] vs. 1 [1-1.5], P = 0.042) and shorter total procedure time (median time [IQR], 113 s [98.5-125.5] vs. 188 s [149.5-260], P < 0.001) than those in the transverse approach group. The incidence of sore throat 24 h after extubation was lower in the parasagittal group (8% vs. 36%, P = 0.041). Hoarseness occurred in more than half of the patients in parasagittal group before intubation (72% vs. 40%, P = 0.023). CONCLUSIONS: Compared to the transverse approach, the ultrasound-guided parasagittal approach showed improved efficacy in terms of the quality of airway topical anesthesia and shorter total procedure time for superior laryngeal nerve block. TRIAL REGISTRATION: This prospective, randomized controlled trial was approved by the Ethics Committee of Nanjing First Hospital (KY20220425-014) and registered in the Chinese Clinical Trial Registry (19/6/2022, ChiCTR2200061287) prior to patient enrollment. Written informed consent was obtained from all participants in this trial.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

OBJECTIVES: Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. METHODS: This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. RESULTS: Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). CONCLUSIONS: Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

The Origin and Course of the Blood Supply to the Lower Eyelid Orbital Fat: Anatomical Study and Clinical Significance.

PURPOSE: The aim of this study is to investigate the origin and course of the orbital fat arterial supply in the lower eyelid using traditional anatomy and three-dimensional computed tomography (CT). METHODS: Twenty-seven cadaver heads were infused with mercury sulfide contrast media through the ophthalmic artery, maxillary artery, transverse facial artery, and facial artery. CT images were obtained after contrast agent injection, three-dimensional CT scans were reconstructed, and the cadaver heads were dissected. RESULTS: Forty-five qualified hemifaces showed that the orbital fat arterial supply in the lower eyelid originates primarily from the inferomedial muscular trunk (IMT) of the ophthalmic artery and the orbital branch of the infraorbital artery. The medial branch of the IMT terminated at the medial fat pad (35.6%) or the orbital floor (64.4%). The lateral branch terminated at the inferior oblique (IO) muscle (28.9%) or the central and lateral fat pads (17.8%). In 53.3%, the lateral branch extended to the anterior part of the lateral fat pad and terminated in the orbital wall or the zygomaticoorbital foramina. The orbital branch of the infraorbital artery coursed between the orbital floor and the orbital fat, providing supply to the IO muscle, inferior rectus (IR) muscle, nasolacrimal duct, and orbital fat. CONCLUSION: This study elucidated the origin and course of the orbital fat arterial supply in the lower eyelid, which may help to avoid reducing the blood supply of the orbital fat pedicles during surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ferroptosis: An Emerging Target for Bladder Cancer Therapy.

Bladder cancer (BC), as one of the main urological cancers in the world, possesses the abilities of multiple-drug resistance and metastasis. However, there remains a significant gap in the understanding and advancement of prognosis and therapeutic strategies for BC. Ferroptosis, a novel type of iron-dependent regulated cell death, depends on lipid peroxidation, which has been proven to have a strong correlation with the development and treatment of BC. Its mechanism mainly includes three pathways, namely, lipid peroxidation, the antioxidant system, and the iron overload pathway. In this review, we reviewed the mechanism of ferroptosis, along with the related therapeutic targets and drugs for BC, as it might become a new anticancer treatment in the future.

Non-line-of-sight ultraviolet transmission coverage in non-precipitating, foggy, and rainy weather.

Sensitivity to weather conditions is the principal limitation of free-space optical communication. However, for the scattering based ultraviolet (UV) non-line-of-sight (NLOS) communication, the atmospheric scattering effect functions as an attenuation factor and potentially as a performance enhancer. To investigate the UV NLOS transmission coverage under different weather conditions, we employ the Mie Theory in conjunction with classical aerosol and hydrometeor particle models to estimate the absorption coefficient, the scattering coefficient, and the scattering phase function. We then use these atmospheric parameters combined with a range estimation model to determine the coverage of the UV NLOS communication for specified path loss. Simulation results reveal that in non-precipitating weather, poorer visibility correlates with broader coverage. In foggy conditions, the coverage range in light fog exceeds that in fog-free environments; however, as fog intensity increases, the coverage range decreases. Rain enhances the coverage range; and heavier precipitation results in a larger coverage area.

Global, regional, and national time trends in cancer mortality attributable to high fasting plasma glucose: an age-period cohort analysis.

BACKGROUND: High fasting plasma glucose (HFPG) is the fastest-growing risk factor for cancer deaths worldwide. We reported the cancer mortality attributable to HFPG at global, regional, and national levels over the past three decades and associations with age, period, and birth cohort. METHODS: Data for this study were retrieved from the Global Burden of Disease Study 2019, and we used age-period-cohort modelling to estimate age, cohort and period effects, as well as net drift (overall annual percentage change) and local drift (annual percentage change in each age group). RESULTS: Over the past 30 years, the global age-standardized mortality rate (ASMR) attributable to HFPG has increased by 27.8%. The ASMR in 2019 was highest in the male population in high sociodemographic index (SDI) areas (8.70; 95% CI, 2.23-18.04). The net drift for mortality was highest in the female population in low SDI areas (2.33; 95% CI, 2.12-2.55). Unfavourable period and cohort effects were found across all SDI quintiles. Cancer subtypes such as "trachea, bronchus, and lung cancers", "colon and rectal cancers", "breast cancer" and "pancreatic cancer" exhibited similar trends. CONCLUSIONS: The cancer mortality attributable to HFPG has surged during the past three decades. Unfavourable age-period-cohort effects on mortality were observed across all SDI quintiles, and the cancer mortality attributable to HFPG is expected to continue to increase rapidly in the future, particularly in lower SDI locations. This is a grim global public health issue that requires immediate attention.

Age, pelvic incidence, facet joint angle and pedicle-facet angle as correlative factors for isthmic spondylolisthesis: a retrospective case control study.

BACKGROUND: Isthmic spondylolisthesis (IS) is a common clinical disease with a high incidence rate. However, most current researches explain the clear pathogenesis from a single perspective. The aim of our study was to explore the relationships between multiple parameters in patients and find the potential risk factors of this disease. METHODS: Our study retrospectively included 115 patients who were diagnosed with isthmic spondylolisthesis and the same number of individuals without spondylolisthesis. The following parameters were measured or collected: age, pelvic incidence (PI), facet joint angle (FJA) and pedicle-facet angle (P-F angle). The radiographic files were imported into Mimics Medical 20.0 and all collected data were analyzed using SPSS, version 26.0, statistical software. RESULTS: The age was higher in IS group than in control group. PI was also higher in the IS group (50.99 ± 7.67) than in the control group (43.77 ± 9.30) significantly (P = 0.009). There was significant difference in cranial and average FJA tropism in L3-L4 level (P = 0.002, P = 0.006, respectively) and in L4-L5 level (P < 0.001). P-F angle of L4-L5 level showed significantly larger in IS group than in control group (P = 0.007).The logistic regression analysis showed a larger age, a greater L3-L4 cranial FJA tropism, and a greater L4-L5 cranial FJA tropism were potential predictors of IS, with an OR of 1.07, 1.28, and 1.39 respectively. The thresholds of the predictors were 60 years, 5.67°, and 8.97° according to the ROC curve. The linear regression equation was established: degree of slippage (%) = 0.220*age - 0.327* L3-4 cranial FJA tropism - 0.346* L4-5 average FJA tropism (F = 3.460, P = 0.011, r = 0.659). CONCLUSIONS: Our study revealed that isthmic spondylolisthesis may be related to multiple factors rather than a single factor. Age, PI, PJA and P-F angle are potentially associated with spondylolisthesis.

Structural Distortion-Modulated Magnetic and Dielectric Properties in Nonstoichiometric Yb2-xTi2O7-δ Pyrochlore.

Rare-earth titanate pyrochlores have attracted considerable attention for their unique magnetic frustration. Among those compounds, Yb2Ti2O7, a candidate for quantum spin ice, has been extensively studied in its magnetic ground state. However, works on its dielectric property and structure-property relationship lag far more behind. Here, by preparing and investigating nonstoichiometric Yb2-xTi2O7-δ (x = 0-0.15) ceramics, we demonstrate that the samples with x ≤ 0.05 maintain a single-pyrochlore phase, but the nonstoichiometry arouses significant structural distortion and increased oxygen vacancy. As a result, the ferromagnetism, indicated by a positive Curie-Weiss temperature, decreases almost linearly with increasing x value. Remarkably composition-dependent low-temperature dielectric relaxations have been observed. In addition, through introducing nonstoichiometry, the relaxor degree of dielectric behavior is enhanced, and the dielectric curve shows an altered shape. The origin of this dielectric relaxation is attributed to the increased structural distortion reflected by the changed bond length/angle, since there is no phase transition in 90-300 K. Our work gives a comprehensive view on the structural, magnetic, and dielectric properties of Yb2Ti2O7, which is instructive for further work on pyrochlores.

CXCR5 down-regulation alleviates cognitive dysfunction in a mouse model of sepsis-associated encephalopathy: potential role of microglial autophagy and the p38MAPK/NF-κB/STAT3 signaling pathway.

BACKGROUND: Cognitive deficits are common in patients with sepsis. Previous studies in sepsis-associated encephalopathy (SAE) implicated the C-X-C chemokine receptor type (CXCR) 5. The present study used a mouse model of SAE to examine whether CXCR5 down-regulation could attenuate cognitive deficits. METHODS: Sepsis was induced in adult male C57BL/6 J and CXCR5-/- mice by cecal ligation and puncture (CLP). At 14-18 days after surgery, animals were tested in a Morris water maze, followed by a fear conditioning test. Transmission electron microscopy of hippocampal sections was used to assess levels of autophagy. Primary microglial cultures challenged with lipopolysaccharide (LPS) were used to examine the effects of short interfering RNA targeting CXCR5, and to investigate the possible involvement of the p38MAPK/NF-κB/STAT3 signaling pathway. RESULTS: CLP impaired learning and memory and up-regulated CXCR5 in hippocampal microglia. CLP activated hippocampal autophagy, as reflected by increases in numbers of autophagic vacuoles, conversion of microtubule-associated protein 1 light chain 3 (LC3) from form I to form II, accumulation of beclin-1 and autophagy-related gene-5, and a decrease in p62 expression. CLP also shifted microglial polarization to the M1 phenotype, and increased levels of IL-1ß, IL-6 and phosphorylated p38MAPK. CXCR5 knockout further enhanced autophagy but partially reversed all the other CLP-induced effects, including cognitive deficits. Similar effects on autophagy and cytokine expression were observed after knocking down CXCR5 in LPS-challenged primary microglial cultures; this knockdown also partially reversed LPS-induced up-regulation of phosphorylated NF-κB and STAT3. The p38MAPK agonist P79350 partially reversed the effects of CXCR5 knockdown in microglial cultures. CONCLUSIONS: CXCR5 may act via p38MAPK/NF-κB/STAT3 signaling to inhibit hippocampal autophagy during sepsis and thereby contribute to cognitive dysfunction. Down-regulating CXCR5 can restore autophagy and mitigate the proinflammatory microenvironment in the hippocampus.

Modeling of ultraviolet omni-directional multiple scattering channel based on Monte Carlo method.

Existing studies of ultraviolet (UV) communication channel models focus mainly on point-to-point scenarios. To analyze UV channel characteristics in omni-directional scenarios, we propose a multiple scattering omni-directional channel model based on the Monte Carlo method in this Letter, where we assume that the receiver can be anywhere in a certain area and all the receivers point to the vertical axis of the transmitter. Meanwhile, we validate the proposed model in comparison to the existing point-to-point Monte Carlo simulation model. Simulation results demonstrate that a single scattering model is not applicable to omni-directional analysis due to the difference in path loss between the single scattering model and the multiple scattering model. Furthermore, the transceiver configurations can affect the coverage area of the UV omni-directional communication system significantly. This work presents a new way to obtain UV path loss distribution and provides guidelines for the omni-directional communication system design.

A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature.

BACKGROUND: Phyllodes tumors (PTs) are well known for local recurrence and progression. Less than 10% of these tumors grow larger than 10 cm. Distant metastases have been reported in up to 22% of malignant PTs, with most metastases being discovered in the lungs. PTs of the breast rarely metastasize to the gastrointestinal tract, and reported cases are scarce. To date, a review of the English literature revealed only 3 cases, including our case, of PTs metastasis to stomach. CASE PRESENTATION: An 82-year-old female patient had 10-year-duration of palpable huge tumor on left breast which was in rapid growth in recent months. Total mastectomy of left breast was performed thereafter, and pathology diagnosis was malignant phyllodes tumor. Adjuvant radiotherapy was suggested while she declined out of personal reasons initially. For PTs recurred locally on left chest wall 2 months later, and excision of the recurrent PTs was performed. She, at length, completed adjuvant radiation therapy since then. Six months later, she was diagnosed of metastasis to stomach due to severe anemia with symptom of melena. Gastrostomy with tumor excision was performed for uncontrollable tumor bleeding. CONCLUSION: For PTs presenting as anemia without known etiologies, further studies are suggested to rule out possible gastrointestinal tract metastasis though such cases are extremely rare. Management of metastatic gastric tumor from PTs should be done on a case-to-case basis, surgical intervention may be needed if there is persistent active bleeding despite medical treatment. Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm and high-risk malignant tumors. Adjuvant chemotherapy or target therapy may be helpful for metastatic PTs. Molecular and genomic techniques may predict clinical outcomes of benign and borderline PTs more precisely.

The Type and Content of Collagen Fibers of the Levator Aponeurosis in Patients With Simple Congenital Blepharoptosis.

BACKGROUND: The pathogenesis of congenital blepharoptosis remains controversial and most of the studies focused on the histologic changes of the levator muscle. However, thickening of the aponeurosis was reported in congenital blepharoptosis. And the thickness of the levator aponeurosis was found to be correlated with the levator function in congenital dysmyogenic blepharoptosis. PURPOSE: The authors conducted this research to investigate the histological changes of the levator aponeurosis of simple congenital blepharoptosis patients. PATIENTS AND METHODS: The authors analyzed 12 levator aponeurosis from ptosis patients and 21 levator aponeurosis from the cadaver specimens without relative medical history. The specimens were stained with hematoxylin and eosin as well as Sirius red. The sections were examined under light-microscopy. The content and type of collagen fibers were examined with the photos taken of the sections stained with Sirius red under polarized light-microscopy. RESULTS: The content and proportion of type I collagen increased significantly in the patient group compared with the cadaver group. The proportion of type I collagen was 97.5% in the patient group, while it was 51.5% in the cadaver group. However, no correlation was found either between the levator strength, degree of ptosis and the proportion of type I collagen in the patient group or between age, gender and proportion of type I collagen in the cadaver group. CONCLUSIONS: To our knowledge, this is the first time this phenomenon was discovered. The increase of type I collagen in the levator aponeurosis of the simple congenital blepharoptosis patients may imply the increased stiffness and undermined ability of transmitting forces, dissipate energy and prevent mechanical failure in the levator aponeurosis.

Modeling of ultraviolet scattering propagation and its applicability analysis.

The existing ultraviolet (UV) single scattering models do not incorporate the applicability of transceiver geometry, which makes them have certain errors even in short-range cases. To solve this issue, we propose a single scattering model in this Letter, which is suitable for the case where the transceiver field of view is above ground. This meets the requirements of general UV communication. For tractable analysis, we utilize the number of intersections between special rays on a transceiver cone to classify communication scenarios. Calculation results show that when the transceiver elevation angle exceeds certain values, the path loss difference between the single scattering model and Monte Carlo simulation model increases rapidly, which implies that single scattering approximation is not applicable to these conditions even in short-range cases. This work presents a new way to obtain the path loss of the UV channel and provides guidelines for experimental system design.

Modeling of ultraviolet scattering propagation and its applicability analysis: erratum.

This erratum provides corrections to Fig. 1, Eqs. (1b) and (6b), and Case (e) of Opt. Lett.44, 4953 (2019)OPLEDP0146-959210.1364/OL.44.004953.

Enhanced photocatalytic efficiency of C3N4/BiFeO3 heterojunctions: the synergistic effects of band alignment and ferroelectricity.

As one of the most promising photocatalysts, graphitic carbon nitride (g-C3N4) shows a visible light response and great chemical stability. However, its relatively low photocatalytic efficiency is a major obstacle to actual applications. Here an effective and feasible method to dramatically increase the visible light photocatalytic efficiency by forming C3N4/BiFeO3 ferroelectric heterojunctions is reported, wherein the band alignment and piezo-/ferroelectricity have synergistic positive effects in accelerating the separation of the photogenerated carriers. At the optimum composition of 10 wt% BiFeO3, the heterojunction shows 1.4 times improved photocatalytic efficiency than that of the pure C3N4. Most importantly, mechanical pressing and electrical poling can also improve the photocatalytic efficiencies by 1.3 times and 1.8 times, respectively. The optimized photocatalytic efficiency is even comparable with that of some noble metal based compounds. These results not only prove the improved photocatalytic activity of the C3N4-ferroelectric heterojunctions, but also provide a new approach for designing high-performance photocatalysts by taking advantage of ferroelectricity.

Analysis of treatment pathways for three chronic diseases using OMOP CDM.

The present study examined treatment pathways (the ordered sequence of medications that a patient is prescribed) for three chronic diseases (hypertension, type 2 diabetes, and depression), compared the pathways with recommendations from guidelines, discussed differences and standardization of medications in different medical institutions, explored population diversification and changes of clinical treatment, and provided clinical big data analysis-based data support for the development and study of drugs in China. In order to run the "Treatment Pathways in Chronic Disease" protocol in Chinese data sources,we have built a large data research and analysis platform for Chinese clinical medical data. Data sourced from the Clinical Data Repository (CDR) of the First Affiliated Hospital of Nanjing Medical University was extracted, transformed, and loaded into an observational medical outcomes partnership common data model (OMOP CDM) Ver. 5.0. Diagnosis and medication information for patients with hypertension, type 2 diabetes, and depression from 2005 to 2015 were extracted for observational research to obtain treatment pathways for the three diseases. The most common medications used to treat diabetes and hypertension were metformin and acarbose, respectively, at 28.5 and 20.9% as first-line medication. New drugs were emerging for depression; therefore, the favorite medication changed accordingly. Most patients with these three diseases had different treatment pathways from other patients with the same diseases. The proportions of monotherapy increased for the three diseases, especially in recent years. The recommendations presented in guidelines show some predominance. High-quality, effective guidelines incorporating domestic facts should be established to further guide medication and improve therapy at local hospitals. Medical institutions at all levels could improve the quality of medical services, and further standardize medications in the future. This research is the first application of the CDM model and OHDSI software in China, which were used to study, treatment pathways for three chronic diseases (hypertension, type 2 diabetes and depression), compare the pathways with recommendations from guidelines, discuss differences and standardization of medications in different medical institutions, demonstrate the urgent need for quality national guidelines, explores population diversification and changes of clinical treatment, and provide clinical big data analysis-based data support for the development and study of drugs in China.

Experimental Observation of Anisotropic Adler-Bell-Jackiw Anomaly in Type-II Weyl Semimetal WTe_{1.98} Crystals at the Quasiclassical Regime.

The asymmetric electron dispersion in type-II Weyl semimetal theoretically hosts anisotropic transport properties. Here, we observe the significant anisotropic Adler-Bell-Jackiw (ABJ) anomaly in the Fermi-level delicately adjusted WTe_{1.98} crystals. Quantitatively, C_{W}, a coefficient representing the intensity of the ABJ anomaly along the a and b axis of WTe_{1.98} are 0.030 and 0.051 T^{-2} at 2 K, respectively. We found that the temperature-sensitive ABJ anomaly is attributed to a topological phase transition from a type-II Weyl semimetal to a trivial semimetal, which is verified by a first-principles calculation using experimentally determined lattice parameters at different temperatures. Theoretical electrical transport study reveals that the observation of an anisotropic ABJ along both the a and b axes in WTe_{1.98} is attributed to electrical transport in the quasiclassical regime. Our work may suggest that electron-doped WTe_{2} is an ideal playground to explore the novel properties in type-II Weyl semimetals.

Controllable Diastereodivergent Synthesis of Pyrrolo[2,1-a]isoquinolines via Catalytic Intramolecular Acylsulfenylation of Activated Alkenes.

A controllable stereoselective synthesis of tetrahydropyrrolo[2,1-a]isoquinoline derivatives bearing a sulfur moiety was demonstrated with high diastereoselectivity through a catalytic intramolecular acylsulfenylation of activated alkenes. This approach involved a catalytic thia-Michael addition triggered intramolecular aldol-type tandem sequence. Both cis- and trans-products can be readily prepared in moderate to high yields with excellent diastereoselectivities in a catalytically atom-economic fashion under the optimized mild reaction conditions.

Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature.

Background: Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Case presentation: Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R't was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of tumor was done. Conclusion: Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.