Pancreatic follicular dendritic cell sarcoma: a rare case report and systematic literature review of 7 cases.

INTRODUCTION: Pancreatic follicular dendritic cell sarcoma (FDCS) is an exceptionally rare and low-to-moderate malignancy, with only seven reported cases to date. Clinical diagnosis of FDCS is challenging due to the lack of distinct biological and radiographic features. CASE PRESENTATION: A 67-year-old woman presented to the hospital with a 4-day history of severe abdominal pain. Imaging studies (CT and MRI) revealed a large cystic mass located at the tail of the pancreas, which was suspected to be myeloid sarcoma (MS) based on EUS and CT-guided pancreatic puncture. Postoperative pathology and immunohistochemistry confirmed the diagnosis of pancreatic FDCS. After the diagnosis was confirmed, the patient received postoperative chemotherapy with the CHOP regimen. At 11 months of follow-up, there was no evidence of recurrence. Seven published cases have been reviewed to comprehensively summarize the clinical characteristics, diagnosis, and treatment options of FDCS. CONCLUSION: While imaging can be useful in detecting pancreatic FDCS, it should be interpreted with caution as it can be challenging to differentiate from other pancreatic tumors. Pathology and immunohistochemistry are considered the gold standard for diagnosis, with CD21, CD23, and CD35 being specific tumor cell markers. However, preoperative diagnosis of pancreatic FDCS remains difficult, and the pancreatic puncture may further increase the risk of misdiagnosis. The disease is highly prone to recurrence and metastasis, and surgery is the preferred method for both diagnosis and treatment of localized disease.

[Connotation of Baimai disease and analysis of compatibility and usage of Baimai Ointment: based on Tibetan medicine theory].

Baimai is a complex of structure and function with the characteristics of wide distribution, complex structure, and multi-dimensional functions. Baimai, consisting of the channels in brain, the internal hidden channels connecting the viscera, and the external channels linking the limbs, governs the sensory, motor, and information transmission functions of human. According to Tibetan medicine, Baimai functions via "Long"(Qi) which moves in Baimai. "Long" is rough, light, cold, tiny, hard, and dynamic. The dysfunction of Baimai is manifested as numbness, swelling and pain, stiffness, atrophy, contracture, disability, hyperactivity, etc. The clinical manifestations of Baimai disease are facial paralysis, limb numbness, hemiplegia, contracture and rigidity, pain, opistho-tonos, paralysis, unconsciousness, head tremor, aphasia and tongue stiffness, and other abnormalities in facial consciousness, limb movement, and tactile sensation. Baimai Ointment for external use is used for the treatment of Baimai disease. It is mainly composed of medicinals which are spicy and bitter, warm, soft, mild, heavy, moist, and stable, and thus it is effective for the rough, light, cold, tiny, hard, and dynamic "Long" of Baimai disease. In clinical practice, it is mainly used for musculoskeletal diseases, such as osteoarthritis, scapulohumeral periarthritis, cervical spondylosis, low back pain, myofascitis, and tenosynovitis, nervous system diseases, such as paralysis and shoulder-hand syndrome, and limb stiffness caused by stroke, spastic cerebral palsy, trigeminal neuralgia, and facial neuritis, and limb motor and sensory dysfunction caused by trauma. According to the main symptoms of Baimai disease such as stiffness, rigidity, contraction, numbness, sensory disturbance and pain, clinicians should apply the Baimai Ointment via the inunction treatment of Tibetan medicine and in combination with Huo'ermai therapy and physiotherapy.

[Enhancing effects of chemical permeation enhancer propylene glycol and ultrasonic technology on transdermal permeation of Baimai Ointment].

This study aimed to improve the transdermal permeation quantity of Baimai Ointment by investigating the enhancing effects of physical and chemical permeation promoting methods on transdermal permeation of Baimai Ointment. The improved Franz diffusion cell method was used for in vitro transdermal experiment. The abdominal skin of mice was used, and the skin was treated with 3% propylene glycol in the chemical enhancement group. Ultrasonic technology was introduced in the physical enhancement group. The conditions of ultrasonic technology were optimized by single factor trial. Taking Q_(EF) and ER as the indexes of penetration promotion performance, the enhancing effects of the two methods were compared. The results showed that the promotion performance of 3% propylene glycol for ammonium glycyrrhizinate, nardosinone and curcumin of the chemical enhancement group were 1.74, 1.60, and 3.73 times higher than those of the blank group, respectively. The overall permeation efficiency of the Baimai Ointment was significantly improved. The comprehensive promoting effect on each component was curcumin>ammonium glycyrrhizinate>nardosinone. In the physical enhancement group, the penetration promoting effect of ultrasonic power 1.0 W was better than that of 2.0 W and 0.5 W, ultrasonic time 5 min was better than 3 min and 8 min, and the ultrasonic frequency 1 MHz was better than 3 MHz. Therefore, the optimal ultrasonic condition was 1.0 W-5 min-1 MHz. Under this condition, in terms of the transdermal permeation for ammonium glycyrrhizinate, the Q_(EF) and ER of the ultrasonic technology were better than those of 3% propylene glycol. In terms of the transdermal permeation for nardosinone and curcumin, the QEF and ER of 3% propylene glycol were better than those of the ultrasonic technology. Therefore, 3% propylene glycol combined with ultrasonic technology can be used to promote permeation of Baimai Ointment that contains both water-soluble and fat-soluble components in the clinical application. This study provides a theoretical basis for the clinical application of Baimai Ointment and other transdermal preparations.

Ectopic pancreas appearing as a giant gastric cyst mimicking gastric lymphangioma: a case report and a brief review.

BACKGROUND: Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular communication with the normal body of the pancreas. Despite improvements in diagnostic endoscopy and imaging studies, differentiating ectopic pancreatic tissue from gastric submucosal diseases remains a challenge. CASE PRESENTATION: Here, we present a case of a 44-year-old woman with severe epigastric pain. Initially, gastric lymphangioma was highly suspected due to a well-demarcated protruding mass with a large size that occurred in the submucosal layer of the gastric antrum and appeared as a cystic lesion. The final correct diagnosis of gastric EP was made during surgery. CONCLUSION: Gastric EP with serous oligocystic adenoma appearing as a giant gastric cyst is extremely rare. The difficulty of making an accurate diagnosis and differential diagnosis is highlighted, which may provide additional clinical experience for the diagnosis of EP with serous oligocystic adenoma in the stomach.

[Suitability of Internet Medical Services of Hospitals from the Perspective of Suppliers].

Objective To investigate the suitable services of telemedicine at present and the future from the perspective of medical service supplier,clarify the challenges in the development of telemedicine services at present,and provide evidence-based suggestions for improving the quality of telemedicine services. Methods A questionnaire was developed through literature review for the survey of telemedicine services from the perspective of service providers.From January to June in 2020,electronic questionnaires were collected from volunteers.The data were collated and analyzed by Excel 2010 and SPSS 21.0. Results A total of 614 questionnaires were distributed,and 582 effective questionnaires were collected,which showed an effective rate of 94.79%.The participants of this study were mainly young healthcare workers,including doctors,nurses,technicians,and medical students.Among them,68.73% expressed concern to telemedicine services-related work,and more than 50% only had a basic understanding of the related work.The top five developable telemedicine/healthcare services were health management,online consultation,disease re-examination,disease screening,and difficult disease consultation,which were basically consistent with the services suitable for future development. Conclusions Healthcare workers have a high degree of recognition to the development of telemedicine services,while their understanding of the related technologies remains to be improved.The available telemedicine services focus on online consultation,difficult disease consultation,and disease re-examination,while the complicated medical services need to be improved.In the future,efforts should be made to continuously improve the information construction level and narrow the regional gap of medical services,so as to promote the continuous improvement and the coordinated development of medical services between regions.

Pathological role of ion channels and transporters in the development and progression of triple-negative breast cancer.

Breast cancer is a common malignancy in women. Among breast cancer types, triple-negative breast cancer (TNBC) tends to affect younger women, is prone to axillary lymph node, lung, and bone metastases; and has a high recurrence rate. Due to a lack of classic biomarkers, the currently available treatments are surgery and chemotherapy; no targeted standard treatment options are available. Therefore, it is urgent to find a novel and effective therapeutic target. As alteration of ion channels and transporters in normal mammary cells may affect cell growth, resulting in the development and progression of TNBC, ion channels and transporters may be promising new therapeutic targets for TNBC. This review summarizes ion channels and transporters related to TNBC and may provide new tumor biomarkers and help in the development of novel targeted therapies.

Gastric tuberculosis mimicking submucosal tumor: a case series.

BACKGROUND: Gastric tuberculosis mimicking submucosal tumors is extremely rare and often misdiagnosed. CASE PRESENTATION: Three cases of gastric tuberculosis mimicking submucosal tumors were identified among patients admitted to local county hospitals because of upper abdominal discomfort and pain, with gastroscopy showing gastric submucosal tumors. The patients were admitted to our hospital for endoscopic ultrasonography (EUS). As EUS revealed evidence of tuberculosis for the first two patients, we first considered gastric tuberculosis. However, because of atypical characteristics of the miniature ultrasonic probe and EUS, the lesion in the third patient was misdiagnosed as a stromal tumor, and the patient underwent endoscopic submucosal dissection (ESD), and intraoperative characteristics and postoperative pathology confirmed the lesion to be tuberculosis. CONCLUSIONS: EUS is of great value in the diagnosis of gastric tuberculosis, especially gastric tuberculosis mimicking submucosal tumors. Here, we summarize some significant characteristics of gastric tuberculosis by EUS, which will be of substantial value to clinical work.

Chronic lead poisoning induced abdominal pain and anemia: a case report and review of the literature.

BACKGROUND: Chronic lead poisoning (CLP) is a rare cause of abdominal pain and is common in young children, in whom the incidence is higher than it is in adults. As the symptoms of CLP are nonspecific, misdiagnoses or missed diagnoses often occur, especially in sporadic cases. CASE PRESENTATION: We report a 28-year-old young man who was misdiagnosed with renal colic due to sudden acute abdominal pain. After a detailed medical history and physical examination, other possible causes were excluded, CLP was finally diagnosed, and he recovered after chelation treatment. CONCLUSION: Abdominal pain is a very common clinical symptom in adults, which has many causes. We should be vigilant against chronic poisoning, especially CLP. Detailed diagnosis and physical examination are crucial in early diagnosis and treatment.

EUS in the diagnosis of pathologically undiagnosed esophageal tuberculosis.

BACKGROUND: Esophageal tuberculosis (ET) is relatively rare, and the diagnosis is challenging. The aim of this study was to evaluate the clinical features of ET and highlight the role of endoscopic ultrasonography (EUS) in the diagnosis of pathologically undiagnosed ET. METHODS: We retrospectively analysed the clinical features, radiological performances, conventional endoscopic appearances, EUS features, treatment and outcomes of pathologically undiagnosed ET between January 2011 and December 2018. All 9 patients failed to be diagnosed by at least two repeated biopsies (such as routine biopsy, multipoint or deep biopsy, and even or EUS-guided fine-needle aspiration (EUS-FNA)). RESULTS: Nine patients (66.7% female) with a mean age of 45 years (range 29-59) complained of retrosternal pain or discomfort, or (and) dysphagia. Esophagoscopy demonstrated protruding lesions in the mucosa with central ulcers or erosion in five patients, submucosal bulges with smooth surfaces in one patient, submucosal bulges with diverticula in one patient, ulcers with suspicious fistula formation in one patient, and multiple ulcers in one patient. None of the patients received confirmed histopathological or bacteriological diagnoses by repeated biopsies. However, they were first suspected to have ET based on EUS examination. Because EUS found some characteristic ultrasonographic changes, which were very helpful for the diagnosis of ET when combined with clinical manifestations, the patients subsequently received diagnostic antituberculosis therapy. Finally, the patients recovered or improved with follow-up times ranging from 3 to 10 months. CONCLUSIONS: EUS could help in the diagnosis of ET on basis of EUS features like poorly defined esophageal wall structure, enlarged paraesophageal or mediastinal lymph nodes, hypoechoic lesions of esophageal wall that are linked to the enlarged paraesophageal lymph nodes. However all attempts should be made to obtain histological or microbiological diagnosis.

Syphilis associated with recreational drug use, depression and high-risk sexual behaviour in men who have sex with men: a case-control study in China.

OBJECTIVE: We investigated syphilis prevalence among men who have sex with men (MSM) in China, as well as potential risk factors. Our principal hypothesis was that syphilis would be associated with the use of recreational drugs such as methamphetamines. METHODS: From April to October 2013, we used several methods to recruit MSM in Qingdao, collecting demographic/behavioural information via self-administrated questionnaires. Trained health workers collected blood for the Treponema pallidum particle assay (TPPA) with positives confirmed by a toluidine red unheated serum test. We used an unmatched case-control study to identify factors that might predict syphilis infection using multivariable logistic regression. RESULTS: We recruited 447 MSM who agreed to participate and who completed syphilis testing. Of 71 (15.9%) syphilis-positive MSM, 44 (62.0%) used drugs. Of 376 (84.1%) syphilis-negative MSM, 186 (49.5%) used drugs. We found a positive association with syphilis for any recreational drug use (crude OR (cOR) 1.7, 95 % CI 1.0 to 2.8), frequent methamphetamine use (cOR 2.4, 95% CI 1.1 to 5.3) and multiple drug use (adjusted OR (aOR) 3.4, 95% CI 1.3 to 9.2). Syphilis-positive men were more likely to have a higher physical depression score (aOR 5.2, 95% CI 1.1 to 24.4), be > 30 years old (aOR 2.7, 95% CI 1.5 to 4.8), report a prior STI (aOR 4.1, 95% CI 2.3 to 7.3) and report a sex party experience (aOR 2.2, 95% CI 1.1 to 4.4). CONCLUSIONS: Recreational drug use, depression and high-risk sexual behaviours were associated with syphilis infection among MSM in China. Only a multifaceted approach is likely be effective in control of both syphilis and HIV .

NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students.

PURPOSE: This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry. METHODS: This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention. RESULTS: The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly. CONCLUSION AND PRACTICE IMPLICATIONS: This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).

[In vitro transdermal permeation of main compositions in Baimai Ointment].

To establish a determination method for the contents of ammonium glycyrrhetate,nardosinone,and curcumin in transdermal receptor liquid of Baimai Ointment,and investigate the percutaneous permeability of Baimai Ointment and the effects of two kinds of penetration enhancers on percutaneous absorption of three components. The contents of ammonium glycyrrhetate,nardosinone,and curcumin in transdermal receptor liquid were determined by high pressure liquid chromatography( HPLC). The vertical modified Franz diffusion cell was used to perform a transdermal experiment in vitro with the abdominal skin of mice( treated and untreated). The transdermal receptor liquid was preferably used to investigate the transdermal absorption rule of the Baimai Ointment and the effect of the penetration enhancer. The results showed that the comprehensive solubility of PEG-ET-NS( 3 ∶3 ∶4) was best among three types of receptor liquid PG-ET-NS( 3 ∶3 ∶4),PEG-ET-NS( 3 ∶3 ∶4),ET-NS( 3 ∶7). PEG-ET-NS was used as the receptor liquid for in vitro transdermal experiments. The cumulative permeation area of ammonium glycyrrhetate,nardosinone and curcumin within 24 h was 5. 73,18. 99,0. 38 µg·cm~(-2)respectively. Taking QEFand ER as comprehensive evaluation indicators of permeation performance,the comprehensive penetration-promoting performance of ammonium glycyrrhizinate: 3% PEG 400-ethanol-normal saline ≈ 1. 19 times( 3%azone) = 1. 94 times( blank); comprehensive penetration-promoting performance of nardosinone: 3% PEG 400-ethanol-normal saline≈1. 28 times( 3% azone) = 1. 37 times( blank); the comprehensive penetration performance of curcumin: 3% PEG 400-ethanol-normal saline≈1. 77 times( 3% azone) ≈3. 42 times( blank). The comprehensive penetration enhancement properties of the two penetration enhancers were as follows: 3% PEG 400-ethanol-normal saline>3%azone>blank. The transdermal absorption curve of ammonium glycyrrhetate,nardosinone and curcumin in Baimai Ointment were consistent with the zero-order equation,indicating that the transdermal absorption process was irrelevant to the concentration of three components,and its was a diffusion process. This experiment provides reference for the study of ointment transdermal preparations.

[Analysis on quality value transmitting of substance benchmarks of Linggui Zhugan Decoction].

By preparing 10 batches of the material reference of Linggui Zhugan Decoction,the methodology of the characteristic spectrum of the material reference was created. The creaming rate range,the contents and the transfer rate range of cinnamaldehyde,glycyrrhizin and glycyrrhizic acid,the characteristic peaks and the similarity range of the characteristic spectrum of Linggui Zhugan Decoction were determined to clarify key quality attributes of the material reference of Linggui Zhugan Decoction. In the 10 batches of the material reference of Linggui Zhugan Decoction,the similarity of characteristic spectrum was higher than 0. 9. Furthermore,after summarizing the characteristic peak information,we knew that Fuling had two characteristic peaks,Guizhi had six characteristic peaks,Baizhu had two characteristic peaks and Gancao had 11 characteristic peaks. The average creaming rate of the material reference of the ten batches was( 12. 13 ± 0. 35) %. The average content of cinnamaldehyde was 0. 32%,the average transfer rate was 10. 69%,the content of cinnamaldehyde in the different batches was between 0. 22% and 0. 42%,and the transfer rate was between 7. 48% and13. 90%. The average content of glycyrrhizin was 0. 84%,the average transfer rate was 50. 39%,the content of glycyrrhizin in the different batches was between 0. 42% and 1. 26%,and the transfer rate was between 35. 27% and 65. 51%. The average content of glycyrrhizic was 1. 88%,the average transfer rate was 40. 74%,the content of glycyrrhizic in the different batches was between 0. 94% and2. 82%,and the transfer rate was between 28. 52% and 52. 96%. In this paper,the quality value transmitting of substance benchmarks of Linggui Zhugan Decoction was analyzed by the combination of characteristic spectrum,creaming rate and the content of index component. A scientific and stable method was preliminarily established,which provided scientific basis for the quality control and formulation development of Linggui Zhugan Decoction.

A modified endoscopic submucosal dissection for a superficial hypopharyngeal cancer: a case report and technical discussion.

BACKGROUND: Adequate working space and a clear view for the dissected lesion are crucial for endoscopic submucosal dissection (ESD). Pharyngeal ESD requires that an otorhinolaryngologist creates working space by lifting the larynx with a curved laryngoscope. However, many countries do not have this kind of curved laryngoscope, and the devices could interfere with endoscope because of the narrow space of the pharynx. To overcome these issues, we used a transparent hood (Elastic Touch, slit and hole type, M (long), Top company, Tokyo Japan) instead of the curved laryngoscope to create adequate working space by pushing the larynx, and pharyngeal ESD could be done by gastroenterologists. CASE PRESENTATION: A 64-year-old male patient was admitted to our hospital because of chronic persistent swallowing dysfunction for 2 years. Oesophagogastroduodenoscopy showed a superficial hypopharyngeal cancer in the right pyriform sinus. We used a transparent hood (Elastic Touch, slit and hole type, M (long), Top company, Tokyo Japan) instead of the curved laryngoscope to create adequate working space by pushing the larynx, and dental floss tied to a haemoclip was applied to create counter traction during ESD. The lesion was pathologically confirmed as superficial squamous cell carcinoma and resected completely. CONCLUSIONS: This is the first report of modified ESD for a superficial hypopharyngeal cancer. The modified ESD enables early pharyngeal superficial cancer to be removed completely under endoscope by gastroenterologist.

Multi-disciplinary team for early gastric cancer diagnosis improves the detection rate of early gastric cancer.

BACKGROUND: Gastric cancer is a frequent malignant tumor worldwide and its early detection is crucial for curing the disease and enhancing patients' survival rate. This study aimed to assess whether the multi-disciplinary team (MDT) can improve the detection rate of early gastric cancer (EGC). METHODS: The detection rate of EGC at the Digestive Endoscopy Center, Affiliated Hospital, Zunyi Medical College, China between September 2013 and September 2015 was analyzed. MDT for the diagnosis of EGC in the hospital was established in September 2014. The study was divided into 2 time periods: September 1, 2013 to August 31, 2014 (period 1) and September 1, 2014 to September 1, 2015 (period 2). RESULTS: A total of 60,800 patients' gastroscopies were performed during the two years. 61 of these patients (0.1%) were diagnosed as EGC, accounting for 16.44% (61/371) of total patients with gastric cancer. The EGC detection rate before MDT (period 1) was 0.05% (16/29403), accounting for 9.09% (16/176) of total patients with gastric cancer during this period. In comparison, the EGC detection rate during MDT (period 2) was 0.15% (45/31397), accounting for 23% (45/195) of total patients with gastric cancer during this period (P < 0.05). Univariate and multivariate logistic analyses showed that intensive gastroscopy for high risk patients of gastric cancer enhanced the detection rate of EGC in cooperation with Department of Pathology (OR = 10.1, 95% CI 2.39-43.3, P < 0.05). CONCLUSION: MDT could improve the endoscopic detection rate of EGC.

[Optimize ethanol-extraction procedure of Shenlian granules by orthogonal design with pharmacodynamics index].

To optimize the ethanol extraction process for Shenlian formula. On the basis of the pharmacodynamics index for different extraction process routes, the contents of salvianolic acid B, tanshinone ⅡA and berberine, as well as the extraction ratio in different experimental schemes were used as the ethanol extraction examining indexes, and multi-criterion synthesizing grading method was used for data analysis to optimize and verify the ethanol-extraction process conditions in orthogonal experiment. The optimum ethanol extraction process was as follows: adding 60% ethanol, 10 times amount, extracting for 2.0 h each time for a total of 2 times. This extraction process showed good stability and availability.

Development and in vitro evaluation of a transdermal hydrogel patch for ferulic acid.

Current work aimed to develop and evaluate a transdermal delivery system of hydrogel patch for ferulic acid to treat skin damage induced by UV radiation. VISCOMATE(TM) NP700, dihydroxy aluminium aminoacetate, glycerine, tartaric acid were used in combination in different ratios to design the hydrogel patch. In vitro release rate was selected as an index to optimize the formulation. The formulated hydrogel patch was evaluated by several parameters like tacking strength, cohesive strength, peeling strength, residuals after peeling and drug content determination. The in vitro penetration was determined by Franz diffusion technology with hairless mouse skin as permeability media. Different kinetics models were employed to simulate the release and penetrate patterns of ferulic acid from patches in order to investigate the drug transport mechanism. The residual drugs in the patch and skin were determined after the penetration experiment. The optimized preparation was dihydroxy aluminium aminoacetate: NP700: glycerine: ferulic acid as a ratio of 0.02:0.4:1.5:1.25:0.25. The cumulative percentage of release was 60.4465±1.7679% for 24h, which results from a combination of diffusion effect and polymer erosion effect. For the barrier of stratum corneum, the cumulative penetrate rate was only 1.3156±0.3588% and the release mechanism turn out to be the effect of erosion of polymer surface. The residual drugs in the patch were 97.5949±1.4932%. The in vitro data revealed that it was easy for ferulic acid to release from the paste while difficult to permeate through the skin barrier, which resulted in most of drugs residued in the paste. Hence, further experiments will be necessary for finding the penetration enhancer in ferulic acid transdermal delivery.