Delayed hepatic rupture post ultrasound-guided percutaneous liver biopsy: A case report.

RATIONALE: Hemorrhage, one of complications after liver biopsy, is often identified immediately after the procedure while delayed liver rupture is relatively rare. PATIENT CONCERNS: A 45-year-old woman was diagnosed with undetermined liver cirrhosis and abnormal liver function. To determine the etiology and severity of liver cirrhosis, ultrasound-guided liver biopsy was arranged. The patients did not complain any pain during the procedure. Ultrasound examination on postoperative day1 (POD 1) and MRI on POD 3 showed no evidence of hematoma and ascites. On POD 7, however, the patient was taken to the hospital with a sudden onset of pain in the right upper quadrant of the abdomen. DIAGNOSES: Contrast-enhanced computed tomography revealed liver rupture of right inferior segment of the liver with subcapsular hematoma. INTERVENTIONS: Patient was treated with infusion of 2-unit red blood cell suspension, fluid and hemostatics. OUTCOMES: The vital signs of the patient were stabilized after the therapy. The follow-up ultrasound 1 month later showed a shrunken subcapsular hematoma measuring 4.2 × 2.1 cm at the right lobe. LESSONS: Whenever a liver biopsy procedure is performed, the care should be taken to avoid puncturing those areas that may have liver incisure. Moreover, the patient need to rest for several days and to avoid heavy activities, which is one of the major risk factors for post-procedure bleeding

Diagnostic Accuracy of CEUS LI-RADS for the Characterization of Liver Nodules 20 mm or Smaller in Patients at Risk for Hepatocellular Carcinoma.

Background: American College of Radiology contrast agent–enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) was developed to improve the accuracy of hepatocellular carcinoma (HCC) diagnosis at contrast agent2enhanced US. However, to the knowledge of the authors, the diagnostic accuracy of the system in characterization of liver nodules 20 mm or smaller has not been fully evaluated. Purpose: To evaluate the diagnostic accuracy of CEUS LI-RADS in diagnosing HCC in liver nodules 20 mm or smaller in patients at risk for HCC. Materials and Methods: Between January 2015 and February 2018, consecutive patients at risk for HCC presenting with untreated liver nodules 20 mm or less were enrolled in this retrospective double-reader study. Each nodule was categorized according to the CEUS LI-RADS and World Federation for Ultrasound in Medicine and Biology (WFUMB)–European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria. Diagnostic performance of CEUS LI-RADS and WFUMB-EFSUMB characterization was evaluated by using tissue histologic analysis, multiphase contrast-enhanced CT and MRI, and imaging follow-up as reference standard and compared by using McNemar test. Results: The study included 175 nodules (mean diameter, 16.1 mm 6 3.4) in 172 patients (mean age, 51.8 years 6 10.6; 136 men). The sensitivity of CEUS LR-5 versus WFUMB-EFSUMB criteria in diagnosing HCC was 73.3% (95% confidence inter-val [CI]: 63.8%, 81.5%) versus 88.6% (95% CI: 80.9%, 94%), respectively (P, .001). The specificity of CEUS LR-5 versus WFUMB-EFSUMB criteria was 97.1% (95% CI: 90.1%, 99.7%) versus 87.1% (95% CI: 77%, 94%), respectively (P = .02). No malignant lesions were found in CEUS LR-1 and LR-2 categories. Only two nodules (of 41; 5%, both HCC) were malignant in CEUS LR-3 category. The incidences of HCC in CEUS LR-4, LR-5, and LR-M were 48% (11 of 23), 98% (77 of 79), and 75% (15 of 20), respectively. Two of 175 (1.1%) histologic analysis2confirmed intrahepatic cholangiocarcinomas were categorized as CEUS LR-M by CEUS LI-RADS and misdiagnosed as HCC by WFUMB-EFSUMB criteria. Conclusion: The contrast-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm was an effective tool for characterization of small (≤20 mm) liver nodules in patients at risk for hepatocellular carcinoma (HCC). Compared with World Federation for Ultrasound in Medicine and Biology2European Federation of Societies for Ultrasound in Medicine and Biology criteria, CEUS LR-5 demonstrated higher specificity for diagnosing small HCCs with lower sensitivity

Prevalence and molecular typing of the antiseptic resistance genes qacA/B among Staphylococcus aureus strains isolated in a teaching hospital

The qacA/B genes are found in Staphylococcus aureus and confer resistance to various antiseptics and disinfectants. Herein, the prevalence of the qacA/B genes in methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) was investigated. Molecular typing systems were used to analyse the relatedness of these qacA/B-positive strains. 176 six strains of clinically isolated S. aureus were collected between July, 2008 and June, 2010. The strains carrying the qacA/B genes were characterised by pulse-field gel electrophoresis (PFGE) typing, Staphylococcus protein A (spa) typing, Panton-Valentine leucocidin (pvl) polymerase chain reaction (PCR) detection, staphylococcal chromosomal cassette (SCC) mec typing, and antimicrobial resistance profiles. Strains carrying the qacA/B genes composed 9.1% of the strains isolated, but the incidence of qacA/B genes in MRSA strains was significantly higher than that in MSSA strains (14.6 versus 4.3%, p < 0.05). Additionally, two predominant PFGE (B and A) and spa types (t037 and t042) were identified along with two major antimicrobial resistance profiles. All of these qacA/B-positive strains strains were pvl-negative by PCR. The qacA/B-positive MRSA strains all contained the group III SCCmec element. These strains were obtained mainly from patients in surgical wards; therefore, the neurosurgical ward and ICU may be considered as a source of MRSA strains carrying the qacA/B genes. Finally, the strain identified as spa type t037 is likely to be an epidemiological clone. The presence of the antiseptic resistance genes qacA/B by MRSA could potentially lead to MRSA strain prevalence. Thus, the optimal usage of antiseptics and disinfectants is warranted. A policy of molecular typing needs to be implemented to track the possible dissemination of these resistance genes.Key words: Staphylococcus aureus, mecA, qacA/B and pvl genes, methicillin-resistant,  Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA)

Primary intramedullary melanocytoma presenting with lower limbs, defecation, and erectile dysfunction:A case report and review of the literature

BACKGROUND: Primary intramedullary melanocytoma is an exceedingly rare type of primary melanocytic tumor in the central nervous system. Unfortunately, primary intramedullary melanocytoma lacks specificity in clinical symptoms and imaging features and there is currently no standard strategy for diagnosis or treatment. CASE SUMMARY: A 52-year-old male patient suffered from weakness and numbness involving the bilateral lower limbs for 18 mo, and defecation and erectile dysfunction for 6 mo. Furthermore, these symptoms started to worsen for the last 3 mo. Preoperative magnetic resonance imaging (MRI) revealed an intramedullary tumor located at the T9-T10 level. In subsequently surgery, the maximal safe resection extent approached to 98%. The lesion was confirmed to be melanocytoma by pathological examination. In addition, the possibility of original melanocytoma outside the spinal cord was excluded after the examination of the whole body. Therefore, a diagnosis of primary intramedullary melanocytoma was established. The patient refused to accept radiotherapy or Gamma Knife, but MRI examination on July 28, 2020 showed no sign of development. In addition, on April 10, 2021, the recent review showed that the disorder of defecation and lower limbs improved further but erectile dysfunction benefited a little from the surgery. CONCLUSION: After diagnosing intramedullary melanocytoma by postoperative pathology, the inspection of the whole body contributed to excluding the possibility of metastasis from other regions and further suggested a diagnosis of primary intramedullary melanocytoma. Complete resection, adjuvant radiation, and regular review are critical. In addition, maximal safe resection also benefits prognosis while the tumor is difficult to be resected totally

The open banking era:An optimal model for the emergency fund

The COVID-19 outbreak has negatively impacted the income of many bank users. Many users without emergency funds had difficulty coping with this unexpected event and had to use credit or apply to the government for bailout funds. Therefore, it is necessary to develop spending plans and deposit plans based on transaction data of users to assist them in saving sufficient emergency funds to cope with unexpected events. In this paper, an emergency fund model is proposed, and two optimization algorithms are applied to solve the optimal solution of the model. Secondly, an early warning mechanism is proposed, i.e. an unexpected prevention index and a consumption index are proposed to measure the ability of users to cope with unexpected events and the reasonableness of their expenditure respectively, which provides early warning to users. Finally, the model is experimented with real bank users and the performance of the model is analysed. The experiments show that compared to the no-planning scenario, the model helps users to save more emergency funds to cope with unexpected events, furthermore, the proposed model is real-time and sensitive.</p