Laparoscopic management of a giant adrenal cyst

AbstractAdrenal cysts, a rare entity, are usually nonfunctional and asymptomatic. Here, we report a 32-year-old woman who presented with mild breathlessness and vague abdominal fullness and discomfort that had lasted 6 months. Chest radiography showed elevation of the left side of the diaphragm. Abdominal sonography showed an anechoic lesion of >15cm, without a septum, that was situated over the left abdominal area. Abdominal computed tomography (CT) showed a 20cm suprarenal cyst located between the pancreas, spleen, and left kidney, causing anterior displacement of the pancreas and inferior displacement of the left kidney. Magnetic resonance imaging confirmed the CT and sonographic findings, and revealed that the cystic mass was originating from the left adrenal gland. Fluid analysis of the cystic lesion showed no evidence of infection or malignancy. A laparoscopic adrenalectomy was performed. Histopathologically, the adrenal tissue showed no evidence of adenoma or malignancy, and the cystic component showed a flattened endothelial lining with fibrotic tissue, consistent with an endothelial cyst. The postoperative course was uneventful and the patient had no evidence of recurrence during a 6-year follow-up. We discuss the diagnosis and management of adrenal cysts

BN-embedded monolayer graphene with tunable electronic and topological properties

Finding an effective and controllable way to create a sizable energy gap in graphene-based systems has been a challenging topic of intensive research. We propose that the hybrid of boron nitride and graphene (h-BNC) at low BN doping serves as an ideal platform for band-gap engineering and valleytronic applications. We report a systematic first-principles study of the atomic configurations and band gap opening for energetically favorable BN patches embedded in graphene. Based on first-principles calculations, we construct a tight-binding model to simulate general doping configurations in large supercells. Unexpectedly, the calculations find a linear dependence of the band gap on the effective BN concentration at low doping, arising from an induced effective on-site energy difference at the two C sublattices as they are substituted by B and N dopants alternately. The significant and tunable band gap of a few hundred meVs, with preserved topological properties of graphene and feasible sample preparation in the laboratory, presents great opportunities to realize valley physics applications in graphene systems at room temperature

Diagnostic Value of I-131 NP-59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD

Clinical radiomics-based machine learning versus three-dimension convolutional neural network analysis for differentiation of thymic epithelial tumors from other prevascular mediastinal tumors on chest computed tomography scan

PurposeTo compare the diagnostic performance of radiomic analysis with machine learning (ML) model with a convolutional neural network (CNN) in differentiating thymic epithelial tumors (TETs) from other prevascular mediastinal tumors (PMTs).MethodsA retrospective study was performed in patients with PMTs and undergoing surgical resection or biopsy in National Cheng Kung University Hospital, Tainan, Taiwan, E-Da Hospital, Kaohsiung, Taiwan, and Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan between January 2010 and December 2019. Clinical data including age, sex, myasthenia gravis (MG) symptoms and pathologic diagnosis were collected. The datasets were divided into UECT (unenhanced computed tomography) and CECT (enhanced computed tomography) for analysis and modelling. Radiomics model and 3D CNN model were used to differentiate TETs from non-TET PMTs (including cyst, malignant germ cell tumor, lymphoma and teratoma). The macro F1-score and receiver operating characteristic (ROC) analysis were performed to evaluate the prediction models.ResultIn the UECT dataset, there were 297 patients with TETs and 79 patients with other PMTs. The performance of radiomic analysis with machine learning model using LightGBM with Extra Tree (macro F1-Score = 83.95%, ROC-AUC = 0.9117) had better performance than the 3D CNN model (macro F1-score = 75.54%, ROC-AUC = 0.9015). In the CECT dataset, there were 296 patients with TETs and 77 patients with other PMTs. The performance of radiomic analysis with machine learning model using LightGBM with Extra Tree (macro F1-Score = 85.65%, ROC-AUC = 0.9464) had better performance than the 3D CNN model (macro F1-score = 81.01%, ROC-AUC = 0.9275).ConclusionOur study revealed that the individualized prediction model integrating clinical information and radiomic features using machine learning demonstrated better predictive performance in the differentiation of TETs from other PMTs at chest CT scan than 3D CNN model

Nonfatal Gastric Mucormycosis Associated With Emphysematous Gastritis

AbstractEmphysematous gastritis is a rare, often fatal disease characterized by the presence of gas within the walls of the stomach and diffuse gastric wall inflammation due to gas-forming bacteria. Gastric mucormycosis is a rare manifestation of invasive fungal disease, ranging from colonization of peptic ulcers to infiltrative disease with vascular invasion and dissemination. The combination of the two conditions is rare. There are a few reports in the literature of invasive gastric mucormycosis associated with emphysematous gastritis that were fatal. Here, we present a case of invasive gastric mucormycosis associated with emphysematous gastritis for which medical management was successful

Safety of Tepotinib Challenge after Capmatinib-Induced Pneumonitis in a Patient with Non-Small Cell Lung Cancer Harboring MET Exon 14 Skipping Mutation: A Case Report

The targeted agents capmatinib and tepotinib provide a new treatment for patients with non-small cell lung cancer (NSCLC) with MET exon 14 skipping mutation (METex14). However, drug-induced pneumonitis is an uncommon but threatening adverse effect found in patients treated with both capmatinib and tepotinib. The safety of treating a patient with a MET inhibitor after drug-induced pneumonitis by another MET inhibitor remains unclear. Here, we present a case of a patient with NSCLC harboring a METex14 who was treated with a standard dose of tepotinib after advanced capmatinib-induced pneumonitis and did not present pneumonitis relapse. Tepotinib may be a safe option when medical professionals consider switching MET inhibitors after patients experience pneumonitis

Synthesis and characterization of the acidic properties and pore textureof Al-SBA-15 supports for the canola oil transesterification

Ordered mesoporous SBA-15 was used as a support for the transesterification of canola oil to producebiodiesel. The pore size and surface acidity of SBA-15 were modified by synthesis conditions using differentaging temperatures and the addition of heterogeneous Al atoms. The results of the characterizationstudy indicated that a large amount of mesopore and surface acidity can greatly improve the transesterificationreaction at a high aging temperature and with the incorporation of aluminum into the SBA-15framework. This improvement in transesterification activity is due to the formation of more stable„SiAOAAl„bonds on the surface of the framework. The transesterification reaction was also comparedwith synthesis involving traditional supports such as acidic and basic c-Al2O3, hydrotalcite, and SiO2. Theactivities of the catalysts were related to their acidic strength