Effect of acupuncture on A1R/cAMP/p-CREB signaling pathway in cau-date putamen of CFA rats / 中国病理生理杂志

AIM:To observe the effect of acupuncture on adenosine A1 receptor(A1R)in the caudate puta-men(CPu)of complete Freund's adjuvant(CFA)rats,and to explore the potential mechanism of acupuncture in treat-ment of inflammatory pain.METHODS:Sixty-four 6～8-week-old male Wistar rats were randomly divided into saline group,model group(CFA group),CFA+manual acupuncture(MA)group,CFA+solvent dimethyl sulfoxide(DMSO)group,CFA+A1R agonist 2-chloro-N6-cyclopentyladenosine(CCPA)group,CFA+A1R antagonist 8-cyclopentyl-1,3-di-propylxanthine(DPCPX)group,CFA+MA+DMSO group and CFA+MA+DPCPX group.In MA groups,on the 2nd day af-ter modeling,the rats were needled at Zusanli points on both sides,30 min at a time,once per day,for 7 d.Pain threshold of plantar thermal radiation was used to observe the pain response of the rats.The content of cyclic adenosine monophos-phate(cAMP)in the CPu was detected by ELISA.The protein expression and phosphorylation levels of protein kinase A(PKA)and cAMP response element-binding protein(CREB)were detected by Western blot.The expression of A1R in the CPu was detected by immunofluorescence staining.RESULTS:Compared with saline group,CFA modeling signifi-cantly lowered the thermal pain threshold of the rats(P<0.01).Compared with CFA group,the thermal pain threshold of the rats in CFA+MA group and CFA+CCPA group was significantly increased(P<0.05 or P<0.01).Compared with CFA+ MA+DMSO group,the thermal pain threshold of the rats in CFA+MA+DPCPX group was decreased(P<0.05).Compared with CFA group,A1R protein relative expression level and positive cells in the CPu of the rats in CFA+MA group were in-creased(P<0.05 or P<0.01).Compared with saline group,cAMP content and p-CREB protein level in the CPu of the rats in CFA+MA group were decreased(P<0.05).Compared with CFA+DMSO group,cAMP content and p-CREB pro-tein level in CFA+MA+DMSO and CFA+CCPA groups were significantly decreased(P<0.01).Compared with CFA+MA+ DMSO group,the levels of cAMP,p-PKA and p-CREB in CFA+MA+DPCPX group were significantly increased(P<0.05 or P<0.01).CONCLUSION:Acupuncture on bilateral Zusanli can relieve inflammatory pain in CFA rats,and its mech-anism may be related to A1R/cAMP/p-CREB signaling pathway.

A case report of primary extubation by partial cricotracheal resection for severe subglottic stenosis / 临床耳鼻咽喉头颈外科杂志

This patient suffered from severe subglottic stenosis(grade Ⅳb). During partial cricotracheal resection, we cut through the cricothyroid membrane and the cricoid arch along the line from the lower edge of the thyroid cartilage to 5 mm of the inferior thyroid cartilage corner anteromedially. This can protect the cricothyroid joint, effectively protect the recurrent laryngeal nerve, and also support the airway. Strictly adhere to airway separation, avoid excessive separation of scars, and combine with reasonable postoperative management to achieve a safe extubation.

Numerical Simulation on Support Performance of NiTi Alloy Thoracic Aortic Stent / 医用生物力学

Objective To study the influence of different support heights, support numbers and cross-sectional dimensions on support performance of NiTi thoracic aortic stents. Methods Twenty-seven scaffold models with different parameters were established by using AutoCAD 2016 and SoildWorks 2014 software. HyperMesh 14.0 was used for tetrahedral mesh division, and ABAQUS 2017 was used for support performance simulation analysis. Results With the decrease of support height, the support stiffness would increase; a larger cross-section size would lead to a larger support stiffness; with the increase of support numbers, the support stiffness would increase. Among the influencing factors of support performance, the order of influence degree was support height＞section size＞support numbers. Conclusions The research findings have certain guiding significance for the development and research of thoracic aortic stents, and provide theoretical basis for the selection and optimization of clinical stents.

Phenotypic spectrum of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy in Fujian, China: a study based on screening scale / 中华神经科杂志

Objective To summarize the phenotypic spectrum of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in Fujian population,evaluate the efficiency of the scale and try to adjust it.Methods Thirty-eight CADASIL patients and 64 CADASIL-like patients were recruited based on the CADASIL scale and gene tests,who visited the First Affiliated Hospital of Fujian Medical University and Fujian Neurology Research Institute from May 2011 to November 2017.Their clinical and neuroimaging characteristics were analyzed.Results The migraine,migraine with aura,transient ischemic attack / stroke,early onset age,psychiatric disturbances,cognitive decline,leukoencephalopathy,subcortical infarcts showed no statistically significant differences between the two groups.Instead,compared with CADASIL-like patients (10/64,15.6％;47/64,73.4％;10/64,15.6％),CADASIL patients demonstrated higher percentages of temporal pole involvements (13/38,34.2％;x5=4.716,P=0.030),external capsule involvements (36/38,94.7％;P=0.008) and family history in at least two generations (13/38,34.2％;x2=4.716,P=0.030).According to the scale,the scores showed statistically significant difference between CADASIL (14.84 ± 3.03) and CADASIL-like patients (13.34 ± 3.31;t=2.282,P=0.025) with an area under receiver operating characteristic curve of 0.622.Conclusions CADASIL showed no specific symptoms in Fujian population.The neuroimaging features were proposed to be focused on,especially the external capsule involvements.CADASIL scale could improve diagnostic efficiency,but still needs to be adjusted for Fujian population.The weight value of migraine,migraine with aura and cognitive decline was suggested to be decreased.

The analysis of risk factors for cerebral microbleeds in cerebral infarction patients / 中国神经精神疾病杂志

Objective To analyze the risk factors of cerebral microbleeds (CMBs) in acute cerebral infarction patients. Methods We consecutively included 255 acute cerebral infarction patients who were admitted in Neurology Department of the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2016. According to the number and location of CMBs, the patients were divided into infratentorial, cortical and deep cerebral groups, each of which included non-mild and moderate-severe subgroups. The differences of the level of glomerular filtration rate (eGFR) and some common arteriosclerotic risk factors were analyzed between subgroups, and the multiple logistic regression analysis was performed. Results A total of 140 subjects (54.9%) had CMBs. In the infratentorial group, the proportion of patients who were with low eGFR level in the moderate-severe CMBs subgroup was higher than in the non-mild CMBs subgroup (P=0.024). The low eGFR level (OR=3.874, 95% CI:1.261～11.901, P=0.018) and the long duration of hypertension (OR=2.128, 95%CI: 1.004～4.510, P=0.018) were the independent risk factors of the moderate-severe infratentorial CMBs. Conclusion The low eGFR level and long duration of hypertension are risk factors for the moderate and severe infratentorial CMBs after acute ischemic stroke.

The Effects of Phonosurgery for Vocal Fold Nodule Combined with Botulinum Toxin of Type A Injection in Adults / 听力学及言语疾病杂志

Objective To investigate the effects of phonosurgery combined with botulinumtoxinof type A in-jection in adults with vocal nodules .Methods A total of 76 adults with diagnosis of vocal nodules were studied in this experiment .They were divided into two group according to the different treatments :the surgery group (n=40) ,and the group with the combined botulinum toxin of type A injection (n=36) .Preoperative and postoperative examinations consisted of electronic laryngoscope ,stroboscopic laryngoscope ,voice assessments of subjective and objective evaluations using GRBAS classification and voice disorder index (VHI) .The evaluation parameters were the longest phonation time (MPT) ,jitter and shimmer and dysphonia severity index (DSI) .The results from the two groups were compared .Results There were 5 cases cured ,28 cases improved and 7 cases of now effects in the surgery group .The effective rate was 82 .5％ .There were 30 cases cured and 6 cases improved in the combined in-jection group with the effective rate of 100％ .There were 22 cases with good glottis closure and 18 cases with incom-plete closure in the surgery group postoperatively ;in the combined injection group ,30 cases glottis closed well and 6 cases still closed incompletely .The differences of postoperative VHI ,MPT ,jitter ,shimmer and DSI in addition to G were significant different between the two groups .Conclusion Phonosurgery combined with botulinum toxin of type A injection is an effective way for the treatment of vocal fold nodules in adults .

The significance of circulating tumor cells in head and neck squamous cell carcinoma: a preliminary study / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the significance of circulating tumor cells (CTC) in squamous cell carcinoma of the head and neck (HNSCC).@*Methods@#Twenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected (experimental group), including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage (5 cases) and Ⅲ- Ⅳ stage (19 cases). All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique (CellCellector system) was used to detect CTC. SPSS23.0 was used for statistical analysis.@*Results@#The total capture rate of CTC in patients with HNSCC before treatment was 70.8% (17/24), with 40% (2/5) for patients at I-Ⅱ stage, and 78.9% (15/19) for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% (8/16). There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis (P>0.05). CTC was related to tumor staging and tumor differentiation (P<0.05). The positive rate of EGFRVⅢ in CTC was 26.3% (5/19).@*Conclusions@#The CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.

A brief introduction to the cultivation of traditional Chinese medicine students based on the phenomenon of "traditional Chinese medicine experimental class" / 国际中医中药杂志

High education plays the most important part in the cultivation of TCM students at present. One of the main problems TCM facing is the professional accomplishment of TCM students cultivation underlying the modes of college education. Based on the data of "TCM Experimental Class" in universities, we analyzed the effecting factors and related prospects behind this cultivation mode as well as made a preliminary discussion on the training objectives and contents of this model combined with the history and fundamental law of TCM students training.

Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.</p><p><b>METHODS</b>Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.</p><p><b>RESULTS</b>Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.</p><p><b>CONCLUSIONS</b>Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.</p>

Preliminary report on meticulous operation of thyroid lobectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Thyroid lobectomy can be programmed to operate as "step by step". Each step must be performed meticulously with quality control, so as to minimize the complications of surgery.</p><p><b>METHODS</b>From May 2013 to Auguest 2014, the meticulous thyroid operation was conducted in 72 cases (144 lobectomies). Pre- and post-operative evaluations by strobe laryngoscopy, parathyroid hormone (PTH), and blood calcium examinations were conducted in all cases.</p><p><b>RESULTS</b>Four cases (5.6%) had transient recurrent laryngeal nerve paralysis after surgery, but no permanent recurrent laryngeal nerve paralysis. There was no transient or permanent superior laryngeal nerve paralysis. Transient hypoparathyroidism occurred in 10 cases, with no permanent hypoparathyroidism. No case presented with postoperative bleeding or infection.</p><p><b>CONCLUSIONS</b>"Meticulous operation of thyroid lobectomy" may minimize effectively the complication of surgery.</p>

Application of philosophy on comprehensive analysis of adenoid hypertrophy space occupying effect in meticulous adenoidectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To achieve targeted and meticulous surgery of adenoid hypertrophy, a comprehensive analysis of adenoid hypertrophy space occupying effect and morphological evaluation were conducted and the clinical results were retrospectively analyzed.@*METHOD@#One hundred and sixty-three children with adenoid hypertrophy were treated in our department from May 2013 to May 2014. All children received three examinations preoperatively, including: Nasopharyngo-fiberoscopy, Audiometry and Tympanometry. Based on the results, space occupying effect of adenoid hypertrophy was divided into three types: vertical hypertrophy type, horizontal hypertrophy type and vertical & horizontal hypertrophy type. We assumed the causal relationship with vertical hypertrophy type to snoring (nasal blockage) and horizontal hypertrophy type to secretory otitis media respectively. All children received transoral endoscopic adenoidectomy with radiofrequency ablation.@*RESULT@#The postoperative followup of these children for 6 to 12 months showed that the vertical hypertrophy type and horizontal hypertrophy type children all recovered from the syndromes of snoring (nasal blockage) and secretory otitis media respectively. The nasopharyngo-fiberoscopy showed that the nasopharyngeal space was smooth and the bilateral choanas opened well. No recurrence was found.@*CONCLUSION@#The philosophy of comprehensive analysis on adenoid hypertrophy space occupying effect could help the surgeons understand adenoid hypertrophy better and can guide the adenoidectomy more meticulously.

Thyroid operation after the discussion on drainage technology / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the possibility of thyroidectomy/lobectomy without drainage after surgery.@*METHOD@#Eighty-eight consecutive cases with thyroid mass have been underwent operations including: lobectomy group(42 cases), thyroid lobectomy with contralateral partial thyroidectomy group (17 cases) and total thyroidectomy group (29 cases) from 2013. 06 to 2014. 06 in Nanjing Tongren Hospital. FIfteen patients with thyroid operation in other hospital were collected from 2014. 01 to 2014. 06, the recovery of postoperative incision were compared.@*RESULTS@#Eighty-four cases were smoothly discharged from hospital except 4 thyroidectomy cases suffered from a small amount of effusion in surgical cavity. Our postoperative wound recovery were more in line with the principle of cosmetology compared with other hospital operation group.@*CONCLUSION@#Drainage following thyroidectomy is not essential, if the thyroid surgery is meticulous in each step of the surgery, and can increase the effect of beauty.

Treatment of recurrent laryngeal papilloma by submucosal resection and the effect on prognosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy of submucosal resection by CO2 laser in the treatment of recurrent laryngeal papilloma and the effect on prognosis.@*METHOD@#A total of 11 patients diagnosed as recurrent laryngeal papilloma were included in this review. Papilloma was marked before operation and checked under fibro-laryngoscope. Papilloma was resected completely including the submucosal tissure with CO2 laser or microequipment. In widespread papilloma, false membrane in raw surface were cleared 7-10 days after operation. Surgical specimens (including membrane) were detected by routine pathology, HPV typing and immunohistochemical pathologic examination. The patients were checked once a month in the first 3 months after operation, and then once for every 3 months. Once the hoarseness and other symptoms aggravated or the disease was recurrent, the patients were treated immediately.@*RESULT@#HPV viral DNA was found in 10/11 cases, with HPV11 (7/11 cases) and HPV6 (3/11 cases). Cases with regards to follow-up, from 6 months to 1 year, 3 cases were followed up 1 year after operation, without recurrence. Five patients including 2 children were followed up 6 to 12 months after operation, without recurrence. Two children underwent 2 or 3 operations, were followed-up more than 6 months withouting recurrence.@*CONCLUSION@#Papilloma submucosal resection could decrease postoperative recurrence and is worth to be further investigated.

Long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy(TON) and to explore its possible influencing factors.@*METHOD@#To summarize the clinical data of 39 cases underwent transnasal decompression, which were followed-up for more than 1 year. The data, including optic canal CT scanning, flashed-elicited visual-evoked potential (FVEP), preoperational vision and visual field examination were reviewed. Nasal endoscopic optic nerve decompression was preformed. Whether or not optic nerve sheath incision decided to perform was according to preoperative CT and situations in operation. Postoperative follow-up including vision, visual field, funduscopy, nasal endoscopy were performed.@*RESULT@#Total efficacy rate was 30. 77% (12/39), inefficacy rate was 69. 23%(27/39). The efficacy rate was 85. 71% with better than nolight perception, and the efficacy rate was 18. 75% with nolight perception, the clinical effect in the group of preoperative better than nolight perception was better than that of nolight perception, the difference was statistically significant (P 0. 05). The efficacy rate was 26. 32% with optic nerve sheathincision, while the efficacy rate was 35. 00% without optic nerve sheath incision, and there was no statistically significant difference (P>0. 05); Postoperative vision tended to stabilize until about 6 months post-operation, without complications.@*CONCLUSION@#The long-term efficacy of nasal endoscopic opticnerve decompression for TON was certain; The efficacy with preoperative residual vision was better than that of nolight perception, the factor of long or short duration from the trauma point to the operation point and the factor of optic nerve sheath incision didn't influence long curative effect. To avoid the secondary damage to the optic nerve after trauma was the key to increase long curative effect in TON.

Spleen-Lung Relations in TCM and Modern Research of“Banking up Earth to Generate Metal” / 世界科学技术-中医药现代化

By employing the mother-child and meridian relations between the spleen and the lung, this paper expanded on the therapeutic method of“banking up earth to generate metal” and its clinical practice in terms of excess and deficiency. After that, a modern research on the theory was made from the following 6 perspectives:refractory angina, asthma, bronchitis and reflux gastritis, pulmonary and digestive lymphatic system, pulmonary and digestive immune system, pulmonary and digestive endocrine system, pulmonary inflammatory disease and gastrointestinal flora system, and the influence of them on spleen-deficiency asthma rats airway inflammation, which fully demonstrated the importance of the classic traditional Chinese medicine (TCM) treatment principle of“banking up earth to generate metal” on the treatment of lung and digestive diseases.

Preservation of parathyroid during the thyroidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.</p><p><b>METHODS</b>Forty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed. Of them 26 cases with malignant and 17 cases with benign thyroid diseases.</p><p><b>RESULTS</b>Intraoperatively, all 4 parathyroid glands were identified in 27 cases, 3 parathyroids in 10 cases and 2 parathyroids in 6 cases. Intraoperative parathyroid transplantation was performed in 6 cases, including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation. With the follow-up of 1-3 months after surgery, 10 cases presented with transient hypocalcemia, 8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.</p><p><b>CONCLUSION</b>Accurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.</p>

Clinical study on vocal cords spontaneous rehabilitation after CO2 laser surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the spontaneous rehabilitation and phonation quality of vocal cords after different types of CO2 laser microsurgery.@*METHOD@#Surgical procedures based on Remacle system Type I, Type II, Type III, Type IV and Type V a respectively. Three hundred and fifteen cases with hoarseness based on strobe laryngoscopy results were prospectively assigned to different group according to vocal lesions apperence,vocal vibration and imaging of larynx CT/MRI. Each group holded 63 cases. The investigation included the vocal cords morphological features,the patients' subjective feelings and objective results of vocal cords.@*RESULT@#There are no severe complications for all patients in perioperative period. Vocal scar found in Type I ,1 case; Type II, 9 cases ;Type III, 47 cases; Type IV, 61 cases and Type Va 63 cases respectively after surgery. The difference of Vocal scar formation after surgery between surgical procedures are statistical significance (χ2 = 222.24, P 0.05). This happened in shimmer parameter and the maximum phonation time (MPT) as jitter. There are no statistical significance between Type IV and Type Va on MPT (P > 0.05).@*CONCLUSION@#Morphological and functional rehabilitation of vocal cord will be affected obviously when the body layer is injured. The depth and range of the CO2 laser microsurgery are the key factors affecting the vocal rehabilitation.

Preliminary study on treatment of lingual tonsil hypertrophy by endoscopic assisted coblation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the feasibility and safety of lingual tonsil excision by endoscopic assisted coblation.@*METHOD@#Twenty seven cases with lingual tonsil hypertrophy were recruited in this study. Preoperative fibrolaryngoscope and CT and (or) MRI examination of the base of the tongue, lingual tonsil was removed by 70 degrees nasal endoscopy-assisted plasma radiofrequency after nasotracheal intubation. The tongue wound healing and post-operative bleeding were observed after operation, the advantages of the endoscopic-assisted plasma radiofrequency on lingual tonsil removal were analyzed, and its feasibility and safety were summarized.@*RESULT@#During the surgery the base of the tongue and epiglottis had satisfaction exposure in the same operative field. No complications happened in the surgery and endotracheal tube was plucked safely after operation. There was no primary bleeding, and the number of secondary bleeding were 4 cases, accounting for 14.81% (4/27), respectively occurred on the sixth, seventh, tenth and twelfth day with the amount of bleeding of 30-70 ml. The bleeding were cured after conservative treatment or re-application applicating of radiofrequency; 27 patients had no taste disturbance, and they were followed up for 6-30 months without recurrence.@*CONCLUSION@#Lingual tonsil excision by nasal endoscopic-assisted coblation has enough exposure, complete resection and low recurrence rate. Stopping bleeding should be attentioned to prevent postoperative bleeding.

Experimental study on the effects of cage-squeezing screw on tendon-bone healing in a rabbit model / 生物医学工程学杂志

This investigation was to study the effects of cage-squeezing screw on tendon-bone healing in rabbits. The tendons of Twenty four rabbits were severed and fixed with cage-squeezing screw or ordinary squeezing screw on its tibia, and the interface of tendon-bone was tested at the ends of 3, 6 and 12 weeks after operations, respectively. The cage-squeezing screw can accelerate bone tunel healing and strengthen the graft intension. The experiments proved that the cage-squeezing screw could help the restructuring process of the graft after the beginning of reconstruction.

CT Diagnosis of Hepatic Alveolar Echinococcosis / 实用放射学杂志

Objective To discuss the CT features and pathologic basis of hepatic alveolar echinococcosis. Methods Total 19 cases were confirmed by ELISA and IHA of antibody of echinococcosis. A part of them were confirmed by pathalogy. Results The main features of the disease were irregular,obscure contour and heterogeneous density with mainly hypodense in the liver. Almost of all accompanied with calcification. The calcification was showed some certainly signification. No contrast enhancement was observed within the lesions after administration of intravenous contrast medium. There were three type of this disease based on CT features including map type, halo type and pseudocystic type. Conclusion CT scanning has value of not only for diagnosis of hepatic alveolar echinococcosis but also useful to display each complications and metastasis.