Salmonella Subcutaneous Abscess: A Rare Complication Post Salmonella Gastroenteritis.

Salmonella is a gram-negative bacilli bacterium that can infect and colonize humans, causing a wide range of clinical manifestations. The most common manifestation is gastroenteritis, usually after ingestion of undercooked and ill-prepared food, particularly in developing countries. Indonesia is among those reported to have a high incidence of Salmonella infection. Uncommonly, extraintestinal manifestations can affect distant body sites, either during or after the episode of bacteremia. This case report presents a rare case of a healthy 19-year-old female who developed an atypical chest wall abscess colonized by Salmonella in the context of experiencing gastroenteritis three weeks prior on her return from Bali, Indonesia. This case highlights the indolent course associated with a Salmonella chest wall abscess with a discussion of the current literature and management.

A Rare Case of Rectosigmoid Small Cell Carcinoma.

Colorectal small cell carcinomas are very rare neuroendocrine malignancies of the colon or rectum. They have poor prognosis due to the aggressive and highly recurrent nature of the disease. It is a malignancy that is also poorly understood with limited literature, and thus there is no consensus in management. This case report presents the clinical features and radiological images of an otherwise healthy 74-year-old gentleman with a rare and aggressive 112-mm rectosigmoid small cell carcinoma with evidence of metastatic disease. This report will also discuss the most current and pertinent diagnostic and therapeutic recommendations from the literature.

A Rare Case of Calculous Gallbladder Hydrops Presenting With Atypical Abdominal and Urinary Symptoms.

Gallbladder hydrops, otherwise known as gallbladder mucocele, is an uncommon gallbladder condition characterised by gallbladder distention and accumulation of clear mucous-like inspissated bile. Patients with gallbladder hydrops are usually asymptomatic and incidentally diagnosed on cross-sectional imaging or diagnostic laparoscopy. This case report presents a rare case of calculous gallbladder hydrops measuring 217mm in maximal length in a 56-year-old female presenting with atypical abdominal and urinary symptoms. The radiological and intraoperative images will also be presented to highlight the extensiveness of the disease and therefore the importance of considering gallbladder hydrops as a differential in these patients.

Virtual reality technology for teaching neurosurgery of skull base tumor.

BACKGROUND: Neurosurgery represents one of the most challenging and delicate of any surgical procedure. Skull base tumors in particular oftentimes present as a very technically difficult procedures in the setting of neurosurgical teaching. Virtual reality technology is one of the most promising surgical planning tools. It can perform fast three-dimensional (3D) reconstruction of computed tomography (CT), magnetic resonance imaging (MRI) and other imaging data sets under conditions of virtual reality (VR). Surgical simulation can more intuitively understand the anatomical relationship of the surgical area in significantly greater detail. METHODS: Thirty clinical undergraduates from the class of 2016 were randomly divided into two groups: the traditional teaching group and the virtual reality teaching group. After the study concluded, the teaching effectiveness was evaluated by combining basic theoretical knowledge, case analysis and questionnaire survey methods. RESULTS: Comparative analysis between both groups showed the response effect of the virtual reality teaching group was better than that of the traditional teaching group (P < 0.05). There was also no difference between both groups in terms of the design of the surgical approach and the listing of surgical matters that required attention (P > 0.05).The results of theoretical knowledge assessment between both groups showed that the scores of basic theory, location, adjacent structure, clinical manifestation, diagnosis and analysis, surgical methods and total scores in the VR group exceeded those in the traditional teaching group (P < 0.05). CONCLUSIONS: This study showed that VR technology might improve neurosurgical skull base teaching quality, which should be promoted in the teaching of clinical subjects.

Effect of Xuebijing injection combined with low-molecular-weight heparin on sepsis patients and its influence on immune function and inflammatory factors / 中国医师进修杂志

Objective:To investigate the effect of Xuebijing injection combined with low-molecular-weight heparin on the immune function and inflammatory factors in patients with sepsis.Methods:The clinical data of 60 patients with sepsis admitted in the department of intensive care unit of Changzhou Wujin Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were analyzed. The patients were randomly divided into observation group (30 cases) and control group (30 cases). The control group was treated with low-molecular-weight heparin sodium; the observation group was given Xuebijing injection combined with low-molecular-weight heparin. The course of treatment was 1 week in both groups. Heart rate (HR), body temperature, respiratory rate and white blood cell count (WBC), systemic infection related organ failure scale (SOFA) score, acute physiology and chronic health evaluation (APACHE) Ⅱ score, immune function and inflammatory factors tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and interleukin-6 (IL-6) were compared between the two groups before and after treatment for 1 week.Results:After treatment, the levels of HR, body temperature, respiratory rate and WBC in the observation group were lower than those in the control group [(83.22 ± 4.34) beats/min vs. (89.14 ± 3.67) beats/min, (37.02 ± 0.37)℃ vs.(37.81 ± 0.4) ℃, (86.83 ± 4.56) times/min vs. (97.32 ± 6.17) times/min, (10.85 ± 1.28) × 10 9/L vs. (12.29 ± 1.34) × 10 9/L], and the differences were statistically significant ( t = 5.705, 7.330, 7.489, 4.256, P < 0.05). After treatment, the scores of SOFA and APACHEⅡ in the observation group were lower than those in the control group [(8.93 ± 1.42) scores vs. (13.24 ± 1.98) scores, (12.13 ± 2.19) scores vs. (15.52 ± 1.98) scores], and the differences were statistically significant ( t = 9.689, 6.289, P < 0.05). After treatment, the levels of CD 3+, CD 3+ CD 4+ and CD 4+/CD 8+ in the observation group were higher than those in the control group [(62.31 ± 5.21)% vs. (54.68 ± 3.75)%, (35.38 ± 2.98)% vs. (29.39 ± 3.10)%, 1.15 ± 0.24 vs. 1.47 ± 0.18], and the differences were statistically significant ( t = 6.510, 7.630, 7.050, P < 0.05). After treatment, the levels of TNF-α, CRP and IL-6 in the observation group were lower than those in the control group [(23.94 ± 4.63) μg/L vs. (37.91 ± 3.6) μg/L, (43.17 ± 9.93) mg/L vs. (75.23 ± 15.42) mg/L, (34.21 ± 4.28) μg/L vs. (48.93 ± 5.12) μg/L], and the differences were statistically significant ( t = 12.978, 9.574, 12.082, P < 0.05). Conclusions:Xuebijing injection combined with low-molecular-weight heparin on sepsis patients can reduce the HR, body temperature, respiratory rate and WBC, reduce the patient's condition and organ damage, improve the immune function of the body, and reduce the inflammatory reaction in the body.

Analysis of the endoplasmic reticulum stress in non-ablative skin rejuvenation using Q-switched 1064nm Nd:YAG laser / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the effect of Q-switched 1 064 nm Nd:YAG laser treatment on the proliferation of dermal collagen and expression of immunoglobulin binding protein/glucose related protein 78 (BiP/GRP78) in rats' skin and the mechanism of endoplasmic reticulum stress.</p><p><b>METHODS</b>Dorsal skin of 25 Wistar rats was divided into two parts equally after hair removal. Q-switched 1 064nm Nd:YAG laser was applied to treat rats' dorsal skin for 4 times at an interval of 2 days in the experiment part. The control part received no laser treatments. The rats' dorsal skin samples were taken on the 14th and 30th day after laser treatment to measure the dermis thickness and collagen bundles under HE stain and to measure the hydroxyproline content by alkaline hydrolysis method after laser treatment. The expression of BiP/GRP78 was also detected by immunohistochemical method. Statistics was used to analyze the data.</p><p><b>RESULTS</b>The dermis thickness increased by 29. 6% on the 14th day and 16.7% on the 30th day after laser treatment. The collagen bundles became thicker and denser. The hydroxyproline in the skin was also raised after laser treatment (P < 0.05). The immunohistochemical result showed the expression of BiP/GRP78 increased to 100% after laser treatment, showing a significant difference from the control group(X2 = 28.76, P < 0.01).</p><p><b>CONCLUSIONS</b>The Q-switched 1064 nm Nd:YAG laser treatment can induce endoplasmic reticulum stress, so as to enhance the protein folding and synthesizing precisely. The proliferation of dermis collagen is the base of effect of non-ablative skin rejuvenation.</p>