Efficacy of chlorine-based disinfectants to control Legionella within premise plumbing systems.

Legionella is an opportunistic waterborne pathogen that causes Legionnaires' disease. It poses a significant public health risk, especially to vulnerable populations in health care facilities. It is ubiquitous in manufactured water systems and is transmitted via inhalation or aspiration of aerosols/water droplets generated from water fixtures (e.g., showers and hand basins). As such, the effective management of premise plumbing systems (building water systems) in health care facilities is essential for reducing the risk of Legionnaires' disease. Chemical disinfection is a commonly used control method and chlorine-based disinfectants, including chlorine, chloramine, and chlorine dioxide, have been used for over a century. However, the effectiveness of these disinfectants in premise plumbing systems is affected by various interconnected factors that can make it challenging to maintain effective disinfection. This systematic literature review identifies all studies that have examined the factors impacting the efficacy and decay of chlorine-based disinfectant within premise plumbing systems. A total of 117 field and laboratory-based studies were identified and included in this review. A total of 20 studies directly compared the effectiveness of the different chlorine-based disinfectants. The findings from these studies ranked the typical effectiveness as follows: chloramine > chlorine dioxide > chlorine. A total of 26 factors were identified across 117 studies as influencing the efficacy and decay of disinfectants in premise plumbing systems. These factors were sorted into categories of operational factors that are changed by the operation of water devices and fixtures (such as stagnation, temperature, water velocity), evolving factors which are changed in-directly (such as disinfectant concentration, Legionella disinfectant resistance, Legionella growth, season, biofilm and microbe, protozoa, nitrification, total organic carbon(TOC), pH, dissolved oxygen(DO), hardness, ammonia, and sediment and pipe deposit) and stable factors that are not often changed(such as disinfectant type, pipe material, pipe size, pipe age, water recirculating, softener, corrosion inhibitor, automatic sensor tap, building floor, and construction activity). A factor-effect map of each of these factors and whether they have a positive or negative association with disinfection efficacy against Legionella in premise plumbing systems is presented. It was also found that evaluating the effectiveness of chlorine disinfection as a water risk management strategy is further complicated by varying disinfection resistance of Legionella species and the form of Legionella (culturable/viable but non culturable, free living/biofilm associated, intracellular replication within amoeba hosts). Future research is needed that utilises sensors and other approaches to measure these key factors (such as pH, temperature, stagnation, water age and disinfection residual) in real time throughout premise plumbing systems. This information will support the development of improved models to predict disinfection within premise plumbing systems. The findings from this study will inform the use of chlorine-based disinfection within premise plumbing systems to reduce the risk of Legionnaires disease.

Cross-waveband optical computing imaging.

A novel, to the best of our knowledge, cross-spectral optical computing imaging experiment has been achieved through a single exposure of a charge-coupled device. The experimental setup integrates single-pixel imaging (SPI) with ghost imaging (GI) through a photoelectric conversion circuit and a synchronous modulation system. The experimental process involves modulation in one wavelength band (in SPI) and demodulation using the GI algorithm in another. Significantly, our approach utilizes optical computing demodulation, a departure from the conventional electronic demodulation in GI (SPI), which involves the convolution between the bucket optical signals and the modulated patterns on the digital micromirror device. A proof-of-concept cross-band imaging experiment from near-infrared to visible light has been carried out. The results highlight the system's ability to capture images at up to 20 frames per second using near-infrared illumination, which are then reconstructed in the visible light spectrum. This success not only validates the feasibility of our approach but also expands the potential applications in the SPI or GI fields, particularly in scenarios where two-dimensional detector arrays are either unavailable or prohibitively expensive in certain electromagnetic spectra such as x-ray and terahertz.

Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of literature.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of death due to its complexity, heterogeneity, rapid metastasis and easy recurrence after surgical resection. We demonstrated that combination therapy with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), Epclusa, Lenvatinib and Sintilimab is useful for patients with advanced HCC. CASE SUMMARY: A 69-year-old man who was infected with hepatitis C virus (HCV) 30 years previously was admitted to the hospital with abdominal pain. Enhanced computed tomography (CT) revealed a low-density mass in the right lobe of the liver, with a volume of 12.9 cm × 9.4 cm × 15 cm, and the mass exhibited a "fast-in/fast-out" pattern, with extensive filling defect areas in the right branch of the portal vein and an alpha-fetoprotein level as high as 657 ng/mL. Therefore, he was judged to have advanced HCC. During treatment, the patient received three months of Epclusa, three TACE treatments, two HAIC treatments, three courses of sintilimab, and twenty-one months of lenvatinib. In the third month of treatment, the patient developed severe side effects and had to stop immunotherapy, and the Lenvatinib dose had to be halved. Postoperative pathological diagnosis indicated a complete response. The patient recovered well after the operation, and no tumor recurrence was found. CONCLUSION: Multidisciplinary conversion therapy for advanced enormous HCC caused by HCV infection has a significant effect. Individualized drug adjustments should be made during any treatment according to the patient's tolerance to treatment.

Unusual coexistence: branchial cleft cyst harboring papillary thyroid carcinoma with lymph node metastasis - a rare case report and clinical insights.

Background: The simultaneous occurrence of Branchial Cleft Cyst (BCC) and Papillary Thyroid Carcinoma (PTC) represents an unusual malignant tumor, with cases featuring associated lymph node metastasis being particularly rare. This combination underscores an increased potential for metastasis, and the assessment of neck masses, particularly on the lateral aspect, may inadvertently overlook the scrutiny of the thyroid. Therefore, healthcare providers should exercise vigilance, especially in patients over the age of 40, regarding the potential for neck masses to signify metastasis from thyroid malignancies. Currently, surgical intervention stands as the primary effective curative method, while the postoperative administration of radioactive iodine therapy remains a topic of ongoing debate. Case report: In the presented case, a 48-year-old male patient with a right neck mass underwent surgical intervention. The procedure included the excision of the right neck mass, unilateral thyroidectomy with isthmus resection, and functional neck lymph node dissection under tracheal intubation and general anesthesia. Postoperative pathology findings revealed the coexistence of a BCC with metastatic PTC in the right neck mass, as well as papillary carcinoma in the right thyroid lobe. Lymph node metastasis was observed in the central and levels III of the right neck. Conclusion: The rare amalgamation of a BCC with PTC and concurrent lymph node metastasis underscores the invasive nature of this malignancy. Healthcare professionals should be well-acquainted with its clinical presentation, pathological characteristics, and diagnostic criteria. A multidisciplinary approach is strongly recommended to enhance patient outcomes.

The feasibility and clinical significance of lateral approach thyroidectomy.

BACKGROUND: By comparing the three lateral approaches to thyroidectomy, the feasibility and clinical effects were analyzed, and the advantages of the lateral approach were summarized. METHODS: From January 2022 to January 2023, 52 patients with thyroid cancer admitted to our department were selected and subjected to Lateral approach for thyroidectomy. Among them, 31 patients underwent thyroidectomy via the supraclavicular approach, 13 patients underwent endoscopic thyroidectomy via the subclavicular approach, and 8 patients underwent endoscopic thyroidectomy via the axillary approach. The basic conditions, surgical conditions, complications, postoperative pain scores and postoperative satisfaction of patients in the three approach surgery groups were recorded and analyzed. RESULTS: There were no significant differences among the three approach groups in terms of patient characteristics, number of central lymph node dissections, intraoperative blood loss, postoperative drainage volume, duration of drainage tube placement, length of hospital stay, postoperative pain, satisfaction, and complications. However, the operation time was longest in the subclavicular approach group, followed by the axillary approach group, and shortest in the supraclavicular approach group. The total hospitalization cost was highest in the axillary approach group, followed by the subclavicular approach group, and lowest in the supraclavicular approach group. CONCLUSION: The lateral approach for thyroidectomy is deemed a safe and effective method. The three different approach paths gradually increase in length, allowing for the accumulation of anatomical experience. This approach has a shorter learning curve for clinical doctors and is a favorable choice for patients seeking aesthetic benefits.

Angiosarcoma of the breast: A review.

Breast angiosarcoma is a rare and highly aggressive malignancy with a poor prognosis. It can occur spontaneously or be associated with factors such as radiation therapy or chronic lymphedema. The etiology and pathogenesis of this disease are still unclear, the clinical symptoms and imaging findings lack specificity, and the pathological morphology is diverse, which is easy to be confused with other diseases. There is no clear guideline for surgical treatment. Although the optimal surgical approach remains unclear, the ultimate goal is surgical excision with optimal margins, which remains the primary method of treatment. In clinical practice, the choice of the surgical approach should be made by considering the tumor size, pathological type, and patient preferences. In clinical practice, the selection of surgical methods should be carried out with comprehensive consideration of tumor size, pathological types and patients' wishes. There is no clear consensus on whether radiotherapy and chemotherapy should be carried out after surgery, and its optimal program and efficacy are uncertain. This article reviews the etiology, clinical manifestations, pathological features, imaging findings, treatment, prognosis and other aspects of breast angiosarcoma, so as to strengthen clinicians' overall understanding of this disease and avoid missed diagnosis and misdiagnosis.

Mycorrhizal effects on crop yield and soil ecosystem functions in a long-term tillage and fertilization experiment.

It is well understood that agricultural management influences arbuscular mycorrhizal (AM) fungi, but there is controversy about whether farmers should manage for AM symbiosis. We assessed AM fungal communities colonizing wheat roots for three consecutive years in a long-term (> 14 yr) tillage and fertilization experiment. Relationships among mycorrhizas, crop performance, and soil ecosystem functions were quantified. Tillage, fertilizers and continuous monoculture all reduced AM fungal richness and shifted community composition toward dominance of a few ruderal taxa. Rhizophagus and Dominikia were depressed by tillage and/or fertilization, and their abundances as well as AM fungal richness correlated positively with soil aggregate stability and nutrient cycling functions across all or no-tilled samples. In the field, wheat yield was unrelated to AM fungal abundance and correlated negatively with AM fungal richness. In a complementary glasshouse study, wheat biomass was enhanced by soil inoculum from unfertilized, no-till plots while neutral to depressed growth was observed in wheat inoculated with soils from fertilized and conventionally tilled plots. This study demonstrates contrasting impacts of low-input and conventional agricultural practices on AM symbiosis and highlights the importance of considering both crop yield and soil ecosystem functions when managing mycorrhizas for more sustainable agroecosystems.

[Meta-analysis of obesity on the outcome of rotator cuff repair].

OBJECTIVE: To systematically evaluate obesity on the outcome of rotator cuff repair. METHODS: Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMed, Embase, Cochrane Library, Web of Science, China biology medicine(CBM), CNKI, Wanfang and VIP databases from building database to August 1, 2022, and were screened independently by two authors according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literature extraction, management and data entry, and Newcastle-Ottawa Scale (NOS) was used to evaluate quality of the included literatures. STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate, reoperation rate, complication rate, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), operative time and external rotation angle of shoulder joint pain were analyzed. RESULTS: Totally 13 literatures were included, including 6 retrospective studies, 5 case-control studies, 1 prospective cohort study, and 1 abstract of a study for which the full text was not available, with 85 503 patients (31 973 in obese group and 53 530 in non-obese group). Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58, 95%CI(1.23, 5.41), P=0.01], reoperation rate[OR=1.31, 95%CI(1.21, 1.42), P<0.00], complication rate [OR=1.57, 95%CI(1.31, 1.87), P=0.00], ASES score[MD=-3.59, 95%CI(-5.45, -1.74), P=0.00], and VAS[MD=0.24, 95%CI(0.00, 0.49), P=0.05]. While there were no differences between two groups in operative time[MD=6.03, 95%CI(-7.63, 19.69), P=0.39], external rotation angle of shoulder joint[MD=-1.79, 95%CI(-5.30, 1.71), P=0.32]. CONCLUSION: Obesity is associated with higher rates of retear, resurgery, complications, poorer shoulder function and pain after rotator cuff repair.

[Spatial and Temporal Distribution Characteristics of Heavy Metals in Main Rivers Sediments and Ecological Risk Assessment in Kaifeng City].

Heavy metal pollution in urban river sediments is an important threat to river ecosystem health. To explore the temporal and spatial distribution characteristics of heavy metals in river sediments of Kaifeng City, the surface sediments of rivers were sampled in 2015 and 2021, respectively, and the contents of Cd, Cr, Cu, Ni, Pb, and Zn in sediments at different periods were compared. The heavy metal pollution in the two periods was evaluated using the indices of geo-accumulation, bio-toxicity risk assessment, and potential ecological risk. The results showed that the content of heavy metals in river sediments of Kaifeng City in 2021 were decreased significantly compared with that in 2015. Cd, Cr, Cu, Ni, Pb, and Zn decreased by 94.42%, 18.4%, 85.7%, 45.19%, 75.61%, and 92.28%, respectively. The heavy metal content in the Huafei River and Huiji River was higher than that in other rivers in both periods. Correlation and principal component analyses showed that the heavy metal pollution sources of river sediments in Kaifeng City were highly similar, and human activities such as industrial layout, road traffic, and land use were the main pollution sources. However, the results showed that the main pollutants were different between the two sampling times. In 2015, Cd, Cr, Pb, and Zn were the main pollutants, and in 2021, Cd, Cu, Pb, and Zn were the main pollutants. The results of the geo-accumulation, bio-toxicity risk assessment, and potential ecological risk indices showed that the temporal and spatial differences in heavy metal pollution in river sediments in Kaifeng City were large. However, the heavy metal pollution of the Huiji River and Huafei River was still serious, with contents in the medium and high pollution levels, especially to Cd. The heavy metal treatment of rivers in Kaifeng City has a long way to go, and it is particularly necessary to strengthen the engineering treatment for key river sections and effectively monitor key pollution elements.

METTL3-mediated m6A modification of lncRNA SNHG3 accelerates gastric cancer progression by modulating miR-186-5p/cyclinD2 axis.

OBJECTIVES: METTL3 as an m6A methyltransferase acts in diverse malignancies including gastric cancer (GC). We aimed to reveal the underlying mechanisms by which METTL3 contributes to gastric carcinogenesis. METHODS: The association of METTL3 and SNHG3 with GC was analyzed by qRT-PCR, Western blot, and TCGA cohort. The functional experiments were implemented to uncover the role of METTL3 in GC. m6A dot blot and MeRIP were used to determine METTL3-mediated m6A modification of lncRNA SNHG3. The effect of METTL3 on SNHG3-mediated miR-186-5p/cyclinD2 axis was evaluated by luciferase gene report, RT-qPCR, and Western blot assays. RESULTS: We found that METTL3 was remarkably elevated in GC tissues and correlated with poor survival in patients with GC. Silencing of METTL3 impaired GC cell growth and invasion, whereas restored METTL3 expression promoted these effects. Mechanistically, reduced expression of METTL3 decreased SNHG3 m6A level and caused a decrease in SNHG3 expression, which could further act as a sponge of miR-186-5p to upregulate cyclinD2. Overexpression of SNHG3 attenuated METTL3 knockdown-induced anti-proliferating and miR-186-5p upregulation and cyclinD2 downregulation. CONCLUSION: We find that METTL3-mediated m6A modification of lncRNA SNHG3 accelerates GC progression by modulating miR-186-5p/cyclinD2 axis.

Maize, wheat, and soybean root traits depend upon soil phosphorus fertility and mycorrhizal status.

Strong effects of plant identity, soil nutrient availability or mycorrhizal fungi on root traits have been well documented, but their interactive influences on root traits are still poorly understood. Here, three crop species (maize, wheat and soybean) were grown under four phosphorus (P) addition levels (0, 20, 40 and 60 mg P kg-1 dry soil), and plants were inoculated with or without five combined arbuscular mycorrhizal fungal (AMF) species. Plant biomass, nutrient contents, root traits (including total root length, average root diameter, specific root length and root tissue density) and plants' mycorrhizal responses were measured. Crop species, P level, AMF, and their interactions strongly affected plant biomass and root traits. P fertilization promoted plant growth but reduced mycorrhizal benefits on plant biomass and nutrient uptake. Root traits of maize were sensitive to P addition only under the non-mycorrhizal condition, whilst most root traits of soybean and wheat plants were responsive to mycorrhizal inoculation but not P addition. Mycorrhizal colonization reduced the root plasticity in response to P fertility for maize but not for wheat or soybean. This study highlights the importance of soil nutrient fertility and mycorrhizal symbiosis in influencing root traits.

Low-Grade Ductal Carcinoma in situ Within a Fibroadenoma of the Breast: A Rare Case Report and Review of the Literature.

Background: Ductal carcinoma in situ within a breast fibroadenoma is a rare malignancy with an incidence of only 0.02-0.125%. Imaging of low-grade ductal carcinoma in situ within a breast fibroadenoma shows no specific presentation. Therefore, pathology and immunohistochemistry are required for definitive diagnosis. Surgery is currently considered to be an effective treatment. There is no uniform clinical standard for postoperative adjuvant radiotherapy. Case Summary: A 60-year-old female patient underwent excisional biopsy on October 19, 2022. Pathology and immunohistochemistry confirmed the diagnosis of low-grade ductal carcinoma in situ within the fibroadenoma. Subsequently, breast-conserving surgery and sentinel lymph node biopsy were performed under general anesthesia with tracheal intubation, and no cancer metastasis was observed in the sentinel lymph nodes or incisional margins. Conclusion: Low-grade ductal carcinoma in situ within a breast fibroadenoma is an extremely rare malignancy, and clinicians should be familiar with its clinicopathological features and treatment methods. Multidisciplinary joint treatment is recommended to maximize the benefits to patients.

[Research progress of optical motion capture technology in shoulder biomechanics].

The shoulder joint is the most flexible joint in the body with the largest range of motion, and the movement pattern is more complex. Accurate capture of three-dimensional motion data of the shoulder joint is crucial for biomechanical evaluation. Optical motion capture systems offer a non-invasive and radiation-free method to capture shoulder joint motion data during complex movements, enabling further biomechanical analysis of the shoulder joint. This review provides a comprehensive overview of optical motion capture technology in the context of shoulder joint movement, including measurement principles, data processing methods to reduce artifacts from skin and soft tissues, factors influencing measurement results, and applications in shoulder joint disorders.

Effects of the crown ether cavity on the performance of anion exchange membranes.

Anion exchange membrane fuel cells (AEMFCs) have emerged as a promising alternative to proton exchange membrane fuel cells (PEMFCs) due to their adaptability to low-cost stack components and non-noble-metals catalysts. However, the poor alkaline resistance and low OH- conductivity of anion exchange membranes (AEMs) have impeded the large-scale implementation of AEMFCs. Herein, the preparation of a new type of AEMs with crown ether macrocycles in their main chains via a one-pot superacid catalyzed reaction was reported. The study aimed to examine the influence of crown ether cavity size on the phase separation structure, ionic conductivity and alkali resistance of anion exchange membranes. Attributed to the self-assembly of crown ethers, the poly (crown ether) (PCE) AEMs with dibenzo-18-crown-6-ether (QAPCE-18-6) exhibit an obvious phase separated structure and a maximum OH- conductivity of 122.5 mS cm-1 at 80 °C (ionic exchange capacity is 1.51 meq g-1). QAPCE-18-6 shows a good alkali resistance with the OH- conductivity retention of 94.5% albeit being treated in a harsh alkali condition. Moreover, the hydrogen/oxygen single cell equipped with QAPCE-18-6 can achieve a peak power density (PPD) of 574 mW cm-2 at a current density of 1.39 A cm-2.

Gallium(III) Amide Corroles: DNA Interaction and Photodynamic Activity in Cancer Cells.

A series of gallium(III) amide corroles including meso-5,15-bis(pentafluorophenyl)-10-(4-Pyridinamide-phenyl)corrole gallium (III) (1-Ga), meso-5,15-bis(pentafluorophenyl)-10-(4-Furamide-phenyl)corrole gallium(III) (2-Ga) and meso-5,15-bis(pentafluorophenyl)-10-(4-Thiophenamide-phenyl)corrole gallium(III) (3-Ga) were synthesized. The interaction of these complexes with DNA and their photodynamic antitumor activities have been studied. UV spectra titration showed that these gallium(III) corroles interact with calf thymus DNA (CT-DNA) through an external binding mode. All three gallium(III) corroles can effectively generate singlet oxygen under illumination and have good photostability. Among the three gallium(III) corroles, 2-Ga exhibited excellent photodynamic antitumor activity against the tested tumor cell lines under light irradiation (625±2 nm, 0.3 mW/cm2 , 1.08 J/cm2 ). The best phototoxicity was observed by 2-Ga against HepG2 cells (IC50 =6.3±0.9), which is even better than temoporfin (IC50 =8.4±1.8). It could block HepG2 cells in the sub-G0 phase and effectively induce apoptosis of HepG2 cells under 625 nm light irradiation.

Research progress of optical motion capture technology in shoulder biomechanics / 中国骨伤

The shoulder joint is the most flexible joint in the body with the largest range of motion, and the movement pattern is more complex. Accurate capture of three-dimensional motion data of the shoulder joint is crucial for biomechanical evaluation. Optical motion capture systems offer a non-invasive and radiation-free method to capture shoulder joint motion data during complex movements, enabling further biomechanical analysis of the shoulder joint. This review provides a comprehensive overview of optical motion capture technology in the context of shoulder joint movement, including measurement principles, data processing methods to reduce artifacts from skin and soft tissues, factors influencing measurement results, and applications in shoulder joint disorders.

Meta-analysis of obesity on the outcome of rotator cuff repair / 中国骨伤

OBJECTIVE@#To systematically evaluate obesity on the outcome of rotator cuff repair.@*METHODS@#Literatures on the relationship between obesity and outcomes after rotator cuff repair were searched from PubMed, Embase, Cochrane Library, Web of Science, China biology medicine(CBM), CNKI, Wanfang and VIP databases from building database to August 1, 2022, and were screened independently by two authors according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literature extraction, management and data entry, and Newcastle-Ottawa Scale (NOS) was used to evaluate quality of the included literatures. STATA 16.0 and RevMan 5.4 softwares were used to evaluate postoperative retear rate, reoperation rate, complication rate, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), operative time and external rotation angle of shoulder joint pain were analyzed.@*RESULTS@#Totally 13 literatures were included, including 6 retrospective studies, 5 case-control studies, 1 prospective cohort study, and 1 abstract of a study for which the full text was not available, with 85 503 patients (31 973 in obese group and 53 530 in non-obese group). Meta-analysis showed there were statistical differences between two groups in retear rate [OR=2.58, 95%CI(1.23, 5.41), P=0.01], reoperation rate[OR=1.31, 95%CI(1.21, 1.42), P<0.00], complication rate [OR=1.57, 95%CI(1.31, 1.87), P=0.00], ASES score[MD=-3.59, 95%CI(-5.45, -1.74), P=0.00], and VAS[MD=0.24, 95%CI(0.00, 0.49), P=0.05]. While there were no differences between two groups in operative time[MD=6.03, 95%CI(-7.63, 19.69), P=0.39], external rotation angle of shoulder joint[MD=-1.79, 95%CI(-5.30, 1.71), P=0.32].@*CONCLUSION@#Obesity is associated with higher rates of retear, resurgery, complications, poorer shoulder function and pain after rotator cuff repair.

Angiosarcoma of the breast with hypofibrinogenemia: A rare case report and review of the literature.

Background: Breast angiosarcoma is a rare malignant tumor, accounting for approximately 0.04% of all breast malignancies. Angiosarcoma of the breast with hypofibrinogenemia is even rarer and has not been described in man. Breast angiosarcoma is associated with high metastatic potential and poor prognosis, and there is no specific manifestation in imaging. At present, surgery is considered to be the only effective treatment. There is no unified standard for postoperative adjuvant radiotherapy and chemotherapy. Case Presentation: A 30-year-old female patient underwent left breast mass resection under local anesthesia on May 22, 2014. Postoperative pathology showed a vasogenic tumor. On November 10, 2017, she visited us again due to left breast swelling and pain during lactation, and underwent breast mass puncture. She was diagnosed with breast hematoma and fibrinogen reduction. On November 14, 2017, mastectomy was performed under tracheal intubation and general anesthesia, and the fibrinogen gradually returned to normal after surgery. Pathological examination showed a hemangiosarcoma with hematoma formation in the left breast. According to the pathological findings and after comprehensive evaluation, the patient underwent modified radical mastectomy for left breast cancer and right axillary sentinel lymph node biopsy on December 5, 2017. The patient died on January 28, 2018 due to rupture and hemorrhage of liver cancer and hemorrhagic shock. Conclusion: Breast angiosarcoma with hypofibrinogenemia is a rare and highly aggressive malignancy. Clinicians should be familiar with its clinicopathological features and diagnostic criteria. Multidisciplinary approach is recommended to benefit the patients.

Subperiosteal orbital hematoma concomitant with abscess in a patient with sinusitis: A case report.

BACKGROUND: Sinusitis-derived subperiosteal orbital collection is uncommon and is usually diagnosed as subperiosteal orbital abscess or, rarely, as hematoma. We report a unique and even rarer case of subperiosteal orbital collection, which is actually a complication of hematoma and abscess. CASE SUMMARY: A 26-year-old female presented with left eyeball pain and ipsilateral chemosis. She had no history of head trauma or upper respiratory infection. Her blood cell count showed an increase in leukocytes. Fiberoptic rhinolaryngoscopy revealed only mucosal edema of the left olfactory crest without apparent discharge. The computed tomography scan results showed an opaque left posterior ethmoid cell with a thickened bony shell and fusiform changes in the periosteal elevation of the medial wall of the left orbit. Emergent surgery revealed an ethmoid mucocele complicated with subperiosteal orbital hematoma and abscess. The pathology of the lamina papyracea between the mucocele and subperiosteal collection was necrotic, and the overlying mucosa was de-epithelialized. CONCLUSION: Subperiosteal orbital hematoma with abscess in a patient with sinusitis adds to the current knowledge of orbital complications of sinusitis.