摘要：
On 5 March 2021,the 4th Session of the13th National People’s Congress was held in the Great Hall of the People,Beijing.Premier Li Keqiang,on behalf the State Council,delivered the government report to the session,and following is the key-points.
摘要：
To solve some unreasonable problems in the acceptance process of the delimitation project of grain production functional zones,the acceptance results of grain production functional zones in Fangzi District,Weifang City were elaborated from the aspects of the third party organization,inspectors,expert group,acceptance criteria,acceptance method,acceptance contents,etc.,and the overall performance of the project was reviewed.The problems that need to be rectified during the implementation of the project were put forward,and the irrationality of the acceptance and the places that need to be improved were pointed out,which would provide a better guiding value for the delimitation of grain production functional zone and the acceptance and performance evaluation of similar projects.
摘要：
BACKGROUND Often in patients with significant three-vessel or left main disease there is coexistent significant peripheral disease rendering them poor candidates for percutaneous left ventricular support during revascularization.Evidence on the management of such cases is limited.CASE SUMMARY We describe a case of such a patient with critical distal left main disease and chronically occluded right coronary artery who presented with chest pain and a non-ST elevation myocardial infarction and had significantly impaired left ventricular function.With the aid of our cardiothoracic surgeons a cut down subclavian Impella 5.0 was inserted and high risk rotablation percutaneous coronary intervention carried out successfully.CONCLUSION This case highlights the need for cross-specialty collaborations in such high-risk cases were alternative access is needed for insertion of large bore mechanical circulatory support devices.
摘要：
BACKGROUND Carcinosarcoma(spindle cell carcinoma) of the esophagus is an extremely rare event;the etiology and origins of this neoplasm have not yet been determined.Epithelial-mesenchymal transition(EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor.CASE SUMMARY We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-Ⅱc lesions located 35 cm from the incisors toward the esophago-gastric junction.Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-Ⅱc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adenocarcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor.The patient was diagnosed with multiple carcinosarcomas, staged at pT1b(SM3),pN1(#110, #7), cM0, Stage Ⅱ(sarcomatous metastasis to the lymph nodes).Spindle cells did not express E-cadherin but were positive for EMT markers,including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery.CONCLUSION This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.
摘要：
BACKGROUND Fistulas are common complications of Crohn’s disease(CD).Gastrocolic fistulas(GFs)are rare,occult and potentially life-threatening complications.Few cases of GFs have been reported.Oral agent contrast-enhanced ultrasound(OA-CEUS)is a novel technique of ultrasound(US)for gut.Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract.Thus,the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning.This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography(CT).To our knowledge,this is the first report of GF secondary to CD detected by OA-CEUS up to date.CASE SUMMARY A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes.Initial gastroscopy failed to show any evidence of lesions.Colonoscopy revealed multiple erosions,mucosal nodularity,linear ulcers and a cobblestone appearance.A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen,with fluid,gas and significant surrounding inflammation.CT also demonstrated an abdominal abscess,which was later treated with US-guided drainage.Colonoscopy,gastroscopy and CT missed the presence of a GF.OA-CEUS was performed.A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract.A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed.With the aid of the“window”,a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections.We also observed the hyperechoic gas flowing dynamically inside the canal.Thus,a GF was suspected.US is the first imaging modality taking GF into account.At the same time,OA-CEUS identified the site of the fistula and its two orifices.Gastroscopy was performed again,revealing a small ulcer approximately 5 mm in diameter,which was considered as an orifice.On the basis of OA-CEUS and other examinations,the patient was diagnosed with a GF secondary to CD.Then,laparoscopic exploration,partial stomach resection,transverse colostomy and abdominal abscess drainage were performed.The patient recovered uneventfully.CONCLUSION GFs are rare,occult and potentially life-threatening complications in CD.US is one of the first-line modalities to evaluate CD and its complications.OA-CEUS,a novel technique of US for gut,may be helpful in reducing the possibility of a missed diagnosis of GF.
摘要：
BACKGROUND Hemolymphangiomas are rare malformations composed of both lymphatic and vascular vessels and are located in the pancreas,spleen,mediastinum,etc.Small intestinal hemolymphangioma is extremely rare and often presents as obscure gastrointestinal bleeding.It is rarely diagnosed correctly before the operation.Endoscopic injection sclerotherapy is usually used as a management of bleeding in esophageal varices and was occasionally reported as a treatment of vascular malformation.The treatment of small intestinal hemolymphangioma with enteroscopic injection sclerotherapy has not been reported.CASE SUMMARY A 42-year-old male complained of recurrent episodes of melena and dizziness,fatigue and reduced exercise capacity for more than 2 mo.Gastroduodenoscopy and blood test revealed a gastric ulcer and anemia.Treatment with oral protonpump inhibitors and iron did not improve symptoms.We then performed a capsule endoscopy and anterograde balloon-assisted enteroscopy and revealed a hemolymphangioma.Considering it is a benign tumor without malignant potential,we performed enteroscopic injection sclerotherapy.He was discharged 4 days later.At follow-up 3 mo later,the melena disappeared.Balloon-assisted enteroscopy revealed an atrophied tumor atrophied and no bleeding.Argon plasma coagulation was applied to the surface of the hemolymphangioma to accelerated healing.When he returned for follow-up 1 year later,anemia was resolved and the tumor had been cured.CONCLUSION Balloon-assisted enteroscopy and capsule endoscopy are effective methods for diagnosis of hemolymphangioma.Enteroscopic injection sclerotherapy is an effective treatment.
摘要：
BACKGROUND Sickle cell hepatopathy(SCH)is an inclusive term referring to any liver dysfunction among patients with sickle cell disease.Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of SCH.We present the 23rd reported case of liver transplantation(LT)for SCH;a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus(HCV)nucleic acid amplification test positive donor.CASE SUMMARY A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain crisis.On examination,he had jaundice and a soft,nontender abdomen.Initially he was alert and fully oriented;within 24 h he developed new-onset confusion.Laboratory evaluation was notable for hyperbilirubinemia,leukocytosis,anemia,thrombocytopenia,acute kidney injury and elevated international normalized ratio(INR).Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal dilatation.The patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver injury.He underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial presentation.The liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and cholestasis.On postoperative day 3,HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day 23.He subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo post-transplant.CONCLUSION This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis.
摘要：
BACKGROUND Congenital intrahepatic arterioportal fistula(IAPF) is a rare vascular malformation in infants that causes severe portal hypertension(PH) with poor prognosis if untreated. Currently, radiological embolisation is considered the first-line therapy for simple IAPF; however, it might be not resolutive for complex hepatic vascular lesions. When endovascular embolization is not sufficient to completely obliterate the IAPF, surgical intervention is needed, but it has been associated with severe morbidity and mortality in small children.Furthermore, indications are not defined.CASE SUMMARY We present the first case of a 6-month-old girl with trisomy 21 affected by a complex congenital IAFP, which caused severe PH, successfully treated with an endovascular-surgical hybrid procedure. The novel technique comprised a multistep endovascular embolisation, including a superselective transarterial embolisation of the afferent vessels and a direct transhepatic embolisation of the dilated portal vein segment, combined with selective surgical ligation of the arterial branches that supply the fistula, which were too small to be embolised.The complex IAPF was also associated with severe cholestasis and intra/extrahepatic biliary tree dilatation, which was successfully treated by a temporary biliary drainage. At 24-mo follow-up, the hybrid endovascularsurgical procedure achieved complete occlusion of the complex IAPF and resolution of the PH. A comprehensive review of the literature on congenital IAPF management, focussed on alternative treatment strategies, is also reported.CONCLUSION The combined radiological-surgical approach is a safe and effective treatment option for complex IAPF and avoids major invasive surgery.
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