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Thymic carcinoma is a rare, aggressive tumor arising from the thymus. In less than 7% of patients with thymic carcinoma, extrathoracic metastases occur in the extrathoracic lymph nodes, liver, and bone. Isolated splenic metastasis can occur but is very uncommon. To date, only 2 cases of splenic metastases from thymic carcinoma have been reported.

A 45-year-old man presented with chronic cough, dyspnea, persistent hoarseness and unintentional weight loss 17 kgs in 6 mo. Neck magnetic resonance imaging revealed a large, lobulated, soft-tissue mass measuring 5.4 cm × 6.6 cm × 3.8 cm which involved the left superior mediastinum and supraclavicular fossa. Chest computed tomography (CT) revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery, right and left carotid arteries, and left subclavian artery in the mediastinum. A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey. The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum, over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa. CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis. The patient was diagnosed of thymic carcinoma, cT2N2M1b, stage IVb.

A fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging. Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.
A fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging. Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.
Metabolic reprogramming is a feature of tumour cells and is essential to support their rapid proliferation. The glycolytic activity of liver cancer cells is significantly higher than that of normal liver cells, and the rapidly proliferating tumour cells are powered by aerobic glycolysis. Lipid metabolism reprogramming enables tumour cells to meet their needs for highly proliferative growth and is an important driving force for the development of hepatocellular carcinoma (HCC).

To explore the influence of different metabolic subtypes of HCC and analyse their significance in guiding prognosis and treatment based on the molecular mechanism of glycolysis and fatty acid oxidation (FAO).

By downloading related data from public databases including the Cancer Genome Atlas (TCGA), the Molecular Signatures Database, and International Cancer Genome Consortium, we utilised unsupervised consensus clustering to divide TCGA Liver Hepatocellular Carcinoma samples into four metabolic subgroups and compared single nucleoous differences in genes, chromosomes, and clinical characteristics between metabolic subgroups. The establishment of a prognostic model could predict patient prognosis and guide clinical treatment.
There are obvious differences in genes, chromosomes, and clinical characteristics between metabolic subgroups. The establishment of a prognostic model could predict patient prognosis and guide clinical treatment.
Wernekink commissural syndrome (WCS) is a distinct midbrain syndrome that involves the caudal tegmentum of the midbrain and selectively damages the Wernekink commissure involved in the decussation of the superior cerebellar peduncle in midbrain. The aim of the study was to explore the clinical manifestations, imaging characteristics, and differential diagnosis of WCS in midbrain infarction to provide reference for clinicians in the diagnosis of WCS.

The clinical data of 4 patients with WCS with midbrain infarction were analyzed retrospectively. WCS is a rare syndrome that can be diagnosed based on its characteristic symptoms and imaging findings of magnetic resonance imaging.

Clinicians should look for this syndrome in cases of bilateral cerebellar dysfunction and eye movement disorders.
Clinicians should look for this syndrome in cases of bilateral cerebellar dysfunction and eye movement disorders.
Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by systemic inflammatory response syndrome and vasculopathy. SARS-CoV-2 associated mortality ranges from 2% to 6%. Liver dysfunction was observed in 14%-53% of COVID-19 cases, especially in moderate severe cases. However, no cases of spontaneous hepatic rupture in pregnant women with SARS-CoV-2 have been reported.

A 32-year-old pregnant patient (gestational age 32 wk + 4 d) without any remarkable medical history or long-term medication presented with epigastralgia. Infectious, non-infectious, and pregnancy-related hepatopathies were excluded. Sudden onset of right subcostal pain with D-dimer and liver enzyme elevation was followed by shock with thrombocytopenia. While performing an emergency cesarean section, hemoperitoneum was observed, and the patient delivered a stillbirth. A 6-cm liver rupture at the edges of segments V and VI had occurred, which was sutured and drained. SARS-CoV-2 positivity on reverse transcription-polymerase chain reaction was confirmed. Further revisions for intrahepatic hematoma with hemorrhagic shock and abdominal compartment syndrome were performed. Subsequently, the patient developed hemoptysis, which was treated using bronchoscopic therapy and non-invasive ventilation. Liver tissue biopsy revealed hemorrhagic foci and necrosis with an irregular centrilobular distribution. Antiphospholipid syndrome and autoimmune hepatitis were also ruled out. Fetal death was caused by acute intrauterine asphyxia.

This case reveals that pregnant women with SARS-CoV-2 infection may be predisposed to liver parenchyma disease with liver rupture.
This case reveals that pregnant women with SARS-CoV-2 infection may be predisposed to liver parenchyma disease with liver rupture.
Synovial sarcoma (SS) is an uncommon and highly malignant soft tissue sarcoma in the clinic, with primary pulmonary SS (PPSS) being extremely rare. click here Here, we describe the clinical characteristics, diagnosis, and treatment of a solitary PPSS case confirmed
surgical resection and fluorescence in situ hybridization (FISH).

A 33-year-old man was admitted because of intermittent coughing and hemoptysis for one month, with lung shadows observed for two years. Whole-body positron emission tomography-computed tomography (PET-CT) revealed a solitary mass in the upper lobe of the right lung, with uneven radioactivity uptake and a maximum standardized uptake value of 5.6. The greyish-yellow specimen obtained following thoracoscopic resection was covered with small multi-nodulated structures and consisted of soft tissue. Hematoxylin and eosin staining revealed spindle-shaped malignant tumor cells. Immunohistochemistry indicated these tumor cells were CD99 and BCL-2-positive. Furthermore, the FISH test revealed synovial sarcoma translocation genetic reassortment, which confirmed the diagnosis of SS.

PPSS is extremely rare and tends to be misdiagnosed as many primary pulmonary diseases. PET-CT, histologic analysis, and FISH tests can be used to differentiate PPSS from other diseases. Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.
PPSS is extremely rare and tends to be misdiagnosed as many primary pulmonary diseases. PET-CT, histologic analysis, and FISH tests can be used to differentiate PPSS from other diseases. Surgical resection is regularly recommended for the treatment of solitary PPSS and is helpful for improving the prognosis.
Postoperative pancreatic fistula (POPF) is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections, sepsis and bleeding. A previous study which identified cut-offs of drains amylase levels (DALs) determined on postoperative day (POD) 1 and POD3, was able to significantly predict POPF, abdominal collections and biliary fistulas, when related to specific findings detected at the abdominal computerized tomography (CT) scan routinely performed on POD3.

To validate the cut-offs of DALs in POD1 and POD3, established during the previous study, to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection.

The DALCUT trial is an interventional prospective study. All patients who will undergo pancreatoduodenectomy (PD) for periampullary neoplasms will be considered eligible. All patients will receive clinical staging and, if eligible for surgery, will undergo routine preoperative evaluation. After the PD, daily DALs will be evaluated from POD1. Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days.

This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD. Drains could be removed in POD3 in case of POD1 DALs < 666 U/L and POD3 DALs < 207 U/L. In case of POD3 DALs ≥ 252, abdominal CT scan will be performed in POD3 to identify abdominal collections ≥ 5 cm. In this latter category of patients, drains could be maintained beyond POD3.

The results of this trial will contribute to a better knowledge of POPF and management of surgical drains.
The results of this trial will contribute to a better knowledge of POPF and management of surgical drains.
Cervical degenerative disc (CDD) disease is a common type of spondylosis. Although anterior cervical discectomy and fusion (ACDF) is the preferred treatment for CDD disease, internal fixation with a titanium plate may cause various complications. The invention of the ACDF with a self-locking fusion cage (ROI-C) has effectively decreased the incidence of postoperative complications.

To observe the outcomes of CDD disease treated by ACDF with a ROI-C.

Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included. They were divided into two groups (control group and observation group,
= 45 in each) using a random number table. Patients in the control group received ACDF plus internal fixation with a titanium plate. Those in the observation group received ACDF + ROI-C placement. The two groups of patients were compared in terms of surgical parameters, pain, cervical spine function, range of motion, and complications.

The two groups of patients showed no significanof complications was only 2.22% in the observation group compared to 15.56% in the control group, and the difference was statistically significant (
< 0.05).

Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.
Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.
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