Tahoe Forest Hospital

Mục tiêu: Đánh giá giá trị tiên lượng của chỉ số MELD trong dự đoán nguy cơ suy gan cấp ở bệnh nhân xơ gan điều trị tại Trung tâm Y tế huyện Thanh Ba. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang tiến cứu trên 52 bệnh nhân xơ gan, chia thành hai nhóm có và không có suy gan cấp. Chỉ số MELD được tính toán và phân tích mối liên quan với nguy cơ suy gan cấp. Kết quả: Bệnh nhân suy gan cấp có chỉ số MELD trung bình cao hơn đáng kể so với nhóm không suy gan cấp (22,4 ± 3,1 so với 15,2 ± 2,8; p < 0,01). Ngưỡng MELD ≥ 18 có độ nhạy 85% và độ đặc hiệu 78% trong tiên lượng suy gan cấp. Khi MELD ≥ 20, độ đặc hiệu tăng lên 85,1%. Kết luận: Chỉ số MELD có giá trị tiên lượng cao trong dự báo nguy cơ suy gan cấp ở bệnh nhân xơ gan. Ngưỡng MELD ≥ 18 giúp phát hiện sớm bệnh nhân có nguy cơ cao, hỗ trợ điều trị kịp thời và giảm tỷ lệ tử vong.

A set of experiments were conducted on the LArge Plasma Device (LAPD) at UCLA to test the operational principles of a traveling wave antenna of the comb-line type. This antenna was designed to launch helicon waves (fast waves in the lower hybrid range of frequencies) on DIII-D. With the order-of-magnitude lower static magnetic field on LAPD, the antenna excites waves in a different regime. Whenever fast waves can propagate in LAPD, slow waves are also supported by the plasma so it is necessary to distinguish between the two cold-plasma branches in evaluating the effectiveness of the launcher. The results show that the launcher couples well to fast waves when the plasma supports fast-wave propagation; control of the principal imposed parallel wavenumber can be achieved through varying the launch frequency on the antenna within its bandwidth of operation; and that the launched waves exhibit strong directionality. We also investigate the role of the plasma profile and wave mode on the loading characteristics. Additionally, a comparison with full-wave modeling of the propagating waves is shown using both a cold-plasma model in COMSOL and a hot-plasma model in RFPisa, which obtain similar results in the present regime.

Mục đích: Mô tả các đặc điểm hình ảnh tĩnh mạch thận trái (TMTT) và mối liên quan với chỉ số khối cơ thể (BMI), chỉ số góc động mạch chủ-mạc treo tràng trên (ĐMC-MTTT) ở người trưởng thành trên hình chụp cắt lớp vi tính (CLVT). Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả trên 627 đối tượng có chụp CLVT tại Bệnh viện đa khoa Tâm Anh TP.HCM từ tháng 07/2023 đến tháng 12/2023, bao gồm các thông số đặc điểm TMTT (đường kính lớn nhất, đường kính nhỏ nhất, tỉ số nén đường kính, góc TMTT, dấu mỏ chim), góc ĐMC-MTTT. Kết quả: Tỉ lệ dấu mỏ chim ở TMTT là 8,8%. Giá trị trung bình của đường kính lớn nhất TMTT là 10,23 ± 1,7 mm, đường kính nhỏ nhất TMTT là 4,72 ± 1,96 mm, tỉ số nén TMTT là 2,52 ± 1,1, góc TMTT là 17,94 ± 11,19 độ, góc ĐMC-MTTT là 60,79 ± 24,97 độ; có sự khác biệt có ý nghĩa giữa nam và nữ. Giá trị trung bình góc ĐMC-MTTT tăng dần ở nhóm gầy, bình thường và thừa cân, lần lượt là 42,56 độ, 56,37 độ, 74,74 độ (p<0,001), tương quan thuận mức độ trung bình (p<0,001). Giá trị trung bình góc TMTT giảm dần ở nhóm gầy, bình thường và thừa cân, lần lượt là 26,7 độ, 18,71 độ, 14,36 độ (p<0,001), tương quan nghịch mức độ yếu (p<0,001). Kết luận: Có sự tương quan giữa chỉ số khối cơ thể với góc ĐMC-MTTT và góc TMTT

Thyroid storm is a rare, life-threatening endocrine emergency with a high mortality rate of up to 30%. We present a unique management challenge of a critically ill patient who developed thyroid storm in the setting of a duodenal perforation from amphetamine-associated non-occlusive mesenteric ischaemia. The diagnosis of ‘thyroid storm’ was made based on clinical criteria and a Burch-Wartofsky score of 100. During emergent exploratory laparotomy, a 1 cm duodenal perforation with surrounding friable tissue was found and repaired. Intraoperatively, a nasogastric tube was guided distal to the area of perforation to allow for enteric administration of medications, which was critical in the setting of thyroid storm. Therapeutic plasma exchange achieved biochemical control of our patient’s thyroid storm but ultimately did not prevent in-hospital mortality.

Organ donors are systematically screened for infection, whereas screening for malignancy is less rigorous. The true incidence of donor-transmitted malignancies is unknown due to a lack of universal tumor testing in the posttransplant setting. Donor-transmitted malignancy may occur even when not suspected based on donor or recipient factors, including age and time to cancer diagnosis. We describe the detection of a gastrointestinal adenocarcinoma transmitted from a young donor to 4 transplant recipients. Multidimensional histopathologic and genomic profiling showed a CDH1 mutation and MET amplification, consistent with gastric origin. At the time of writing, one patient in this series remains alive and without evidence of cancer after prompt organ explant after cancer was reported in other recipients. Because identification of a donor-derived malignancy changes management, our recommendation is to routinely perform short tandem repeat testing (or a comparable assay) immediately upon diagnosis of cancer in any organ transplant recipient. Routine testing for a donor-origin cancer and centralized reporting of outcomes are necessary to establish a robust evidence base for the future development of clinical practice guidelines.

414 Background: Donor-derived malignancy may occur even when not suspected based on donor or recipient factors, including age and time to cancer diagnosis. Early recognition of donor-derived malignancy has treatment implications. We describe the molecular characterization of a gastric cancer transmitted from an organ donor to heart, liver (LR), left kidney (LKR), and right kidney-pancreas (KPR) recipients. Methods: IRB approval for chart review was obtained; LR, LKR, and KPR also provided research consent for molecular profiling. Short Tandem Repeat (STR) genotyping was performed by polymerase chain reaction and gel electrophoresis. Tumor and germline DNA from patients and the organ donor were subjected to next generation sequencing (NGS) of 479 genes. Fluorescence in situ hybridization (FISH) was used to confirm MET amplification. Results: Donor origin was established by STR analysis, with the tumors showing high levels of donor alleles. Pathology revealed a poorly differentiated adenocarcinoma with signet ring features. Immunohistochemical staining and CA-19-9 elevation were most consistent with gastric or pancreas origin. Tumor sequencing was notable for somatic mutation of CDH1, MET amplification and wild-type KRAS genes. Tumors from LR and KPR were nearly identical based on pathogenic variants, allele frequency, and copy number variation. Insufficient tumor cellularity in all LKR specimens precluded NGS profiling, but clinical testing found that the cancer was mismatch repair proficient; ERBB2 equivocal; and PDL-1 positive. A circulating tumor DNA test did not uncover any genomic alterations; however, MET amplification was confirmed in this tumor using FISH probes. Conclusions: STR analysis and reporting should be standard immediately following diagnosis of cancer in an organ transplant recipient to ascertain donor derivation. Further molecular characterization, including NGS, may aid in defining primary tumor origin. Here, diagnosis with PDL1-positive gastric cancer enabled use of pembrolizumab. One patient remains alive and without evidence of cancer following prompt organ explant after cancer was reported in other recipients.

The fabella is a sesamoid bone situated in the posterolateral knee, which may contribute to posterolateral knee pain by impinging on the adjacent common peroneal nerve (CPN). Although anatomic studies have established an relationship between the fabella and CPN, we present 4 cases of posterolateral knee pain radiating into the anterolateral leg in which sonography was able to determine the source of the pain as CPN compression by an adjacent fabella. In 2 of these cases, resolution of symptoms was achieved with ultrasound-guided CPN blocks, whereas 1 case was surgically treated, and another was managed with oral analgesics. These cases illustrate the utility of diagnostic and interventional sonography in the evaluation and treatment of posterolateral knee pain secondary to fabellar impingement of the CPN.