We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

Objective

To investigate the clinicopathological features， treatment and prognosis of hepatic sarcomatoid carcinoma （HSC）.

Methods

Clinical data of 14 patients with HSC admitted to the First Affiliated Hospital of Guangxi Medical University from March 2002 to March 2022 were retrospectively analyzed. Among them， 12 patients were male and 2 female， aged from 46 to 77 years， with a median age of 56 years. Clinical features， imaging manifestations， pathological findings， treatment and prognosis were summarized and analyzed between two groups. According to different treatment， 14 patients were divided into the surgery（n=9） and non-surgery groups （n=5）. Survival status was compared between two groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The male-to-female ratio was 6∶1.11 patients developed initial symptoms of epigastric discomfort， 1 case of weight loss， and 3 patients were detected during physical examination. 11 cases were with positive HBsAg， 11 cases had a serum ALB level ＜34 g/L and 1 case of TB level ＞17.1 μmol/L， 1 case of AFP level ＞400 μg/L， and 3 cases of CA19-9 level ＞40 kU/L.11 cases were graded as Child-Pugh grade A and 3 cases of grade B. One patient was classified as stageⅠB，5 cases of stage Ⅲ and 8 cases of stage Ⅳ based on the TNM staging system. Among 14 patients， 8 cases had lymph node metastases. Imaging examination detected intratumoral necrosis in 7 cases. Vimentin， CK， P53 and Ki-67 were positive. The follow-up time was 1.0-58.0 months， with a median of 8.5 months. The median overall survival （OS） of 14 patients was 5 months. The median OS of surgery group was 5 months， and 25 months for non-surgery group. There was no statistical difference in OS between two groups （χ²=0.356， P=0.551）.

Conclusions

Clinical manifestations， laboratory and imaging examination of HSC are non-specific， and the diagnosis depends on pathological examination. No significant difference is found between surgical and nonsurgical treatment. Nevertheless， extended radical resection combined with multi-organ resection contributes to improving the quality of life and prolonging the survival time in certain patients.

Objective

To investigate the clinical characteristics，diagnosis，treatment and prognosis of children with Mycoplasmapneumoniae encephalitis（MPE）complicated with binocular diplopia.

Methods

A child （patient 1）diagnosed with MPE and experiencing binocular diplopia was admitted to Dingxi Hospital of Traditional Chinese Medicine in November 2023，was selected as the subject of this research.A retrospective analysis was conducted to evaluate the clinical data of patient 1，and relevant studies on children with MPE were reviewed from both domestic and international databases to summarize the clinical characteristics，diagnosis，treatment and prognosis of the disease.The procedures followed in this study adhered to the WorldMedicalAssociationDeclarationof Helsinki revised in 2013.The guardian provided informed consent for the diagnosis and treatment of patient 1.

Results

①Patient 1，male，9 years old，developed with fever，headache，dizziness，and binocular diplopia，without other manifestations of nervous system involvement.The serum Mycoplasmapneumoniae（MP）-Ig M antibody was positive.Cerebrospinal fluid examination showed that cerebral pressure was normal，with colorless，water-like liquid，clear and transparent，mucin was qualitatively negative.Biochemical analysis of cerebrospinal fluid showed that glucose level was normal，lactate dehydrogenase and chlorine levels were decreased；Bacterial culture in cerebrospinal fluid was negative.After 5 days of treatment with azithromycin for anti-infection and MPE，the above symptoms of patient 1 were quickly relieved and cured，and was discharged from hospital for 5 days hospitalization.The discharge diagnosis was MPE.There were no recurrence and no neurological sequelae during follow up of 2 months after discharge.②Literature review results：there were 241 children with MPE in 11 MPE related studies and plus patient 1，the clinical data of 242 children with MPE were analyzed as follows.Among the 242 children with MPE，fever （73.9%），headache（72.3%），disturbance of consciousness （47.9%）were the main clinical manifestations，and most of the meningeal irritation signs （46.7%）and pathological signs （21.4%）were positive.In auxiliary examinations，the higher positive rates were electroencephalogram （77.3%），serum MP-Ig M positive（73.1%），and increased white blood cell count in cerebrospinal fluid （41.7%），respectively.Moreover，more children with MPE have pneumonia，but hallucinations，auditory hallucinations，and visual hallucinations were rare.MPE with binocular diplopia has not been reported yet.All 242 children were treated with macrolides，and severe children were treated with methylprednisolone sodium succinate or gamma globulin.Most children with MPE diagnosed and treated early had a good prognosis.

Conclusion

Binocular diplopia can occur in children with MPE，which has certain reference for early diagnosis and treatment of children with MPE.

This article reports a case of pelvic recurrence after radical cystectomy for bladder cancer.The patient was admitted to the hospital due to "progressive increase of pelvic mass for 2 years after radical cystectomy for bladder cancer 9 years".PET-CT showed a cystic and solid mass on the right side of the pelvis after radical cystectomy， which was considered a malignant lesion， possibly from the intestinal substitute bladder or recurrence of bladder cancer.The lesion involved the right iliac vessels， the right obturator internus muscle， and the left ureteral stoma， accompanied by hydronephrosis of the left kidney and hydroureter of the left ureter.The local lesion was indistinguishable from the adjacent sigmoid colon and small intestine， and there was a presacral nodule with abnormally increased glucose metabolism， suggesting metastasis.After multidisciplinary consultation on difficult cases in Guangdong Urological Association， experts considered that the surgery was difficult and recommended taking a biopsy first to confirm the pathology and then give chemotherapy.The surgery would be re-evaluated based on the therapeutic effect.Subsequently， a biopsy of the pelvic mass was performed under ultrasound guidance， and the pathological result indicated metastatic urothelial carcinoma.The patient was treated with GC chemotherapy （gemcitabine 1 600 mg + lobaplatin 45 mg）.The patient underwent a follow-up CT scan after over a month of chemotherapy， which showed no significant changes in tumor size compared to previous imaging.Experts recommend continuing chemotherapy or participating in clinical drug trials.The patient is currently continuing chemotherapy， and the next treatment plan will be reassessed after monitoring the therapeutic effects.The prognosis of pelvic recurrence after bladder cancer surgery is poor， with severe tumor adhesion， high surgical difficulty and risk.Ultrasound-guided biopsy has advantages.Treatment should be individualized， providing radiotherapy， chemotherapy， surgery or combined treatment.

Objective

Toevaluatetheeffectivenessofcase-basedcollaborativelearning（CBCL）teaching mode in clinical teaching of coronary atherosclerotic disease complicated with chronic kidney disease.

Methods

Medical students with bachelor degree or above who received standardized training in nephrology department of our hospital from December 2022 to May 2024 were randomly divided into an observation group and a control group. The CBCL teaching mode was used in the observation group， while conventional teaching methods were used in the control group. After the same training period， the examination results of the two groups of students were analyzed and compared， and the effects of the two teaching methods were evaluated. And the satisfaction levels of the participating medical students with the training were collected through a questionnaire survey.

Results

A total of 30 medical students were included， with 15 in the observation group and 15 in the control group. Both the theoretical ［（95.29±2.99）vs （85.13±4.74）， P＜0.001］and operational ［（94.07±1.98） vs （86.47±6.49）， P＜0.001］assessment scores of the observation group students were higher than those of the control group. The observation group students showed higher satisfaction with the overall course （93.3%）， and the teaching mode （86.7%） （P＜0.05）. In terms of theoretical knowledge understanding and clinical thinking cultivation， the satisfaction of the observation group was also higher than that of the control group （P＜0.05）.

Conclusion

The application of CBCL teaching mode in the clinical teaching of coronary atherosclerotic disease complicated with chronic kidney disease could improve the theoretical and operational scores of the medical students as well as satisfaction from them.