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BACKGROUND Paraneoplastic syndromes are characterized by atypical clinical manifestations. Several reports of hepatocellular carcinoma (HCC) paraneoplastic phenomena have been reported. They usually manifest as one type in an individual, but it is not common for the two clinical manifestations to occur simultaneously. CASE SUMMARY A 52-year-old female patient was admitted to hospital with pale skin and numbness of the second to fifth fingers in the left hand, which rapidly developed into severe digital ischemia. Computed tomography angiography revealed uneven thickness of the left ulnar artery with severe local luminal stenosis. Blood analysis during hospitalization showed persistent mild to medium thrombocytopenia and insensitive to hormonal therapy. Antiphospholipid antibody testing showed high titer of IgG anticardiolipin antibodies (aCLs), IgA aCLs, IgG anti-β2-glycoprotein-I (anti-β2 GPI), and IgA anti-β2 GPI. The exact diagnosis was HCC when the high a-fetoprotein levels, computed tomography findings, and the history of chronic hepatitis B came together. This was a rare case of coexisting manifestations as presenting symptoms of malignancy-associated antiphospholipid syndrome. The patient underwent several operations, antithrombotic treatments and hormonal therapy. However, the patient refused chemotherapy and died 8 wk after diagnosis. CONCLUSION This report highlights the importance of atypical clinical changes that could alert the physicians to vigilance for a concomitant underlying malignancy.

BACKGROUND Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research. AIM To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic, social and clinical risk factors. METHODS This cross-sectional study was performed in geriatric patients (aged ≥ 60 years, both sexes) with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017. Demographic, social, and clinical characteristics were described. Huaxi Emotional-Distress Index (HEI) was used to evaluate the severity of anxiety and depression status. Differences in continuous variables were tested using the t-test, and differences in categorical variables were assessed using the Pearson χ2 test. Binary logistic regression analyses were used to identify the factors associated with a HEI score > 8. RESULTS Among the 966 patients, 487 were male and 479 were female, with a mean age of 70.2 ± 7.1 years. The age ranged from 60 to 90 years. Seventy-five patients had an HEI score > 8, accounting for about 7.8% of all patients. A higher Injury Severity Score (4.17 ± 3.10 vs 7.96 ± 6.68, P < 0.001), higher Visual Analog Score (5.05 ± 1.09 vs 6.89 ±1.23, P < 0.001), number of chronic diseases (P < 0.001), injury type (P = 0.038), and education level (P = 0.001) were significantly associated with HEI score > 8. On logistic regression, a higher education level was a protective factor for emotional disorders (P = 0.047), whereas Injury Severity Score (P = 0.024), Visual Analog Score (P < 0.001), two or more chronic diseases (P < 0.001) were the related independent risk factors. CONCLUSION Emotional disorders are common in geriatric patients with orthopedic trauma. Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

Objective: To explore the effect of tentorium cerebelli hiatus incision in combined with standard large decompressive craniectomy on the immunological function and serum t-PA and PAI-1 in patients with severe craniocerebral injury. Methods: A total of 80 patients with severe craniocerebral injury who were admitted in our hospital were included in the study, and randomized into the treatment group and the control group with 40 cases in each group. The patients in the control group were given standard large decompressive craniectomy, while the patients in the treatment group were given tentorium cerebelli hiatus incision in combined with standard large decompressive craniectomy. The postoperative intracranial pressure in the two groups was observed. The immunological function, serum t-PA and PAI-1 levels, and the occurrence of complications before and after treatment in the two groups were compared. Results: The intracranial pressure and occurrence rate of stress ulcer, cerebral artery infarction, and hydrocephalus after operation in the treatment group were significantly reduced when compared with the control group. The serum and CSF t-PA and PAI-1 levels 1 d to 7 d after operation in the two groups were gradually reduced. The serum and CSF t-PA and PAI-1 levels 3 d and 7 d after operation in the treatment group were significantly lower than those in the control group. IgG, IgA, and IgM levels, and CD3+ , CD4+ , and CD8+ after operation in the two groups were significantly elevated, but CD4+ /CD8+ was significantly reduced when compared with before operation. Conclusions: Tentorium cerebelli hiatus incision in combined with standard large decompressive craniectomy in the treatment of severe craniocerebral injury has a small effect on the immunological function and serum t-PA and PAI-1, and can reduce the occurrence rate of postoperative complications, with an accurate efficacy.

OBJECTIVE To study the feasibility of applying the Bron-Kerbosch (BK) algorithm on the discovery of basic formulas (BFs) of traditional Chinese medicine. METHOD This essay introduces the BK algorithm for the discovery of BFs of traditional Chinese medicine and relevant indicators. On the basis of the compatibility network of drugs, with the confidence coefficient of basic formulas anti the support degree to the decline of alpha level as indicators, the BK algorithm was used for the discovery of BFs of traditional Chinese medicine. And prescriptions of Professor Ma Shaoyao, a traditional Chinese medicine (TCM) dermatologist of Longhua hospital, were taken as examples for analysis. RESULT After the parameters were optimized, three BFs for psoriasis and four BFs for eczema were found using the BK algorithm, which had a relatively high confidence coefficient and basically conformed to the clinical practices. CONCLUSION The BK algorithm can be used for the discovery of basic formulas (BF) of traditional Chinese medicine, and therefore it is one of the effective methods to study and summarize the diagnosis and treatment experiences and prescription thoughts of famous and experienced TCM doctors.