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1. In case dùng khi nào?
In case (trong trường hợp, phòng khi) chủ yếu được dùng để chỉ sự dự phòng – những điều chúng ta chuẩn bị cho các tình huống có thể xảy ra trong tương lai. Ví dụ: I always take an umbrella in case it rains. (=…because it might rain.)
Để nói về tương lai, chúng ta dùng thì hiện tại sau in case. Ví dụ: I’ve bought a chicken in case your mother stays to lunch. (Em đã mua một con gà phòng khi mẹ anh ở lại ăn trưa.) KHÔNG DÙNG: chúng tôi case your mother will stay…
2. Cấu trúc In case … should
Chúng ta dùng should + infinitive sau in case với nghĩa tương tự như might (có thể). Cấu trúc này cũng được dùng với nghĩa là tình cờ, vô tình (by chance) Ví dụ: I’ve bought a chicken in case your mother should stay to lunch. (Em mua thêm một con gà phòng khi mẹ anh có thể ở lại ăn trưa.)
Cấu trúc này được sử dụng phổ biến trong những câu nói về quá khứ. Ví dụ: I wrote down her address in case I should forget it. (Tôi viết lại địa chỉ của cô ấy đề phòng tôi quên nó.)
Khi muốn diễn tả sự tình cờ (by chance) chúng ta có thể thêm (should) happen to sau in case. Ví dụ: We took our swimming things in case we happened to find a pool. (Chúng tôi mang theo đồ bơi phòng khi chúng tôi tình cờ tìm thấy một bể bơi.) HOẶC …in case we should happen to find a pool)
3. Phân biệt in case và If In case và If thường được dùng trong ngữ cảnh khác nhau. In case được dùng khi muốn diễn tả trước khi một việc nào đó xảy ra, bạn làm gì để đề phòng nó. If được dùng để diễn tả sau khi việc đó xảy ra rồi thì bạn mới làm gì đó. Hãy so sánh: – Let’s buy a bottle of wine in case Roger comes. (=Let’s buy some wine now because Roger might come later.) (Hãy mua một chai rượu vang đi phòng khi Roger tới. = Hãy mua rượu vang ngay bởi vì Roger có thể đến sau đó.) Let’s buy a bottle of wine if Roger comes. (= We will wait and see. If Roger comes then we will buy the wine. If he doesn’t, we won’t.) (Hãy mua một chai rượu vang nếu Roger đến. = Chúng tôi sẽ đợi xem, nếu Roger tới thì chúng tôi sẽ đi mua rượu, nếu anh ấy không tới, chúng tôi sẽ không mua.) – I’m taking an umbrella in case it rains. (Tôi mang theo ô đề phòng trời mưa.) I’ll open the umbrella if it rains. (Tôi sẽ mở ô ra nếu trời mưa.) KHÔNG DÙNG: I’ll open the umbrella in case it rains. – People insure their houses in case they catch fire. (Người ta mua bảo hiểm nhà cửa đề phòng chúng bị cháy.) KHÔNG DÙNG: chúng tôi they catch… People telephone the fire brigade if their houses catch fire. (Mọi người gọi lính cứu hỏa đến khi nhà họ bị cháy.) KHÔNG DÙNG: …telephone the fire brigade in case their houses catch fire.
4. Cách dùng In case of
Cụm giới từ In case of mang nghĩa rộng hơn liên từ In case và có thể sử dụng ở những trường hợp tương tự như If. Ví dụ: In case of fire, break glass. (= If there is a fire…) (Nếu có cháy hãy đập kính.)
Sự Khác Nhau Giữa Test Case Và Test Scenario
Lĩnh vực kiểm thử phần mềm là một lĩnh vực rất thú vị khi làm việc, tuy nhiên cũng có khi các tester – những người thực hiện việc kiểm thử cảm thấy khó hiểu trước một rừng những thuật ngữ chung của ngành phần mềm. Khi được hỏi “Sự khác nhau giữa Test Case và Test Scenario là gì?”, rất nhiều người tỏ ra bối rối khi phải trả lời câu hỏi đó một cách chuẩn xác, nên người viết sẽ đưa ra một vài định nghĩa và cách phân biệt những thuật ngữ kiểm thử phần mềm cơ bản, bắt đầu với Test Case và Test Scenario và sự khác nhau giữa hai thuật ngữ này.
Test Case có nghĩa là “Cần được test như thế nào?” và Test Scenario là “Cái gì cần được test?”
Vậy hãy thử xem qua định nghĩa về Test Case và Test Scenario:
Test case: là một tập hợp các điều kiện hoặc các biến mà tester sẽ xác định xem liệu một ứng dụng, một hệ thống phần mềm hay một trong những chức năng của nó có chạy đúng như nó được thiết lập theo mục đích vốn có hay không.
Test scenario: một quá trình thử nghiệm toàn diện (tức là trên tất cả mọi khía cạnh, mọi hoàn cảnh) là bất khả thi bởi khối lượng dữ liệu khổng lồ chồng chéo và những đường hướng phức tạp trong phần mềm. Chính vì vậy scenario testing – kịch bản thử nghiệm cho phép chúng ta chắc chắn rằng chức năng của một ứng dụng được kiểm thử từ đầu đến cuối được đảm bảo là sẽ chạy đúng như dự kiến. Và cũng để kiểm tra xem tất cả các luồng kinh doanh có làm việc đúng như mong đợi hay không. Trong scenario testing, tester cần phải đặt bản thân vào vị trí của người sử dụng cuối cùng để kiểm tra và chạy các chức năng của sản phẩm. Việc chuẩn bị các scenario – kịch bản là phần quan trọng nhất đối với các tester, để làm được thì tester sẽ cần tới sự tư vấn hoặc giúp đỡ từ phía khách hàng và các lập trình viên.
Ví dụ 2:
Yêu cầu mẫu: Sử dụng case ID là UC 0001 – xác nhận và hợp thức hóa tính công năng khép kín của một website thương mại điện tử. Chỉ có khách hàng đã đăng ký mới được đăng nhập vào trang, sử dụng chứng chỉ có hiệu lực và tạo lệnh đặt hàng.
Test scenario Test case
Thông qua hai ví dụ trên, hy vọng bạn đã có thể phân biệt và hiểu rõ hơn về Test Case và Test Scenario. Việc sử dụng Test Case hay Test Scenario sẽ phụ thuộc vào hoàn cảnh và tester cần phải dựa vào đặc điểm của từng loại để quyết định.
Source: http://www.softwaretestingclass.com/what-is-difference-between-test-cases-vs-test-scenarios/ Vietnamese translated by Nguyen Thu Mai. Please do not take out for any reasons.
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Microbiology And Management Of Pediatric Liver Abscesses: Two Cases Caused By Streptococcus Anginosus Group
Pyogenic liver abscesses in the pediatric population are rare occurrences in the developed world. We present two cases of previously healthy males presenting with fever and abdominal pain found to have liver abscesses due to organisms in the Streptococcus anginosus group. The microbiology of S. anginosus along with the management and recommended treatment in children with liver abscesses is discussed.
1. Case 1
DK is a 16-year-old male presenting with severe abdominal pain. Three days prior while playing baseball, DK slid and began complaining of chest pain. Three days later he developed fever to 102°F and chills. His vital signs on presentation were blood pressure 102/71, pulse 108 bpm, respirations 16 bpm, and temperature 39.2°C. He was awake, tired, and flushed appearing. He had pain along his ribs on the lower right side of his abdomen along with decreased bowel sounds and tenderness of the right upper quadrant with voluntary guarding. There was no hepatosplenomegaly or masses. Labs included a disseminated intravascular coagulation (DIC) profile which showed fibrinogen 766 and a CBC showing WBC 13.6, HgB 12.7, Hct 35, platelets of 386 with 76% neutrophils, 15% lymphocytes, and 8% monocytes. Liver function testing was normal. He had a negative monospot, a normal amylase and lipase, an erythrocyte sedimentation rate (ESR) of 97 mm/hr, and a c-reactive protein (CRP) of 37.1 mg/dL. An ultrasound of the abdomen revealed a hypoechoic mass within the anterolateral right hepatic lobe further delineated by CT (Figure 1(a)) which revealed an abscess. He was placed on intravenous Piperacillin/Tazobactam followed by percutaneous drainage. Culture revealed 2+ Streptococcus intermedius (viridians strep). DK had serial CRPs which improved. A repeat ultrasound showed no lesion and the drain was removed. He was discharged home on intravenous Clindamycin; however, five days later he became febrile and returned to the emergency room. He had a WBC 17.7 with 85% neutrophils, a mild transaminitis, and a CRP of 5.8 mg/dL. An ultrasound of his abdomen revealed cm fluid collection. He was taken to interventional radiology for repeat aspiration and replacement of drain. A follow-up ultrasound showed a persistent hypoechoic area adjacent to the drain consistent with hematoma so the drain was capped. Repeat ultrasound remained unchanged and the drain was removed. Inflammatory markers continued to decline and he was discharged home on intravenous ampicillin.
2. Case 2
MM is a 14-year-old male with cold symptoms four days prior to presentation followed by the onset of several episodes of emesis and diarrhea along with decreased appetite and fever to 105.4°F. His vital signs were blood pressure 99/47 mmHg, pulse 137, respirations 18, and temperature 39.5°C. He was well appearing with dry mucus membranes. His abdominal exam was benign without hepatosplenomegaly or masses. Labs were drawn, that showed a WBC 4.1, a hemoglobin 10.7 g/dL, platelets 109 K/uL, AST 95 U/L, ALT 93 U/L, albumin 2.7 g/dL, total and direct bilirubin 2.6 mg/dL and 0.6 mg/dL, respectively, PT 13.8 sec, and fibrinogen 744 mg/dL. During admission MM began complaining of RUQ abdominal pain and an ultrasound showed a 6 cm mass in the liver along with a thickened gallbladder wall. A CT of the abdomen was completed (Figure 1(b)) and a liver biopsy was performed with 3 mLs of purulent fluid drained. MM’s blood culture and abscess culture revealed Streptococcus consellatus and he was started on intravenous Piperacillin/Tazobactam. A repeat ultrasound was performed five days later which showed interval increased size and cystic component of the liver abscess. He underwent repeat drainage and percutaneous drain placement. He had significant improvement and ultrasounds showed interval decrease in size and cystic components of the complex liver abscess. The drain was capped and a subsequent ultrasound revealed an interval decrease in size. The drain was then removed and he was discharged home on intravenous ceftriaxone.
Most descriptions of pyogenic liver abscesses (PLA) have been in the adult literature. These abscesses tend to be polymicrobial and typically are associated with cholangitis. PLA are a rare occurrence in infants and children, with an incidence of 0.007% to 0.04% of all hospital admissions per year. When left untreated, mortality rates of 80%-100% have been seen [ 1]. Most cases of liver abscesses result from direct extension from either the biliary or intestinal tract or from hematogenous spread. While both of our cases were previously healthy, the majority of cases of PLA have been described in patients in developing countries or those who are immunocompromised, especially those with chronic granulomatous disease (CGD) [ 2]. The clinical features of features of PLA are nonspecific: fever (89.6%), chills (69%), and abdominal pain (72.2%). However, only about 30% of patients present with all three symptoms [ 3]. Other common symptoms include nausea, vomiting, anorexia, weight loss, and malaise. Tender hepatomegaly has been described in adults but is rare in children [ 2]. Laboratory abnormalities include a leukocytosis (84% of patients), anemia (88.9% of patients), hypoalbuminemia (94% of patients), and an elevated alkaline phosphatase (73% of patients). An elevated CRP is commonly seen as well [ 2- 4].
PLA are almost always the result of bacterial infections, although fungal infections may occur. Entamoeba histolytica is an important cause to consider in developing countries. Unlike adults, the most common organism identified in the pediatric population is Staphylococcus aureus but many organisms have been implicated which include Gram-negative bacteria such as E. coli, Klebsiella, and Pseudomonas, anaerobes and streptococci. The streptococci that were isolated from our patients were members of the Streptococcus anginosus group (also known as the S. milleri group) which is a subgroup of Viridans Streptococci that consists of three distinct streptococcal species: S. anginosus, S. intermedius, and S. constellatus. Members of the S. anginosus group are located in the intestinal tract and are the cause of many infections within the abdominal cavity [ 5, 6]. The S. anginosus group has a tendency to form abscess; however, the reasons are not completely understood. The group has been shown to possess intrinsic factors that are likely to be involved in their pathogenesis such as adhesins on their cell surfaces that facilitate adherence to cell walls and allow pathogens to attach to the sites of tissue damage [ 5, 6]. Members possess polysaccharide capsules that inhibit phagocytosis and enables them to replicate after arriving at and adhering to a site of tissue damage. In particular, S. intermedius produces a cytolytic exotoxin, intermedilysin, which has been noted to have potent hemolytic effects on human erythrocytes. The most likely virulence factor is due to the intermedilysin’s production of superantigens which share the ability to activate specific lymphocyte subsets without regard to the antigenic specificity of the T cells and without prior cellular processing. After stimulation, superantigen-responsive T cells often die through apoptosis leading to acute toxic shock syndromes, necrotizing fasciitis, and multisystem illnesses due to the release of inflammatory cytokines [ 5]. These organisms tend to be sensitive to penicillin as was the case with both of our patients.
The early recognition of PLA is important. Abdominal ultrasound is the imaging modality of choice as it is diagnostic in over 90% of cases [ 3]. The right lobe of the liver is most commonly affected. When the abscesses are too small to be effectively drained (typically less than 2 cm) then one must employ a treatment strategy of antibiotics alone. In abscesses that are not multiloculated and less than 5 cm in size percutaneous needle aspiration and antibiotics have been described to be successful in most patients [ 4, 7]. Half of patients who undergo aspiration may need repeat aspiration when no indwelling drain is placed. This may need to be done up to three times [ 7, 8]. This approach of repeated aspiration without complete drainage in addition to antibiotics has been reported to be successful in 97% of patients [ 8]. In patients that fail this approach after 72 hours percutaneous drain placement is typically attempted under CT or sonographic guidance. Routine flushing of the drains is performed. Drains are left in place until the drainage is minimal. Risk factors for failed initial nonoperative management include multiloculated abscesses, biliary communication, increased serum urea and creatinine, or increased serum bilirubin [ 1]. Open laparotomy is typically reserved for those that display a poor response to percutaneous drainage and antibiotic therapy, when the pus is thick, or in patients with CGD [ 4]. Previously, laparotomy was also used in patients with multiple abscesses or those with biliary communication. Newer literature suggests that percutaneous drain placement is typically successful even in those with multiloculated abscesses, with multiple abscesses, or with biliary communication without obstruction and can be attempted in place of initial laparotomy [ 9].
Appropriate initial antibiotic regimens include ampicillin-sulbactam, Piperacillin-Tazobactam, or a third generation cephalosporin with metronidazole [ 1]. Antibiotic choices can be tailored once an organism is identified and susceptibilities are available. In immunocompromised patients, especially those with CGD, it is not unreasonable to add antifungal coverage [ 1, 2]. The recommended duration of treatment is 4-6 weeks in patient with multiple abscesses or shorter in those that have been well drained. Initial IV antibiotic therapy may be changed to appropriate oral antibiotic therapy after 2-4 weeks of treatment. One of the above regimens should be begun once a diagnosis of PLA is made, independent of other treatment plans. Monitoring response to treatment typically involves following serial inflammatory markers such as CRP. The clinical response may be delayed because of the time necessary to obtain effective concentrations in the liver. The median time to resolution of CRP is about 3 weeks [ 2]. Resolution on imaging typically lags behind clinical and laboratory improvement as some studies suggest sonographic evidence can persist for an average of 14 weeks and up to 2 years [ 10].
M. Cellucci, E. Simon, and S. Eppes have no relevant financial disclosures to report.
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Copyright © 2012 Michael Cellucci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hemorrhage In The Wall Of Pyogenic Brain Abscess On Susceptibility Weighted Mr Sequence: A Report Of 3 Cases
Background and Purpose. In pyogenic brain abscess, hemorrhage in the walls is considered exceptional. Recently, hemorrhagic changes in the walls of pyogenic abscess have been demonstrated on susceptibility weighted imaging with 3T MRI. Here, we report hemorrhagic changes in the walls of pyogenic brain abscess on susceptibility weighted imaging with 1.5T MRI. Method. MRI of brain was done using 1.5T MRI with diffusion weighted sequence, susceptibility weighted sequence, and other standard sequences in 3 consecutive cases of pyogenic brain abscess. Stereotactic biopsy and cultures were obtained in 2 cases. One case was treated empirically with antibiotics. Results. Susceptibility sequence demonstrated hemorrhage in the wall of brain abscess in all three cases. All three cases also demonstrated restricted diffusion on diffusion weighted imaging. Conclusion. Susceptibility weighted imaging can demonstrate hemorrhagic changes in the walls of pyogenic brain abscess on 1.5T MRI. Presence of hemorrhage in the walls of ring enhancing lesions should not automatically lead to a diagnosis of tumor.
2. Case Presentation
2.1. Case 1
A 34-year-old male presented to the emergency with severe headache of 2-day duration, confusion, vomiting, and an episode of tonic clonic seizure. On neurological examination, no focal deficits were identified. Laboratory investigation revealed a total count of 8.47 K/ μL and a platelet count of 229 K/ μL. Coagulation profile was normal. An emergent noncontrast CT head revealed a hypodense lesion in the left temporal lobe with no evidence of hemorrhage or calcification. MRI brain was obtained with 1.5T MRI 14 hours later. Along with routine pre- and postcontrast T1 SE, T2 FSE, FLAIR, and diffusion imaging, susceptibility weighted sequence was obtained with parameters TR49 mS, TE40mS, ETL 1, flip angle 15°, slice thickness 1.5 mm, 12 mm thickness for minIP, matrix 256 × 208 and field of view 240 × 195, and excitation 1 and total acquisition time of 4 minutes and 23 seconds. MRI of brain revealed an irregular thin ring enhancing lesion with restricted diffusion measuring approximately 25 mm × 25 mm. The enhancing portion demonstrated signals similar to the white matter on both noncontrast T1 and T2 sequences. Perilesional vasogenic edema was also noted. SWI images demonstrated prominent hypointensity in the wall consistent with hemorrhage (Figure 1). A stereotactic biopsy was obtained to exclude tumor. Culture of the biopsy material grew Streptococcus viridans. He was initiated on intravenous ceftriaxone 2 gm IV every 12 hours and oral metronidazole 500 mg every 6 hours for 10 weeks. He made an uneventful recovery and a follow-up imaging obtained after the completion of antibiotics identified resolution of the lesion with residual hemosiderin scar. No primary focus of infection was identified.
2.2. Case 2
A 59-year-old female with past history of treated myelodysplastic syndrome, basal cell carcinoma, mitral valve prolapse, and melanoma presented to the emergency department with several days history of fatigue, lethargy, slurring of speech, headaches, and altered mental status that started worsening for 3 days prior to admission. On examination, she was febrile. Neurological examination revealed no focal deficits. She had pancytopenia with thrombocytopenia and received blood transfusion every 2 years. Laboratory investigation revealed a total count of 2.32 K/ μL, a red blood cell count of 2.39 M/ μL, a platelet count of 26 K/ μL, prothrombin time 19.7 seconds, INR 1.61, and PTT 39 seconds. Noncontrast CT head obtained at the time of admission identified left basal ganglia hypoattenuating lesion with a central ring like lesion having attenuation similar to the gray matter. No hemorrhage or calcification was seen in the lesion. An MRI of brain was obtained 4 hours after the admission with 1.5T MRI. Along with routine pre- and postcontrast T1 SE, T2 FSE, FLAIR, and diffusion imaging, susceptibility weighted sequence was obtained with parameters TR49 mS, TE40mS, ETL 1, flip angle 15°, slice thickness 1.5 mm, 12 mm thickness for minIP, matrix 256 × 224 with phase encoding steps 155 and field of view 240 × 210, and excitation 1 and total acquisition time of 4 minutes and 23 seconds. MRI of brain revealed an irregular thin ring enhancing lesion in the left anterior lentiform nucleus with associated prominent vasogenic edema. The enhancing portion demonstrated signals similar to the white matter on both noncontrast T1 and T2 sequences. Ring enhancement and restricted diffusion were seen in the lesion with prominent hypointense signals on SWI image in the wall of the lesion (Figure 2). Abscess was considered with a differential of hemorrhagic metastasis. Blood cultures did not grow pathogens. Biopsy was withheld in view of low platelet count. She received intravenous ceftriaxone 2 gm every 12 hours and oral metronidazole 500 mg every 6 hours for a period of 6 weeks. She made an uneventful recovery at the end of antibiotic treatment and follow-up imaging demonstrated resolution of the lesion with residual susceptibility signals from hemosiderin scar.
2.3. Case 3
A 65-year-old male presented to the emergency department with three-day worsening of headache. A neurological assessment revealed no focal deficits. Total count was 9.95 K/ μL and platelets were 274 K/ μL. His coagulation parameters were not obtained. He did not receive Coumadin. There was no history of bleeding disorder. Noncontrast CT head at the time of admission showed focal hypodense lesion in the left temporooccipital region with no evidence of hemorrhage or calcification. Seven hours after admission, an MRI of brain was obtained as part of evaluation. Along with routine pre- and postcontrast T1 SE, T2 FSE, FLAIR, and diffusion imaging, susceptibility weighted sequence was obtained with parameters TR49 mS, TE40mS, ETL 1, flip angle 15°, slice thickness 1.5 mm, 12 mm thickness for minIP, matrix 256 × 224 with phase encoding steps 155 and field of view 230 × 200, and excitation 1 and total acquisition time of 5 minutes. MRI of brain revealed an irregular thin ring enhancing lesion in the left parietotemporooccipital region with associated perilesional vasogenic edema. The enhancing portion demonstrated signals similar to the white matter on both noncontrast T1 and T2 sequences. Restricted diffusion was seen in the center of the lesion. SWI demonstrated prominent hypointense signals in the enhancing walls (Figure 3). Blood cultures did not grow pathogens. In view of his old age, surgery was done to differentiate tumor from infection. No tumor was identified on histopathological examination. Culture of the surgical tissue grew Streptococcus viridans. He received intravenous ceftriaxone 2 gm IV every 12 hours and oral metronidazole 500 mg every 6 hours. Later, his antibiotic was switched to vancomycin, ciprofloxacin, and Flagyl due to drop in blood cell and platelet count. Antibiotics were administered over a period of 6 weeks. Finally, he made an uneventful recovery with resolution of the lesion. No primary source of infection was identified.
Susceptibility weighted image is a high resolution 3D fully velocity compensated gradient echo sequence [ 12]. Its variants include susceptibility weighted angiography (SWAN) and venous blood oxygen level dependent (venoBOLD) techniques. In SWI, data from phase and magnitude images is used to create minimum intensity projection (minIP) image to increase the conspicuity of hemorrhage, clot, and deoxyhemoglobin in veins. This enhances the sensitivity of susceptibility weighted imaging to detect hemorrhage much better than traditional 2D gradient echo sequence [ 7]. Presence of prominent hypointense signals in the ring enhancing lesions on susceptibility imaging in all three of our cases is consistent with hemorrhage. A histopathological analysis may be the best step to confirm the presence of hemorrhage in the wall of a brain abscess. However, it is important to understand that surgical intervention is not needed in each and every case of brain abscess and smaller lesions can be treated with antibiotics alone.
Susceptibility weighted sequence at 1.5T MRI can demonstrate prominent hypointense signals from hemorrhage in the walls of pyogenic brain abscess. It is essential that one should pay attention to identifying restricted diffusion and preventing a misdiagnosis of hemorrhagic tumor and delay in the diagnosis of brain abscess. Appropriate clinical background and blood culture should be sought after and, if needed, MR spectroscopy may be utilized to confirm abscess. Prospective analysis with susceptibility weighted imaging at 1.5T MRI will help identify the true incidence of hemorrhage in the wall of pyogenic brain abscess.
Conflict of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
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