A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing rel...A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.展开更多
This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the am...This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the ambitious blueprint is a key event that will steer pan-African development onto the right path,and put renewed focus on the pan-African vision of building an integrated,prosperous and peaceful Africa within a 50-year period from 2013 to 2063.展开更多
The study explores the yearnings of fisherfolks on their child’s education, hindrances, and factors that shape their desire as parents. Field observations and key informant interview among elder members of fisherfolk...The study explores the yearnings of fisherfolks on their child’s education, hindrances, and factors that shape their desire as parents. Field observations and key informant interview among elder members of fisherfolk communities surrounding the Albay, Ragay, and Asid Gulfs of the Bicol Region was utilized. The study revealed that the majority of the fisherfolk parents do not want their children to continue fishing as their main source of livelihood because of potential risks, hardships, and cultural factors like collectivism, close family ties, and dependence on the elders. The parents’ aspirations were shaped by their persistence over various threats, fears, personal unfulfilled dreams, and career opportunities thru education. Most of the parents desired a college education and a safe and secure profession for their children. The study deduced that these challenges can be a contributory factor for the declining number of fisherfolks surrounding the gulfs. Influencing this sector is the factor motivating fishers in their aspirations for their children’s education. The study recommends introducing strategies for fisherfolks to develop a strong sense of hope and drive in realizing their aspirations and further research on the impact of culture, the role of women and children, and fisherfolks and their success stories.展开更多
In September 2021,I trav-eled to Xinjiang Uygur Autonomous Region for the second time,the first being in.2014,in the midst of turmoil due to separatists.
This book is a collect!on of novellas created by writer Wen Qingli with the theme of Kunqu Opera,a masterpiece of human oral and intangible heritage.With elegant and rich words,clear and poetic style,and delicate and ...This book is a collect!on of novellas created by writer Wen Qingli with the theme of Kunqu Opera,a masterpiece of human oral and intangible heritage.With elegant and rich words,clear and poetic style,and delicate and expressive character descriptions,the beauty of Kunqu Opera and the persistenee and inheritanee of traditional opera art by Kunqu Opera performers is conveyed,reflect!ng Chinese characteristics,grandeur,and style.展开更多
This paper delves into the ancient concept of shi yan zhi(poetry expressing aspirations)within Chinese poetry.It examines the precise meaning of zhi,the dialectical relationship between yan and zhi,and the historical ...This paper delves into the ancient concept of shi yan zhi(poetry expressing aspirations)within Chinese poetry.It examines the precise meaning of zhi,the dialectical relationship between yan and zhi,and the historical development of“poetry expressing aspirations.”It further looks at how this foundational concept underpins the logical construction of Chinese poetic tradition,reaffirming its historical significance as the“manifesto”of Chinese poetics.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,neces...BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.展开更多
Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnos...Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-ye...BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.展开更多
BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intra...BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injur...Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.展开更多
BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous di...BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.展开更多
Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It ...Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.展开更多
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxi...BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.展开更多
BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy fo...BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy for OA due to its rich composition of mesenchymal stromal cells(MSCs)and bioactive factors.While intra-articular BMAC injections provide short-term symptomatic relief,recent literature suggests that targeting the subchondral bone—an area crucial to OA progression—may offer superior and longer-lasting clinical benefits.AIM To compares the outcomes of subchondral vs intra-articular BMAC injections in patients with primary knee OA.METHODS In this unicentric,double-blinded,randomized controlled trial,30 patients with radiologically confirmed primary knee OA(Kellgren-Lawrence grades II and III)will be equally randomized to receive either subchondral(Group A)or intra-articular(Group B)BMAC injections.BMAC will be harvested from the posterior iliac crest,processed using a standardized centrifugation protocol to yield a product with>85%cell viability,and administered under image guidance.The primary outcome is the change in pain intensity at 12 months as measured by the Visual Analog Scale(VAS).Secondary outcomes include functional improvement assessed by Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee(IKDC),and Western Ontario and McMaster Universities Arthritis Index(WOMAC)scores,structural changes evaluated through advanced magnetic resonance imaging using(MRI)the whole-organ MRI Score,and safety as determined by the incidence of adverse events.RESULTS This study aims to evaluate pain reduction at 12 months post-injection,using the VAS as the primary outcome.Secondary outcomes include functional improvement(KOOS,WOMAC,IKDC),cartilage regeneration(T2 cartigram),adverse event incidence,patient satisfaction(standardized questionnaires,Likert scale),and quality of life(EQ-5D).Ethical considerations follow the Declaration of Helsinki and Good Clinical Practice,with institutional review board approval and participant informed consent ensured.Confidentiality and data security comply with regulations,and a data safety monitoring board oversees trial safety.Results will be shared via peer-reviewed journals,presentations at international orthopedic conferences,and detailed summaries for stakeholders and participants.The trial is registered under clinical trial registry of India/2024/04/065284.Findings emphasize patient-centered advancements in knee osteoarthritis management.CONCLUSION This trial aims to refine regenerative strategies for knee OA by comparing subchondral vs intra-articular BMAC injections,addressing long-term efficacy,safety,and treatment standardization to guide targeted interventions.This trial will provide critical insights into the comparative efficacy and safety of subchondral vs intra-articular BMAC injections in treating primary knee OA.展开更多
文摘A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.
文摘This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the ambitious blueprint is a key event that will steer pan-African development onto the right path,and put renewed focus on the pan-African vision of building an integrated,prosperous and peaceful Africa within a 50-year period from 2013 to 2063.
文摘The study explores the yearnings of fisherfolks on their child’s education, hindrances, and factors that shape their desire as parents. Field observations and key informant interview among elder members of fisherfolk communities surrounding the Albay, Ragay, and Asid Gulfs of the Bicol Region was utilized. The study revealed that the majority of the fisherfolk parents do not want their children to continue fishing as their main source of livelihood because of potential risks, hardships, and cultural factors like collectivism, close family ties, and dependence on the elders. The parents’ aspirations were shaped by their persistence over various threats, fears, personal unfulfilled dreams, and career opportunities thru education. Most of the parents desired a college education and a safe and secure profession for their children. The study deduced that these challenges can be a contributory factor for the declining number of fisherfolks surrounding the gulfs. Influencing this sector is the factor motivating fishers in their aspirations for their children’s education. The study recommends introducing strategies for fisherfolks to develop a strong sense of hope and drive in realizing their aspirations and further research on the impact of culture, the role of women and children, and fisherfolks and their success stories.
文摘In September 2021,I trav-eled to Xinjiang Uygur Autonomous Region for the second time,the first being in.2014,in the midst of turmoil due to separatists.
文摘This book is a collect!on of novellas created by writer Wen Qingli with the theme of Kunqu Opera,a masterpiece of human oral and intangible heritage.With elegant and rich words,clear and poetic style,and delicate and expressive character descriptions,the beauty of Kunqu Opera and the persistenee and inheritanee of traditional opera art by Kunqu Opera performers is conveyed,reflect!ng Chinese characteristics,grandeur,and style.
文摘This paper delves into the ancient concept of shi yan zhi(poetry expressing aspirations)within Chinese poetry.It examines the precise meaning of zhi,the dialectical relationship between yan and zhi,and the historical development of“poetry expressing aspirations.”It further looks at how this foundational concept underpins the logical construction of Chinese poetic tradition,reaffirming its historical significance as the“manifesto”of Chinese poetics.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.
基金supported by the Special Project for the Construction of Innovative Provinces in Hunan Province,China(2020SK2013)。
文摘Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
文摘BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.
文摘BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
基金supported by the National Natural Science Foundation of China(No.82272243)the Science and Technology Commission of Shanghai Municipality(No.22Y11900800).
文摘Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.
文摘BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.
文摘Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.
文摘BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.
文摘BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy for OA due to its rich composition of mesenchymal stromal cells(MSCs)and bioactive factors.While intra-articular BMAC injections provide short-term symptomatic relief,recent literature suggests that targeting the subchondral bone—an area crucial to OA progression—may offer superior and longer-lasting clinical benefits.AIM To compares the outcomes of subchondral vs intra-articular BMAC injections in patients with primary knee OA.METHODS In this unicentric,double-blinded,randomized controlled trial,30 patients with radiologically confirmed primary knee OA(Kellgren-Lawrence grades II and III)will be equally randomized to receive either subchondral(Group A)or intra-articular(Group B)BMAC injections.BMAC will be harvested from the posterior iliac crest,processed using a standardized centrifugation protocol to yield a product with>85%cell viability,and administered under image guidance.The primary outcome is the change in pain intensity at 12 months as measured by the Visual Analog Scale(VAS).Secondary outcomes include functional improvement assessed by Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee(IKDC),and Western Ontario and McMaster Universities Arthritis Index(WOMAC)scores,structural changes evaluated through advanced magnetic resonance imaging using(MRI)the whole-organ MRI Score,and safety as determined by the incidence of adverse events.RESULTS This study aims to evaluate pain reduction at 12 months post-injection,using the VAS as the primary outcome.Secondary outcomes include functional improvement(KOOS,WOMAC,IKDC),cartilage regeneration(T2 cartigram),adverse event incidence,patient satisfaction(standardized questionnaires,Likert scale),and quality of life(EQ-5D).Ethical considerations follow the Declaration of Helsinki and Good Clinical Practice,with institutional review board approval and participant informed consent ensured.Confidentiality and data security comply with regulations,and a data safety monitoring board oversees trial safety.Results will be shared via peer-reviewed journals,presentations at international orthopedic conferences,and detailed summaries for stakeholders and participants.The trial is registered under clinical trial registry of India/2024/04/065284.Findings emphasize patient-centered advancements in knee osteoarthritis management.CONCLUSION This trial aims to refine regenerative strategies for knee OA by comparing subchondral vs intra-articular BMAC injections,addressing long-term efficacy,safety,and treatment standardization to guide targeted interventions.This trial will provide critical insights into the comparative efficacy and safety of subchondral vs intra-articular BMAC injections in treating primary knee OA.
