Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is sig...Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.展开更多
Background The role of bile acids in modulating the gut microbiota and their impact on host metabolism has garnered significant attention.Taurochenodeoxycholic acid(TCDCA)is the predominant bile acid within the chicke...Background The role of bile acids in modulating the gut microbiota and their impact on host metabolism has garnered significant attention.Taurochenodeoxycholic acid(TCDCA)is the predominant bile acid within the chicken bile acid pool and is closely related to metabolic disorders.The current study aims to investigate the potential effects of TCDCA on abdominal fat deposition in broilers.From 14 to 28 days of age,the broilers in the CON group received an oral administration of 1 mL of saline,while those in the treatment groups were administered 1 mL of a solution containing 0.05 g,0.10 g,or 0.20 g of TCDCA.Results The results showed that TCDCA treatments from 14 to 28 d had no significant effects on BW,ADFI,ADG and FCR in broilers at the age of 28 days of age.However,the abdominal fat percentage in the 0.20 g TCDCA group significantly increased,accompanied by higher TBA and HDL-c levels,as well as a reduction in apolipoprotein B levels in serum.In addition,serum triglyceride levels tended to be higher in the 0.20 g TCDCA group(P=0.098).The 0.20 g TCDCA treatment increased the gene expressions of SREBP-1,C/EBP-α,and ELOVL6,while decreasing the mRNA abundance of ATGL and CPT-1 in the abdominal fat.Serum levels of TCDCA,TDCA,and THDCA were significantly higher after 0.20 g TCDCA administration,while TCA levels were significantly lower,as determined by the targeted bile acid metabolomics analysis.Conversely,hepatic mRNA levels of CYP7A1,CYP27A1,BAAT,and BSEP were increased in the 0.20 g TCDCA group.The oral administration of 0.20 g TCDCA also upregulated the expression of FXR,VDR,and FGF19 in abdominal fat.The 16S rRNA analysis of cecal microbiota revealed that a decrease in the Shannon and Simpson indexes in the 0.20 g TCDCA group,and an increase in the Firmicutes/Bacteroidetes ratio.LEfSe analysis revealed that the predominant bacteria in the CON group were Streptococcus and Oscillospira at the genus level,while Lactobacillus,Parabacteroides,Anaeroplasma,and Helicobacter were identified as the dominant genera in the 0.20 g TCDCA group.Functional predictions for the gut microbiota exhibited that lipid metabolism,replication and repair pathway were enhanced in the 0.20 g TCDCA group.Correlation analysis demonstrated that the abundance of Lactobacillus was positively correlated with serum levels of TCDCA,THDCA,and TDCA,while the abundance of Streptococcus and Oscillospira showed a positive correlation with serum TCA levels.Conclusion Overall,this study elucidates that the intervention of 0.20 g TCDCA may promote abdominal fat deposition by activating bile acid receptors in abdominal fat,and concurrent alterations in both the intestinal microbial community and bile acid profile.展开更多
Background Excessive abdominal fat in broilers not only reduces feed efficiency and increases processing costs but also raises environmental concerns.This pathological overaccumulation results from complex metabolic d...Background Excessive abdominal fat in broilers not only reduces feed efficiency and increases processing costs but also raises environmental concerns.This pathological overaccumulation results from complex metabolic dysregulation across multiple organs.While current research largely centers on adipogenesis within adipose tissue,a comprehensive understanding of the cross-organ regulatory factors influencing this process remains elusive.Results Here,we employed a high-fat diet(HFD)model and multi-omics approaches to investigate cross-organ regulatory mechanisms underlying abdominal fat deposition in broilers.Our results demonstrated that HFD not only promoted fat accumulation but also altered meat quality traits.Through 16S rRNA amplicon sequencing,we identified significant gut microbiota dysbiosis in HFD-fed chickens,manifested by an increased abundance of Lactobacillus and a decreased abundance of Enterococcus.However,jejunal microbiota transplantation from HFD donors did not induce abdominal fat deposition in recipient chickens.Metabolomic profiling revealed that HFD elevated the level of succinic acid,a metabolite positively correlated with Lactobacillus abundance and potentially generated by Lactobacillus.This increase in succinic acid(SA)further triggered metabolic inflammation response in both jejunal tissue and serum.In vivo validation established succinic acid as a key inflammatory mediator facilitating HFD-induced cross-organ communication between the jejunum and abdominal adipose tissue,enhancing intestinal lipid uptake and subsequent abdominal fat deposition.Bulk and single-nucleus RNA sequencing(snRNA-seq)revealed that HFD induced macrophage population expansion and intensified adipocyte-macrophage crosstalk.Adipocyte-macrophage co-culture systems further elucidated that macrophages are an indispensable factor in succinic acid-induced fat deposition.Conclusion This study delineates a succinic acid-driven"gut-fat axis"governing abdominal fat deposition in broilers,integrating gut microbiota dysbiosis and macrophage-mediated inflammatory adipogenesis.By identifying succinic acid as a cross-organ signaling molecule that enhances lipid absorption and activates macrophage-dependent adipogenesis,we establish systemic metabolic-immune crosstalk as a pivotal regulatory mechanism.These findings redefine fat deposition as a process extending beyond adipose-centric models,advancing multi-omics-guided strategies for sustainable poultry production.展开更多
BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pat...BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pathophysiological factor in functional gastrointestinal disorders,may be influenced by body mass index(BMI).AIM To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders(FAPDs).METHODS We assessed gastric motility in 176 children with FAPDs(61.4%females,mean age 7.94 years,SD 1.96 years)and 63 healthy controls(57.1%females,mean age 9.17 years,SD 1.90 years)at the Gastroenterology Research Laboratory,University of Kelaniya,Sri Lanka.FAPDs were diagnosed and subtyped using the Rome IV criteria:Functional abdominal pain 97 patients;irritable bowel syndrome 39 patients,functional dyspepsia(FD)25 patients;and abdominal migraine 15 patients.Gastric motility was measured using a validated ultrasound method.Weight and height were measured using sensitive standard scales.RESULTS The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m^(2),respectively(P=0.33).Fasting antral area(FAA)and antral area at 1 min(AA1)and 15 min(AA15)were significantly greater in patients with FAPD with a higher BMI(2.71 cm^(2),12.57 cm^(2),and 7.19 cm^(2),respectively)compared with those with a lower BMI(2.12 cm^(2),10.68 cm^(2),and 6.13 cm^(2),respectively)(P<0.01).BMI positively correlated with FAA and AA15(r=0.18 and r=0.19,respectively)(P<0.01)in those with FAPDs.In controls,only AA1 was greater in the higher BMI group(12.51 cm^(2)vs 9.93 cm^(2))and had a positive correlation(r=0.33)(P≤0.01).Subgroup analysis revealed that in patients with FD,BMI negatively correlated with gastric emptying rate(GER)(r=-0.59)and antral motility index(MI)(r=-0.49),while in functional abdominal pain,MI positively correlated(r=0.25)with BMI(P≤0.01).CONCLUSION In children with FAPDs,higher BMI was associated with increased gastric antral distention during fasting and postprandial periods(as indicated by FAA,AA1,and AA15)but not with contractility and transit(MI,GER).However,in the FD subgroup,high BMI correlated with reduced GER and MI.This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD.These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs,particularly FD.展开更多
OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a mor...OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.METHODS:From March 2021 to July 2021,a multicenter,triple-blind,randomized 2×2 factorial design clinical trial was conducted across 7 centers in 4 major cities within China's mainland.The trial participants were patients diagnosed with AO.The trial followed a 1∶1∶1∶1 random allocation ratio,assigning participants to one of four groups:QYY placebo plus simulated press needles(SPN)(placebo+SPN),QYY plus SPN(QYY+SPN),QYY placebo plus PN(placebo+PN),and QYY plus PN(QYY+PN).The trial participants received treatment for 12 weeks.Observe the changes in waist circumference,body weight,body mass index(BMI),Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI)scores,and Pittsburgh Sleep Quality Index(PSQI)before and after treatment.RESULTS:The QYY+PN group exhibited significant improvements in waist circumference compared to placebo+PN[Difference=-1.59,95%CI(-3.03,-0.16)]and placebo+SPN groups[Difference=-2.01,95%CI(-3.46,-0.57)].QYY+PN demonstrated a significant advantage over placebo+SPN[Difference=-2.01,95%CI(-3.46,-0.57)],and no statistically significant interaction was observed between the two interventions(P>0.05).In terms of weight and BMI improvements,the QYY+PN,QYY+SPN,and the PN+placebo groups all experienced trending greater reductions in weight compared to the placebo group.In terms of the total scores of PSQI,BAI,and BDI,all four groups exhibited improvements compared to the baseline.Specifically,concerning the change in total PSQI scores,the QYY+PN group exhibited a greater reduction;Regarding the change in total BAI scores,the PN+placebo group demonstrated a greater decrease;As for the change in total BDI scores,the QYY+SPN group displayed a greater reduction.CONCLUSION:This study confirmed that QYY+PN can effectively reduce the waist circumference of patients with AO.Furthermore,the combined approach offers greater benefits than either treatment alone,all without any reported serious adverse events.展开更多
BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE ...BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE SUMMARY This study reports the case of a 67-year-old woman who developed recurrent abdominal pain after 10 years of continuous hydroxyurea therapy for primary thrombocythemia.Colonoscopy revealed an ileocecal ulcer.After discontinuing hydroxyurea therapy for 6 months,follow-up colonoscopy showed a significant reduction in the ulceration.CONCLUSION We consider cecal ulcers as a rare complication of hydroxyurea therapy which typically resolves upon stopping the drug.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD succes...BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.展开更多
Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in in...Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.展开更多
A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital sign...A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital signs were stable.Laboratory examinations revealed no significant abnormalities.展开更多
BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abd...Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.展开更多
Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause...Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause,typically managed with diagnostic nerve blocks and,in refractory cases,surgical neurectomy.In traditional Chinese medicine(TCM),this condition aligns with“collateral disorder”(Luo Bing),in which pathogenic obstruction of superficial collaterals produces localized pain that is neither strictly external nor internal.This review examines conceptual parallels between ACNES and TCM,emphasizing theoretical foundations,modern innovations in minimally invasive acupuncture,and the potential for interdisciplinary integration.Western research on ACNES pathogenesis,diagnosis,and treatment is discussed alongside TCM classical sources and contemporary studies on Pizhen(a flat-head acupuncture needle)therapy.Western medicine provides diagnostic precision through imaging and nerve blocks but offers limited long-term solutions beyond invasive surgery.By contrast,TCM acupuncture,particularly Pizhen therapy,delivers a micro-invasive,precise,and systemic approach to fascial decompression and nerve release.Biomechanical studies indicate that it can relieve high-tension points,restore microcirculation,and regulate neuromuscular activity.Clinical practice highlights the importance of accurate localization of entrapment sites,pattern differentiation,and holistic regulation.Interdisciplinary integration combines the diagnostic strengths of Western medicine with the therapeutic versatility of TCM,reducing misdiagnosis,improving outcomes,and minimizing invasiveness.ACNES remains a treatable but under-recognized source of abdominal pain.Integrating minimally invasive TCM needle techniques with Western diagnostic methods offers a promising pathway toward precision and holistic care.Future priorities include standardizing protocols,conducting rigorous clinical trials,strengthening multidisciplinary collaboration,and enhancing public awareness.Such approaches hold strong potential to improve outcomes and quality of life for patients with chronic abdominal wall pain.展开更多
BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine lea...BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.展开更多
BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patie...BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.展开更多
Metabolic syndrome(MetS),characterized by central obesity,insulin resistance,dyslipidemia,and hypertension,has been increasingly recognized as a significant contributor to the development and progression of colorectal...Metabolic syndrome(MetS),characterized by central obesity,insulin resistance,dyslipidemia,and hypertension,has been increasingly recognized as a significant contributor to the development and progression of colorectal cancer(CRC).This review comprehensively summarizes current evidence linking MetS to CRC risk and outcomes from mechanistic,epidemiological,and clinical perspectives.Mechanistic studies suggest that hyperinsulinemia,activation of the insulin-like growth factor axis,chronic systemic inflammation,and adipokine dysregulation create a tumor-promoting environment.Epidemiological data from large-scale cohort studies and meta-analyses consistently demonstrate a positive association between MetS and CRC incidence,with abdominal obesity and hyperglycemia identified as key components.Mendelian randomization studies further support a causal relationship between visceral adiposity and CRC risk.Clinically,MetS is associated with increased risk of recurrence and reduced overall and disease-free survival in CRC patients.Emerging evidence also indicates that persistent metabolic abnormalities may contribute to early-onset CRC.Interventions targeting metabolic health-including lifestyle modification and bariatric surgery-have shown potential in reducing CRC risk and improving outcomes.Despite these advances,heterogeneity in MetS definitions and a paucity of prospective interventional studies limit the generalizability of current findings.Further research is warranted to establish standardized diagnostic criteria,elucidate sex-and agespecific mechanisms,and integrate metabolic profiling into risk stratification frameworks for CRC prevention and management.展开更多
BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery duri...BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery during embryonic life.This disease can cause intestinal torsion,intestinal obstruction and other acute abdominal symptoms.CASE SUMMARY A 23-year-old female patient was admitted to our hospital on January 11,2024,with a history of recurrent periumbilical pain for over 10 years and worsening for 6 months.In this report,the patient was diagnosed with a congenital midgut malrotation with herniation of the jejunum into a malformed omentum in surgery.The patient developed a hernia sac of the omentum adjacent to the duodenum,with the upper jejunum herniating to form an intra-abdominal hernia.During surgery,the jejunum-ileum and ileocecal junction were positioned according to their normal anatomy,and the mesentery root was linearly fixed to the posterior abdominal wall.Ascending colon and right transverse colon were repositioned in their normal anatomical locations.The patient was monitored for more than 1 year post-surgery and recovered well with no signs of abdominal pain or distension.CONCLUSION Congenital midgut reverse transposition is a specific malrotation of the intestine that is often found in adulthood.It is prone to forming intra-abdominal epiploic hernias.Personalized surgical treatment can achieve better results.展开更多
BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unad...BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.展开更多
The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to mode...The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to model AAA include intraluminal pressurized elastase infusion,chronic infusion of angiotensin Ⅱ(Ang Ⅱ) via an osmotic pump,periarterial application of calcium chloride,vascular grafting,and gene modification.AAA models induced by elastase and Ang Ⅱ are the two most widely used animal models.In the elastase-induced model,because intraluminal infusion is transient,with the cessation of initial stimulation,the aneurysm lesion tends to be stable and rarely ruptures.The model induced by Ang Ⅱ infusion often presents with a typical aortic dissection with a false lumen,whereas clinical AAA patients do not necessarily have dissection.Currently,the treatment of AAA in clinical practice remains endovascular,and there is a lack of pharmacological therapy,which is also related to the fact that the pathogenic mechanism has not been fully elucidated.Smoking,old age,male sex,and hypertension are the main risk factors for AAA,but these risk factors have not been fully investigated in the current modeling methods,which may affect the clinical translational application of research results based on animal models.Therefore,this article reviews the most commonly used AAA modeling methods,comments on their applications and limitations,and provides a perspective on the development of novel animal models.展开更多
BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosi...BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosis and management planning,though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.AIM To comprehensively evaluate the diagnostic accuracy,utility and clinical implications of CT in patients with acute lower abdominal pain,emphasizing rare anatomical variations,pregnancy-related issues,and practical limitations of other imaging modalities in emergency settings in Japan.METHODS This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014.CT findings were systematically correlated with the final clinical diagnoses.Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists.The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.RESULTS Idiopathic pain was the most common diagnosis(104 cases,45.2%),followed by appendicitis(46 cases,20.0%)and diverticulitis(27 cases,11.7%).Right lower quadrant pain predominantly revealed appendicitis(20.2%),whereas left lower quadrant pain frequently indicated diverticulitis(12.1%).Nonspecific pain cases have diverse etiologies.Rare conditions included situs inversus(one case)and intestinal malrotation(one case).Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.CONCLUSION CT significantly aids in the diagnosis of lower abdominal pain,especially given limited access to ultrasonography and MRI during emergency hours in Japan.Awareness of the anatomical variations and pregnancy-related constraints is crucial.Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.展开更多
文摘Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.
基金funded by the National Key Research&Development Program of China(2023YFD1301400 and 2023YFF1001900)the Program for Shaanxi Science&Technology(2022GD-TSLD-46-0302,2023KXJ-243,2023GXJS-02-01 and L2022-QCYZX-NY-004)。
文摘Background The role of bile acids in modulating the gut microbiota and their impact on host metabolism has garnered significant attention.Taurochenodeoxycholic acid(TCDCA)is the predominant bile acid within the chicken bile acid pool and is closely related to metabolic disorders.The current study aims to investigate the potential effects of TCDCA on abdominal fat deposition in broilers.From 14 to 28 days of age,the broilers in the CON group received an oral administration of 1 mL of saline,while those in the treatment groups were administered 1 mL of a solution containing 0.05 g,0.10 g,or 0.20 g of TCDCA.Results The results showed that TCDCA treatments from 14 to 28 d had no significant effects on BW,ADFI,ADG and FCR in broilers at the age of 28 days of age.However,the abdominal fat percentage in the 0.20 g TCDCA group significantly increased,accompanied by higher TBA and HDL-c levels,as well as a reduction in apolipoprotein B levels in serum.In addition,serum triglyceride levels tended to be higher in the 0.20 g TCDCA group(P=0.098).The 0.20 g TCDCA treatment increased the gene expressions of SREBP-1,C/EBP-α,and ELOVL6,while decreasing the mRNA abundance of ATGL and CPT-1 in the abdominal fat.Serum levels of TCDCA,TDCA,and THDCA were significantly higher after 0.20 g TCDCA administration,while TCA levels were significantly lower,as determined by the targeted bile acid metabolomics analysis.Conversely,hepatic mRNA levels of CYP7A1,CYP27A1,BAAT,and BSEP were increased in the 0.20 g TCDCA group.The oral administration of 0.20 g TCDCA also upregulated the expression of FXR,VDR,and FGF19 in abdominal fat.The 16S rRNA analysis of cecal microbiota revealed that a decrease in the Shannon and Simpson indexes in the 0.20 g TCDCA group,and an increase in the Firmicutes/Bacteroidetes ratio.LEfSe analysis revealed that the predominant bacteria in the CON group were Streptococcus and Oscillospira at the genus level,while Lactobacillus,Parabacteroides,Anaeroplasma,and Helicobacter were identified as the dominant genera in the 0.20 g TCDCA group.Functional predictions for the gut microbiota exhibited that lipid metabolism,replication and repair pathway were enhanced in the 0.20 g TCDCA group.Correlation analysis demonstrated that the abundance of Lactobacillus was positively correlated with serum levels of TCDCA,THDCA,and TDCA,while the abundance of Streptococcus and Oscillospira showed a positive correlation with serum TCA levels.Conclusion Overall,this study elucidates that the intervention of 0.20 g TCDCA may promote abdominal fat deposition by activating bile acid receptors in abdominal fat,and concurrent alterations in both the intestinal microbial community and bile acid profile.
基金supported by the National Key Research and Development Program of China(2022YFF1000201)National Scientific Foundation of China(32272861)the China Agriculture Research System of MOF and MARA(CARS-41)。
文摘Background Excessive abdominal fat in broilers not only reduces feed efficiency and increases processing costs but also raises environmental concerns.This pathological overaccumulation results from complex metabolic dysregulation across multiple organs.While current research largely centers on adipogenesis within adipose tissue,a comprehensive understanding of the cross-organ regulatory factors influencing this process remains elusive.Results Here,we employed a high-fat diet(HFD)model and multi-omics approaches to investigate cross-organ regulatory mechanisms underlying abdominal fat deposition in broilers.Our results demonstrated that HFD not only promoted fat accumulation but also altered meat quality traits.Through 16S rRNA amplicon sequencing,we identified significant gut microbiota dysbiosis in HFD-fed chickens,manifested by an increased abundance of Lactobacillus and a decreased abundance of Enterococcus.However,jejunal microbiota transplantation from HFD donors did not induce abdominal fat deposition in recipient chickens.Metabolomic profiling revealed that HFD elevated the level of succinic acid,a metabolite positively correlated with Lactobacillus abundance and potentially generated by Lactobacillus.This increase in succinic acid(SA)further triggered metabolic inflammation response in both jejunal tissue and serum.In vivo validation established succinic acid as a key inflammatory mediator facilitating HFD-induced cross-organ communication between the jejunum and abdominal adipose tissue,enhancing intestinal lipid uptake and subsequent abdominal fat deposition.Bulk and single-nucleus RNA sequencing(snRNA-seq)revealed that HFD induced macrophage population expansion and intensified adipocyte-macrophage crosstalk.Adipocyte-macrophage co-culture systems further elucidated that macrophages are an indispensable factor in succinic acid-induced fat deposition.Conclusion This study delineates a succinic acid-driven"gut-fat axis"governing abdominal fat deposition in broilers,integrating gut microbiota dysbiosis and macrophage-mediated inflammatory adipogenesis.By identifying succinic acid as a cross-organ signaling molecule that enhances lipid absorption and activates macrophage-dependent adipogenesis,we establish systemic metabolic-immune crosstalk as a pivotal regulatory mechanism.These findings redefine fat deposition as a process extending beyond adipose-centric models,advancing multi-omics-guided strategies for sustainable poultry production.
基金Supported by The University of Kelaniya,Sri Lanka,Research Council Grant No.G23.
文摘BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pathophysiological factor in functional gastrointestinal disorders,may be influenced by body mass index(BMI).AIM To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders(FAPDs).METHODS We assessed gastric motility in 176 children with FAPDs(61.4%females,mean age 7.94 years,SD 1.96 years)and 63 healthy controls(57.1%females,mean age 9.17 years,SD 1.90 years)at the Gastroenterology Research Laboratory,University of Kelaniya,Sri Lanka.FAPDs were diagnosed and subtyped using the Rome IV criteria:Functional abdominal pain 97 patients;irritable bowel syndrome 39 patients,functional dyspepsia(FD)25 patients;and abdominal migraine 15 patients.Gastric motility was measured using a validated ultrasound method.Weight and height were measured using sensitive standard scales.RESULTS The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m^(2),respectively(P=0.33).Fasting antral area(FAA)and antral area at 1 min(AA1)and 15 min(AA15)were significantly greater in patients with FAPD with a higher BMI(2.71 cm^(2),12.57 cm^(2),and 7.19 cm^(2),respectively)compared with those with a lower BMI(2.12 cm^(2),10.68 cm^(2),and 6.13 cm^(2),respectively)(P<0.01).BMI positively correlated with FAA and AA15(r=0.18 and r=0.19,respectively)(P<0.01)in those with FAPDs.In controls,only AA1 was greater in the higher BMI group(12.51 cm^(2)vs 9.93 cm^(2))and had a positive correlation(r=0.33)(P≤0.01).Subgroup analysis revealed that in patients with FD,BMI negatively correlated with gastric emptying rate(GER)(r=-0.59)and antral motility index(MI)(r=-0.49),while in functional abdominal pain,MI positively correlated(r=0.25)with BMI(P≤0.01).CONCLUSION In children with FAPDs,higher BMI was associated with increased gastric antral distention during fasting and postprandial periods(as indicated by FAA,AA1,and AA15)but not with contractility and transit(MI,GER).However,in the FD subgroup,high BMI correlated with reduced GER and MI.This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD.These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs,particularly FD.
基金National Key Research and Development Project:Clinical Evaluation of the Interventional Techniques for Abdominal Obesity(No.2019YFC1710102)。
文摘OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.METHODS:From March 2021 to July 2021,a multicenter,triple-blind,randomized 2×2 factorial design clinical trial was conducted across 7 centers in 4 major cities within China's mainland.The trial participants were patients diagnosed with AO.The trial followed a 1∶1∶1∶1 random allocation ratio,assigning participants to one of four groups:QYY placebo plus simulated press needles(SPN)(placebo+SPN),QYY plus SPN(QYY+SPN),QYY placebo plus PN(placebo+PN),and QYY plus PN(QYY+PN).The trial participants received treatment for 12 weeks.Observe the changes in waist circumference,body weight,body mass index(BMI),Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI)scores,and Pittsburgh Sleep Quality Index(PSQI)before and after treatment.RESULTS:The QYY+PN group exhibited significant improvements in waist circumference compared to placebo+PN[Difference=-1.59,95%CI(-3.03,-0.16)]and placebo+SPN groups[Difference=-2.01,95%CI(-3.46,-0.57)].QYY+PN demonstrated a significant advantage over placebo+SPN[Difference=-2.01,95%CI(-3.46,-0.57)],and no statistically significant interaction was observed between the two interventions(P>0.05).In terms of weight and BMI improvements,the QYY+PN,QYY+SPN,and the PN+placebo groups all experienced trending greater reductions in weight compared to the placebo group.In terms of the total scores of PSQI,BAI,and BDI,all four groups exhibited improvements compared to the baseline.Specifically,concerning the change in total PSQI scores,the QYY+PN group exhibited a greater reduction;Regarding the change in total BAI scores,the PN+placebo group demonstrated a greater decrease;As for the change in total BDI scores,the QYY+SPN group displayed a greater reduction.CONCLUSION:This study confirmed that QYY+PN can effectively reduce the waist circumference of patients with AO.Furthermore,the combined approach offers greater benefits than either treatment alone,all without any reported serious adverse events.
基金Supported by National Natural Science Foundation of China,No.82370604Major Science and Technology innovation Project of Fujian Province,No.2023Y9269Natural Science Foundation of Fujian Province,China,No.2023J01239.
文摘BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE SUMMARY This study reports the case of a 67-year-old woman who developed recurrent abdominal pain after 10 years of continuous hydroxyurea therapy for primary thrombocythemia.Colonoscopy revealed an ileocecal ulcer.After discontinuing hydroxyurea therapy for 6 months,follow-up colonoscopy showed a significant reduction in the ulceration.CONCLUSION We consider cecal ulcers as a rare complication of hydroxyurea therapy which typically resolves upon stopping the drug.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
基金Supported by Beijing Municipal Commission of Education,No.SM202214075001。
文摘BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.
文摘Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.
基金supported by the National Natural Science Foundation of China(Project No.82160348)the Yunnan Province Major Special Plan(No.202302AA310018-D-8)+1 种基金the Youth Talent Project of Yunnan Province's“Xingdian Talent Support Program”(No.XDYC-QNRC-2022-0608)the 2024 Senior Health Technology and Medical Discipline Leader of Yunnan Provincial Health Commission(No.D-2024056).
文摘A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital signs were stable.Laboratory examinations revealed no significant abnormalities.
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.
文摘Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause,typically managed with diagnostic nerve blocks and,in refractory cases,surgical neurectomy.In traditional Chinese medicine(TCM),this condition aligns with“collateral disorder”(Luo Bing),in which pathogenic obstruction of superficial collaterals produces localized pain that is neither strictly external nor internal.This review examines conceptual parallels between ACNES and TCM,emphasizing theoretical foundations,modern innovations in minimally invasive acupuncture,and the potential for interdisciplinary integration.Western research on ACNES pathogenesis,diagnosis,and treatment is discussed alongside TCM classical sources and contemporary studies on Pizhen(a flat-head acupuncture needle)therapy.Western medicine provides diagnostic precision through imaging and nerve blocks but offers limited long-term solutions beyond invasive surgery.By contrast,TCM acupuncture,particularly Pizhen therapy,delivers a micro-invasive,precise,and systemic approach to fascial decompression and nerve release.Biomechanical studies indicate that it can relieve high-tension points,restore microcirculation,and regulate neuromuscular activity.Clinical practice highlights the importance of accurate localization of entrapment sites,pattern differentiation,and holistic regulation.Interdisciplinary integration combines the diagnostic strengths of Western medicine with the therapeutic versatility of TCM,reducing misdiagnosis,improving outcomes,and minimizing invasiveness.ACNES remains a treatable but under-recognized source of abdominal pain.Integrating minimally invasive TCM needle techniques with Western diagnostic methods offers a promising pathway toward precision and holistic care.Future priorities include standardizing protocols,conducting rigorous clinical trials,strengthening multidisciplinary collaboration,and enhancing public awareness.Such approaches hold strong potential to improve outcomes and quality of life for patients with chronic abdominal wall pain.
基金Supported by the Shanghai Municipal Health Commission Project,No.20214Y0284.
文摘BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.
文摘BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.
文摘Metabolic syndrome(MetS),characterized by central obesity,insulin resistance,dyslipidemia,and hypertension,has been increasingly recognized as a significant contributor to the development and progression of colorectal cancer(CRC).This review comprehensively summarizes current evidence linking MetS to CRC risk and outcomes from mechanistic,epidemiological,and clinical perspectives.Mechanistic studies suggest that hyperinsulinemia,activation of the insulin-like growth factor axis,chronic systemic inflammation,and adipokine dysregulation create a tumor-promoting environment.Epidemiological data from large-scale cohort studies and meta-analyses consistently demonstrate a positive association between MetS and CRC incidence,with abdominal obesity and hyperglycemia identified as key components.Mendelian randomization studies further support a causal relationship between visceral adiposity and CRC risk.Clinically,MetS is associated with increased risk of recurrence and reduced overall and disease-free survival in CRC patients.Emerging evidence also indicates that persistent metabolic abnormalities may contribute to early-onset CRC.Interventions targeting metabolic health-including lifestyle modification and bariatric surgery-have shown potential in reducing CRC risk and improving outcomes.Despite these advances,heterogeneity in MetS definitions and a paucity of prospective interventional studies limit the generalizability of current findings.Further research is warranted to establish standardized diagnostic criteria,elucidate sex-and agespecific mechanisms,and integrate metabolic profiling into risk stratification frameworks for CRC prevention and management.
文摘BACKGROUND Congenital malrotation of the intestine is characterized by an abnormality in intestinal anatomy and mesenteric fixation resulting from disordered rotation of the intestine around the mesenteric artery during embryonic life.This disease can cause intestinal torsion,intestinal obstruction and other acute abdominal symptoms.CASE SUMMARY A 23-year-old female patient was admitted to our hospital on January 11,2024,with a history of recurrent periumbilical pain for over 10 years and worsening for 6 months.In this report,the patient was diagnosed with a congenital midgut malrotation with herniation of the jejunum into a malformed omentum in surgery.The patient developed a hernia sac of the omentum adjacent to the duodenum,with the upper jejunum herniating to form an intra-abdominal hernia.During surgery,the jejunum-ileum and ileocecal junction were positioned according to their normal anatomy,and the mesentery root was linearly fixed to the posterior abdominal wall.Ascending colon and right transverse colon were repositioned in their normal anatomical locations.The patient was monitored for more than 1 year post-surgery and recovered well with no signs of abdominal pain or distension.CONCLUSION Congenital midgut reverse transposition is a specific malrotation of the intestine that is often found in adulthood.It is prone to forming intra-abdominal epiploic hernias.Personalized surgical treatment can achieve better results.
文摘BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.
基金Natural Science Foundation of Shaanxi Province,Grant/Award Number:2023-CX-PT-17General Project of Natural Science Research in Luoyang Polytechnic College,Grant/Award Number:2024B01。
文摘The mortality rate of patients with abdominal aortic aneurysm(AAA) after rupture is extremely high,and this disease has become an important disease endangering the health of the Chinese population.Methods used to model AAA include intraluminal pressurized elastase infusion,chronic infusion of angiotensin Ⅱ(Ang Ⅱ) via an osmotic pump,periarterial application of calcium chloride,vascular grafting,and gene modification.AAA models induced by elastase and Ang Ⅱ are the two most widely used animal models.In the elastase-induced model,because intraluminal infusion is transient,with the cessation of initial stimulation,the aneurysm lesion tends to be stable and rarely ruptures.The model induced by Ang Ⅱ infusion often presents with a typical aortic dissection with a false lumen,whereas clinical AAA patients do not necessarily have dissection.Currently,the treatment of AAA in clinical practice remains endovascular,and there is a lack of pharmacological therapy,which is also related to the fact that the pathogenic mechanism has not been fully elucidated.Smoking,old age,male sex,and hypertension are the main risk factors for AAA,but these risk factors have not been fully investigated in the current modeling methods,which may affect the clinical translational application of research results based on animal models.Therefore,this article reviews the most commonly used AAA modeling methods,comments on their applications and limitations,and provides a perspective on the development of novel animal models.
文摘BACKGROUND Lower abdominal pain presents as a common complaint with diverse etiologies ranging from benign conditions to surgical emergencies.Computed tomography(CT)imaging has become instrumental in accurate diagnosis and management planning,though clinicians must carefully balance its benefits against radiation exposure concerns and resource allocation constraints.AIM To comprehensively evaluate the diagnostic accuracy,utility and clinical implications of CT in patients with acute lower abdominal pain,emphasizing rare anatomical variations,pregnancy-related issues,and practical limitations of other imaging modalities in emergency settings in Japan.METHODS This retrospective review included 230 patients who underwent CT scans for acute lower abdominal pain at Juntendo University Shizuoka Hospital throughout 2014.CT findings were systematically correlated with the final clinical diagnoses.Cases with diagnostic uncertain underwent independent reviewed by two experienced radiologists.The CT protocols included portal venous-phase imaging with selective arterial-phase acquisition when clinically indicated.RESULTS Idiopathic pain was the most common diagnosis(104 cases,45.2%),followed by appendicitis(46 cases,20.0%)and diverticulitis(27 cases,11.7%).Right lower quadrant pain predominantly revealed appendicitis(20.2%),whereas left lower quadrant pain frequently indicated diverticulitis(12.1%).Nonspecific pain cases have diverse etiologies.Rare conditions included situs inversus(one case)and intestinal malrotation(one case).Pregnancy-related diagnoses included acute appendicitis and uterine fibroid degeneration.CONCLUSION CT significantly aids in the diagnosis of lower abdominal pain,especially given limited access to ultrasonography and MRI during emergency hours in Japan.Awareness of the anatomical variations and pregnancy-related constraints is crucial.Diagnosis-specific protocols for CT based on pain location can optimize clinical management and resource utilization.
