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
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
In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and the...In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and their prevalence remains unclear.Most GBPs in children are benign,and although the risk of malignancy is influenced by polyp size,growth rate,and morphology,specific criteria for the pediatric population are lacking.Management,therefore,is based on adult guidelines,with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation,while surveillance is applied to asymptomatic patients with smaller polyps.Further research is needed to develop pediatric-specific guidelines for the management of GBPs.This review discusses the classification,diagnosis,risk factors,and management of pediatric GBPs.展开更多
Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effe...Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effects.However,its molecular mechanism in treating AAA remains unclear.Methods An AAA model was established in mice via angiotensin Ⅱ(AngⅡ)infusion[1000 ng/(kg·min)],with a subset receiving RSV treatment[100 mg/(kg·day)by gavage].Aortic diameter was measured,and histopathological changes were assessed by Hematoxylin-Eosin(HE)and Elastica Van Gieson(EVG)staining.Vascular aging was evaluated by senescence-associatedβ-galactosidase(SA-β-gal)activity and pulse wave velocity(PWV).In vitro,human umbilical vein endothelial cells(HUVECs)were treated with AngⅡ(10-6 M)with or without RSV(40μM)and/or the sirtuin 1(SIRT1)inhibitor EX527(10μM).Senescence markers,senescence-associated secretory phenotype(SASP)factor expression[interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],and SIRT1/p21 pathway proteins were analyzed.Results In vivo,RSV significantly attenuated Ang Ⅱ-induced AAA formation,reducing aortic diameter,preserving elastic fiber integrity,and suppressing vascular senescence and stiffness.In HUVECs,Ang Ⅱ-induced senescence and SASP expression were markedly inhibited by RSV.However,these protective effects were abolished by EX527.Mechanistically,RSV reversed the Ang Ⅱ-induced downregulation of SIRT1 and upregulation of p21,which was also blocked by SIRT1 inhibition.Conclusions RSV effectively prevented experimental AAA formation by alleviating vascular aging and endothelial cell senescence.This protective effect was abrogated by the SIRT1 inhibitor EX527,confirming that RSV mitigated AAA development and vascular senescence through the SIRT1/p21 signaling pathway.These findings highlighted RSV as a promising therapeutic candidate for AAA treatment.展开更多
BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In...BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.展开更多
BACKGROUND Hypertension(HTN)is a significant global health concern due to its rising prevalence and associated risks of cardiovascular disease,chronic kidney disease,and other comorbidities.The increasing rates of HTN...BACKGROUND Hypertension(HTN)is a significant global health concern due to its rising prevalence and associated risks of cardiovascular disease,chronic kidney disease,and other comorbidities.The increasing rates of HTN among youth have been partly attributed to the global rise in childhood obesity,lipid abnormalities,and sedentary lifestyles.AIM To investigate the independent associations of aerobic fitness(AF),the triglyceride-to-high-density lipoprotein cholesterol(TG/HDL-C)ratio,visceral adiposity index(VAI),and resting blood pressure(BP)in Nigerian adolescents.METHODS A multistage sampling technique was used to select 403 in-school adolescents aged 11-19 years in Kogi East,Nigeria.Participants were assessed for AF,TG/HDL-C ratio,VAI,systolic BP(SBP),and diastolic BP(DBP).The associations between the independent variables and the risk of systolic and diastolic HTN were examined using multivariate regression models,controlling for age and maturity status.Receiver operating characteristics curve(ROC)and area under the curve(AUC)were employed to determine the predictive capacities of the independent variables.RESULTS The overall prevalence of systolic HTN was 5.5%(girls:7%;boys:4%)while diastolic HTN was 12.7%(girls:16.9%;boys:8.4%).Among girls,all independent variables showed significant associations with SBP,including fitness(P<0.001),TG/HDL-C(P<0.001),and VAI(P<0.001),with VAI showing the strongest association.In boys,all independent variables except VAI(P=0.063)were significantly associated with SBP,with fitness showing the stronger predictive power(Fitness,P<0.001;TG/HDL-C,P=0.029).For DBP,all independent variables,except fitness in girls(P=0.099),were significantly associated(P<0.001)in both sexes.Unfit boys were 1.1 times more likely to develop systolic HTN(95%CI:1.01–1.15,P=0.018)and had 1.1 times higher odds of developing diastolic HTN(95%CI:1.03–1.13,P=0.001).Only the ROC for DBP turned up significant(P<0.001)AUCs for TG/HDL-C and VAI in girls only,with 0.6 and 1.0 thresholds respectively.CONCLUSION AF,dyslipidemia,and visceral adipose tissue dysfunction were independently associated with the risk of HTN in Nigerian adolescents.These findings highlight the importance of promoting a healthy diet and encouraging aerobic physical activity among adolescents to reduce the risk of HTN.展开更多
BACKGROUND Sclerosing encapsulating peritonitis(SEP),also known as abdominal cocoon syndrome,is rare in children.The etiology of primary SEP is believed to be associated with retrograde menstruation or viral peritonit...BACKGROUND Sclerosing encapsulating peritonitis(SEP),also known as abdominal cocoon syndrome,is rare in children.The etiology of primary SEP is believed to be associated with retrograde menstruation or viral peritonitis in young adolescent girls,whereas secondary SEP refers to SEP caused by other factors such as surgery,peritoneal dialysis,or tuberculosis.Secondary SEP is rare and lack diagnostic specificity in children.Given the potential to cause acute intestinal obstruction,surgical intervention is often required.CASE SUMMARY We report the case of a 10-year-old girl with secondary SEP who was admitted to our center with acute bowel obstruction.CONCLUSION In this report,we emphasized the imaging manifestations,diagnosis,and operative management of the case.Although postoperative SEP in children is rare,the long-term prognosis is favorable when accompanied with accurate diagnosis,appropriate perioperative management,and timely follow-up.展开更多
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.
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.
文摘In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and their prevalence remains unclear.Most GBPs in children are benign,and although the risk of malignancy is influenced by polyp size,growth rate,and morphology,specific criteria for the pediatric population are lacking.Management,therefore,is based on adult guidelines,with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation,while surveillance is applied to asymptomatic patients with smaller polyps.Further research is needed to develop pediatric-specific guidelines for the management of GBPs.This review discusses the classification,diagnosis,risk factors,and management of pediatric GBPs.
基金supported by the grant from the Fujian Province Natural Science Foundation(No.2024J01608)。
文摘Background Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease associated with endothelial cell senescence.Resveratrol(RSV),a natural polyphenol,exerts potent anti-senescent and anti-inflammatory effects.However,its molecular mechanism in treating AAA remains unclear.Methods An AAA model was established in mice via angiotensin Ⅱ(AngⅡ)infusion[1000 ng/(kg·min)],with a subset receiving RSV treatment[100 mg/(kg·day)by gavage].Aortic diameter was measured,and histopathological changes were assessed by Hematoxylin-Eosin(HE)and Elastica Van Gieson(EVG)staining.Vascular aging was evaluated by senescence-associatedβ-galactosidase(SA-β-gal)activity and pulse wave velocity(PWV).In vitro,human umbilical vein endothelial cells(HUVECs)were treated with AngⅡ(10-6 M)with or without RSV(40μM)and/or the sirtuin 1(SIRT1)inhibitor EX527(10μM).Senescence markers,senescence-associated secretory phenotype(SASP)factor expression[interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],and SIRT1/p21 pathway proteins were analyzed.Results In vivo,RSV significantly attenuated Ang Ⅱ-induced AAA formation,reducing aortic diameter,preserving elastic fiber integrity,and suppressing vascular senescence and stiffness.In HUVECs,Ang Ⅱ-induced senescence and SASP expression were markedly inhibited by RSV.However,these protective effects were abolished by EX527.Mechanistically,RSV reversed the Ang Ⅱ-induced downregulation of SIRT1 and upregulation of p21,which was also blocked by SIRT1 inhibition.Conclusions RSV effectively prevented experimental AAA formation by alleviating vascular aging and endothelial cell senescence.This protective effect was abrogated by the SIRT1 inhibitor EX527,confirming that RSV mitigated AAA development and vascular senescence through the SIRT1/p21 signaling pathway.These findings highlighted RSV as a promising therapeutic candidate for AAA treatment.
文摘BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care.Injuries to the hollow viscera,including the duodenum,jejunum,urinary bladder,and colorectum,are relatively common.In contrast,owing to the protective function of the anterior rib cage,gastric rupture is exceptionally rare,with an incidence of<1.7%.Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures.This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.CASE SUMMARY A 21-year-old man,who was involved in a motorcycle collision at 70 km/hour after consuming a large meal,presented with hypotension.Physical examination revealed abdominal tenderness.Laboratory test results indicated elevated amylase,lipase,and liver enzyme levels.Computed tomography showed pneumoperitoneum,hemoperitoneum,and gastric wall discontinuation,suggesting gastric perforation alongside pancreatic,splenic,and hepatic injuries.Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries.Emergency laparotomy revealed substantial blood loss,hematoma,and gastric contents scattered throughout the abdominal cavity.Two 10 cm gastric perforations in the anterior and posterior walls were identified,as well as severe liver damage,splenic injury,and pancreatic contusion.Surgical interventions included primary closure of the gastric wall,splenectomy,and partial hepatectomy.After temporary abdominal closure,the patient underwent a second surgery without further bleeding.The gastric repair site was resected and reinforced for optimal tissue healing.CONCLUSION Gastric rupture following blunt trauma is fatal.However,patients without severe complications can recover through surgical interventions and postoperative care.
文摘BACKGROUND Hypertension(HTN)is a significant global health concern due to its rising prevalence and associated risks of cardiovascular disease,chronic kidney disease,and other comorbidities.The increasing rates of HTN among youth have been partly attributed to the global rise in childhood obesity,lipid abnormalities,and sedentary lifestyles.AIM To investigate the independent associations of aerobic fitness(AF),the triglyceride-to-high-density lipoprotein cholesterol(TG/HDL-C)ratio,visceral adiposity index(VAI),and resting blood pressure(BP)in Nigerian adolescents.METHODS A multistage sampling technique was used to select 403 in-school adolescents aged 11-19 years in Kogi East,Nigeria.Participants were assessed for AF,TG/HDL-C ratio,VAI,systolic BP(SBP),and diastolic BP(DBP).The associations between the independent variables and the risk of systolic and diastolic HTN were examined using multivariate regression models,controlling for age and maturity status.Receiver operating characteristics curve(ROC)and area under the curve(AUC)were employed to determine the predictive capacities of the independent variables.RESULTS The overall prevalence of systolic HTN was 5.5%(girls:7%;boys:4%)while diastolic HTN was 12.7%(girls:16.9%;boys:8.4%).Among girls,all independent variables showed significant associations with SBP,including fitness(P<0.001),TG/HDL-C(P<0.001),and VAI(P<0.001),with VAI showing the strongest association.In boys,all independent variables except VAI(P=0.063)were significantly associated with SBP,with fitness showing the stronger predictive power(Fitness,P<0.001;TG/HDL-C,P=0.029).For DBP,all independent variables,except fitness in girls(P=0.099),were significantly associated(P<0.001)in both sexes.Unfit boys were 1.1 times more likely to develop systolic HTN(95%CI:1.01–1.15,P=0.018)and had 1.1 times higher odds of developing diastolic HTN(95%CI:1.03–1.13,P=0.001).Only the ROC for DBP turned up significant(P<0.001)AUCs for TG/HDL-C and VAI in girls only,with 0.6 and 1.0 thresholds respectively.CONCLUSION AF,dyslipidemia,and visceral adipose tissue dysfunction were independently associated with the risk of HTN in Nigerian adolescents.These findings highlight the importance of promoting a healthy diet and encouraging aerobic physical activity among adolescents to reduce the risk of HTN.
文摘BACKGROUND Sclerosing encapsulating peritonitis(SEP),also known as abdominal cocoon syndrome,is rare in children.The etiology of primary SEP is believed to be associated with retrograde menstruation or viral peritonitis in young adolescent girls,whereas secondary SEP refers to SEP caused by other factors such as surgery,peritoneal dialysis,or tuberculosis.Secondary SEP is rare and lack diagnostic specificity in children.Given the potential to cause acute intestinal obstruction,surgical intervention is often required.CASE SUMMARY We report the case of a 10-year-old girl with secondary SEP who was admitted to our center with acute bowel obstruction.CONCLUSION In this report,we emphasized the imaging manifestations,diagnosis,and operative management of the case.Although postoperative SEP in children is rare,the long-term prognosis is favorable when accompanied with accurate diagnosis,appropriate perioperative management,and timely follow-up.
