This paper reviews the dynamics of ocean pipes aspirating fluid and presents a selective review of the research undertaken on it. It focuses on the equations of motion, fluid-solid interaction at the inlet of the free...This paper reviews the dynamics of ocean pipes aspirating fluid and presents a selective review of the research undertaken on it. It focuses on the equations of motion, fluid-solid interaction at the inlet of the free end of the pipe, the stability mechanism of pipes aspirating steady fluid, etc. In particular, some unresolved or partly resolved issues on these important aspects are discussed. Finally, the promising future development in this area is discussed.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,neces...BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.展开更多
Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnos...Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-ye...BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.展开更多
A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing rel...A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.展开更多
BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intra...BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injur...Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.展开更多
BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous di...BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.展开更多
Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It ...Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.展开更多
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxi...BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.展开更多
BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy fo...BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy for OA due to its rich composition of mesenchymal stromal cells(MSCs)and bioactive factors.While intra-articular BMAC injections provide short-term symptomatic relief,recent literature suggests that targeting the subchondral bone—an area crucial to OA progression—may offer superior and longer-lasting clinical benefits.AIM To compares the outcomes of subchondral vs intra-articular BMAC injections in patients with primary knee OA.METHODS In this unicentric,double-blinded,randomized controlled trial,30 patients with radiologically confirmed primary knee OA(Kellgren-Lawrence grades II and III)will be equally randomized to receive either subchondral(Group A)or intra-articular(Group B)BMAC injections.BMAC will be harvested from the posterior iliac crest,processed using a standardized centrifugation protocol to yield a product with>85%cell viability,and administered under image guidance.The primary outcome is the change in pain intensity at 12 months as measured by the Visual Analog Scale(VAS).Secondary outcomes include functional improvement assessed by Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee(IKDC),and Western Ontario and McMaster Universities Arthritis Index(WOMAC)scores,structural changes evaluated through advanced magnetic resonance imaging using(MRI)the whole-organ MRI Score,and safety as determined by the incidence of adverse events.RESULTS This study aims to evaluate pain reduction at 12 months post-injection,using the VAS as the primary outcome.Secondary outcomes include functional improvement(KOOS,WOMAC,IKDC),cartilage regeneration(T2 cartigram),adverse event incidence,patient satisfaction(standardized questionnaires,Likert scale),and quality of life(EQ-5D).Ethical considerations follow the Declaration of Helsinki and Good Clinical Practice,with institutional review board approval and participant informed consent ensured.Confidentiality and data security comply with regulations,and a data safety monitoring board oversees trial safety.Results will be shared via peer-reviewed journals,presentations at international orthopedic conferences,and detailed summaries for stakeholders and participants.The trial is registered under clinical trial registry of India/2024/04/065284.Findings emphasize patient-centered advancements in knee osteoarthritis management.CONCLUSION This trial aims to refine regenerative strategies for knee OA by comparing subchondral vs intra-articular BMAC injections,addressing long-term efficacy,safety,and treatment standardization to guide targeted interventions.This trial will provide critical insights into the comparative efficacy and safety of subchondral vs intra-articular BMAC injections in treating primary knee OA.展开更多
BACKGROUND Although limited clinical evidence exists,such as case reports of azoospermia treatment in humans using bone marrow aspirate concentrate(BMAC)injection,these findings provide a compelling foundation for exp...BACKGROUND Although limited clinical evidence exists,such as case reports of azoospermia treatment in humans using bone marrow aspirate concentrate(BMAC)injection,these findings provide a compelling foundation for exploring mesenchymal stem cell therapy in male infertility.AIM To evaluate the safety and efficacy of autologous BMAC injection into human testis for men with severe oligospermia or azoospermia over the existing standard of care pharmacotherapy and lifestyle modifications.METHODS We included patients diagnosed with male infertility of the age group between 35–45 years in this trial comparing BMAC injection therapy with pharmacotherapy and lifestyle modifications over a 6-month follow-up period.Semen analysis was used to evaluate the efficacy of the interventions analyzed.RESULTS We enrolled 30 patients in the trial with 10 patients in each arm of the trial.Compared to the baseline,neither the BMAC group(P=0.139)or pharmacotherapy group(P=0.056)nor the lifestyle modification group(P=0.112)demonstrated a statistically significant increase in sperm count at 6 months.However,the BMAC group demonstrated a significant increase in sperm count(mean 19.2 million;P=0.001)compared to the pharmacotherapy group(mean 3.5 million)and lifestyle modification group(mean 2.2 million)at 6 months.Significant improvement was noted in the motility grade(P<0.001)only in the BMAC group while no changes were noted in the other groups.CONCLUSION This trial highlights the potential of autologous BMAC as a promising therapeutic option for male infertility.Despite the absence of significant changes within individual treatment arms,BMAC therapy demonstrated superior efficacy in improving both sperm count and motility compared to standard pharmacotherapy and lifestyle modifications.These findings underscore the potential role of regenerative medicine in addressing severe oligospermia and azoospermia,warranting further research to solidify its clinical applicability.展开更多
This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the am...This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the ambitious blueprint is a key event that will steer pan-African development onto the right path,and put renewed focus on the pan-African vision of building an integrated,prosperous and peaceful Africa within a 50-year period from 2013 to 2063.展开更多
This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incid...This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.展开更多
BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s...BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s role in diagnosing and managing biliary strictures.METHODS Two independent reviewers searched five electronic databases(PubMed,CENTRAL,Science Direct,Google Scholar,and EMBASE)for articles published up to January 2025.Included articles met specific criteria,and statistical software was used to analyze reported outcomes.RESULTS Of 935 articles,19 met the inclusion criteria.Ten articles focused on diagnostic EUS,while nine focused on EUSguided therapeutic interventions.EUS fine-needle aspiration demonstrated superior sensitivity[0.43-1.00;95%confidence interval(CI):0.24-1.00]compared to conventional techniques(0.36-0.96;95%CI:0.19-0.99)for diagnosing malignant biliary strictures.Both EUS-fine-needle aspiration and conventional methods exhibited high specificity,with most achieving 100%specificity.EUS-guided interventions showed significantly higher clinical success rates than control interventions(odds ratio=2.89;95%CI:1.22-6.84;P=0.02).No significant difference was observed in technical success rates(odds ratio=0.97;95%CI:0.30-3.16;P=0.96).CONCLUSION EUS is a promising tool for diagnosing and managing biliary strictures.Combining EUS-guided and conventional interventions improves diagnostic performance.Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.展开更多
BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%...BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%),may occa-sionally secrete hormones,causing syndromes.Diagnosis relies on markers like chromogranin A,synaptophysin,and Ki-67,along with imaging modalities.Ri-sing NETs incidence is attributed to advancements in diagnostic modalities,parti-cularly endoscopic ultrasonography(EUS).EUS demonstrates high accuracy in detecting small lesions,assessing tumor depth,and identifying locoregional lymph nodes.Despite its proven diagnostic utility,there is limited data on EUS's role in evaluating GEP-NETs in resource-constrained settings like Pakistan.AIM To evaluate the diagnostic role of EUS in characterizing GEP-NETs based on clinical,histopathological,tumor grading,and site-specific differences.METHODS This single-center retrospective descriptive study was conducted at Aga Khan University Hospital,Karachi,a tertiary care hospital,from January 2021 to December 2023.Fourteen adult patients(≥18 years)with suspected NETs who underwent EUS and were diagnosed via histopathology were included.Data on demographics,clinical features,radiological findings,and histopathological characteristics were collected.Descriptive analysis was performed using SPSS version 23,with descriptive statistics expressed as means±SD for continuous variables and frequencies/percentages for categorical data.RESULTS A total of 14 adult GEP-NETs patients who underwent EUS were included,with a mean age of 52±14 years and the majority being male(71.4%).Common clinical presentations included weight loss(85.7%)and abdominal pain(78.6%).Computed tomography scans were performed in 92.9%of cases,with pancreatic masses detected in 42.9%of patients.EUS-guided fine needle biopsy(FNB)had a 100%diagnostic yield.The pancreas was the most common tumor site(57.1%).Histopathology revealed 78.6%of cases as well-differentiated NETs with 42.9%being grade II.Metastases were seen in 57.1%of patients,with the liver being the most common site.Surgical interventions were performed in 28.6%of patients,and all patients were alive at the time of study analysis.CONCLUSION EUS,with accurate imaging and effective EUS-FNB,is the gold standard for GEP-NET diagnosis,aiding tumor assessment and prognosis.Larger studies are needed to validate its impact on management outcomes.展开更多
Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspira...Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.展开更多
基金The workis supported bythe National Natural Science Foundation of China (Grant No.10772071)the ScienceInvestigation Foundtion of HUST(Grant No.2006Q003B)
文摘This paper reviews the dynamics of ocean pipes aspirating fluid and presents a selective review of the research undertaken on it. It focuses on the equations of motion, fluid-solid interaction at the inlet of the free end of the pipe, the stability mechanism of pipes aspirating steady fluid, etc. In particular, some unresolved or partly resolved issues on these important aspects are discussed. Finally, the promising future development in this area is discussed.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘BACKGROUND Adrenocortical oncocytoma is a rare,mostly benign,nonfunctional tumor that is typically detected incidentally.Its diagnosis is challenging because of the absence of distinctive imaging characteristics,necessitating pathological validation.CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side,where endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)was performed after comprehensive diagnostic assessment.Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location.Given the limited number of reports on this condition,long-term follow-up is crucial to enhance our understanding of its prognosis.CONCLUSION For patients with adrenocortical oncocytoma,EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.
基金supported by the Special Project for the Construction of Innovative Provinces in Hunan Province,China(2020SK2013)。
文摘Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
文摘BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.
文摘A Malawian perspective on China’s influence,innovation and shared growth In today’s interconnected world,diplomacy,trade,and culture are drawing nations once thought distant closer.A case in point is the growing relationship between Malawi and China-two geographically and historically distinct countries that are finding powerful common ground and shared aspirations.
文摘BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
基金supported by the National Natural Science Foundation of China(No.82272243)the Science and Technology Commission of Shanghai Municipality(No.22Y11900800).
文摘Background:Aspiration pneumonia is a severe health concern,particularly for ICU patients with impaired airway defenses.Current animal models fail to fully replicate the condition,focusing solely on chemical lung injury from gastric acid while neglecting pathogen-induced inflammation.This gap hinders research on pathogenesis and treatment,creating an urgent need for a clinically relevant model.This study aimed to develop an improved rat model of aspiration pneumonia by combining hydrochloric acid(HCl)and lipopolysaccharide(LPS)administration.Methods:Specific pathogen-free Sprague Dawley rats underwent intratracheal instillation of HCl and LPS.Techniques included rat weight measurement,tracheal intubation,pulmonary function monitoring,lung tissue sampling with HE staining and scoring,bronchoalveolar lavage fluid(BALF)sampling,protein and inflammatory cytokine analysis via BCA and ELISA,BALF pH determination,Evans Blue dye assessment,blood gas analysis,FITC-dextran leakage,Western blotting,electron microscopy,survival analysis,and transcriptome sequencing with bioinformatics.Statistical analysis was performed using GraphPad Prism.Results:The optimal model involved instillation of 1.5μL/g.wt HCl(pH=1)followed by 20μg/g.wt LPS after 1 h.This model reproduced acute lung injury,including tissue damage,pulmonary microvascular dysfunction,inflammatory responses,hypoxemia,and impaired pulmonary ventilation,with recovery observed at 72 h.PANoptosis was confirmed,characterized by increased markers.Concentration-dependent effects of HCl and LPS on lung damage were identified,alongside cytokine elevation and microvascular dysfunction.Conclusions:This optimized model closely mimics clinical aspiration pneumonia,providing a valuable tool for studying pathophysiology and therapeutic strategies.
文摘BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.
文摘Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.
文摘BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/B)is the most common modality for tissue acquisition from pancreatic masses.Despite high specificity,sensitivity remains less than 90%.Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically.However,data regarding the same have shown conflicting results.AIM To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUSFNA/B for pancreatic lesions.METHODS The electronic databases of MEDLINE,EMBASE,and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.A bivariate hierarchical model was used to perform the meta-analysis.RESULTS A total of 10 studies were identified.The pooled sensitivity,specificity,and area under the receiver-operated curve(AUROC)for standard EUS-FNA/B were 0.82(95%CI:0.79-0.85),1.00(95%CI:0.96-1.00),and 0.97(95%CI:0.95-0.98),respectively.The pooled sensitivity,specificity,and AUROC for EUS-FNA/B with auxiliary techniques were 0.86(95%CI:0.83-0.89),1.00(95%CI:0.94-1.00),and 0.96(95%CI:0.94-0.98),respectively.Comparing the two diagnostic modalities,sensitivity[Risk ratio(RR):1.04,95%CI:0.99-1.09],specificity(RR:1.00,95%CI:0.99-1.01),and diagnostic accuracy(RR:1.03,95%CI:0.98-1.09)were comparable.CONCLUSION Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B.Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.
文摘BACKGROUND Knee osteoarthritis(OA)imposes a substantial burden through pain,functional limitation,and progressive cartilage loss.Bone marrow aspirate concentrate(BMAC)has emerged as a promising regenerative therapy for OA due to its rich composition of mesenchymal stromal cells(MSCs)and bioactive factors.While intra-articular BMAC injections provide short-term symptomatic relief,recent literature suggests that targeting the subchondral bone—an area crucial to OA progression—may offer superior and longer-lasting clinical benefits.AIM To compares the outcomes of subchondral vs intra-articular BMAC injections in patients with primary knee OA.METHODS In this unicentric,double-blinded,randomized controlled trial,30 patients with radiologically confirmed primary knee OA(Kellgren-Lawrence grades II and III)will be equally randomized to receive either subchondral(Group A)or intra-articular(Group B)BMAC injections.BMAC will be harvested from the posterior iliac crest,processed using a standardized centrifugation protocol to yield a product with>85%cell viability,and administered under image guidance.The primary outcome is the change in pain intensity at 12 months as measured by the Visual Analog Scale(VAS).Secondary outcomes include functional improvement assessed by Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee(IKDC),and Western Ontario and McMaster Universities Arthritis Index(WOMAC)scores,structural changes evaluated through advanced magnetic resonance imaging using(MRI)the whole-organ MRI Score,and safety as determined by the incidence of adverse events.RESULTS This study aims to evaluate pain reduction at 12 months post-injection,using the VAS as the primary outcome.Secondary outcomes include functional improvement(KOOS,WOMAC,IKDC),cartilage regeneration(T2 cartigram),adverse event incidence,patient satisfaction(standardized questionnaires,Likert scale),and quality of life(EQ-5D).Ethical considerations follow the Declaration of Helsinki and Good Clinical Practice,with institutional review board approval and participant informed consent ensured.Confidentiality and data security comply with regulations,and a data safety monitoring board oversees trial safety.Results will be shared via peer-reviewed journals,presentations at international orthopedic conferences,and detailed summaries for stakeholders and participants.The trial is registered under clinical trial registry of India/2024/04/065284.Findings emphasize patient-centered advancements in knee osteoarthritis management.CONCLUSION This trial aims to refine regenerative strategies for knee OA by comparing subchondral vs intra-articular BMAC injections,addressing long-term efficacy,safety,and treatment standardization to guide targeted interventions.This trial will provide critical insights into the comparative efficacy and safety of subchondral vs intra-articular BMAC injections in treating primary knee OA.
文摘BACKGROUND Although limited clinical evidence exists,such as case reports of azoospermia treatment in humans using bone marrow aspirate concentrate(BMAC)injection,these findings provide a compelling foundation for exploring mesenchymal stem cell therapy in male infertility.AIM To evaluate the safety and efficacy of autologous BMAC injection into human testis for men with severe oligospermia or azoospermia over the existing standard of care pharmacotherapy and lifestyle modifications.METHODS We included patients diagnosed with male infertility of the age group between 35–45 years in this trial comparing BMAC injection therapy with pharmacotherapy and lifestyle modifications over a 6-month follow-up period.Semen analysis was used to evaluate the efficacy of the interventions analyzed.RESULTS We enrolled 30 patients in the trial with 10 patients in each arm of the trial.Compared to the baseline,neither the BMAC group(P=0.139)or pharmacotherapy group(P=0.056)nor the lifestyle modification group(P=0.112)demonstrated a statistically significant increase in sperm count at 6 months.However,the BMAC group demonstrated a significant increase in sperm count(mean 19.2 million;P=0.001)compared to the pharmacotherapy group(mean 3.5 million)and lifestyle modification group(mean 2.2 million)at 6 months.Significant improvement was noted in the motility grade(P<0.001)only in the BMAC group while no changes were noted in the other groups.CONCLUSION This trial highlights the potential of autologous BMAC as a promising therapeutic option for male infertility.Despite the absence of significant changes within individual treatment arms,BMAC therapy demonstrated superior efficacy in improving both sperm count and motility compared to standard pharmacotherapy and lifestyle modifications.These findings underscore the potential role of regenerative medicine in addressing severe oligospermia and azoospermia,warranting further research to solidify its clinical applicability.
文摘This year marks the 10th anniversary of the adoption of the African Union(AU)Agenda 2063,Africa’s blueprint and master plan for transforming the continent into a global powerhouse of the future.The adoption of the ambitious blueprint is a key event that will steer pan-African development onto the right path,and put renewed focus on the pan-African vision of building an integrated,prosperous and peaceful Africa within a 50-year period from 2013 to 2063.
文摘This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.
文摘BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s role in diagnosing and managing biliary strictures.METHODS Two independent reviewers searched five electronic databases(PubMed,CENTRAL,Science Direct,Google Scholar,and EMBASE)for articles published up to January 2025.Included articles met specific criteria,and statistical software was used to analyze reported outcomes.RESULTS Of 935 articles,19 met the inclusion criteria.Ten articles focused on diagnostic EUS,while nine focused on EUSguided therapeutic interventions.EUS fine-needle aspiration demonstrated superior sensitivity[0.43-1.00;95%confidence interval(CI):0.24-1.00]compared to conventional techniques(0.36-0.96;95%CI:0.19-0.99)for diagnosing malignant biliary strictures.Both EUS-fine-needle aspiration and conventional methods exhibited high specificity,with most achieving 100%specificity.EUS-guided interventions showed significantly higher clinical success rates than control interventions(odds ratio=2.89;95%CI:1.22-6.84;P=0.02).No significant difference was observed in technical success rates(odds ratio=0.97;95%CI:0.30-3.16;P=0.96).CONCLUSION EUS is a promising tool for diagnosing and managing biliary strictures.Combining EUS-guided and conventional interventions improves diagnostic performance.Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.
文摘BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%),may occa-sionally secrete hormones,causing syndromes.Diagnosis relies on markers like chromogranin A,synaptophysin,and Ki-67,along with imaging modalities.Ri-sing NETs incidence is attributed to advancements in diagnostic modalities,parti-cularly endoscopic ultrasonography(EUS).EUS demonstrates high accuracy in detecting small lesions,assessing tumor depth,and identifying locoregional lymph nodes.Despite its proven diagnostic utility,there is limited data on EUS's role in evaluating GEP-NETs in resource-constrained settings like Pakistan.AIM To evaluate the diagnostic role of EUS in characterizing GEP-NETs based on clinical,histopathological,tumor grading,and site-specific differences.METHODS This single-center retrospective descriptive study was conducted at Aga Khan University Hospital,Karachi,a tertiary care hospital,from January 2021 to December 2023.Fourteen adult patients(≥18 years)with suspected NETs who underwent EUS and were diagnosed via histopathology were included.Data on demographics,clinical features,radiological findings,and histopathological characteristics were collected.Descriptive analysis was performed using SPSS version 23,with descriptive statistics expressed as means±SD for continuous variables and frequencies/percentages for categorical data.RESULTS A total of 14 adult GEP-NETs patients who underwent EUS were included,with a mean age of 52±14 years and the majority being male(71.4%).Common clinical presentations included weight loss(85.7%)and abdominal pain(78.6%).Computed tomography scans were performed in 92.9%of cases,with pancreatic masses detected in 42.9%of patients.EUS-guided fine needle biopsy(FNB)had a 100%diagnostic yield.The pancreas was the most common tumor site(57.1%).Histopathology revealed 78.6%of cases as well-differentiated NETs with 42.9%being grade II.Metastases were seen in 57.1%of patients,with the liver being the most common site.Surgical interventions were performed in 28.6%of patients,and all patients were alive at the time of study analysis.CONCLUSION EUS,with accurate imaging and effective EUS-FNB,is the gold standard for GEP-NET diagnosis,aiding tumor assessment and prognosis.Larger studies are needed to validate its impact on management outcomes.
文摘Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction(AMI).While initial studies suggested benefits of thrombus aspiration(TA),recent large trials have questioned its routine use.This review examines the role of thr-ombectomy in the management of AMI,focusing on its potential to improve my-ocardial perfusion and mitigate no-reflow risk.Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion.Similarly,standardising TA techn-iques and ensuring appropriate patients’selection may also improve enhance our understanding of the role of thrombectomy in AMI.Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.
