BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
PURPOSE:To investigate the differences in gut microbial characteristics between two traditional Chinese syndromes of premature ovarian insufficiency(POI).METHODS:Forty women with POI were recruited from the Department...PURPOSE:To investigate the differences in gut microbial characteristics between two traditional Chinese syndromes of premature ovarian insufficiency(POI).METHODS:Forty women with POI were recruited from the Department of Traditional Chinese Medicine at Shenzhen Maternity and Child Healthcare Hospital between June and December 2020.Women with POI were divided into the kidney deficiency and blood stasis syndrome(SDBS)and Qi and blood deficiency syndrome(QBDS)groups.Gut microbial community profiles were analyzed by 16S rRNA gene sequencing using an Illumina Mi Seq system.A retrospective study comparing hormone levels and gut microbiota information was performed between the SDBS and QBDS groups.RESULTS:Compared with the QBDS group,the serum levels of estradiol(E2)and anti-Müllerian hormone(AMH)were significantly decreased in the SDBS group.The quantities of Adlercreutzia,Eggerthella,Klebsiella,and Paraprevotella significantly increased in the SDBS group,whereas Lactobacillus decreased significantly.Moreover,alterations in the microbiome in the SDBS and QBDS groups were closely related to the levels of E2 and AMH.The area under the receiver operating characteristic curve for the classification of the two syndromes by the gut microbiome was 0.71.CONCLUSIONS:There were significant differences in the dominant microbiota between the SDBS and QBDS groups,and the change in Proteobacteria in the QBDS group was more significant.The characteristics of gut microbiota help us differentiate between the SDBS and QBDS groups,which may provide a basis for the objectification of TCM syndrome types.展开更多
This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and...This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more ...BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more likely not to receive adequate treatment as this drug is not part of the Chinese national essential medicine list.AIM To examine the cost-effectiveness of PERT for patients suffering from PEI in China.METHODS A decision analytical Markov model was constructed to simulate the progress of patients with PEI in China.The population included in the analyses were patients suffering from PEI with advanced(non-resectable)pancreatic cancer,who have undergone surgery due to pancreatic cancer and who have undergone endoscopic treatment due to chronic pancreatitis.The cost-effectiveness analyses were undertaken from a Chinese societal perspective comparing PERT with no PERT.The incremental cost-effectiveness ratio in United States dollars per quality adjusted life year(QALY)gained is the main outcome.Input was informed by publicly available data supplemented with expert clinical advice.RESULTS The cost-effectiveness analyses estimated that PERT resulted in additional 0.45 to 2.93 QALYs at discounted costs of between 4315 dollars to 15193 dollars.This resulted in an incremental cost-effectiveness ratio of 5178 dollars to 9533 dollars per QALY.The one-way sensitivity analyses showed that the main drivers of the model were the cost of PERT and overall survival.CONCLUSION This study demonstrates that PERT is a cost-effective treatment for patients suffering from PEI in China.展开更多
Premature ovarian insufficiency(POI)is characterized by irreversible loss of ovarian function before 40 years of age and affects 3.7%of women worldwide(Golezar et al.,2019;Huang et al.,2021).Raised serum follicle-stim...Premature ovarian insufficiency(POI)is characterized by irreversible loss of ovarian function before 40 years of age and affects 3.7%of women worldwide(Golezar et al.,2019;Huang et al.,2021).Raised serum follicle-stimulating hormone(FSH)levels,menstrual disturbance,and estrogen deficiency are the main symptoms of POl(European Society for Human Reproduction et al.,2016).Besides infertility,patients have an increased risk of long-term complications due to the early deficiency of ovarian steroids,such as osteoporosis,cardiovascular disease,and metabolic disorders(lshizuka,2021).Due to the lack of biomarkers for prediction or early diagnosis,most patients are not diagnosed until the failure stage(serum levels of FSH above 25 IU/L and amenorrhea),missing opportunities for intervention.Therefore,developing sensitive biomarkers for diminished ovarian reserves is paramount for timely treatment to improve reproductive outcomes and prevent long-term complications.展开更多
Resection of the terminal ileum and ileocecal valve remains the most commonly performed procedure in patients with Crohn's disease.However,despite radical treatment,there is a risk of disease recurrence at the sit...Resection of the terminal ileum and ileocecal valve remains the most commonly performed procedure in patients with Crohn's disease.However,despite radical treatment,there is a risk of disease recurrence at the site of the intestinal ana-stomosis in some cases.Therefore,long-term postoperative management is crucial and requires systematic clinical assessment,endoscopic surveillance,and pharma-cological support when indicated.A key challenge is identifying the risk factors associated with the recurrence of anastomotic failure and defining the principles of follow-up care to prevent secondary intestinal insufficiency.This paper focuses on both surgical and non-surgical factors that may play a role in preventing complications in patients undergoing ileocecal resection,providing a compre-hensive approach to postoperative management.展开更多
OBJECTIVE:To investigate the potential mechanism of electroacupuncture(EA)in alleviating premature ovarian insufficiency(POI)and to provide a theoretical basis for EA treatment of POI.METHODS:For this purpose,a POI mi...OBJECTIVE:To investigate the potential mechanism of electroacupuncture(EA)in alleviating premature ovarian insufficiency(POI)and to provide a theoretical basis for EA treatment of POI.METHODS:For this purpose,a POI mice model was developed by injecting 12 mg/kg busulfan and 120 mg/kg cyclophosphamide intraperitoneally to induce POI.It was then proceeded by EA intervention at Guanyuan(CV4)acupoint on the second day following modeling.Similarly,apoptosis in ovarian granulosa cells was detected by terminal deoxynucleotidyl transferase d UTP nick end labeling staining,while enzyme-linked immunosorbent assay was employed for measuring serum folliclestimulating hormone(FSH),luteinizing hormone(LH),estrogen(E_(2)),and anti-müllerian hormone(AMH)levels.Moreover,transmission electron microscopy(TEM)was employed for examining mitochondrial morphology,while autophagy and hippo-yes-associated protein/transcriptional co-activator with postsynaptic density protein,drosophila disc large tumor suppressor,and zonula occludens-1 protein binding motif(YAP/TAZ)pathway related protein levels in ovarian tissue were detected via Western blotting.RESULTS:Analysis of serum levels of various hormones indicated that serum FSH and LH were reduced in EA compared to the POI group,while E_(2) and AMH levels were found to be elevated in EA compared to the POI group.The EA was found to inhibit apoptosis in granulosa cells in POI model mice,in addition to improved mitochondrial damage and significantly improved mitophagy.Pathway analysis revealed that EA was involved in activating the hippo-YAP/TAZ pathway,followed by reversing EA effects on granulosa cell apoptosis and mitophagy with the use of verteporfin,an autophagy and YAP-T-cell factor/enhancer of split and activator of transcription domain family member interaction inhibitor.CONCLUSIONS:EA at the Guanyuan(CV4)acupoint protected the granulosa cell by inhibiting cell apoptosis and promoting mitophagy,which was mediated by the Hippo-YAP/TAZ pathway.展开更多
Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Noc...Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Nocardia brasiliensis skin infection in a 93-year-old patient with chronic renal insufficiency.This editorial explores the importance of timely diagnosis,microbiological confirmation,and tailored antibiotic therapy.Emphasis is placed on the role of immune status evaluation,drug concentration monitoring,and the necessity of long-term antimicrobial therapy.Improved clinician awareness and adherence to evidencebased management protocols are essential to achieving better outcomes in nocardiosis cases.展开更多
AIM:To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire(COVD-QOL)and the Convergence Insufficiency Symptom Survey(CISS)in detecting convergenc...AIM:To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire(COVD-QOL)and the Convergence Insufficiency Symptom Survey(CISS)in detecting convergence insufficiency and to compare their diagnostic value in clinical applications.METHODS:Using the diagnostic test method,62 adult patients with convergence insufficiency(age:24.74±3.75y)and 62 normal participants(age:23.61±3.13y)who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included.All subjects completed the CISS and COVD-QOL.Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed.RESULTS:The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5%and 71.0%,respectively,while the specificity was 96.8%and 67.7%,respectively.Compared to the CISS alone,the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity.The areas under the receiver operating characteristic curve of CISS,COVD-QOL and CISS combined with COVD-QOL were 0.806,0.694 and 0.782,respectively.CONCLUSION:Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL,it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.展开更多
Pancreatic exocrine insufficiency(PEI)can be induced by various kinds of diseases,including chronic pancreatitis,acute pancreatitis,and post-pancreatectomy.The main pathogenetic mechanism of PEI involves the decline o...Pancreatic exocrine insufficiency(PEI)can be induced by various kinds of diseases,including chronic pancreatitis,acute pancreatitis,and post-pancreatectomy.The main pathogenetic mechanism of PEI involves the decline of trypsin synthesis,disorder of pancreatic fluid flow,and imbalance of secretion feedback.Animal studies have shown that PEI could induce gut bacterial overgrowth and dysbiosis,with the abundance of Lactobacillus and Bifidobacterium increasing the most,which could be partially reversed by pancreatic enzyme replacement therapy.Clinical studies have also confirmed the association between PEI and the dysbiosis of gut microbiota.Pancreatic exocrine secretions and changes in duodenal p H as well as bile salt malabsorption brought about by PEI may affect and shape the abundance and composition of gut microbiota.In turn,the gut microbiota may impact the pancreatic exocrine acinus through potential bidirectional crosstalk.Going forward,more and higher-quality studies are needed that focus on the mechanism underlying the impact of PEI on the gut microbiota.展开更多
The incidence of premature ovarian insufficiency(POI)is increasing worldwide,particularly among younger women,posing a significant challenge to fertility.In addition to menopausal symptoms,POI leads to several complic...The incidence of premature ovarian insufficiency(POI)is increasing worldwide,particularly among younger women,posing a significant challenge to fertility.In addition to menopausal symptoms,POI leads to several complications that profoundly affect female reproductive function and overall health.Unfortunately,current clinical treatment strategies for this condition are limited and often yield unsatisfactory outcomes.These approaches typically involve hormone repla-cement therapy combined with psychological support.Recently,mesenchymal stem cell(MSC)therapies for POI have garnered considerable attention in global research.MSCs can restore ovarian reproductive and endocrine functions through diverse mechanisms,including controlling differentiation,promoting angiogenesis,regulating ovarian fibrosis,inhibiting apoptosis,enhancing autocrine and paracrine effects,suppressing inflammation,modulating the immune system,and genetic regulation.This editorial offers a succinct summary of the application of MSC therapy in the context of POI,providing evidence for groundbreaking medical approaches that have potential to enhance reproductive health and overall well-being for women.展开更多
BACKGROUND Premature ovarian insufficiency(POI)is a condition that causes secondary amenorrhea owing to ovarian hypofunction at an early stage.Early follicular depletion results in intractable infertility,thereby cons...BACKGROUND Premature ovarian insufficiency(POI)is a condition that causes secondary amenorrhea owing to ovarian hypofunction at an early stage.Early follicular depletion results in intractable infertility,thereby considerably reducing the quality of life of females.Given the continuum in weakened ovarian function,progressing from incipient ovarian failure(IOF)to transitional ovarian failure and further to POI,it is necessary to develop biomarkers for predicting POI.The oxidative stress states in IOF and POI were comprehensively evaluated via oxidative stress[diacron-reactive oxygen metabolites(d-ROMs)]test and anti-oxidant capacity[biological antioxidant potential(BAP)].METHODS Females presenting with secondary amenorrhea over 4 mo and a follicle stimulating hormone level of>40 mIU/mL were categorized into the POI group.Females presenting with a normal menstrual cycle and a follicle stimulating hormone level of>10.2 mIU/mL were categorized into the IOF group.Healthy females without ovarian hypofunction were categorized into the control group.Among females aged<40 years who visited our hospital from January 2021 to June 2022,we recruited 11 patients into both POI and IOF groups.For the potential antioxidant capacity,the relative oxidative stress index(BAP/d-ROMs×100)was calculated,and the oxidative stress defense system was comprehensively evaluated.RESULTS d-ROMs were significantly higher in the POI and IOF groups than in the control group,(478.2±58.7 U.CARR,434.5±60.6 U.CARR,and 341.1±35.1 U.CARR,respectively)(U.CARR is equivalent to 0.08 mg/dL of hydrogen peroxide).However,no significant difference was found between the POI and IOF groups.Regarding BAP,no significant difference was found between the control,IOF,and POI groups(2078.5±157.4μmol/L,2116.2±240.2μmol/L,and 2029.0±186.4μmol/L,respectively).The oxidative stress index was significantly higher in the POI and IOF groups than in the control group(23.7±3.3,20.7±3.6,and 16.5±2.1,respectively).However,no significant difference was found between the POI and IOF groups.CONCLUSION High levels of oxidative stress suggest that evaluating the oxidative stress state may be a useful indicator for the early detection of POI.展开更多
OBJECTIVE:To analyze the serum metabolic targets of the"Zhibian(BL54)through Shuidao(ST28)"acupuncture technique in cyclophosphamide(CTX)-induced premature ovarian insufficiency(POI)model rats and to elucida...OBJECTIVE:To analyze the serum metabolic targets of the"Zhibian(BL54)through Shuidao(ST28)"acupuncture technique in cyclophosphamide(CTX)-induced premature ovarian insufficiency(POI)model rats and to elucidate the potential molecular mechanism of acupuncture in improving POI.METHODS:We used an intraperitoneal injection of CTX to establish the POI rat model(POI group)and compared serum hormone levels and ovarian histopathological changes to evaluate the effect of the Zhibian(BL54)through Shuidao(ST28)technique(ZS+POI group)on ovarian function.Then,nontargeted metabolomics was performed using rat serum by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS).RESULTS:After acupuncture intervention,the serum hormone levels and ovarian pathological morphology of POI rats were effectively improved.Moreover,UPLC-Q-TOF/MS results showed that the ZS+POI group showed a significant reversal of the levels of 6 differential metabolites.Among them,the levels of four serum metabolic markers,divanillyltetrahydrofuran ferulate,trans-ferulic acid,tryptamine,and neuraminic acid,increased significantly.Further analysis of biological effects showed that all metabolites were involved in the regulation of reproductive hormone levels and antioxidant and antiapoptotic effects.CONCLUSIONS:The"Zhibian(BL54)through Shuidao(ST28)"acupuncture method may improve the ovarian function of POI rats by regulating serum metabolite markers to exert antioxidant and antiapoptotic effects,which provides a theoretical basis for the clinical application of acupuncture in the treatment of POI.展开更多
BACKGROUND Crohn's disease(CD)often necessitates surgical intervention,particularly when it manifests in the terminal ileum and ileocecal valve.Despite undergoing radical surgery,a subset of patients experiences r...BACKGROUND Crohn's disease(CD)often necessitates surgical intervention,particularly when it manifests in the terminal ileum and ileocecal valve.Despite undergoing radical surgery,a subset of patients experiences recurrent inflammation at the anasto-motic site,necessitating further medical attention.AIM To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients.METHODS This study enrolled 77 patients who underwent open ileocolic resection with pri-mary stapled anastomosis.Patients were stratified into two groups:Group I co-mprised individuals without anastomotic insufficiency,while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period.Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts.RESULTS Anastomotic insufficiency was detected in 12 patients(15.6%),with a mean time interval of 30 months between the initial surgery and recurrence.The predomi-nant reasons for re-intervention included stenosis and excessive perianastomotic lesions.Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction,anastomotic bleeding,and clinically confirmed micro-leakage.Additionally,patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD.CONCLUSION Successful surgical outcomes hinge on the attainment of a fully functional anastomosis,optimal metabolic status,and clinical remission of the underlying disease.Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure,thereby enabling noninvasive interventions.展开更多
Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is cruc...Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.展开更多
Premature ovarian insufficiency(POI)is a severe female reproductive disorder that affects 1%of women in general populations(European Society for Human Reproduction and Embryology[ESHRE]Guideline Group on POI et al.,20...Premature ovarian insufficiency(POI)is a severe female reproductive disorder that affects 1%of women in general populations(European Society for Human Reproduction and Embryology[ESHRE]Guideline Group on POI et al.,2016).An increasing prevalence up to 3.7%has been reported in a recent meta-analysis(Golezar et al.,2019).POl can lead to infertility or subfertility,as well as a range of complex complications suffering multi-organ systems,seriously threatening women's health and reducing the life quality.By contrast,POl is a representative heterogeneous disease with multiple etiologies.While more than 70 causative POI genes have been identified,the etiology of more than half of the POI patients is still ambiguous(Jiao et al.,2018).Unreported POI causative genes,therefore,remain to be identified.展开更多
BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SU...BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.展开更多
Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with o...Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.展开更多
Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-spec...Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .展开更多
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
基金Sanming Project of Medicine in Shenzhen:the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Luo Songping National Famous Chinese Medicine Practitioner Female Reproductive Disorders Prevention and Treatment Team(SZZYSM202311010)Guangdong Provincial Administration of Traditional Chinese Medicine:Investigation of the Mechanism of Regulating Ren-Tong-Du Acupuncture on Ovarian Granulosa Cells in Polycystic Ovary Syndrome based on Activin A/Smads Signalling Pathway(No.20181229)+1 种基金Guangdong Provincial Administration of Traditional Chinese Medicine:Evaluation of the Efficacy of Menstrual Regulation and Pregnancy Promotion by Acupuncture in the Treatment of Premature Ovarian Insufficiency(No.20201294)Shenzhen Science and Innovation Commission:Investigating the Mechanism of Action of Acupuncture in Regulating the Gut Microbiome to Inhibit Apoptosis of Ovarian Granulosa Cells in Premature Ovarian Insufficiency Mice based on the Rictor/Torepamycin Target Protein C2 Pathway(No.JCYJ20210324130001004)。
文摘PURPOSE:To investigate the differences in gut microbial characteristics between two traditional Chinese syndromes of premature ovarian insufficiency(POI).METHODS:Forty women with POI were recruited from the Department of Traditional Chinese Medicine at Shenzhen Maternity and Child Healthcare Hospital between June and December 2020.Women with POI were divided into the kidney deficiency and blood stasis syndrome(SDBS)and Qi and blood deficiency syndrome(QBDS)groups.Gut microbial community profiles were analyzed by 16S rRNA gene sequencing using an Illumina Mi Seq system.A retrospective study comparing hormone levels and gut microbiota information was performed between the SDBS and QBDS groups.RESULTS:Compared with the QBDS group,the serum levels of estradiol(E2)and anti-Müllerian hormone(AMH)were significantly decreased in the SDBS group.The quantities of Adlercreutzia,Eggerthella,Klebsiella,and Paraprevotella significantly increased in the SDBS group,whereas Lactobacillus decreased significantly.Moreover,alterations in the microbiome in the SDBS and QBDS groups were closely related to the levels of E2 and AMH.The area under the receiver operating characteristic curve for the classification of the two syndromes by the gut microbiome was 0.71.CONCLUSIONS:There were significant differences in the dominant microbiota between the SDBS and QBDS groups,and the change in Proteobacteria in the QBDS group was more significant.The characteristics of gut microbiota help us differentiate between the SDBS and QBDS groups,which may provide a basis for the objectification of TCM syndrome types.
文摘This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
文摘BACKGROUND Pancreatic exocrine insufficiency(PEI)leads to fat malabsorption and maldigestion and is most commonly treated with pancreatic enzyme replacement therapy(PERT).Patients suffering from PEI in China are more likely not to receive adequate treatment as this drug is not part of the Chinese national essential medicine list.AIM To examine the cost-effectiveness of PERT for patients suffering from PEI in China.METHODS A decision analytical Markov model was constructed to simulate the progress of patients with PEI in China.The population included in the analyses were patients suffering from PEI with advanced(non-resectable)pancreatic cancer,who have undergone surgery due to pancreatic cancer and who have undergone endoscopic treatment due to chronic pancreatitis.The cost-effectiveness analyses were undertaken from a Chinese societal perspective comparing PERT with no PERT.The incremental cost-effectiveness ratio in United States dollars per quality adjusted life year(QALY)gained is the main outcome.Input was informed by publicly available data supplemented with expert clinical advice.RESULTS The cost-effectiveness analyses estimated that PERT resulted in additional 0.45 to 2.93 QALYs at discounted costs of between 4315 dollars to 15193 dollars.This resulted in an incremental cost-effectiveness ratio of 5178 dollars to 9533 dollars per QALY.The one-way sensitivity analyses showed that the main drivers of the model were the cost of PERT and overall survival.CONCLUSION This study demonstrates that PERT is a cost-effective treatment for patients suffering from PEI in China.
基金supported by the National Key Research&Developmental Program of China(2022YFC2703800,2022YFC2703000)the National Natural Science Foundation of China(82125014,82371646,32070847)+1 种基金Basic Science Center Program of NSFC(31988101)the Natural Science Foundation of Shandong Province(ZR202105250005,ZR2022YQ69,tsqn202211371).
文摘Premature ovarian insufficiency(POI)is characterized by irreversible loss of ovarian function before 40 years of age and affects 3.7%of women worldwide(Golezar et al.,2019;Huang et al.,2021).Raised serum follicle-stimulating hormone(FSH)levels,menstrual disturbance,and estrogen deficiency are the main symptoms of POl(European Society for Human Reproduction et al.,2016).Besides infertility,patients have an increased risk of long-term complications due to the early deficiency of ovarian steroids,such as osteoporosis,cardiovascular disease,and metabolic disorders(lshizuka,2021).Due to the lack of biomarkers for prediction or early diagnosis,most patients are not diagnosed until the failure stage(serum levels of FSH above 25 IU/L and amenorrhea),missing opportunities for intervention.Therefore,developing sensitive biomarkers for diminished ovarian reserves is paramount for timely treatment to improve reproductive outcomes and prevent long-term complications.
文摘Resection of the terminal ileum and ileocecal valve remains the most commonly performed procedure in patients with Crohn's disease.However,despite radical treatment,there is a risk of disease recurrence at the site of the intestinal ana-stomosis in some cases.Therefore,long-term postoperative management is crucial and requires systematic clinical assessment,endoscopic surveillance,and pharma-cological support when indicated.A key challenge is identifying the risk factors associated with the recurrence of anastomotic failure and defining the principles of follow-up care to prevent secondary intestinal insufficiency.This paper focuses on both surgical and non-surgical factors that may play a role in preventing complications in patients undergoing ileocecal resection,providing a compre-hensive approach to postoperative management.
基金Shenzhen Science and Innovation Commission:Investigating the Mechanism of Action of Acupuncture in Regulating the Gut Microbiome to Inhibit Apoptosis of Ovarian Granulosa Cells in Premature Ovarian Insufficiency Mice based on the Rictor/Torepamycin Target Protein c2 Pathway(No.JCYJ20210324130001004)Sanming Project of Medicine in Shenzhen:the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Luo Songping National Famous Chinese Medicine Practitioner Female Reproductive Disorders Prevention and Treatment Team(SZZYSM202311010)。
文摘OBJECTIVE:To investigate the potential mechanism of electroacupuncture(EA)in alleviating premature ovarian insufficiency(POI)and to provide a theoretical basis for EA treatment of POI.METHODS:For this purpose,a POI mice model was developed by injecting 12 mg/kg busulfan and 120 mg/kg cyclophosphamide intraperitoneally to induce POI.It was then proceeded by EA intervention at Guanyuan(CV4)acupoint on the second day following modeling.Similarly,apoptosis in ovarian granulosa cells was detected by terminal deoxynucleotidyl transferase d UTP nick end labeling staining,while enzyme-linked immunosorbent assay was employed for measuring serum folliclestimulating hormone(FSH),luteinizing hormone(LH),estrogen(E_(2)),and anti-müllerian hormone(AMH)levels.Moreover,transmission electron microscopy(TEM)was employed for examining mitochondrial morphology,while autophagy and hippo-yes-associated protein/transcriptional co-activator with postsynaptic density protein,drosophila disc large tumor suppressor,and zonula occludens-1 protein binding motif(YAP/TAZ)pathway related protein levels in ovarian tissue were detected via Western blotting.RESULTS:Analysis of serum levels of various hormones indicated that serum FSH and LH were reduced in EA compared to the POI group,while E_(2) and AMH levels were found to be elevated in EA compared to the POI group.The EA was found to inhibit apoptosis in granulosa cells in POI model mice,in addition to improved mitochondrial damage and significantly improved mitophagy.Pathway analysis revealed that EA was involved in activating the hippo-YAP/TAZ pathway,followed by reversing EA effects on granulosa cell apoptosis and mitophagy with the use of verteporfin,an autophagy and YAP-T-cell factor/enhancer of split and activator of transcription domain family member interaction inhibitor.CONCLUSIONS:EA at the Guanyuan(CV4)acupoint protected the granulosa cell by inhibiting cell apoptosis and promoting mitophagy,which was mediated by the Hippo-YAP/TAZ pathway.
文摘Nocardiosis remains a rare and often underdiagnosed bacterial infection,particularly in immunocompromised individuals.The case report by Zhang et al highlights the diagnostic and therapeutic challenges in managing Nocardia brasiliensis skin infection in a 93-year-old patient with chronic renal insufficiency.This editorial explores the importance of timely diagnosis,microbiological confirmation,and tailored antibiotic therapy.Emphasis is placed on the role of immune status evaluation,drug concentration monitoring,and the necessity of long-term antimicrobial therapy.Improved clinician awareness and adherence to evidencebased management protocols are essential to achieving better outcomes in nocardiosis cases.
文摘AIM:To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire(COVD-QOL)and the Convergence Insufficiency Symptom Survey(CISS)in detecting convergence insufficiency and to compare their diagnostic value in clinical applications.METHODS:Using the diagnostic test method,62 adult patients with convergence insufficiency(age:24.74±3.75y)and 62 normal participants(age:23.61±3.13y)who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included.All subjects completed the CISS and COVD-QOL.Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed.RESULTS:The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5%and 71.0%,respectively,while the specificity was 96.8%and 67.7%,respectively.Compared to the CISS alone,the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity.The areas under the receiver operating characteristic curve of CISS,COVD-QOL and CISS combined with COVD-QOL were 0.806,0.694 and 0.782,respectively.CONCLUSION:Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL,it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.
基金supported by the Construction Project of Clinical Advanced Subjects of Capital Medical University(No.1192070312)the Beijing Municipal Science&Technology Commission(Nos.Z171100001017077 and Z191100006619038)+1 种基金the Capital Health Research and Development of Special(No.2020-1-2012)the Capital Medical University Youth Science Foundation(No.PTZ21035),China。
文摘Pancreatic exocrine insufficiency(PEI)can be induced by various kinds of diseases,including chronic pancreatitis,acute pancreatitis,and post-pancreatectomy.The main pathogenetic mechanism of PEI involves the decline of trypsin synthesis,disorder of pancreatic fluid flow,and imbalance of secretion feedback.Animal studies have shown that PEI could induce gut bacterial overgrowth and dysbiosis,with the abundance of Lactobacillus and Bifidobacterium increasing the most,which could be partially reversed by pancreatic enzyme replacement therapy.Clinical studies have also confirmed the association between PEI and the dysbiosis of gut microbiota.Pancreatic exocrine secretions and changes in duodenal p H as well as bile salt malabsorption brought about by PEI may affect and shape the abundance and composition of gut microbiota.In turn,the gut microbiota may impact the pancreatic exocrine acinus through potential bidirectional crosstalk.Going forward,more and higher-quality studies are needed that focus on the mechanism underlying the impact of PEI on the gut microbiota.
基金Supported by the Cohort Construction Project of Peking University Third Hospital,No.BYSYDL2022013Clinical Key Project of Peking University Third Hospital,No.BYSY2023049+1 种基金Special Grant for Capital Health Research and Development,No.2022-2-4097and Funding from State Key Laboratory of Female Fertility Promotion,Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,No.BYSYSZKF2023027.
文摘The incidence of premature ovarian insufficiency(POI)is increasing worldwide,particularly among younger women,posing a significant challenge to fertility.In addition to menopausal symptoms,POI leads to several complications that profoundly affect female reproductive function and overall health.Unfortunately,current clinical treatment strategies for this condition are limited and often yield unsatisfactory outcomes.These approaches typically involve hormone repla-cement therapy combined with psychological support.Recently,mesenchymal stem cell(MSC)therapies for POI have garnered considerable attention in global research.MSCs can restore ovarian reproductive and endocrine functions through diverse mechanisms,including controlling differentiation,promoting angiogenesis,regulating ovarian fibrosis,inhibiting apoptosis,enhancing autocrine and paracrine effects,suppressing inflammation,modulating the immune system,and genetic regulation.This editorial offers a succinct summary of the application of MSC therapy in the context of POI,providing evidence for groundbreaking medical approaches that have potential to enhance reproductive health and overall well-being for women.
文摘BACKGROUND Premature ovarian insufficiency(POI)is a condition that causes secondary amenorrhea owing to ovarian hypofunction at an early stage.Early follicular depletion results in intractable infertility,thereby considerably reducing the quality of life of females.Given the continuum in weakened ovarian function,progressing from incipient ovarian failure(IOF)to transitional ovarian failure and further to POI,it is necessary to develop biomarkers for predicting POI.The oxidative stress states in IOF and POI were comprehensively evaluated via oxidative stress[diacron-reactive oxygen metabolites(d-ROMs)]test and anti-oxidant capacity[biological antioxidant potential(BAP)].METHODS Females presenting with secondary amenorrhea over 4 mo and a follicle stimulating hormone level of>40 mIU/mL were categorized into the POI group.Females presenting with a normal menstrual cycle and a follicle stimulating hormone level of>10.2 mIU/mL were categorized into the IOF group.Healthy females without ovarian hypofunction were categorized into the control group.Among females aged<40 years who visited our hospital from January 2021 to June 2022,we recruited 11 patients into both POI and IOF groups.For the potential antioxidant capacity,the relative oxidative stress index(BAP/d-ROMs×100)was calculated,and the oxidative stress defense system was comprehensively evaluated.RESULTS d-ROMs were significantly higher in the POI and IOF groups than in the control group,(478.2±58.7 U.CARR,434.5±60.6 U.CARR,and 341.1±35.1 U.CARR,respectively)(U.CARR is equivalent to 0.08 mg/dL of hydrogen peroxide).However,no significant difference was found between the POI and IOF groups.Regarding BAP,no significant difference was found between the control,IOF,and POI groups(2078.5±157.4μmol/L,2116.2±240.2μmol/L,and 2029.0±186.4μmol/L,respectively).The oxidative stress index was significantly higher in the POI and IOF groups than in the control group(23.7±3.3,20.7±3.6,and 16.5±2.1,respectively).However,no significant difference was found between the POI and IOF groups.CONCLUSION High levels of oxidative stress suggest that evaluating the oxidative stress state may be a useful indicator for the early detection of POI.
基金the Research Grant from the Natural Science Research Program of Shanxi Province:Based on Ultra-Performance Liquid Chromatography-Mass Spectrometry,the effect of"Zhibian(BL54)through Shuidao(ST28)"Needle Method on Ovarian Metabolism and Apoptosis Pathways in rats with Premature Ovarian Insufficiency was Discussed(No.2022030211216)。
文摘OBJECTIVE:To analyze the serum metabolic targets of the"Zhibian(BL54)through Shuidao(ST28)"acupuncture technique in cyclophosphamide(CTX)-induced premature ovarian insufficiency(POI)model rats and to elucidate the potential molecular mechanism of acupuncture in improving POI.METHODS:We used an intraperitoneal injection of CTX to establish the POI rat model(POI group)and compared serum hormone levels and ovarian histopathological changes to evaluate the effect of the Zhibian(BL54)through Shuidao(ST28)technique(ZS+POI group)on ovarian function.Then,nontargeted metabolomics was performed using rat serum by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS).RESULTS:After acupuncture intervention,the serum hormone levels and ovarian pathological morphology of POI rats were effectively improved.Moreover,UPLC-Q-TOF/MS results showed that the ZS+POI group showed a significant reversal of the levels of 6 differential metabolites.Among them,the levels of four serum metabolic markers,divanillyltetrahydrofuran ferulate,trans-ferulic acid,tryptamine,and neuraminic acid,increased significantly.Further analysis of biological effects showed that all metabolites were involved in the regulation of reproductive hormone levels and antioxidant and antiapoptotic effects.CONCLUSIONS:The"Zhibian(BL54)through Shuidao(ST28)"acupuncture method may improve the ovarian function of POI rats by regulating serum metabolite markers to exert antioxidant and antiapoptotic effects,which provides a theoretical basis for the clinical application of acupuncture in the treatment of POI.
文摘BACKGROUND Crohn's disease(CD)often necessitates surgical intervention,particularly when it manifests in the terminal ileum and ileocecal valve.Despite undergoing radical surgery,a subset of patients experiences recurrent inflammation at the anasto-motic site,necessitating further medical attention.AIM To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients.METHODS This study enrolled 77 patients who underwent open ileocolic resection with pri-mary stapled anastomosis.Patients were stratified into two groups:Group I co-mprised individuals without anastomotic insufficiency,while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period.Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts.RESULTS Anastomotic insufficiency was detected in 12 patients(15.6%),with a mean time interval of 30 months between the initial surgery and recurrence.The predomi-nant reasons for re-intervention included stenosis and excessive perianastomotic lesions.Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction,anastomotic bleeding,and clinically confirmed micro-leakage.Additionally,patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD.CONCLUSION Successful surgical outcomes hinge on the attainment of a fully functional anastomosis,optimal metabolic status,and clinical remission of the underlying disease.Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure,thereby enabling noninvasive interventions.
基金Supported by The National Research Foundation of Korea Grant Funded by The Korea Government(MSIT),No.00219725.
文摘Pain is a common complaint among patients seeking medical care.If left un-treated,pain can become chronic,significantly affecting patients’quality of life.An accurate diagnosis of the underlying cause of pain is crucial for effective treatment.Chronic venous insufficiency(CVI)is frequently overlooked by pain physicians.Moreover,many pain physicians lack sufficient knowledge about CVI.CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins.Symptoms of CVI,ranging from mild to severe,include pain,heaviness,fatigue,itching,swelling,skin color changes,and ulcers in the lower limbs.Recently,it has become more widely known that these symptoms can be attributed to CVI.Even slight or mild CVI can cause related symptoms.Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain,and often neglect the possibility of CVI.In clinical practice,when pain physicians encounter patients with unresolved leg pain,they must assess whether the patients exhibit symptoms of CVI and conduct tests to differ-entiate CVI from other potential causes.
基金supported by the National Natural Science Foundation of China(32270658 and 32288101)the National Key Research and Development Program of China(2022YFC2703800)the Natural Science Foundation of Shanghai(20ZR1407000).
文摘Premature ovarian insufficiency(POI)is a severe female reproductive disorder that affects 1%of women in general populations(European Society for Human Reproduction and Embryology[ESHRE]Guideline Group on POI et al.,2016).An increasing prevalence up to 3.7%has been reported in a recent meta-analysis(Golezar et al.,2019).POl can lead to infertility or subfertility,as well as a range of complex complications suffering multi-organ systems,seriously threatening women's health and reducing the life quality.By contrast,POl is a representative heterogeneous disease with multiple etiologies.While more than 70 causative POI genes have been identified,the etiology of more than half of the POI patients is still ambiguous(Jiao et al.,2018).Unreported POI causative genes,therefore,remain to be identified.
文摘BACKGROUND Unroofed coronary sinus(UCS)is a rare subtype of atrial septal defect.It is frequently associated with a persistent left superior vena cava and is often part of a more intricate cardiac malformation.CASE SUMMARY This report describes a rare case of an adolescent patient with UCS featuring atrial situs solitus,absence of the right superior vena cava and a persistent left superior vena cava draining into the left atrium consistent with total unroofing of the coronary sinus.This was associated with concurrent severe mitral insufficiency secondary to redundant and prolapsing leaflets,and a substantial left-to-right shunt across the coronary sinus orifice.A comprehensive examination of the existing literature is included,shedding light on the diagnostic challenges of UCS and describing the available surgical options within the context of mitral valve surgery.CONCLUSION UCS is a complex condition requiring careful consideration of associated anomalies and a tailored surgical approach.
文摘Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.
文摘Background: Addison’s disease is a rare disorder of the adrenal cortex that leads to inadequate production of cortisol initially followed by aldosterone and androgens. Its manifestations are usually slow and non-specific with potential for life-threatening adrenal crisis following hypermetabolic demands (infection, trauma, surgery). Patients: Over the past 10 years, 19 CRD-patients were diagnosed with occult PAI in our center. Results: Unprovoked hypotension was the most common manifestations of occult PAI and was the unmasking event in 11 (58%). It was without significant cardiac and/or severe systemic sepsis and was refractory to isotonic saline infusions. Equal number of the remaining patients (n = 2) presented with persistent and inexplicable electrolytes abnormalities viz. 1) hyponatremia despite restricted oral fluid intake, lack of dehydration and massive fluid overload, as well as 2) hyperkalemia despite potassium-restricted diet, hyperkalemic drugs and adequate therapy with Furosemide and low-potassium dialysis-baths. On the other hand, similar proportions presented with unprovoked 3) progressive weight loss, decrease appetite and cachexia as well as 4) frequent hypoglycemic attacks. All patients were treated and were medically stable after 29 (2 - 60) months of follow up. Autoantibodies to 21-hydroxylase enzyme were positive in 16 (90%). At diagnosis, and subsequent follow up, only 7 patients (37%) had multi-endocrine dysfunction of whom 2 with type 1 and 5 with type 2. Conclusion: High index of suspicion should be exerted in diagnosis of PAI in patients with CRD, since its clinical picture is similar to CRD manifestations and complications. In those patients, confirmatory tests and specific management can save their lives. .
