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
Currently,the use of immune checkpoint inhibitors(ICIs)has shown notable clinical efficacy in treating various malignant tumors,significantly improving patient prognosis.However,while ICIs enhance the body’s anti-tum...Currently,the use of immune checkpoint inhibitors(ICIs)has shown notable clinical efficacy in treating various malignant tumors,significantly improving patient prognosis.However,while ICIs enhance the body’s anti-tumor effects,they can also trigger immune-related adverse events(irAEs),with ICI-associated colitis being one of the more prevalent forms.This condition can disrupt treatment,necessitate drug discontinuation,and adversely affect therapeutic outcomes.In severe cases,irAEs may even become life-threatening.A recent case report by Hong et al highlights the importance of vigilance for ICI-associated colitis in patients experiencing symptoms such as diarrhea and abdominal pain,which can arise both during and even after completion of ICI treatment.Early identification,multidisciplinary management,and continuous monitoring of patients are essential steps to further improve outcomes.展开更多
Hepatobiliary tumor (HBT), one of the leading causes of cancer deaths globally, is more frequent in East Asia including China [1].HBTincludeslivercancer,cholangiocarcinomaandgallbladder cancer.HBTburdenvariesmarkedlyb...Hepatobiliary tumor (HBT), one of the leading causes of cancer deaths globally, is more frequent in East Asia including China [1].HBTincludeslivercancer,cholangiocarcinomaandgallbladder cancer.HBTburdenvariesmarkedlybygenderandgeographic regionduetotheexposureofriskfactors.MajorityofthehepatocellularcarcinomasareassociatedwithhepatitisB-typevirus展开更多
Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a br...Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.展开更多
Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone ...Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone disease,including both gallbladder and bile duct stones,due to excessive bilirubin production from hemolysis.Gallstones in HS patients,primarily composed of bilirubin,can lead to complications such as cholecystitis,cholangitis,and obstructive jaundice.This review provides a comprehensive landscape of the pathophysiological mechanisms linking HS to gallstone formation,emphasizing the roles of hemolysis,bile composition,and genetic factors.It also discusses the clinical manifestations of gallstone disease in HS,including recurrent jaundice and biliary obstruction,and highlights the diagnostic value of imaging modalities such as ultrasonography and magnetic resonance cholangiopancreatography.Furthermore,current management strategies,including splenectomy,cholecystectomy,and endoscopic approaches for bile duct stones,are examined in the context of HS.By synthesizing existing knowledge,this review aims to provide insights into improving the diagnosis,prevention,and treatment of gallstone disease in patients with HS,while identifying gaps for future research.展开更多
This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause ...This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause of maternal and perinatal morbidity and mortality,encompassing subtypes such as gestational hypertension,preeclampsia,and eclampsia.Research indicates that anxiety is closely associated with the occurrence of HDP,potentially influencing blood pressure regulation and vascular function through neuroendocrine,inflammatory,genetic,and gut microbiota effects.Epidemiological data show that anxiety is prevalent during pregnancy and is linked to an increased risk of HDP.Biological mechanism studies reveal that anxiety can increase the risk of HDP by activating the hypothalamic-pituitary-adrenal axis,promoting inflammation,and affecting gut microbiota.In terms of treatment and management,psychological interventions(such as relaxation training,yoga,and mindfulness meditation)and pharmacological treatments(such as labetalol and nifedipine)play important roles in alleviating anxiety and improving the prognosis of HDP.Additionally,multidisciplinary collaboration and long-term postpartum follow-up are crucial for reducing the long-term risk of cardiovascular diseases.Despite significant progress in research on anxiety and HDP,many issues still require further exploration,including in-depth mechanism studies,optimization of clinical interventions,improvement of multidisciplinary collaboration models,long-term follow-up studies,and the impact of cultural and social factors.展开更多
BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are...BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.展开更多
BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with cl...BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.展开更多
Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific ...Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific presentations.Many studies have highlighted the challenges in emergency settings,where atypical symptoms may lead to misdiagnosis.We report a rare case of disseminated mucormycosis originating from the stomach in a pregnancy-induced thrombocytopenia(PITP)patient,emphasizing rapid gastroscopy examination,histopathological confi rmation,multidisciplinary management,and high-risk factors for hospital-acquired gastrointestinal mucormycosis infection.展开更多
BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,p...BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,patient perspectives,and future research directions regarding GI symptoms in genetic myopathies.METHODS A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.We searched PubMed,Scopus,EMBASE,and Web of Science from inception to December 2024.Eligible studies reported GI manifestations in genetic myopathies,including clinical evaluations,imaging,physiological tests,histopathology,and genetic analyses.Inclusion criteria encompassed original research studies,review articles,case reports,and clinical guidelines published in peer-reviewed journals.Exclusion criteria included conference abstracts without full-text availability and non-peer-reviewed sources.Two independent reviewers screened studies and extracted data.They assessed methodological quality using the Newcastle-Ottawa Scale for observational studies,A MeaSurement Tool to Assess Systematic Reviews for systematic reviews,and the Joanna Briggs Institute checklist for case reports.A systematic narrative synthesis was employed to summarize the findings.RESULTS A total of 234 studies met the inclusion criteria.GI manifestations varied widely,with dysphagia,gastroesophageal reflux,abdominal pain,constipation,diarrhea,and fecal incontinence being the most frequently reported symptoms.The included studies highlighted a multidisciplinary diagnostic approach incorporating clinical assessment,imaging,physiological testing,histopathology,and genetic testing.Management strategies ranged from dietary interventions and rehabilitative therapies to pharmacological treatments and surgical procedures.Patient perspectives underscored the significant impact of GI symptoms on quality of life,social interactions,and emotional well-being.The main limitations of the included studies were high heterogeneity in study design,small sample sizes,and the potential risk of bias due to limited methodological rigor in some reports.CONCLUSION This review underscores the complexity of GI manifestations in genetic myopathies and the need for a comprehensive,multidisciplinary management approach.Future research should focus on elucidating molecular mechanisms,identifying biomarkers,and developing targeted therapies to improve patient outcomes.The findings have implications for both clinical practice and public health,emphasizing the necessity of early diagnosis and personalized management strategies.展开更多
Leiomyosarcoma of the gonadal vein is an exceedingly rare entity, representing a small subset of smooth muscle tumors that more commonly arise in the retroperitoneum, uterus, and blood vessels. To date, fewer than 10 ...Leiomyosarcoma of the gonadal vein is an exceedingly rare entity, representing a small subset of smooth muscle tumors that more commonly arise in the retroperitoneum, uterus, and blood vessels. To date, fewer than 10 cases of gonadal vein leiomyosarcoma have been reported in the literature, highlighting its rarity and the limited understanding of its clinical behavior. These tumors are often diagnosed incidentally or present with nonspecific symptoms, such as abdominal pain or a palpable mass, which can complicate early detection. The proximity of gonadal vein leiomyosarcomas to critical structures, such as the ureter, renal vessels, and surrounding organs, introduces unique diagnostic and surgical challenges. Previous reports have underscored the importance of advanced imaging techniques, including CT and MRI, in delineating the tumor’s anatomical relationships and guiding surgical planning. This case, involving a leiomyosarcoma closely associated with the patient’s left ureter, provides an opportunity to build on existing knowledge by addressing the clinical presentation, diagnostic approach, treatment pathway, and long-term follow-up strategies required for optimal management. By presenting this detailed review, we aim to contribute valuable insights into the diagnosis and management of this rare malignancy.展开更多
Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary pers...Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary perspectives that address two underrepresented dimensions:Vascular surgical decision-making and psychiatric rehabilitation.We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management.Additionally,we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors.Embedding these domains into standardized protocols could enhance both short-and long-term outcomes,particularly in highimpact trauma and disaster settings.展开更多
Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the ki...Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the kidneys,thyroid,soft tissues,and bones.The study by Celik et al presents a series of five clinical cases where hydatid cysts were found in these rare anatomical regions,challenging conventional diagnostic and therapeutic approaches.The paper emphasizes the importance of differential diagnosis,as these cases can mimic other conditions,such as cancer,abscesses,or cysts.Advanced imaging techniques,such as com-puted tomography,magnetic resonance imaging,and ultrasound,play a crucial role in accurate diagnosis and help avoid misdiagnosis.The study demonstrates that early diagnosis and appropriate treatment of echinococosis in atypical localiz-ations are critical for preventing complications like cyst rupture and secondary infections.The use of albendazole and surgical intervention,especially in combi-nation with modern imaging techniques,yields good outcomes in these patients.However,several unanswered questions remain:What are the precise criteria for selecting the optimal treatment method in each case?What is the long-term effect-iveness of different approaches?Do patients with hydatid cysts in atypical lo-cations require additional monitoring and preventive treatment to avoid recu-rrence?Addressing these questions requires further research,and a multidisci-plinary approach involving radiologists,surgeons,and infectious disease spe-cialists is essential to optimize diagnosis and treatment.Early and accurate diagnostic methods based on differential diagnosis play a key role in improving treatment outcomes and reducing morbidity.展开更多
To editor:Glanzmann thrombasthenia(GT)is a rare autosomal recessive bleeding disorder that is characterized by a quantitative and/or qualitative defect in the platelet integrinαIIbβ3(previously known as glycoprotein...To editor:Glanzmann thrombasthenia(GT)is a rare autosomal recessive bleeding disorder that is characterized by a quantitative and/or qualitative defect in the platelet integrinαIIbβ3(previously known as glycoprotein(GP)IIb/IIIa),the major platelet receptor of fibrinogen.DefectiveαIIbβ3 can result in the absence of platelet aggregation.Pregnancy and delivery in women with GT can present specific challenges as there is a significant risk of both maternal and fetal bleeding.展开更多
Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for pa...Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for patients.However,this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications.Here,we propose the novel discipline of uro-cardio-oncology,an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer.In this comprehensive review,we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers,including androgen deprivation therapy,vascular endothelial growth factor receptor tyrosine kinase inhibitors,immune checkpoint inhibitors,and chemotherapeutics.In addition,we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance,diagnosis,and effective management of cardiovascular complications.Finally,we provide an analysis of future perspectives in this emerging specialty,identifying areas in need of further research.展开更多
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.
基金Supported by 2021 Key Topic of Qinghai Provincial Health System–Guiding Plan Topic,No.2021-WJZDX-43.
文摘Currently,the use of immune checkpoint inhibitors(ICIs)has shown notable clinical efficacy in treating various malignant tumors,significantly improving patient prognosis.However,while ICIs enhance the body’s anti-tumor effects,they can also trigger immune-related adverse events(irAEs),with ICI-associated colitis being one of the more prevalent forms.This condition can disrupt treatment,necessitate drug discontinuation,and adversely affect therapeutic outcomes.In severe cases,irAEs may even become life-threatening.A recent case report by Hong et al highlights the importance of vigilance for ICI-associated colitis in patients experiencing symptoms such as diarrhea and abdominal pain,which can arise both during and even after completion of ICI treatment.Early identification,multidisciplinary management,and continuous monitoring of patients are essential steps to further improve outcomes.
基金supported by grants from the “919 Tumor Pre-cision Medicine Public Welfare Foundation”the International Sci-ence and Technology Cooperation Projects(2015DFA30650 and 2016YFE0107100)+2 种基金Chinese Academy of Medical Sciences(CAMS) Innovation Fund for Medical Sciences(CIFMS)(2017-I2M-4-003)the Capital Special Research Project for the Clinical Application(Z151100004015170)Beijing Natural Science Foundation Haid-ian Joint Fund Frontier Project(L172055)
文摘Hepatobiliary tumor (HBT), one of the leading causes of cancer deaths globally, is more frequent in East Asia including China [1].HBTincludeslivercancer,cholangiocarcinomaandgallbladder cancer.HBTburdenvariesmarkedlybygenderandgeographic regionduetotheexposureofriskfactors.MajorityofthehepatocellularcarcinomasareassociatedwithhepatitisB-typevirus
文摘Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.
文摘Hereditary spherocytosis(HS),a common inherited hemolytic anemia,is characterized by red blood cell membrane protein defects leading to chronic hemolysis.This condition significantly predisposes patients to gallstone disease,including both gallbladder and bile duct stones,due to excessive bilirubin production from hemolysis.Gallstones in HS patients,primarily composed of bilirubin,can lead to complications such as cholecystitis,cholangitis,and obstructive jaundice.This review provides a comprehensive landscape of the pathophysiological mechanisms linking HS to gallstone formation,emphasizing the roles of hemolysis,bile composition,and genetic factors.It also discusses the clinical manifestations of gallstone disease in HS,including recurrent jaundice and biliary obstruction,and highlights the diagnostic value of imaging modalities such as ultrasonography and magnetic resonance cholangiopancreatography.Furthermore,current management strategies,including splenectomy,cholecystectomy,and endoscopic approaches for bile duct stones,are examined in the context of HS.By synthesizing existing knowledge,this review aims to provide insights into improving the diagnosis,prevention,and treatment of gallstone disease in patients with HS,while identifying gaps for future research.
文摘This article comprehensively explores the relationship between anxiety and hypertensive disorders of pregnancy(HDP),covering epidemiology,potential mechanisms,and management strategies.HDP is the second leading cause of maternal and perinatal morbidity and mortality,encompassing subtypes such as gestational hypertension,preeclampsia,and eclampsia.Research indicates that anxiety is closely associated with the occurrence of HDP,potentially influencing blood pressure regulation and vascular function through neuroendocrine,inflammatory,genetic,and gut microbiota effects.Epidemiological data show that anxiety is prevalent during pregnancy and is linked to an increased risk of HDP.Biological mechanism studies reveal that anxiety can increase the risk of HDP by activating the hypothalamic-pituitary-adrenal axis,promoting inflammation,and affecting gut microbiota.In terms of treatment and management,psychological interventions(such as relaxation training,yoga,and mindfulness meditation)and pharmacological treatments(such as labetalol and nifedipine)play important roles in alleviating anxiety and improving the prognosis of HDP.Additionally,multidisciplinary collaboration and long-term postpartum follow-up are crucial for reducing the long-term risk of cardiovascular diseases.Despite significant progress in research on anxiety and HDP,many issues still require further exploration,including in-depth mechanism studies,optimization of clinical interventions,improvement of multidisciplinary collaboration models,long-term follow-up studies,and the impact of cultural and social factors.
文摘BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.
文摘BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.
基金supported by a grant from Guangdong Provincial Natural Science Foundation of China(2023A15115012665).
文摘Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific presentations.Many studies have highlighted the challenges in emergency settings,where atypical symptoms may lead to misdiagnosis.We report a rare case of disseminated mucormycosis originating from the stomach in a pregnancy-induced thrombocytopenia(PITP)patient,emphasizing rapid gastroscopy examination,histopathological confi rmation,multidisciplinary management,and high-risk factors for hospital-acquired gastrointestinal mucormycosis infection.
文摘BACKGROUND Gastrointestinal(GI)manifestations are prevalent in genetic myopathies,posing significant diagnostic and management challenges.AIM To synthesize evidence on the diagnostic approaches,management strategies,patient perspectives,and future research directions regarding GI symptoms in genetic myopathies.METHODS A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.We searched PubMed,Scopus,EMBASE,and Web of Science from inception to December 2024.Eligible studies reported GI manifestations in genetic myopathies,including clinical evaluations,imaging,physiological tests,histopathology,and genetic analyses.Inclusion criteria encompassed original research studies,review articles,case reports,and clinical guidelines published in peer-reviewed journals.Exclusion criteria included conference abstracts without full-text availability and non-peer-reviewed sources.Two independent reviewers screened studies and extracted data.They assessed methodological quality using the Newcastle-Ottawa Scale for observational studies,A MeaSurement Tool to Assess Systematic Reviews for systematic reviews,and the Joanna Briggs Institute checklist for case reports.A systematic narrative synthesis was employed to summarize the findings.RESULTS A total of 234 studies met the inclusion criteria.GI manifestations varied widely,with dysphagia,gastroesophageal reflux,abdominal pain,constipation,diarrhea,and fecal incontinence being the most frequently reported symptoms.The included studies highlighted a multidisciplinary diagnostic approach incorporating clinical assessment,imaging,physiological testing,histopathology,and genetic testing.Management strategies ranged from dietary interventions and rehabilitative therapies to pharmacological treatments and surgical procedures.Patient perspectives underscored the significant impact of GI symptoms on quality of life,social interactions,and emotional well-being.The main limitations of the included studies were high heterogeneity in study design,small sample sizes,and the potential risk of bias due to limited methodological rigor in some reports.CONCLUSION This review underscores the complexity of GI manifestations in genetic myopathies and the need for a comprehensive,multidisciplinary management approach.Future research should focus on elucidating molecular mechanisms,identifying biomarkers,and developing targeted therapies to improve patient outcomes.The findings have implications for both clinical practice and public health,emphasizing the necessity of early diagnosis and personalized management strategies.
文摘Leiomyosarcoma of the gonadal vein is an exceedingly rare entity, representing a small subset of smooth muscle tumors that more commonly arise in the retroperitoneum, uterus, and blood vessels. To date, fewer than 10 cases of gonadal vein leiomyosarcoma have been reported in the literature, highlighting its rarity and the limited understanding of its clinical behavior. These tumors are often diagnosed incidentally or present with nonspecific symptoms, such as abdominal pain or a palpable mass, which can complicate early detection. The proximity of gonadal vein leiomyosarcomas to critical structures, such as the ureter, renal vessels, and surrounding organs, introduces unique diagnostic and surgical challenges. Previous reports have underscored the importance of advanced imaging techniques, including CT and MRI, in delineating the tumor’s anatomical relationships and guiding surgical planning. This case, involving a leiomyosarcoma closely associated with the patient’s left ureter, provides an opportunity to build on existing knowledge by addressing the clinical presentation, diagnostic approach, treatment pathway, and long-term follow-up strategies required for optimal management. By presenting this detailed review, we aim to contribute valuable insights into the diagnosis and management of this rare malignancy.
文摘Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary perspectives that address two underrepresented dimensions:Vascular surgical decision-making and psychiatric rehabilitation.We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management.Additionally,we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors.Embedding these domains into standardized protocols could enhance both short-and long-term outcomes,particularly in highimpact trauma and disaster settings.
文摘Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the kidneys,thyroid,soft tissues,and bones.The study by Celik et al presents a series of five clinical cases where hydatid cysts were found in these rare anatomical regions,challenging conventional diagnostic and therapeutic approaches.The paper emphasizes the importance of differential diagnosis,as these cases can mimic other conditions,such as cancer,abscesses,or cysts.Advanced imaging techniques,such as com-puted tomography,magnetic resonance imaging,and ultrasound,play a crucial role in accurate diagnosis and help avoid misdiagnosis.The study demonstrates that early diagnosis and appropriate treatment of echinococosis in atypical localiz-ations are critical for preventing complications like cyst rupture and secondary infections.The use of albendazole and surgical intervention,especially in combi-nation with modern imaging techniques,yields good outcomes in these patients.However,several unanswered questions remain:What are the precise criteria for selecting the optimal treatment method in each case?What is the long-term effect-iveness of different approaches?Do patients with hydatid cysts in atypical lo-cations require additional monitoring and preventive treatment to avoid recu-rrence?Addressing these questions requires further research,and a multidisci-plinary approach involving radiologists,surgeons,and infectious disease spe-cialists is essential to optimize diagnosis and treatment.Early and accurate diagnostic methods based on differential diagnosis play a key role in improving treatment outcomes and reducing morbidity.
文摘To editor:Glanzmann thrombasthenia(GT)is a rare autosomal recessive bleeding disorder that is characterized by a quantitative and/or qualitative defect in the platelet integrinαIIbβ3(previously known as glycoprotein(GP)IIb/IIIa),the major platelet receptor of fibrinogen.DefectiveαIIbβ3 can result in the absence of platelet aggregation.Pregnancy and delivery in women with GT can present specific challenges as there is a significant risk of both maternal and fetal bleeding.
基金Tianjin Key Medical Discipline(Specialty)Construction Project,Grant/Award Number:TJYXZDXK-029ANational Natural Science Foundation of China,Grant/Award Numbers:82170327,82370332Research Impact Fund of the Hong Kong Metropolitan University,Grant/Award Number:RIF/2022/2.2。
文摘Cancer remains a major cause of mortality worldwide,and urological cancers are the most common cancers among men.Several therapeutic agents have been used to treat urological cancer,leading to improved survival for patients.However,this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications.Here,we propose the novel discipline of uro-cardio-oncology,an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer.In this comprehensive review,we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers,including androgen deprivation therapy,vascular endothelial growth factor receptor tyrosine kinase inhibitors,immune checkpoint inhibitors,and chemotherapeutics.In addition,we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance,diagnosis,and effective management of cardiovascular complications.Finally,we provide an analysis of future perspectives in this emerging specialty,identifying areas in need of further research.
