BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National ...This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.展开更多
Young women’s physical and mental health is seriously impacted by recurrent spontaneous abortion(RSA),a prevalent obstetric complication that is becoming more commonplace worldwide.Therefore,a thorough investigation ...Young women’s physical and mental health is seriously impacted by recurrent spontaneous abortion(RSA),a prevalent obstetric complication that is becoming more commonplace worldwide.Therefore,a thorough investigation into the pathophysiology of RSA and the development of novel therapeutic strategies are imperative.Recent developments suggest that mesenchymal stem cell(MSC)-based therapies may be viable for addressing RSA.Through a variety of mechanisms,the immunological circumstances at the maternal-fetal contact can be altered,including regulating immune cell homeostasis,enhancing immune tolerance,alleviating inflammatory responses,promoting angiogenic processes,and promoting tissue regeneration.MSCs exhibit a remarkable capacity for multidifferentiation that could enhance pregnancy outcomes.This article provides compelling studies supporting the efficacy of MSC-based therapies in improving pregnancy outcomes in women with RSA.展开更多
Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predi...Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
In this paper,a new study concerning the usage of artificial neural networks in the control application is given.It is shown,that the data gathered during proper operation of a given control plant can be used in the l...In this paper,a new study concerning the usage of artificial neural networks in the control application is given.It is shown,that the data gathered during proper operation of a given control plant can be used in the learning process to fully embrace the control pattern.Interestingly,the instances driven by neural networks have the ability to outperform the original analytically driven scenarios.Three different control schemes,namely perfect,linear-quadratic,and generalized predictive controllers were used in the theoretical study.In addition,the nonlinear recurrent neural network-based generalized predictive controller with the radial basis function-originated predictor was obtained to exemplify the main results of the paper regarding the real-world application.展开更多
Recurrent aphthous stomatitis(RAS)is a very frequent condition in developed countries whose basic symptom is a lesion referred to as an aphthous ulcer.High levels of interleukin(IL)-1 and IL-6 and low salivary levels ...Recurrent aphthous stomatitis(RAS)is a very frequent condition in developed countries whose basic symptom is a lesion referred to as an aphthous ulcer.High levels of interleukin(IL)-1 and IL-6 and low salivary levels of IL-10 are the basis of RAS pathogenesis.Sublingual supplements based on IL-10 can be very useful in reducing the phenomenon of aphthous recurrence in patients with RAS.An observational clinical experience with a group of 5 patients with RAS receiving a commercially available IL-10-based supplement was reported by the authors.The findings revealed a subsequent reduction in the incidence of mouth ulcers.展开更多
Electric vehicles(EVs)are gradually being deployed in the transportation sector.Although they have a high impact on reducing greenhouse gas emissions,their penetration is challenged by their random energy demand and d...Electric vehicles(EVs)are gradually being deployed in the transportation sector.Although they have a high impact on reducing greenhouse gas emissions,their penetration is challenged by their random energy demand and difficult scheduling of their optimal charging.To cope with these problems,this paper presents a novel approach for photovoltaic grid-connected microgrid EV charging station energy demand forecasting.The present study is part of a comprehensive framework involving emerging technologies such as drones and artificial intelligence designed to support the EVs’charging scheduling task.By using predictive algorithms for solar generation and load demand estimation,this approach aimed at ensuring dynamic and efficient energy flow between the solar energy source,the grid and the electric vehicles.The main contribution of this paper lies in developing an intelligent approach based on deep recurrent neural networks to forecast the energy demand using only its previous records.Therefore,various forecasters based on Long Short-term Memory,Gated Recurrent Unit,and their bi-directional and stacked variants were investigated using a real dataset collected from an EV charging station located at Trieste University(Italy).The developed forecasters have been evaluated and compared according to different metrics,including R,RMSE,MAE,and MAPE.We found that the obtained R values for both PV power generation and energy demand ranged between 97%and 98%.These study findings can be used for reliable and efficient decision-making on the management side of the optimal scheduling of the charging operations.展开更多
BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmaphe...BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.展开更多
Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will...Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will account for a continued increase in the rates of liver cancer.The recurrence of HCC has been reported across the different etiologies of liver disease.Unlike primary HCC,there is no agreed consensus or guidance as to the optimum management of re-current HCC(RHCC).Furthermore,the management of RHCC may prove more challenging compared to primary liver cancer,given the smaller residual liver volume and functions in settings following surgery or transplantation.Various modalities exist for the treatment of primary HCC including resection,liver transplantation,loco-regional and systemic therapies.Nevertheless,the role of such modalities remains unclear in the management of RHCC.In this article,we aim to review the different approaches of the current standards for the mana-gement of RHCC.We will also shed some light on the future perspectives in this field.展开更多
Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associa...Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associated with Behçet’s disease(BD),and RAS in individuals with HIV infection.A systematic review was conducted following PICOS(Patient,Intervention,Control,Outcome,Study design)principles.Given the heterogeneity across studies,a qualitative analysis was performed in place of a meta-analysis.Eight randomized controlled trials(RCTs)were deemed eligible for inclusion.In three RCTs focused on RAS,a dosage of thalidomide at 100 mg/d demonstrated efficacy,while a lower dose of 25 mg/d helped prolong the recurrence interval of RAS.For oro-genital ulcers of BD,two RCTs indicated that both 300 mg/d for 24 weeks and 200 mg/d for 28 d,preceded by an initial dose of 400 mg/d for 5 d,were effective.In three RCTs investigating RAS in HIV-infected patients,thalidomide at 200 mg/d for either 4 or 7 weeks,with an initial dose of 400 mg/d for the first week,proved effective.However,a regimen of 100 mg three times per week failed to prevent the recurrence of oral ulcers.Adverse reactions to thalidomide were generally tolerable within the dosage ranges used in these studies.Overall,thalidomide showed promising efficacy for treating RAS,oro-genital ulcers in BD,and RAS in HIV-infected individuals.However,the variability in trial designs,dosages,and treatment durations makes it challenging to recommend an optimal dose and course of therapy.Further high-quality RCTs are necessary to establish more definitive guidelines.展开更多
Endometrial cancer is the most common gynecologic cancer diagnosed in the United States and mortality is on the rise.Advanced and recurrent endometrial cancer represents a treatment challenge as historically there hav...Endometrial cancer is the most common gynecologic cancer diagnosed in the United States and mortality is on the rise.Advanced and recurrent endometrial cancer represents a treatment challenge as historically there have been limited therapeutic options for patients.In the last several years,multiple practice-changing clinical trials have led to significant improvements in the treatment landscape.This review will cover updates in the treatment and management of advanced and recurrent endometrial cancer with a focus on novel therapeutics,such as anti-PD-L1 and PD-1 inhibitors,poly ADP-ribose polymerase(PARP)inhibitors,antibody-drug conjugates,and hormonal therapy.展开更多
BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval....BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.展开更多
BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psycholog...BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.展开更多
Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated wi...Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated with immune disorders that may affect the endometrial immune micro-environment.However,the effect of STRIGs on RIF remains unknown.Methods:Training(GSE111974)and validation(GSE106602)cohorts were acquired from the Gene Expression Omnibus database.STIRGs were extracted from the Molecular Signatures Database and relevant studies.Consensus clustering analysis was used to identify RIF molecular subtypes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment and immune infiltration analyses were performed between RIF subtypes.Drug-related potential therapeutic target genes were discovered.Results:Two distinct molecular subtypes were discovered in both the training and validation groups according to STIRGs.In subtype C2,there was a notable decrease in the presence of different types of immune cells,such as natural killer cells and macrophages.Furthermore,the examination of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated a decrease in numerous immune-related biological processes within subtype C2.Finally,nine hub genes(CXCR4,POU5F1,PPARG,TLR2,EGFR,CSF1,BCL2A1,BTK,and SRGN)were identified as potential therapeutic targets for RIF.Conclusion:Based on STIRGs,we identified a new molecular subtype with significantly reduced immune infiltration in RIF.Nine genes might be potential therapeutic targets for RIF.展开更多
The converter steelmaking process represents a pivotal aspect of steel metallurgical production,with the characteristics of the flame at the furnace mouth serving as an indirect indicator of the internal smelting stag...The converter steelmaking process represents a pivotal aspect of steel metallurgical production,with the characteristics of the flame at the furnace mouth serving as an indirect indicator of the internal smelting stage.Effectively identifying and predicting the smelt-ing stage poses a significant challenge within industrial production.Traditional image-based methodologies,which rely on a single static flame image as input,demonstrate low recognition accuracy and inadequately extract the dynamic changes in smelting stage.To address this issue,the present study introduces an innovative recognition model that preprocesses flame video sequences from the furnace mouth and then employs a convolutional recurrent neural network(CRNN)to extract spatiotemporal features and derive recognition outputs.Ad-ditionally,we adopt feature layer visualization techniques to verify the model’s effectiveness and further enhance model performance by integrating the Bayesian optimization algorithm.The results indicate that the ResNet18 with convolutional block attention module(CBAM)in the convolutional layer demonstrates superior image feature extraction capabilities,achieving an accuracy of 90.70%and an area under the curve of 98.05%.The constructed Bayesian optimization-CRNN(BO-CRNN)model exhibits a significant improvement in comprehensive performance,with an accuracy of 97.01%and an area under the curve of 99.85%.Furthermore,statistics on the model’s average recognition time,computational complexity,and parameter quantity(Average recognition time:5.49 ms,floating-point opera-tions per second:18260.21 M(1 M=1×10^(6)),parameters:11.58 M)demonstrate superior performance.Through extensive repeated ex-periments on real-world datasets,the proposed CRNN model is capable of rapidly and accurately identifying smelting stages,offering a novel approach for converter smelting endpoint control.展开更多
By analyzing the bus operation environment and accounting for prediction uncertainties,a bus arrival interval prediction model was developed utilizing a gated recur-rent unit(GRU)neural network.To reduce the impact of...By analyzing the bus operation environment and accounting for prediction uncertainties,a bus arrival interval prediction model was developed utilizing a gated recur-rent unit(GRU)neural network.To reduce the impact of irrelevant data and boost prediction accuracy,an attention mechanism was integrated into the point model to concen-trate on important input sequence information.Based on the point predictions,the lower upper bound estimation(LUBE)method was used,providing a range for the bus interval times predicted by the model.The model was vali-dated using data from 169 bus routes in Nanchang,Jiangxi Province.The results indicated that the attention-GRU model outperformed neural network,long short-term memory and GRU models.Compared with the Bootstrap method,the LUBE method has a narrower average interval width.The coverage width-based criterion(CWC)was reduced by 8.1%,2.2%,and 5.7%at confidence levels of 85%,90%,and 95%,respectively,during the off-peak period,and by 23.2%,26.9%,and 27.3%at confidence levels of 85%,90%,and 95%,respectively,during the peak period.Therefore,it can accurately describe the fluctuation range in bus arrival times with higher accuracy and stability.展开更多
The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of availabl...The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.展开更多
BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases ...BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases in this area are partic-ularly uncommon,posing considerable surgical complexities.Owing to their neu-roendocrine activity,PGLs are capable of secreting hormones like catecholamines,thereby presenting significant challenges in hemodynamic management during the perioperative period.CASE SUMMARY We report a 64-year-old man with a recurrent retroperitoneal PGL.The patient underwent retroperitoneal mass resection in 2013,with postoperative pathology revealing a PGL.Regular follow-up was not conducted until April 2024,when a computed tomography scan revealed a huge mass in the retroperitoneum,closely adjacent to the abdominal aorta.Laboratory examinations revealed elevated levels of catecholamines in the patient's blood serum.Upon admission,volume expan-sion and blood pressure(BP)monitoring were carried out for one week,with catecholamine levels reviewed and normalized.Adequate preoperative prepa-ration was conducted,including central venous access,arterial BP monitoring,and the preparation of vasoactive agents.During tumor resection,the patient ex-perienced acute,significant fluctuations in BP.The timely intervention of the anesthesiologist stabilized the BP,facilitating the successful resection of the tumor which was confirmed as a recurrent PGL.Postoperative follow-up revealed no evidence of tumor residual or recurrence.CONCLUSION PGL recurrence is rare but non-negligible.PGLs adjacent to major arteries com-plicate surgery,and perioperative hemodynamic stability demands meticulous attention.Core Tip:Recurrent retroperitoneal paragangliomas are infrequent but pose substantial surgical challenges,particularly when located adjacent to critical vascular structures such as the abdominal aorta.Effective perioperative management of he-modynamic fluctuations,driven by catecholamine secretion,requires meticulous preoperative planning,including volume expansion,blood pressure monitoring,and vasoactive agent preparation.Surgical intervention demands prompt and coordinated anesthetic support to stabilize hemodynamics,ensuring successful tumor resection.Given the potential for late recurrence,long-term follow-up is essential for early detection and management of asymptomatic recurrences.INTRODUCTION Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia,which are associated with the autonomic nervous system[1].These tumors arise from chromaffin cells or similar cells capable of secreting catecholamines,such as adrenaline and noradrenaline.PGLs manifest in various anatomical locations,including the head,neck,chest,abdomen,and pelvis,and are characterized by neurosecretory and chief cells surrounded by prominent vascular stroma.Although typically benign,malignant forms of PGL are also recognized,and they may exhibit a tendency for recurrence or me-tastasis[2].PGLs located in the retroperitoneum are relatively uncommon and present greater surgical challenges because of their complex anatomical location near vital organs and major blood vessels.Their catecholamine-secreting nature further complicates the maintenance of hemodynamic stability during the perioperative period.In May 2024,a patient with recurrent retroperitoneal PGL was admitted to our hospital,and the details are reported below.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.
基金Supported by the Natural Science Foundation of Liaoning Province,No.2024-MSLH-525.
文摘Young women’s physical and mental health is seriously impacted by recurrent spontaneous abortion(RSA),a prevalent obstetric complication that is becoming more commonplace worldwide.Therefore,a thorough investigation into the pathophysiology of RSA and the development of novel therapeutic strategies are imperative.Recent developments suggest that mesenchymal stem cell(MSC)-based therapies may be viable for addressing RSA.Through a variety of mechanisms,the immunological circumstances at the maternal-fetal contact can be altered,including regulating immune cell homeostasis,enhancing immune tolerance,alleviating inflammatory responses,promoting angiogenic processes,and promoting tissue regeneration.MSCs exhibit a remarkable capacity for multidifferentiation that could enhance pregnancy outcomes.This article provides compelling studies supporting the efficacy of MSC-based therapies in improving pregnancy outcomes in women with RSA.
文摘Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
文摘In this paper,a new study concerning the usage of artificial neural networks in the control application is given.It is shown,that the data gathered during proper operation of a given control plant can be used in the learning process to fully embrace the control pattern.Interestingly,the instances driven by neural networks have the ability to outperform the original analytically driven scenarios.Three different control schemes,namely perfect,linear-quadratic,and generalized predictive controllers were used in the theoretical study.In addition,the nonlinear recurrent neural network-based generalized predictive controller with the radial basis function-originated predictor was obtained to exemplify the main results of the paper regarding the real-world application.
文摘Recurrent aphthous stomatitis(RAS)is a very frequent condition in developed countries whose basic symptom is a lesion referred to as an aphthous ulcer.High levels of interleukin(IL)-1 and IL-6 and low salivary levels of IL-10 are the basis of RAS pathogenesis.Sublingual supplements based on IL-10 can be very useful in reducing the phenomenon of aphthous recurrence in patients with RAS.An observational clinical experience with a group of 5 patients with RAS receiving a commercially available IL-10-based supplement was reported by the authors.The findings revealed a subsequent reduction in the incidence of mouth ulcers.
基金University of Jeddah,Jeddah,Saudi Arabia,grant No.(UJ-23-SRP-10).
文摘Electric vehicles(EVs)are gradually being deployed in the transportation sector.Although they have a high impact on reducing greenhouse gas emissions,their penetration is challenged by their random energy demand and difficult scheduling of their optimal charging.To cope with these problems,this paper presents a novel approach for photovoltaic grid-connected microgrid EV charging station energy demand forecasting.The present study is part of a comprehensive framework involving emerging technologies such as drones and artificial intelligence designed to support the EVs’charging scheduling task.By using predictive algorithms for solar generation and load demand estimation,this approach aimed at ensuring dynamic and efficient energy flow between the solar energy source,the grid and the electric vehicles.The main contribution of this paper lies in developing an intelligent approach based on deep recurrent neural networks to forecast the energy demand using only its previous records.Therefore,various forecasters based on Long Short-term Memory,Gated Recurrent Unit,and their bi-directional and stacked variants were investigated using a real dataset collected from an EV charging station located at Trieste University(Italy).The developed forecasters have been evaluated and compared according to different metrics,including R,RMSE,MAE,and MAPE.We found that the obtained R values for both PV power generation and energy demand ranged between 97%and 98%.These study findings can be used for reliable and efficient decision-making on the management side of the optimal scheduling of the charging operations.
文摘BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.
文摘Hepatocellular carcinoma(HCC)remains one of the commonest cancers world-wide with an overall poor prognosis and survival rates.The rising incidence of liver disease,in particular non-alcoholic fatty liver disease,will account for a continued increase in the rates of liver cancer.The recurrence of HCC has been reported across the different etiologies of liver disease.Unlike primary HCC,there is no agreed consensus or guidance as to the optimum management of re-current HCC(RHCC).Furthermore,the management of RHCC may prove more challenging compared to primary liver cancer,given the smaller residual liver volume and functions in settings following surgery or transplantation.Various modalities exist for the treatment of primary HCC including resection,liver transplantation,loco-regional and systemic therapies.Nevertheless,the role of such modalities remains unclear in the management of RHCC.In this article,we aim to review the different approaches of the current standards for the mana-gement of RHCC.We will also shed some light on the future perspectives in this field.
文摘Thalidomide,an immunomodulatory drug,is widely recommended for the treatment of recurrent aphthous stomatitis(RAS).This review aimed to assess the reliability of thalidomide for managing RAS,oro-genital ulcers associated with Behçet’s disease(BD),and RAS in individuals with HIV infection.A systematic review was conducted following PICOS(Patient,Intervention,Control,Outcome,Study design)principles.Given the heterogeneity across studies,a qualitative analysis was performed in place of a meta-analysis.Eight randomized controlled trials(RCTs)were deemed eligible for inclusion.In three RCTs focused on RAS,a dosage of thalidomide at 100 mg/d demonstrated efficacy,while a lower dose of 25 mg/d helped prolong the recurrence interval of RAS.For oro-genital ulcers of BD,two RCTs indicated that both 300 mg/d for 24 weeks and 200 mg/d for 28 d,preceded by an initial dose of 400 mg/d for 5 d,were effective.In three RCTs investigating RAS in HIV-infected patients,thalidomide at 200 mg/d for either 4 or 7 weeks,with an initial dose of 400 mg/d for the first week,proved effective.However,a regimen of 100 mg three times per week failed to prevent the recurrence of oral ulcers.Adverse reactions to thalidomide were generally tolerable within the dosage ranges used in these studies.Overall,thalidomide showed promising efficacy for treating RAS,oro-genital ulcers in BD,and RAS in HIV-infected individuals.However,the variability in trial designs,dosages,and treatment durations makes it challenging to recommend an optimal dose and course of therapy.Further high-quality RCTs are necessary to establish more definitive guidelines.
文摘Endometrial cancer is the most common gynecologic cancer diagnosed in the United States and mortality is on the rise.Advanced and recurrent endometrial cancer represents a treatment challenge as historically there have been limited therapeutic options for patients.In the last several years,multiple practice-changing clinical trials have led to significant improvements in the treatment landscape.This review will cover updates in the treatment and management of advanced and recurrent endometrial cancer with a focus on novel therapeutics,such as anti-PD-L1 and PD-1 inhibitors,poly ADP-ribose polymerase(PARP)inhibitors,antibody-drug conjugates,and hormonal therapy.
文摘BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.
文摘BACKGROUND Despite advances in the use of in vitro fertilization-embryo transfer(ET)in couples with infertility,recurrent implantation failure(RIF)after ET is still a major problem affecting women,with great psychological and economic burdens for the patient and his/her family.AIM To investigate the psychological burden(anxiety and depression)and evaluate the clinical benefits of endometrial receptivity testing(ERT)in patients experiencing RIF following frozen-thawed ET.METHODS A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People’s Hospital of Changde City between January 2021 and June 2024.Demographic and clinical data were systematically collected through standardized questionnaires.Psychological assessment utilized validated instruments:The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment.Participants were stratified by psychological status(anxiety/non-anxiety and depression/nondepression)to analyze influencing factors for anxiety and depression.The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes.Additionally,they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models.Compared with the non-ERT group,the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate,thicker endometrium on transfer day,fewer embryos transferred,and a lower miscarriage rate.RESULTS The study identified a substantial psychological burden,with anxiety prevalence at 55.0%(mean Self-Rating Anxiety Scale score,50.89±9.34)and depression at 61.2%(mean Self-Rating Depression Scale score,55.55±9.48).Multivariate analysis identified annual household income>100000 yuan as protective factors against both anxiety and depression,whereas advanced maternal age(>35 years)and multiple implantation failures(≥3)served as risk factors.Additionally,anxiety-specific risk factors included prolonged infertility treatment(>5 years)and the spouse’s status as an only child.As to depression-specific risks,chronic infertility(>3 years)and higher educational attainment(college/bachelor’s degree or higher)were key determinants,whereas urban residence was a protective factor.Age>35 years was a risk factor for clinical pregnancy in patients experiencing RIF,whereas blastocyst-stage ET,a higher number of embryos transferred,and thicker endometrium were protective factors.CONCLUSION Patients experiencing RIF are particularly susceptible to anxiety and depression,and advanced maternal age and multiple implantation failures represent salient risk factors.Clinicians should implement proactive and evidencebased interventions to mitigate these psychological burdens.For patients experiencing RIF,ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.
文摘Background:Recurrent implantation failure(RIF)is a difficult problem with a multifaceted cause.Recent studies have demonstrated that stimulator of interferon genes-induced immune-related genes(STIRGs)are associated with immune disorders that may affect the endometrial immune micro-environment.However,the effect of STRIGs on RIF remains unknown.Methods:Training(GSE111974)and validation(GSE106602)cohorts were acquired from the Gene Expression Omnibus database.STIRGs were extracted from the Molecular Signatures Database and relevant studies.Consensus clustering analysis was used to identify RIF molecular subtypes.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment and immune infiltration analyses were performed between RIF subtypes.Drug-related potential therapeutic target genes were discovered.Results:Two distinct molecular subtypes were discovered in both the training and validation groups according to STIRGs.In subtype C2,there was a notable decrease in the presence of different types of immune cells,such as natural killer cells and macrophages.Furthermore,the examination of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated a decrease in numerous immune-related biological processes within subtype C2.Finally,nine hub genes(CXCR4,POU5F1,PPARG,TLR2,EGFR,CSF1,BCL2A1,BTK,and SRGN)were identified as potential therapeutic targets for RIF.Conclusion:Based on STIRGs,we identified a new molecular subtype with significantly reduced immune infiltration in RIF.Nine genes might be potential therapeutic targets for RIF.
基金financially supported by the National Natural Science Foundation of China(No.52374320).
文摘The converter steelmaking process represents a pivotal aspect of steel metallurgical production,with the characteristics of the flame at the furnace mouth serving as an indirect indicator of the internal smelting stage.Effectively identifying and predicting the smelt-ing stage poses a significant challenge within industrial production.Traditional image-based methodologies,which rely on a single static flame image as input,demonstrate low recognition accuracy and inadequately extract the dynamic changes in smelting stage.To address this issue,the present study introduces an innovative recognition model that preprocesses flame video sequences from the furnace mouth and then employs a convolutional recurrent neural network(CRNN)to extract spatiotemporal features and derive recognition outputs.Ad-ditionally,we adopt feature layer visualization techniques to verify the model’s effectiveness and further enhance model performance by integrating the Bayesian optimization algorithm.The results indicate that the ResNet18 with convolutional block attention module(CBAM)in the convolutional layer demonstrates superior image feature extraction capabilities,achieving an accuracy of 90.70%and an area under the curve of 98.05%.The constructed Bayesian optimization-CRNN(BO-CRNN)model exhibits a significant improvement in comprehensive performance,with an accuracy of 97.01%and an area under the curve of 99.85%.Furthermore,statistics on the model’s average recognition time,computational complexity,and parameter quantity(Average recognition time:5.49 ms,floating-point opera-tions per second:18260.21 M(1 M=1×10^(6)),parameters:11.58 M)demonstrate superior performance.Through extensive repeated ex-periments on real-world datasets,the proposed CRNN model is capable of rapidly and accurately identifying smelting stages,offering a novel approach for converter smelting endpoint control.
基金The National Natural Science Foundation of China(No.52162042)General Science and Technology Project of Jiangxi Provincial Department of Transportation(No.2024YB039).
文摘By analyzing the bus operation environment and accounting for prediction uncertainties,a bus arrival interval prediction model was developed utilizing a gated recur-rent unit(GRU)neural network.To reduce the impact of irrelevant data and boost prediction accuracy,an attention mechanism was integrated into the point model to concen-trate on important input sequence information.Based on the point predictions,the lower upper bound estimation(LUBE)method was used,providing a range for the bus interval times predicted by the model.The model was vali-dated using data from 169 bus routes in Nanchang,Jiangxi Province.The results indicated that the attention-GRU model outperformed neural network,long short-term memory and GRU models.Compared with the Bootstrap method,the LUBE method has a narrower average interval width.The coverage width-based criterion(CWC)was reduced by 8.1%,2.2%,and 5.7%at confidence levels of 85%,90%,and 95%,respectively,during the off-peak period,and by 23.2%,26.9%,and 27.3%at confidence levels of 85%,90%,and 95%,respectively,during the peak period.Therefore,it can accurately describe the fluctuation range in bus arrival times with higher accuracy and stability.
基金approved by the Ethics Committee of the Second Affiliated Hospital,Zhejiang University School of Medicine(2024-0690).
文摘The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.
基金Supported by Natural Science Foundation of Zhejiang Province,China,No.LQ21H020007.
文摘BACKGROUND Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia that can occur in various locations,such as the head,neck,chest,abdomen,and pelvis.Retroperitoneal PGLs are rare,and recurrent cases in this area are partic-ularly uncommon,posing considerable surgical complexities.Owing to their neu-roendocrine activity,PGLs are capable of secreting hormones like catecholamines,thereby presenting significant challenges in hemodynamic management during the perioperative period.CASE SUMMARY We report a 64-year-old man with a recurrent retroperitoneal PGL.The patient underwent retroperitoneal mass resection in 2013,with postoperative pathology revealing a PGL.Regular follow-up was not conducted until April 2024,when a computed tomography scan revealed a huge mass in the retroperitoneum,closely adjacent to the abdominal aorta.Laboratory examinations revealed elevated levels of catecholamines in the patient's blood serum.Upon admission,volume expan-sion and blood pressure(BP)monitoring were carried out for one week,with catecholamine levels reviewed and normalized.Adequate preoperative prepa-ration was conducted,including central venous access,arterial BP monitoring,and the preparation of vasoactive agents.During tumor resection,the patient ex-perienced acute,significant fluctuations in BP.The timely intervention of the anesthesiologist stabilized the BP,facilitating the successful resection of the tumor which was confirmed as a recurrent PGL.Postoperative follow-up revealed no evidence of tumor residual or recurrence.CONCLUSION PGL recurrence is rare but non-negligible.PGLs adjacent to major arteries com-plicate surgery,and perioperative hemodynamic stability demands meticulous attention.Core Tip:Recurrent retroperitoneal paragangliomas are infrequent but pose substantial surgical challenges,particularly when located adjacent to critical vascular structures such as the abdominal aorta.Effective perioperative management of he-modynamic fluctuations,driven by catecholamine secretion,requires meticulous preoperative planning,including volume expansion,blood pressure monitoring,and vasoactive agent preparation.Surgical intervention demands prompt and coordinated anesthetic support to stabilize hemodynamics,ensuring successful tumor resection.Given the potential for late recurrence,long-term follow-up is essential for early detection and management of asymptomatic recurrences.INTRODUCTION Paraganglioma(PGL)is a neuroendocrine tumor originating from paraganglia,which are associated with the autonomic nervous system[1].These tumors arise from chromaffin cells or similar cells capable of secreting catecholamines,such as adrenaline and noradrenaline.PGLs manifest in various anatomical locations,including the head,neck,chest,abdomen,and pelvis,and are characterized by neurosecretory and chief cells surrounded by prominent vascular stroma.Although typically benign,malignant forms of PGL are also recognized,and they may exhibit a tendency for recurrence or me-tastasis[2].PGLs located in the retroperitoneum are relatively uncommon and present greater surgical challenges because of their complex anatomical location near vital organs and major blood vessels.Their catecholamine-secreting nature further complicates the maintenance of hemodynamic stability during the perioperative period.In May 2024,a patient with recurrent retroperitoneal PGL was admitted to our hospital,and the details are reported below.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
