BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary app...BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary tota...BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary total knee replacement(TKR)OP-Rs has never been reported.Therefore,a standardized benchmark for assessment and factors affecting the completeness of TKR OP-Rs needs to be evaluated.AIM To evaluate the completeness rate of primary TKR OP-Rs in a teaching hospital and to assess the factors affecting completeness.METHODS A retrospective review of 58 consecutive primary TKR OP-Rs in a tertiary te-aching hospital were included in this study.We used document analysis to review the OP-Rs against a standardized list of six subsets of mandatory variables.The correlation between the percentage of completeness and the specific variables was determined.RESULTS After analyzing 58 cases,we found that the time to documentation was 1.5 hours.Out of the 52 mandatory variables,a median of 30 variables were documented yielding a completeness of 58%.Administrative,procedural,exposure,and im-plant variables were documented the most often,whereas clinical and process variables were most frequently left uncompleted.The documentation of the operative maneuver was variable.There was no association between the com-pleteness of the reports and the time to documentation,documenter level,com-plication rate,operative duration,or length of hospital stay.CONCLUSION Multiple variables were left undocumented on the unstructured primary TKR OP-Rs.The completeness percentage will likely improve after the implementation of a standardized structured OP-R.展开更多
Continuously increasing inflation is a major challenge in presenting reliable and relevant financial reports,especially in developing countries like Indonesia.This study aims to analyze the role of inflation accountin...Continuously increasing inflation is a major challenge in presenting reliable and relevant financial reports,especially in developing countries like Indonesia.This study aims to analyze the role of inflation accounting in increasing the reliability of financial reports during times of high inflation.With a qualitative-descriptive approach,this research examines two main methods in inflation accounting,namely General Price Level Accounting(GPLA)and Current Cost Accounting(CCA),and their impact on the value of assets,liabilities,income,and costs.The analysis results show that historical cost-based financial reports do not reflect actual economic conditions during inflation,so they can be misleading in decision making.The application of inflation accounting,through adjustments to purchasing power and current prices,has been proven to be able to increase the relevance and reliability of financial information.However,limitations in implementation in Indonesia are due to the lack of regulations and practical understanding regarding this method.Therefore,the application of inflation accounting is important in supporting the quality of financial reports and more accurate decision making amidst economic instability.展开更多
Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).W...Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).Written informed consents were obtained from the patients.Acupuncture is an integral part of traditional Chinese medicine,and is widely used for the treatment of systemic diseases and ophthalmologic diseases^([1-8]),such as paralysis caused by stroke^([4]),diabetes^([7]),dry eye disease^([8]),pigmentary degeneration of retina,macular degeneration,glaucoma,and optic atrophy^([6]).Improper acupuncture technique can lead to accidents.展开更多
Intravascular large B-cell lymphoma(IVLBCL),a rare subtype of non-Hodgkin lymphoma,is classified as an independent subtype of extranodal diffuse large B-cell lymphoma(DLBCL)in the 2008 World Health Organization(WHO)Cl...Intravascular large B-cell lymphoma(IVLBCL),a rare subtype of non-Hodgkin lymphoma,is classified as an independent subtype of extranodal diffuse large B-cell lymphoma(DLBCL)in the 2008 World Health Organization(WHO)Classification(Turner et al.,2010).The 5th edition of the World Health Organization(WHO 2022)classification of hematolymphoid tumors retains this subtype(Alaggio et al.,2022).IVLBCL,which is characterized by neoplastic lymphocyte proliferation within the lumen of small blood vessels,tends to invade organs,such as the nervous system,skin,bone marrow(BM),and lung(D'Angelo et al.,2019;Satoh et al.,2019;Vasquez et al.,2019;Fukami et al.,2020).展开更多
Objective To develop a quality appraisal tool for case reports in traditional Chinese medicine(TCM)based on their characteristics.Methods An extensive literature search was conducted in Chinese Biomedical Literature D...Objective To develop a quality appraisal tool for case reports in traditional Chinese medicine(TCM)based on their characteristics.Methods An extensive literature search was conducted in Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),and China Science and Technology Journal Database(CSTJ),focusing on expert consensus statements and check-lists for TCM case reports.Relevant items were extracted,and a Delphi method involving 34 experts was used in two rounds to rate each item on a 5-point Likert scale.Items were screened based on measures of central tendency and coordination(including total score,mean score,percentage of items rated as unimportant,and coefficient of variation).The weighted average method was used to determine item weights and construct the appraisal tool.Internal consistency was assessed using Cronbach’sαcoefficient.The finalized tool was pilot-tested by two reviewers independently appraising 20 case reports,with an additional four reviewers evaluating 5 of these cases to compare inter-rater consistency.Results A total of 9513 articles were retrieved,and 96 items from 25 articles were extracted.After two rounds of the Delphi method,27 items across 10 domains were retained.The Cron-bach’sαcoefficient was 0.72 in the first round(acceptable range),and 0.96 in the second round,indicating strong internal consistency.The tool was piloted by six reviewers,achieving a kappa value of 0.663 and a Kendall’s coefficient of concordance of 0.845,demonstrating high consistency among reviewers.Conclusion The developed TCM case report quality appraisal tool,consisting of 27 items in 10 domains,offers a scientific and reliable means of assessing the quality of TCM case reports.The tool showed high consistency and practical utility,and its application is expected to en-hance the standardization,scientific rigor,and evidence quality of TCM case reports,facilitat-ing the integration of traditional medical knowledge with modern evidence-based standards.展开更多
BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple pri...BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.展开更多
BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs interve...BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs intervention.More-over,diffuse hepatic hemangiomatosis(DHH)is not rare in the liver parenchyma adjacent to a GCH.The management strategy for hepatic hemangiomas can differ depending on the presence of associated hemangiomatosis and the amount and distribution of the residual hepatic parenchyma.CASE SUMMARY Herein,we report two patients with GCH coexistent with DHH successfully treated by laparoscopic microwave ablation.The two GCHs were ablated com-pletely and the ablated zone atrophied obviously in imaging follow-ups after ablation.Surprisingly,there was a trend toward gradual reduction and dimini-shment of DHH.CONCLUSION Thermal ablation treatment might be an effective and less invasive treatment for GCH coexistent with DHH around the hemangioma.展开更多
BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with a...BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.展开更多
BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver fu...BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.展开更多
BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and cornea.Diagnoses and treatments are challenging in settings,where advanced diagnostic tests are ...BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and cornea.Diagnoses and treatments are challenging in settings,where advanced diagnostic tests are unavailable,copper chelating agents are frequently scarce,healthcare professionals lack disease awareness,and medical follow-ups are limited.Prompt diagnoses and treatments help prevent complications,improve patients’quality of life,and ensure a normal life expectancy.The clinical presentations and outcomes of WD can vary within a single family.CASE SUMMARY We present the cases of two siblings(19 and 27 years)from a consanguineous family in rural Ecuador,diagnosed as having WD during a family screening.The male patient,diagnosed at age 19 after his brother’s death from acute liver failure,presented with compensated cirrhosis,neurological symptoms,and bilateral Kayser-Fleischer rings.He developed progressive neurological deterioration during an irregular treatment with D-penicillamine due to medication shortages.His condition improved upon switching to trientine tetrahydrochloride,and his neurological symptoms improved over an 8-year period of follow-ups.The female patient,diagnosed at age 10,exhibited only biochemical alterations.Her treatment history was similar;however,she remained asymptomatic without disease progression over the same follow-up period.We discuss the potential influence of epigenetic mechanisms and modifier genes on the various phenotypes,emphasizing the need for research in these areas to optimize therapeutic strategies.CONCLUSION Our patients’medical histories show how early diagnosis and treatment can prevent disease progression;and,how suboptimal treatments impact disease outcomes.展开更多
BACKGROUND Food protein-induced enterocolitis syndrome(FPIES)is the most serious type of non-immunoglobulin E(IgE)-mediated food allergic reaction manifesting as sepsis-like symptom,which can lead to shock.Saccharomyc...BACKGROUND Food protein-induced enterocolitis syndrome(FPIES)is the most serious type of non-immunoglobulin E(IgE)-mediated food allergic reaction manifesting as sepsis-like symptom,which can lead to shock.Saccharomyces boulardii(S.boulardii),a probiotic prescribed frequently in clinical settings,has been reported to trigger FPIES in an infant with soy-triggered FPIES.In this report,we describe a new clinical FPIES in which S.boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.CASE SUMMARY Seven FPIES cases triggered by only S.boulardii were gathered from 2011 to the present.None of the patients had previously experienced any allergic reaction to cow’s milk,soy,or complementary food.The age of the patients was 4-10-months old,and the symptoms of FPIES developed after ingestion of S.boulardii,which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea.All patients experienced severe repetitive vomiting 1-3 hours after S.boulardii ingestion.Extreme lethargy,marked pallor,and cyanosis were also observed.No IgE-mediated hypersensitivity developed in any patient.Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S.boulardii ingestion,and only one case showed bloody,purulent,and foul-smelling diarrhea.The patients stabilized quickly,mostly within 6 hours.Symptoms got all improved within 24 hours after discontinuation of S.boulardii.CONCLUSION S.boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.展开更多
BACKGROUND This manuscript describes the first known cases of sick sinus syndrome(SSS)associated with the use of anlotinib in non-small cell lung cancer patients,highlighting the need for increased vigilance and cardi...BACKGROUND This manuscript describes the first known cases of sick sinus syndrome(SSS)associated with the use of anlotinib in non-small cell lung cancer patients,highlighting the need for increased vigilance and cardiac monitoring.CASE SUMMARY Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment,respectively,presenting with syncope and palpit-ations.Electrocardiogram confirmed SSS,and different treatment approaches were taken for each patient.One patient received a dual-chamber permanent pacemaker,while the other discontinued the medication and experienced symptom resolution.CONCLUSION Anlotinib can induce SSS,suggesting that cardiac monitoring is crucial during anlotinib treatment.Individualized management strategies are necessary for affected individuals.展开更多
BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical man...BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.展开更多
Breast cancer is one of the most common malignancies among women globally.Magnetic resonance imaging(MRI),as the final non-invasive diagnostic tool before biopsy,provides detailed free-text reports that support clinic...Breast cancer is one of the most common malignancies among women globally.Magnetic resonance imaging(MRI),as the final non-invasive diagnostic tool before biopsy,provides detailed free-text reports that support clinical decision-making.Therefore,the effective utilization of the information in MRI reports to make reliable decisions is crucial for patient care.This study proposes a novel method for BI-RADS classification using breast MRI reports.Large language models are employed to transform free-text reports into structured reports.Specifically,missing category information(MCI)that is absent in the free-text reports is supplemented by assigning default values to the missing categories in the structured reports.To ensure data privacy,a locally deployed Qwen-Chat model is employed.Furthermore,to enhance the domain-specific adaptability,a knowledge-driven prompt is designed.The Qwen-7B-Chat model is fine-tuned specifically for structuring breast MRI reports.To prevent information loss and enable comprehensive learning of all report details,a fusion strategy is introduced,combining free-text and structured reports to train the classification model.Experimental results show that the proposed BI-RADS classification method outperforms existing report classification methods across multiple evaluation metrics.Furthermore,an external test set from a different hospital is used to validate the robustness of the proposed approach.The proposed structured method surpasses GPT-4o in terms of performance.Ablation experiments confirm that the knowledge-driven prompt,MCI,and the fusion strategy are crucial to the model’s performance.展开更多
BACKGROUND Glucocorticoids(GC)are the cornerstone in the treatment of severe alcoholassociated hepatitis(SAH)but may be associated with adverse events.CASE SUMMARY We report a prospective series of patients with SAH w...BACKGROUND Glucocorticoids(GC)are the cornerstone in the treatment of severe alcoholassociated hepatitis(SAH)but may be associated with adverse events.CASE SUMMARY We report a prospective series of patients with SAH who were treated with GC and developed de novo arthropathy within 2 weeks of GC cessation.Five patients were included in this series,three of whom were women.All patients underwent ultrasound evaluation and were referred to the Rheumatology Clinics.Final diagnoses were:Arthralgia associated with GC cessation(n=3),polymyalgia rheumatica(n=1)and psoriatic arthritis(n=1).Joint soreness was the main symptom,whereas arthritis occurred rarely.Patients with arthralgia associated with GC cessation required longer regimes of GC and tapering strategies but remained free of symptoms and specific treatment in the long term.CONCLUSION De novo arthropathy may occur following GC for SAH.Close monitoring and tapering regimes are advised.展开更多
文摘BACKGROUND Sorafenib has been the conventional treatment for advanced hepatocellular carcinoma(HCC)since 2008.While radiological complete responses are extremely rare,improved supportive care and multidisciplinary approaches in clinical practice may explain the recent increase in case reports and retrospective series documenting such responses.CASE SUMMARY This case series describes 3 patients with advanced HCC who achieved durable complete responses using first-line sorafenib therapy,even in the presence of portal vein thrombosis or extrahepatic spread,and highlights the potential for sustained remission in selected patients.Dermatologic toxicity and non-viral etiology may correlate with favorable outcomes;however,reliable predictive biomarkers for sorafenib response are lacking.CONCLUSION Future research into the etiology and molecular differences in HCC is necessary to develop more personalized therapy options.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Operative reports(OP-Rs)are essential for communication among healthcare providers.They require accuracy and completeness to serve as a quality indicator of patient care.Objective assessment of primary total knee replacement(TKR)OP-Rs has never been reported.Therefore,a standardized benchmark for assessment and factors affecting the completeness of TKR OP-Rs needs to be evaluated.AIM To evaluate the completeness rate of primary TKR OP-Rs in a teaching hospital and to assess the factors affecting completeness.METHODS A retrospective review of 58 consecutive primary TKR OP-Rs in a tertiary te-aching hospital were included in this study.We used document analysis to review the OP-Rs against a standardized list of six subsets of mandatory variables.The correlation between the percentage of completeness and the specific variables was determined.RESULTS After analyzing 58 cases,we found that the time to documentation was 1.5 hours.Out of the 52 mandatory variables,a median of 30 variables were documented yielding a completeness of 58%.Administrative,procedural,exposure,and im-plant variables were documented the most often,whereas clinical and process variables were most frequently left uncompleted.The documentation of the operative maneuver was variable.There was no association between the com-pleteness of the reports and the time to documentation,documenter level,com-plication rate,operative duration,or length of hospital stay.CONCLUSION Multiple variables were left undocumented on the unstructured primary TKR OP-Rs.The completeness percentage will likely improve after the implementation of a standardized structured OP-R.
文摘Continuously increasing inflation is a major challenge in presenting reliable and relevant financial reports,especially in developing countries like Indonesia.This study aims to analyze the role of inflation accounting in increasing the reliability of financial reports during times of high inflation.With a qualitative-descriptive approach,this research examines two main methods in inflation accounting,namely General Price Level Accounting(GPLA)and Current Cost Accounting(CCA),and their impact on the value of assets,liabilities,income,and costs.The analysis results show that historical cost-based financial reports do not reflect actual economic conditions during inflation,so they can be misleading in decision making.The application of inflation accounting,through adjustments to purchasing power and current prices,has been proven to be able to increase the relevance and reliability of financial information.However,limitations in implementation in Indonesia are due to the lack of regulations and practical understanding regarding this method.Therefore,the application of inflation accounting is important in supporting the quality of financial reports and more accurate decision making amidst economic instability.
基金Supported by Shaanxi Provincial Science and Technology Development Plan Project(No.2024SFYBXM-327).
文摘Dear Editor,We report two rare cases of ocular perforating injuries caused by acupuncture needles.Both cases were approved by the Ethics Committee of Xi’an People’s Hospital(Xi’an No.4 Hospital)(KJLL-Z-K-2023060).Written informed consents were obtained from the patients.Acupuncture is an integral part of traditional Chinese medicine,and is widely used for the treatment of systemic diseases and ophthalmologic diseases^([1-8]),such as paralysis caused by stroke^([4]),diabetes^([7]),dry eye disease^([8]),pigmentary degeneration of retina,macular degeneration,glaucoma,and optic atrophy^([6]).Improper acupuncture technique can lead to accidents.
文摘Intravascular large B-cell lymphoma(IVLBCL),a rare subtype of non-Hodgkin lymphoma,is classified as an independent subtype of extranodal diffuse large B-cell lymphoma(DLBCL)in the 2008 World Health Organization(WHO)Classification(Turner et al.,2010).The 5th edition of the World Health Organization(WHO 2022)classification of hematolymphoid tumors retains this subtype(Alaggio et al.,2022).IVLBCL,which is characterized by neoplastic lymphocyte proliferation within the lumen of small blood vessels,tends to invade organs,such as the nervous system,skin,bone marrow(BM),and lung(D'Angelo et al.,2019;Satoh et al.,2019;Vasquez et al.,2019;Fukami et al.,2020).
基金General Program of National Natural Science Foundation of China (82274412)Natural Science Foundation of Hunan Province (2020JJ4062)Science and Technology Innovation Program of Hunan Province (2020RC2061)。
文摘Objective To develop a quality appraisal tool for case reports in traditional Chinese medicine(TCM)based on their characteristics.Methods An extensive literature search was conducted in Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),and China Science and Technology Journal Database(CSTJ),focusing on expert consensus statements and check-lists for TCM case reports.Relevant items were extracted,and a Delphi method involving 34 experts was used in two rounds to rate each item on a 5-point Likert scale.Items were screened based on measures of central tendency and coordination(including total score,mean score,percentage of items rated as unimportant,and coefficient of variation).The weighted average method was used to determine item weights and construct the appraisal tool.Internal consistency was assessed using Cronbach’sαcoefficient.The finalized tool was pilot-tested by two reviewers independently appraising 20 case reports,with an additional four reviewers evaluating 5 of these cases to compare inter-rater consistency.Results A total of 9513 articles were retrieved,and 96 items from 25 articles were extracted.After two rounds of the Delphi method,27 items across 10 domains were retained.The Cron-bach’sαcoefficient was 0.72 in the first round(acceptable range),and 0.96 in the second round,indicating strong internal consistency.The tool was piloted by six reviewers,achieving a kappa value of 0.663 and a Kendall’s coefficient of concordance of 0.845,demonstrating high consistency among reviewers.Conclusion The developed TCM case report quality appraisal tool,consisting of 27 items in 10 domains,offers a scientific and reliable means of assessing the quality of TCM case reports.The tool showed high consistency and practical utility,and its application is expected to en-hance the standardization,scientific rigor,and evidence quality of TCM case reports,facilitat-ing the integration of traditional medical knowledge with modern evidence-based standards.
基金Supported by Gansu Provincial Natural Science Foundation,No.21JR1RA010In-Hospital Research Fund of Gansu Provincial Hospital,No.23GSSYD-5.
文摘BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.
文摘BACKGROUND Hepatic hemangioma represents the most common benign primary hepatic neo-plasm.Although most such tumors are small and asymptomatic,giant cavernous hemangioma(GCH)is frequently symptomatic,and needs intervention.More-over,diffuse hepatic hemangiomatosis(DHH)is not rare in the liver parenchyma adjacent to a GCH.The management strategy for hepatic hemangiomas can differ depending on the presence of associated hemangiomatosis and the amount and distribution of the residual hepatic parenchyma.CASE SUMMARY Herein,we report two patients with GCH coexistent with DHH successfully treated by laparoscopic microwave ablation.The two GCHs were ablated com-pletely and the ablated zone atrophied obviously in imaging follow-ups after ablation.Surprisingly,there was a trend toward gradual reduction and dimini-shment of DHH.CONCLUSION Thermal ablation treatment might be an effective and less invasive treatment for GCH coexistent with DHH around the hemangioma.
基金Supported by Xinjiang“Tianshan Talents”Medical and Health High-Level Talent Training Program-Young and Middle-Aged Backbone Medical Talents.
文摘BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.
文摘BACKGROUND This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placen-tal extract(HPE)therapy to improve the liver function of patients with chronic liver disease(CLD).CASE SUMMARY This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD.The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD.Im-provements were observed using abdominal ultrasonography.Unlike traditional methods,this protocol provided more sustainable and meaningful results.Treat-ment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function.The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.CONCLUSION This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.
文摘BACKGROUND Wilson's disease(WD)is a rare metabolic disorder of copper accumulation in organs such as liver,brain,and cornea.Diagnoses and treatments are challenging in settings,where advanced diagnostic tests are unavailable,copper chelating agents are frequently scarce,healthcare professionals lack disease awareness,and medical follow-ups are limited.Prompt diagnoses and treatments help prevent complications,improve patients’quality of life,and ensure a normal life expectancy.The clinical presentations and outcomes of WD can vary within a single family.CASE SUMMARY We present the cases of two siblings(19 and 27 years)from a consanguineous family in rural Ecuador,diagnosed as having WD during a family screening.The male patient,diagnosed at age 19 after his brother’s death from acute liver failure,presented with compensated cirrhosis,neurological symptoms,and bilateral Kayser-Fleischer rings.He developed progressive neurological deterioration during an irregular treatment with D-penicillamine due to medication shortages.His condition improved upon switching to trientine tetrahydrochloride,and his neurological symptoms improved over an 8-year period of follow-ups.The female patient,diagnosed at age 10,exhibited only biochemical alterations.Her treatment history was similar;however,she remained asymptomatic without disease progression over the same follow-up period.We discuss the potential influence of epigenetic mechanisms and modifier genes on the various phenotypes,emphasizing the need for research in these areas to optimize therapeutic strategies.CONCLUSION Our patients’medical histories show how early diagnosis and treatment can prevent disease progression;and,how suboptimal treatments impact disease outcomes.
基金Supported by The Keimyung University Dongsan Medical Center in 2006.
文摘BACKGROUND Food protein-induced enterocolitis syndrome(FPIES)is the most serious type of non-immunoglobulin E(IgE)-mediated food allergic reaction manifesting as sepsis-like symptom,which can lead to shock.Saccharomyces boulardii(S.boulardii),a probiotic prescribed frequently in clinical settings,has been reported to trigger FPIES in an infant with soy-triggered FPIES.In this report,we describe a new clinical FPIES in which S.boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.CASE SUMMARY Seven FPIES cases triggered by only S.boulardii were gathered from 2011 to the present.None of the patients had previously experienced any allergic reaction to cow’s milk,soy,or complementary food.The age of the patients was 4-10-months old,and the symptoms of FPIES developed after ingestion of S.boulardii,which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea.All patients experienced severe repetitive vomiting 1-3 hours after S.boulardii ingestion.Extreme lethargy,marked pallor,and cyanosis were also observed.No IgE-mediated hypersensitivity developed in any patient.Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S.boulardii ingestion,and only one case showed bloody,purulent,and foul-smelling diarrhea.The patients stabilized quickly,mostly within 6 hours.Symptoms got all improved within 24 hours after discontinuation of S.boulardii.CONCLUSION S.boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.
文摘BACKGROUND This manuscript describes the first known cases of sick sinus syndrome(SSS)associated with the use of anlotinib in non-small cell lung cancer patients,highlighting the need for increased vigilance and cardiac monitoring.CASE SUMMARY Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment,respectively,presenting with syncope and palpit-ations.Electrocardiogram confirmed SSS,and different treatment approaches were taken for each patient.One patient received a dual-chamber permanent pacemaker,while the other discontinued the medication and experienced symptom resolution.CONCLUSION Anlotinib can induce SSS,suggesting that cardiac monitoring is crucial during anlotinib treatment.Individualized management strategies are necessary for affected individuals.
基金Supported by Science and Technology Plan Project of Jiaxing,No.2021AD30044Supporting Discipline of Neurology in Jiaxing,No.2023-ZC-006Affiliated Hospital of Jiaxing University,No.2020-QMX-16.
文摘BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.
基金supported in part by the National Natural Science Foundation of China,Nos.62371499,U23A20483,82102130in part by the Department of Science and Technology of Shandong Province,No.SYS202208+2 种基金in part by the Suzhou Science and Technology Bureau,No.SJC2021023in part by the Guangdong Basic and Applied Basic Research Foundation,No.2023A1515011305in part by the Guangzhou Basic and Applied Basic Research Foundation,No.2023A04J2112.
文摘Breast cancer is one of the most common malignancies among women globally.Magnetic resonance imaging(MRI),as the final non-invasive diagnostic tool before biopsy,provides detailed free-text reports that support clinical decision-making.Therefore,the effective utilization of the information in MRI reports to make reliable decisions is crucial for patient care.This study proposes a novel method for BI-RADS classification using breast MRI reports.Large language models are employed to transform free-text reports into structured reports.Specifically,missing category information(MCI)that is absent in the free-text reports is supplemented by assigning default values to the missing categories in the structured reports.To ensure data privacy,a locally deployed Qwen-Chat model is employed.Furthermore,to enhance the domain-specific adaptability,a knowledge-driven prompt is designed.The Qwen-7B-Chat model is fine-tuned specifically for structuring breast MRI reports.To prevent information loss and enable comprehensive learning of all report details,a fusion strategy is introduced,combining free-text and structured reports to train the classification model.Experimental results show that the proposed BI-RADS classification method outperforms existing report classification methods across multiple evaluation metrics.Furthermore,an external test set from a different hospital is used to validate the robustness of the proposed approach.The proposed structured method surpasses GPT-4o in terms of performance.Ablation experiments confirm that the knowledge-driven prompt,MCI,and the fusion strategy are crucial to the model’s performance.
基金Supported by the Instituto de Salud Carlos III,No.PI22/00910.
文摘BACKGROUND Glucocorticoids(GC)are the cornerstone in the treatment of severe alcoholassociated hepatitis(SAH)but may be associated with adverse events.CASE SUMMARY We report a prospective series of patients with SAH who were treated with GC and developed de novo arthropathy within 2 weeks of GC cessation.Five patients were included in this series,three of whom were women.All patients underwent ultrasound evaluation and were referred to the Rheumatology Clinics.Final diagnoses were:Arthralgia associated with GC cessation(n=3),polymyalgia rheumatica(n=1)and psoriatic arthritis(n=1).Joint soreness was the main symptom,whereas arthritis occurred rarely.Patients with arthralgia associated with GC cessation required longer regimes of GC and tapering strategies but remained free of symptoms and specific treatment in the long term.CONCLUSION De novo arthropathy may occur following GC for SAH.Close monitoring and tapering regimes are advised.
