Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1...Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1-3].Risk factors for fungal keratitis include trauma with vegetative matter,contact lens wear,history of ocular surgery,chronic topical steroid use,low socioeconomic status and tropical climate[1-2].Fungi have the propensity to penetrate deep into the corneal stroma,making the infection difficult to treat with topical antifungal agents alone.Complications such as corneal perforation and endophthalmitis can arise in severe cases,making early identification of the causative fungal pathogen of utmost importance[4-5].Moreover,obtaining susceptibilities to the available antifungal agents can be sight and eye saving[5].展开更多
Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,pote...Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.展开更多
Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein ...Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein abundance but are also primarily regulated by various post-translational protein modifications.Lactate,once considered merely a byproduct of anaerobic metabolism,has emerged as a crucial energy substrate and signaling molecule involved in both physiological and pathological processes within the nervous system.Furthermore,recent studies have emphasized the significant role of lactate in numerous neurological diseases,including Alzheimer's disease,Parkinson's disease,acute cerebral ischemic stroke,multiple sclerosis,Huntington's disease,and myasthenia gravis.The purpose of this review is to synthesize the current research on lactate and lactylation modifications in neurological diseases,aiming to clarify their mechanisms of action and identify potential therapeutic targets.As such,this work provides an overview of the metabolic regulatory roles of lactate in various disorders,emphasizing its involvement in the regulation of brain function.Additionally,the specific mechanisms of brain lactate metabolism are discussed,suggesting the unique roles of lactate in modulating brain function.As a critical aspect of lactate function,lactylation modifications,including both histone and non-histone lactylation,are explored,with an emphasis on recent advancements in identifying the key regulatory enzymes of such modifications,such as lactylation writers and erasers.The effects and specific mechanisms of abnormal lactate metabolism in diverse neurological diseases are summarized,revealing that lactate acts as a signaling molecule in the regulation of brain functions and that abnormal lactate metabolism is implicated in the progression of various neurological disorders.Future research should focus on further elucidating the molecular mechanisms underlying lactate and lactylation modifications and exploring their potential as therapeutic targets for neurological diseases.展开更多
While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal mana...While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.展开更多
Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Rec...Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Recent advances in proteomic profiling have identified significant dysregulation in astrocytic and microglial metabolic pathways in AD pathogenesis,establishing mechanistic links between metabolic dyshomeostasis and neuroimmune crosstalk.Accumulating evidence indicates that acupuncture has gained prominence as a non-pharmacological therapeutic modality for AD management,owing to its multimodal regulatory effects on neuroinflammatory cascades,metabolic recalibration,and immune network stabilization.This study aims to elucidate the molecular mechanisms through which acupuncture exerts its neuroprotective effects,focusing on three interconnected axes:immunometabolic reprogramming in glial cells(particularly microglial bioenergetic adaptation),gut microbiota-derived metabolite signaling(including short-chain fatty acid-mediated pathways),and neuro‐immune‐metabolic interplay.We present a novel therapeutic framework highlighting acupuncture-mediated immunometabolic modulation,thereby providing a mechanistic foundation for developing targeted therapeutic strategies in AD management.展开更多
The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios re...The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios require a more specialized approach,and some groups of patients may benefit from customized Ilizarov constructs.Engineering science has designed various external fixators for orthopedic purposes,and some of those have become the gold standard for specific clinical tasks.We aimed to determine the current state and novel modifications of specialized external fixators for specific clinical situations which are based on the principles of the Ilizarov method.They are half-pin-based fixators for temporal fracture fixation,ring or hybrid devices for gradual deformity correction,and compression-distraction devices tailored for definite limb segments.Gradual correction of deformities can be achieved with external hexapods incorporating universal reduction units.Alternatively,external fixators with special connection mechanisms are able to provide independent movement of the rings in six degrees of freedom.Deformity correction can be performed with combined or sequential use of external and internal fixators.Special devices were developed for moving the split fragment for revascularization of the tibia.The units of external frames on the foot were modified to consider its complex anatomy and the clinical needs ranging from correction of multi-plane deformities,joint arthrodesis to distraction arthroplasty.Mini-fixators are compact external fixators for small bones of the hand and foot.The varieties of external fixators based on the Ilizarov principles have been designed to fulfill an ultimate goal of improving treatment outcomes.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk fa...Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical res...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.展开更多
Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms ...Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.展开更多
Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions t...Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.展开更多
A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoho...A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoholic liver injury,viral hepatitis,hepatic fibrosis,cirrhosis,and hepatocellular carcinoma.The underlying pathogenic mechanisms are multifactorial,encompassing oxidative stress,inflammatory cascades,mitochondrial impairment,and disturbances in immune homeostasis.Hepatic encephalopathy patients experience cognitive impairment,mood disturbances,and psychomotor dysfunction,significantly reducing quality of life through mechanisms including oxidative stress,neuroinflammation,and neurotransmitter imbalances.The nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway serves as a critical antioxidative defense mechanism in these conditions.Nrf2 regulates the expression of protective enzymes,while HO-1 exerts anti-inflammatory,anti-apoptotic,and antifibrotic effects through heme degradation products.Natural herbal monomers as Nrf2 activators offer advantages of low toxicity,multi-target actions,and extensive traditional use.Various herbal monomers demonstrate specific effects against different liver diseases:In fatty liver,baicalin alleviates lipid accumulation and inflammation;In alcoholic liver disease,curcumin enhances Nrf2 activity reducing oxidative damage;In drug-induced liver injury,dihydromyricetin mitigates oxidative stress;In viral hepatitis,andrographolide inhibits hepatitis C virus replication;In liver fibrosis,multiple compounds inhibit stellate cell activation.These natural compounds simultaneously alleviate hepatic dysfunction and neuropsychiatric symptoms by modulating the Nrf2/HO-1 pathway,though clinical application still faces challenges such as low bioavailability,requiring further research.展开更多
OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patie...OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patients with osteoporotic vertebral compression fractures treated by vertebroplasty at our hospital were divided into four groups. The control group received non-steroidal anti-inflammatory drugs, the Treatment Group Ⅰ received acupuncture alone, Treatment Group Ⅱ was treated with medicated wine for warming meridians alongside polarized light physiotherapy, and Treatment Group Ⅲ received a combination of medicated wine for warming meridians, polarized light therapy, and acupuncture. The clinical efficacy, pain thresholds at various time points, temperature pain threshold, electric pain threshold, quality of life, sleep quality index, lumbar dysfunction index, visual analog scale(VAS) scores, and incidence of adverse reactions were compared and analyzed across the four groups. RESULTS:The total clinical effective rate in Treatment Group Ⅲ was significantly higher than that in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). At 24 and 72 h post-treatment, the VAS scores, temperature pain thresholds, and electric pain thresholds in Treatment Group Ⅲ were significantly lower than those in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). Additionally, quality-of-life scores in Treatment Group Ⅲ were markedly higher compared to the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ, while the Pittsburgh Sleep Quality Index scores, Oswestry Disability Index scores, and incidence of adverse reactions in Treatment Group Ⅲ were significantly lower than in the other groups(P < 0.05). CONCLUSION:The external application of warm meridian medicated wine and polarized light therapy combined with acupuncture significantly reduces postoperative pain following vertebroplasty, enhances lumbar function, and improves both sleep quality and overall quality of life for patients. This approach is recommended for clinical application.展开更多
BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a...BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a diameter exceeding 30 cm is extremely rare.Its diagnosis and treatment present extremely great challenges.CASE SUMMARY The patient,a 62-year-old woman,presented to the hospital complaining of abdominal distension for more than six months.Imaging examination revealed a large retroperitoneal mass.Finally,the patient was diagnosed with giant RPLS.The tumor occupied the entire abdominal cavity,severely compressed the abdominal organs,and adhered tightly to the bilateral ureters.After careful preoperative preparation(including three-dimensional visualization and bilateral ureteral stent implantation),we performed resection of the large retroperitoneal mass.The tumor was completely removed and consisted of multiple masses,with a total weight of 17 kg and the largest mass size of 35 cm×28 cm×14 cm.Postoperative pathological results revealed that the mass was a well-differentiated liposarcoma.The patient recovered well after surgery,and there was no sign of recurrence after 2 months of follow-up.CONCLUSION Surgical resection is the only radical treatment for giant RPLS.Preoperative preparation is essential,and three-dimensional visualization reconstruction is helpful for the formulation of surgical plans.Postoperative radiotherapy and neoadjuvant therapy can be reasonably selected,but whether they can reduce the recurrence rate is still controversial.展开更多
BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic n...BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic nutritional index(PNI)remains underexplored for novel therapies.AIM To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection(CKI)with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.METHODS SII and PNI were calculated prior to treatment from peripheral blood samples,and critical values were determined by receiver operating characteristic analysis.SII-PNI scores were categorized as follows:2,high SII(≥558.5)and low PNI(≤33.58);1,high SII or low PNI;and 0,neither high SII nor low PNI.After immunotherapy combined with CKI,patients with advanced HCC were evaluated using the SII-PNI scoring criteria.RESULTS The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS(P=0.017).Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score(P=0.0125).Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS(P<0.001).CONCLUSION The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI.It also represents a crucial basis for evaluating treatment efficacy and prognosis,aiding in the identification of high-risk groups and prognosis prediction.展开更多
Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchron...Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchronization therapy defibrillators improve morbidity,quality of life,and mortality in eligible patients with heart failure who are on optimal medical therapy.However,these devices may adversely affect the patients’psychological status after the delivery of shock therapies or even because of the fear of impending therapy.On the other hand,the potential of effective treatment of malignant arrhythmias may provide a‘safety’sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability.During the past few years,an increasing number of reports have investigated psychological distress,including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients.However,heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited.Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident.Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender,younger age,and device shock therapies.Moreover,depression and anxiety may have an adverse impact on patients’clinical outcomes exacerbating heart failure and increasing the arrhythmic risk.In this brief review article,we provide a concise and critical overview of the current literature on this topic,and we also discuss unresolved and conflicting issues delineating future perspectives.展开更多
Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill pa...Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.展开更多
Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expres...Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expressed in both healthy and malignant prostate cells.This study aimed to demonstrate the relationship between pathological characteristics,survival,recurrence,and tissue expression of EZH2 and FOXM1 in high-risk PCa patients.Methods:PCa tissues were used in a retrospective analysis that spanned from September 2009 to August 2019.Inclusion criteria comprised pathological tumor stage(pT)3 patients with positive surgical margins or tumor proximity to inked margins within 5 mm.After case selection,tissue slides were stained for EZH2 and FOXM1 antibodies,and Allred scores were calculated.Patients or relatives of deceased patients were contacted for signed agreements and disease follow-ups.Results:The pT3b,ductal carcinoma component,and moderate EZH2 expression were associated with relapse(odds ratio[OR]6.21,95%confidence interval[CI]1.41-27.27,p=0.016;OR 7.29,95%CI 1.03-51.43,p=0.046;OR 5.96,95%CI 1.09-32.48,p=0.039;respectively).The unilateral and bilateral seminal vesicle invasion increased the likelihood of recurrence by 9.98 times and 5.36 times,and the risk of death by around 9.78 times and 10.79 times,respectively.The pT3b was linked to higher death likelihood(OR 7.16,95%CI 1.38-37.23,p=0.019),while moderate EZH2 expression did not show statistical significance(OR 4.54,95%CI 0.87-23.60,p=0.072,marginally).Pathological regional lymph node stage(pN)1 had significantly higher probability of mortality than pN unknown(3.9%vs.27%,p<0.001).PCa in the neck and apex of the prostate gland increased death risk tenfold.Conclusion:Sufficient immunoexpression of EZH2,ductal carcinoma component,and neoplastic proliferation in the seminal vesicles,apex and neck of the prostate gland correlates with elevated risks of recurrence and mortality.Clinicians should use these criteria for appropriate patient referrals,and a multicenter trial could provide accurate classifications.展开更多
BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of d...BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma(DLBCL),determine the value of individual MRI sequences,and assess patients’concerns with wbMRI.METHODS In this single-center prospective study,adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner[diffusion weighted images with background suppression(DWIBS),T2,short tau inversion recovery(STIR),contrast-enhanced T1]and fluorodeoxyglucose(18F-FDG)positron emission tomo-graphy/computed tomography(PET/CT)(reference standard).The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT.The utility of wbMRI sequences was rated on a five-point scale(0=not useful,4=very useful).Patients received a questionnaire regarding wbMRI.RESULTS Of 60 eligible patients,14(23%)were enrolled and completed the study.The sensitivity of wbMRI in the nodal involvement(182 nodal sites)was 0.84,with 0.99 specificity,positive predictive value of 0.96,negative predictive value of 0.97,and 0.97 accuracy.PET/CT and wbMRI were concordant both in extranodal involvement(13 instances)and staging(κ=1.0).The mean scores of the utility of MRI sequences were 3.71±0.73 for DWIBS,2.64±0.84 for T1,2.14±0.77 for STIR,and 1.29±0.73 for T2(P<0.0001).Patients were mostly concerned about the enclosed environment and duration of the MRI examination(27%of patients).CONCLUSION The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL.DWIBS and contrast-enhanced T1 were rated as the most useful sequences.Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT,especially owing to the long duration and the enclosed environment.展开更多
BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisu...BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.展开更多
文摘Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1-3].Risk factors for fungal keratitis include trauma with vegetative matter,contact lens wear,history of ocular surgery,chronic topical steroid use,low socioeconomic status and tropical climate[1-2].Fungi have the propensity to penetrate deep into the corneal stroma,making the infection difficult to treat with topical antifungal agents alone.Complications such as corneal perforation and endophthalmitis can arise in severe cases,making early identification of the causative fungal pathogen of utmost importance[4-5].Moreover,obtaining susceptibilities to the available antifungal agents can be sight and eye saving[5].
文摘Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.
基金supported by Applied Basic Research Joint Fund Project of Yunnan Province,No.202301AY070001-200Middle-aged Academic and Technical Training Project for High-Level Talents,No.202105AC160065+1 种基金Yunnan Clinical Medical Center for Neurological and Cardiovascular Diseases,No.YWLCYXZX2023300077Key Clinical Specialty of Neurology in Yunnan Province,No.300064(all to CL)。
文摘Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein abundance but are also primarily regulated by various post-translational protein modifications.Lactate,once considered merely a byproduct of anaerobic metabolism,has emerged as a crucial energy substrate and signaling molecule involved in both physiological and pathological processes within the nervous system.Furthermore,recent studies have emphasized the significant role of lactate in numerous neurological diseases,including Alzheimer's disease,Parkinson's disease,acute cerebral ischemic stroke,multiple sclerosis,Huntington's disease,and myasthenia gravis.The purpose of this review is to synthesize the current research on lactate and lactylation modifications in neurological diseases,aiming to clarify their mechanisms of action and identify potential therapeutic targets.As such,this work provides an overview of the metabolic regulatory roles of lactate in various disorders,emphasizing its involvement in the regulation of brain function.Additionally,the specific mechanisms of brain lactate metabolism are discussed,suggesting the unique roles of lactate in modulating brain function.As a critical aspect of lactate function,lactylation modifications,including both histone and non-histone lactylation,are explored,with an emphasis on recent advancements in identifying the key regulatory enzymes of such modifications,such as lactylation writers and erasers.The effects and specific mechanisms of abnormal lactate metabolism in diverse neurological diseases are summarized,revealing that lactate acts as a signaling molecule in the regulation of brain functions and that abnormal lactate metabolism is implicated in the progression of various neurological disorders.Future research should focus on further elucidating the molecular mechanisms underlying lactate and lactylation modifications and exploring their potential as therapeutic targets for neurological diseases.
文摘While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.
基金Supported by the National Key Research and Development Program of China(2023YFC3503704)the Harbin Municipal Science and Technology Program(Self-funded Project,022ZCZJNS070).
文摘Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Recent advances in proteomic profiling have identified significant dysregulation in astrocytic and microglial metabolic pathways in AD pathogenesis,establishing mechanistic links between metabolic dyshomeostasis and neuroimmune crosstalk.Accumulating evidence indicates that acupuncture has gained prominence as a non-pharmacological therapeutic modality for AD management,owing to its multimodal regulatory effects on neuroinflammatory cascades,metabolic recalibration,and immune network stabilization.This study aims to elucidate the molecular mechanisms through which acupuncture exerts its neuroprotective effects,focusing on three interconnected axes:immunometabolic reprogramming in glial cells(particularly microglial bioenergetic adaptation),gut microbiota-derived metabolite signaling(including short-chain fatty acid-mediated pathways),and neuro‐immune‐metabolic interplay.We present a novel therapeutic framework highlighting acupuncture-mediated immunometabolic modulation,thereby providing a mechanistic foundation for developing targeted therapeutic strategies in AD management.
文摘The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios require a more specialized approach,and some groups of patients may benefit from customized Ilizarov constructs.Engineering science has designed various external fixators for orthopedic purposes,and some of those have become the gold standard for specific clinical tasks.We aimed to determine the current state and novel modifications of specialized external fixators for specific clinical situations which are based on the principles of the Ilizarov method.They are half-pin-based fixators for temporal fracture fixation,ring or hybrid devices for gradual deformity correction,and compression-distraction devices tailored for definite limb segments.Gradual correction of deformities can be achieved with external hexapods incorporating universal reduction units.Alternatively,external fixators with special connection mechanisms are able to provide independent movement of the rings in six degrees of freedom.Deformity correction can be performed with combined or sequential use of external and internal fixators.Special devices were developed for moving the split fragment for revascularization of the tibia.The units of external frames on the foot were modified to consider its complex anatomy and the clinical needs ranging from correction of multi-plane deformities,joint arthrodesis to distraction arthroplasty.Mini-fixators are compact external fixators for small bones of the hand and foot.The varieties of external fixators based on the Ilizarov principles have been designed to fulfill an ultimate goal of improving treatment outcomes.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
基金supported by the First Department of Cardiology,School of Medicine in Katowice,Medical University of Silesia,Katowice,Poland.
文摘Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.
文摘Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.
文摘Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.
文摘OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patients with osteoporotic vertebral compression fractures treated by vertebroplasty at our hospital were divided into four groups. The control group received non-steroidal anti-inflammatory drugs, the Treatment Group Ⅰ received acupuncture alone, Treatment Group Ⅱ was treated with medicated wine for warming meridians alongside polarized light physiotherapy, and Treatment Group Ⅲ received a combination of medicated wine for warming meridians, polarized light therapy, and acupuncture. The clinical efficacy, pain thresholds at various time points, temperature pain threshold, electric pain threshold, quality of life, sleep quality index, lumbar dysfunction index, visual analog scale(VAS) scores, and incidence of adverse reactions were compared and analyzed across the four groups. RESULTS:The total clinical effective rate in Treatment Group Ⅲ was significantly higher than that in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). At 24 and 72 h post-treatment, the VAS scores, temperature pain thresholds, and electric pain thresholds in Treatment Group Ⅲ were significantly lower than those in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). Additionally, quality-of-life scores in Treatment Group Ⅲ were markedly higher compared to the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ, while the Pittsburgh Sleep Quality Index scores, Oswestry Disability Index scores, and incidence of adverse reactions in Treatment Group Ⅲ were significantly lower than in the other groups(P < 0.05). CONCLUSION:The external application of warm meridian medicated wine and polarized light therapy combined with acupuncture significantly reduces postoperative pain following vertebroplasty, enhances lumbar function, and improves both sleep quality and overall quality of life for patients. This approach is recommended for clinical application.
文摘BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a diameter exceeding 30 cm is extremely rare.Its diagnosis and treatment present extremely great challenges.CASE SUMMARY The patient,a 62-year-old woman,presented to the hospital complaining of abdominal distension for more than six months.Imaging examination revealed a large retroperitoneal mass.Finally,the patient was diagnosed with giant RPLS.The tumor occupied the entire abdominal cavity,severely compressed the abdominal organs,and adhered tightly to the bilateral ureters.After careful preoperative preparation(including three-dimensional visualization and bilateral ureteral stent implantation),we performed resection of the large retroperitoneal mass.The tumor was completely removed and consisted of multiple masses,with a total weight of 17 kg and the largest mass size of 35 cm×28 cm×14 cm.Postoperative pathological results revealed that the mass was a well-differentiated liposarcoma.The patient recovered well after surgery,and there was no sign of recurrence after 2 months of follow-up.CONCLUSION Surgical resection is the only radical treatment for giant RPLS.Preoperative preparation is essential,and three-dimensional visualization reconstruction is helpful for the formulation of surgical plans.Postoperative radiotherapy and neoadjuvant therapy can be reasonably selected,but whether they can reduce the recurrence rate is still controversial.
基金Supported by the 2022 Anhui Provincial Health Commission Scientific Research Project,No.AHWJ2022b053the 2022 Scientific Research Project of Anhui University of Chinese Medicine,No.2022AH050415+1 种基金the Horizontal Project,No.2022HZ009the 2024 Open Project of the Key Laboratory of Xin’an Medicine,Ministry of Education,No.2024xayx02.
文摘BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic nutritional index(PNI)remains underexplored for novel therapies.AIM To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection(CKI)with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.METHODS SII and PNI were calculated prior to treatment from peripheral blood samples,and critical values were determined by receiver operating characteristic analysis.SII-PNI scores were categorized as follows:2,high SII(≥558.5)and low PNI(≤33.58);1,high SII or low PNI;and 0,neither high SII nor low PNI.After immunotherapy combined with CKI,patients with advanced HCC were evaluated using the SII-PNI scoring criteria.RESULTS The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS(P=0.017).Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score(P=0.0125).Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS(P<0.001).CONCLUSION The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI.It also represents a crucial basis for evaluating treatment efficacy and prognosis,aiding in the identification of high-risk groups and prognosis prediction.
文摘Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchronization therapy defibrillators improve morbidity,quality of life,and mortality in eligible patients with heart failure who are on optimal medical therapy.However,these devices may adversely affect the patients’psychological status after the delivery of shock therapies or even because of the fear of impending therapy.On the other hand,the potential of effective treatment of malignant arrhythmias may provide a‘safety’sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability.During the past few years,an increasing number of reports have investigated psychological distress,including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients.However,heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited.Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident.Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender,younger age,and device shock therapies.Moreover,depression and anxiety may have an adverse impact on patients’clinical outcomes exacerbating heart failure and increasing the arrhythmic risk.In this brief review article,we provide a concise and critical overview of the current literature on this topic,and we also discuss unresolved and conflicting issues delineating future perspectives.
文摘Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.
文摘Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expressed in both healthy and malignant prostate cells.This study aimed to demonstrate the relationship between pathological characteristics,survival,recurrence,and tissue expression of EZH2 and FOXM1 in high-risk PCa patients.Methods:PCa tissues were used in a retrospective analysis that spanned from September 2009 to August 2019.Inclusion criteria comprised pathological tumor stage(pT)3 patients with positive surgical margins or tumor proximity to inked margins within 5 mm.After case selection,tissue slides were stained for EZH2 and FOXM1 antibodies,and Allred scores were calculated.Patients or relatives of deceased patients were contacted for signed agreements and disease follow-ups.Results:The pT3b,ductal carcinoma component,and moderate EZH2 expression were associated with relapse(odds ratio[OR]6.21,95%confidence interval[CI]1.41-27.27,p=0.016;OR 7.29,95%CI 1.03-51.43,p=0.046;OR 5.96,95%CI 1.09-32.48,p=0.039;respectively).The unilateral and bilateral seminal vesicle invasion increased the likelihood of recurrence by 9.98 times and 5.36 times,and the risk of death by around 9.78 times and 10.79 times,respectively.The pT3b was linked to higher death likelihood(OR 7.16,95%CI 1.38-37.23,p=0.019),while moderate EZH2 expression did not show statistical significance(OR 4.54,95%CI 0.87-23.60,p=0.072,marginally).Pathological regional lymph node stage(pN)1 had significantly higher probability of mortality than pN unknown(3.9%vs.27%,p<0.001).PCa in the neck and apex of the prostate gland increased death risk tenfold.Conclusion:Sufficient immunoexpression of EZH2,ductal carcinoma component,and neoplastic proliferation in the seminal vesicles,apex and neck of the prostate gland correlates with elevated risks of recurrence and mortality.Clinicians should use these criteria for appropriate patient referrals,and a multicenter trial could provide accurate classifications.
基金Supported by the Czech Ministry of Health,General University Hospital in Prague,No.VFN00064165。
文摘BACKGROUND Whole-body magnetic resonance imaging(wbMRI)allows general assessment of systemic cancers including lymphomas without radiation burden.AIM To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma(DLBCL),determine the value of individual MRI sequences,and assess patients’concerns with wbMRI.METHODS In this single-center prospective study,adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner[diffusion weighted images with background suppression(DWIBS),T2,short tau inversion recovery(STIR),contrast-enhanced T1]and fluorodeoxyglucose(18F-FDG)positron emission tomo-graphy/computed tomography(PET/CT)(reference standard).The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT.The utility of wbMRI sequences was rated on a five-point scale(0=not useful,4=very useful).Patients received a questionnaire regarding wbMRI.RESULTS Of 60 eligible patients,14(23%)were enrolled and completed the study.The sensitivity of wbMRI in the nodal involvement(182 nodal sites)was 0.84,with 0.99 specificity,positive predictive value of 0.96,negative predictive value of 0.97,and 0.97 accuracy.PET/CT and wbMRI were concordant both in extranodal involvement(13 instances)and staging(κ=1.0).The mean scores of the utility of MRI sequences were 3.71±0.73 for DWIBS,2.64±0.84 for T1,2.14±0.77 for STIR,and 1.29±0.73 for T2(P<0.0001).Patients were mostly concerned about the enclosed environment and duration of the MRI examination(27%of patients).CONCLUSION The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL.DWIBS and contrast-enhanced T1 were rated as the most useful sequences.Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT,especially owing to the long duration and the enclosed environment.
基金Supported by Heilongjiang Provincial Natural Science Foundation Team Project,No.TD2020H002.
文摘BACKGROUND Endoscopic minor papilla intervention(EMPI)is an option for diagnosing or treating symptomatic pancreatic diseases in cases with failed pancreatic duct deep cannulation via the major papilla,pancreas divisum with obstruction of the minor papilla,or an abnormal patulous orifice of the minor papilla during endoscopic retrograde cholangiopancreatography(ERCP).However,the relatively low pa-tency and small opening of the minor papillae pose technical challenges.AIM To evaluate the technical success,clinical success,stone clearance,and safety pro-file of EMPI for diagnosis and treatment of symptomatic pancreatic diseases.METHODS Patients diagnosed with symptomatic pancreatic diseases and EMPI between February 1996 and February 2023 were included.The primary outcomes were the initial technical success,defined as successful deep cannulation via the minor papilla(DCMP;access of the guidewire to the upstream pancreatic duct via the minor papilla)alone,overall technical success,defined as successful DCMP alone and successful DCMP with additional needle-knife precut minor papillotomy(NKPMP),and immediate clinical success,defined as>50%improvement in abdominal pain after therapeutic EMPI.Secondary outcomes included long-term clinical success at 1,3,and 7 years,pancreatic stone clearance,and procedure-related early and late adverse events(AEs).RESULTS Overall,43 patients,32 with obstructive chronic pancreatitis,8 with pancreatic divisum,and 3 with intraductal papillary mucinous neoplasm were included.The initial and overall technical success rates were 74.4%(32/43)and 88.4%(38/43),respectively.The immediate clinical success rate was 79.1%(34/43),and the long-term clinical success rates at 1,3,and 7 years were 74.7%,55.3%,and 41.5%,respectively,among the 22 patients with a follow-up period of 57.5(7-266)months.Complete and partial success of pancreatic stone clearance was achieved in 53.9%(7/13)and 15.4%(2/13),respectively.Early AEs included post-ERCP pancreatitis(PEP,n=5)and self-limiting bleeding(n=1);surgery therapy was required for 1 case with severe PEP and conservative management for the other 4 with mild PEP.Late AEs included minor papilla stricture(n=1)after endoscopic minor papillotomy and pancreatic duct stricture(n=1)after double pancreatic stent placement;no specific treatment was implemented for these events.CONCLUSION EMPI is feasible,effective,and safe for symptomatic pancreatic diseases,in terms of the technical and clinical success,stone clearance,and incidence and severity of AEs.NKPMP appears to enhance technical success.However,potential risks of developing PEP and late AEs should be kept in mind.
