BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free r...BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free rates.AIM To assess the role of VCSD in determining success of SWL in urinary calculi.METHODS Charts review was utilized for collection of data variables.The patients were subjected to SWL,using an electromagnetic lithotripter.Mean stone density(MSD),stone heterogeneity index(SHI),and VCSD were calculated by generating regions of interest on computed tomography(CT)images.Role of these factors were determined by applying the relevant statistical tests for continuous and categorical variables and a P value of<0.05 was gauged to be statistically significant.RESULTS There were a total of 407 patients included in the analysis.The mean age of the subjects in this study was 38.89±14.61 years.In total,165 out of the 407 patients could not achieve stone free status.The successful group had a significantly lower stone volume as compared to the unsuccessful group(P<0.0001).Skin to stone distance was not dissimilar among the two groups(P=0.47).MSD was significantly lower in the successful group(P<0.0001).SHI and VCSD were both significantly higher in the successful group(P<0.0001).CONCLUSION VCSD,a useful CT based parameter,can be utilized to gauge stone fragility and hence the prediction of SWL outcomes.展开更多
In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in ped...In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.展开更多
BACKGROUND The categorization and assessment of diabetes-related risks during Ramadan have evolved significantly over three decades.Research interest in the health effects of fasting has grown significantly,with diabe...BACKGROUND The categorization and assessment of diabetes-related risks during Ramadan have evolved significantly over three decades.Research interest in the health effects of fasting has grown significantly,with diabetes emerging as the most extensively studied condition.AIM To explore the historical development of risk stratification approaches for Ramadan fasting in people with diabetes,culminating in the 2021 International Diabetes Federation-Diabetes and Ramadan(IDF-DAR)risk assessment tool.We also evaluated the evidence for its validation and real-world utility.METHODS The PubMed and Google Scholar databases were searched using the term“Diabetes AND Ramadan AND Risk Assessment”.Eligible studies included fulltext articles on risk stratification concept and tools for diabetes during Ramadan.Selected studies were reviewed and synthesized thematically.RESULTS Risk categorization began with a dichotomy and tripartite models and progressed to a four-tier narrative scale.In 2021,the IDF-DAR tool introduced a point-based system with three risk categories.Validation studies across diverse populations demonstrated strong predictive value,though moderate inter-clinician variability and potential overestimation in type 2 diabetes cases were noted.CONCLUSION The IDF-DAR risk stratification tool significantly advances individualized diabetes care during Ramadan.Its conservative bias in some populations and variability in physician scoring suggests the need for standardized training.展开更多
BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatm...BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures;however,evidence supporting this recommendation is limited,and deviations from real-world practice are often observed.AIM To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.METHODS Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included.Patients were categorized into two groups based on the duration of effective antimicrobial treatment:(1)Short-course treatment(SCT)(<14 days);and(2)Long-course treatment(LCT)(≥14 days).The outcomes assessed included mortality,recurrence,reinfection with the same organism related to the cholangitis,and length of hospital stay.RESULTS A total of 44 patients were included in the study:(1)19 patients in the SCT group;and(2)25 patients in the LCT group.The median duration of antimicrobial treatment was 9 days[interquartile range(IQR):2.5-11.0 days]and 16 days(IQR:15.0-19.0 days)in the SCT and LCT groups,respectively,with a statistically significant difference(P<0.05).No significant differences were observed in 30-day mortality,cholangitis recurrence,or reinfection with the same organisms within 3 months.However,the length of hospital stay was shorter in the SCT group(median:12.0 days vs 14.0 days,P=0.092).CONCLUSION For acute cholangitis complicated by GPC bacteremia,shorter antimicrobial treatment may be a viable option following appropriate biliary drainage.Further studies with larger sample sizes are warranted.展开更多
BACKGROUND Tramadol is a synthetic opioid analgesic commonly employed in postoperative pain control due to its moderate efficacy and comparatively favorable safety profile.Nonetheless,overdose can result in significan...BACKGROUND Tramadol is a synthetic opioid analgesic commonly employed in postoperative pain control due to its moderate efficacy and comparatively favorable safety profile.Nonetheless,overdose can result in significant adverse effects,notably central nervous system depression.This risk is amplified in individuals with chronic kidney disease(CKD),where reduced renal clearance may potentiate drug accumulation and toxicity.Elderly patients are particularly at risk owing to ageassociated alterations in pharmacokinetics and pharmacodynamics.We describe a case of tramadol overdose in a 77-year-old male with stage 3 CKD following total knee arthroplasty.CASE SUMMARY A 77-year-old male with diabetes mellitus and CKD stage 3 underwent elective right total knee arthroplasty for grade 4 osteoarthritis under spinal anesthesia.Preoperative evaluation revealed deranged renal function tests but no other significant abnormalities.Postoperative pain was managed with multimodal analgesics,including intravenous tramadol and a buprenorphine skin patch.On postoperative third day,the patient was found unconscious(Glasgow Coma Scale 8/15)with mild respiratory depression.Investigations ruled out stroke,pulmonary embolism,or other cardiopulmonary events.Elevated serum tramadol levels suggested opioid toxicity exacerbated by impaired renal clearance.The buprenorphine patch was removed,and diuresis was initiated.Supportive management,including prophylactic intubation,led to recovery of consciousness within 48 hours,and the patient was extubated and mobilized by postoperative sixth day.Pain control was maintained with oral paracetamol and pregabalin.The patient was discharged on postoperative tenth day in stable condition with improved pain scores and mobility.This case underscores the need for cautious use of tramadol in elderly patients with CKD due to impaired drug clearance and the potential for toxicity.It highlights the importance of close monitoring,judicious analgesic use,and prompt management of complications to ensure favorable postoperative outcomes in high-risk populations.CONCLUSION This case underscores the necessity for judicious tramadol administration in elderly patients with CKD,as diminished renal function markedly impairs drug clearance,predisposing to toxicity.Vigilant assessment of renal function and individualized dose adjustments are essential to mitigate the risk of adverse events in this demographic.Clinicians should maintain a heightened awareness of potential opioid toxicity in postoperative patients presenting with unexplained neurological manifestations.Timely identification and initiation of appropriate supportive measures are pivotal in achieving favorable clinical outcomes.展开更多
BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the...BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.展开更多
Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of ...Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.展开更多
Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown pr...Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.展开更多
BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigat...BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.展开更多
Traditional Mongolian Medicine(TMM)therapies have emerged as a prominent therapeutic option for Cervical Spondylotic Radiculopathy(CSR),owing to their demonstrated efficacy,cost-effectiveness,and high clinical accessi...Traditional Mongolian Medicine(TMM)therapies have emerged as a prominent therapeutic option for Cervical Spondylotic Radiculopathy(CSR),owing to their demonstrated efficacy,cost-effectiveness,and high clinical accessibility.This study systematically reviews classical Mongolian medical texts to synthesize CSR-related knowledge,including disease profiles,pathogenesis,and therapeutic strategies—through dual analytical perspectives from modern medicine and TMM theory.Furthermore,it critically evaluates recent clinical research on TMM interventions for CSR,encompassing manual therapies,herbal formulations,and holistic regimens.The integrated analysis aims to provide references for optimizing TMM clinical practices in CSR treatment.展开更多
AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent...AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined.Efficacy indicators for research statistics included the intraocular pressure(IOP)level,degree of decrease,changes in medication dosage,and success rate.Safety indicators included the best-corrected visual acuity and incidence of complications.RESULTS:This study comprised 31 patients,including 11 males and 20 females,with ages ranging from 8mo to 67y(mean age:29.40±22.10y).The average postoperative IOP at 1d,1wk,1mo,3mo,6mo,1y,and the last followup was significantly lower than the average preoperative IOP(31.33±9.24 mm Hg,P<0.05).The average number of postoperative medications at 1y was 0.48±1.51,which was significantly reduced compared to that used preoperatively(3.77±0.99,P=0.00).The absolute and qualified success rates were 45.16% and 83.87%,respectively.Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points,except for the first day after surgery.The most common postoperative complications were anterior chamber hemorrhage(25 cases,86.21%)and high IOP(10 cases,34.48%).CONCLUSION:Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.展开更多
This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to Novemb...This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to November 2024,a total of 60 elderly patients with PICC admitted to Guiqian International General Hospital were selected as research subjects.Using a digital random table method,these patients were randomly divided into a control group and an experimental group,with 30 patients in each.The control group received routine nursing care,while the experimental group received specialized intravenous therapy nursing intervention in addition to routine care.The nursing effects of both groups were comprehensively evaluated,including treatment compliance,psychological state,quality of life,incidence of complications,and satisfaction with nursing care.The results showed that after the intervention,the treatment compliance in the experimental group was significantly higher than that of the control group(P<0.05).Additionally,scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were markedly lower in the experimental group compared to the control group(P<0.05),indicating improved psychological well-being.The experimental group also scored higher in all dimensions of quality of life(P<0.05),and had a lower complication rate and higher satisfaction with nursing care(P<0.05).In conclusion,the application of specialized intravenous therapy nursing intervention in the care of elderly patients with PICC can significantly enhance treatment compliance,improve psychological status,elevate quality of life,and reduce complications,demonstrating strong clinical value and providing important guidance for future treatment and nursing of such patients.展开更多
[Objectives]To observe the clinical efficacy of Mongolian medicine silver needle combined with cupping and bloodletting therapy in the treatment of cervical spondylotic radiculopathy(CSR).[Methods]A total of 120 patie...[Objectives]To observe the clinical efficacy of Mongolian medicine silver needle combined with cupping and bloodletting therapy in the treatment of cervical spondylotic radiculopathy(CSR).[Methods]A total of 120 patients diagnosed with CSR who received treatment at the International Mongolian Hospital of Inner Mongolia between October 2021 and October 2022 were selected and randomly divided into two groups:A test group and a control group,with 60 patients in each group.The patients in the test group received Mongolian medicine silver needle combined with cupping and bloodletting therapy,following the principles of syndrome differentiation in Mongolian medicine.In contrast,the patients in the control group received only the Mongolian medicine silver needle therapy.After treatment,the Mongolian medicine syndrome scores,visual analogue scale(VAS)scores,and total clinical therapeutic effects in the two groups of patients were compared both prior to and following the treatment.[Results]The improvement in VAS and Mongolian medicine syndrome scores in the test group was greater than that in the control group,with a statistically significant difference(P<0.05).The scores of the test group surpassed those of the control group,and this difference was also statistically significant(P<0.05).Furthermore,the overall therapeutic effect in the test group was 93.33%,which was markedly higher than 76.67%observed in the control group(P<0.05).[Conclusions]The therapeutic effect of Mongolian medicine silver needle combined with cupping and bloodletting therapy in the treatment of CSR is remarkable.This approach has demonstrated efficacy in alleviating patient pain and improving the functionality of the cervical vertebrae,thereby warranting clinical promotion and application.展开更多
Background:Whether chronic hepatitis B or C virus infection is a risk factor for autoimmune liver diseases(AILDs)remains unclear.This study aimed to investigate the causal relationship between the two disease entities...Background:Whether chronic hepatitis B or C virus infection is a risk factor for autoimmune liver diseases(AILDs)remains unclear.This study aimed to investigate the causal relationship between the two disease entities and underlying mechanisms.Methods:Bidirectional Mendelian randomization analysis was performed using genome-wide association study summary statistics for hepatitis B or C virus infection and AILDs in individuals of European ancestry.Statistically significant findings underwent meta-analysis for validation and single-cell RNA-seq were conducted to explore the potential mechanisms.Results:A causal relationship was observed between chronic hepatitis B virus(HBV)infection and an elevated risk of primary biliary cholangitis(PBC).Meta-analysis of all PBC-outcome findings confirmed the association(Odds ratio:1.32,95%confidence interval:1.23–1.42)without a reverse causal effect.Chronic HBV infection was also potentially associated with an increased risk of autoimmune hepatitis,but not with primary sclerosing cholangitis.No causal relationship was found between hepatitis C virus infection and AILDs.Single-cell RNA-seq revealed HLA gene activated in liver and impaired innate immune suppressive function in chronic hepatitis B patients.Conclusion:This study demonstrates a one-way causal association between chronic HBV infection and certain AILDs(PBC and autoimmune hepatitis),but not chronic hepatitis C virus infection.Single-cell transcriptome analysis revealed immune dysfunction caused by chronic HBV infection persists and is difficult to resolve even after HBV clearance,potentially leading to autoimmune hepatic diseases.展开更多
Nonobstructive azoospermia(NOA)affects about 60%of men with azoospermia,representing a severe form of male infertility.The current approach to manage NOA primarily involves testicular sperm retrieval methods such as c...Nonobstructive azoospermia(NOA)affects about 60%of men with azoospermia,representing a severe form of male infertility.The current approach to manage NOA primarily involves testicular sperm retrieval methods such as conventional testicular sperm extraction(c-TESE)and microdissection testicular sperm extraction(micro-TESE).While combining testicular sperm retrieval with intracytoplasmic sperm injection(ICSI)offers hope for patients,the overall sperm retrieval rate(SRR)stands at around 50%.In cases where micro-TESE fails to retrieve sperm,limited options,like donor sperm or adoption,can be problematic in certain cultural contexts.This paper delves into prospective treatments for NOA management.Gene editing technologies,particularly clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated(Cas)protein 9(CRISPR/Cas9),hold potential for correcting genetic mutations underlying testicular dysfunction.However,these technologies face challenges due to their complexity,potential off-target effects,ethical concerns,and affordability.This calls for research to address key challenges associated with NOA management within the clinical settings.This also necessitate ongoing research essential for developing more sensitive diagnostic tests,validating novel treatments,and customizing current treatment strategies for individual patients.This review concluded that the future of NOA management may entail a combination of these treatment options,tailored to each patient’s unique circumstances,providing a comprehensive approach to address NOA challenges.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this...BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.展开更多
This article provides an in-depth analysis of the study conducted by Wang et al,which explores hepatic arterial infusion chemotherapy and its synergistic strategies in managing advanced hepatocellular carcinoma(HCC).H...This article provides an in-depth analysis of the study conducted by Wang et al,which explores hepatic arterial infusion chemotherapy and its synergistic strategies in managing advanced hepatocellular carcinoma(HCC).HCC ranks as the fourth most common cause of cancer-related mortality globally and is frequently associated with portal vein tumor thrombus(PVTT).The approach to managing HCC,particularly when PVTT is present,diverges markedly between Eastern and Western practices.These differences are rooted in variations in epidemiology,etiology,pathology,comorbidities,and prognosis.The paper delves into the diagnosis,classification,and treatment strategies for HCC with PVTT,as well as the evolving role and advancements of hepatic arterial infusion chemotherapy in the therapeutic landscape of HCC.展开更多
This study explored the therapeutic effect of trimebutine maleate dispersible tablets combined with berberine on PI-IBS rats with liver depression and spleen deficiency.Fifty male rats were divided into five groups:no...This study explored the therapeutic effect of trimebutine maleate dispersible tablets combined with berberine on PI-IBS rats with liver depression and spleen deficiency.Fifty male rats were divided into five groups:normal,model,berberine(XB),trimebutine(QM),and combination(XB+QM).The PI-IBS model was established using maternal separation,TNBS perfusion,and chronic restraint.After 20 days of drug intervention,DAI,CMDI,TDI,AWR scores,histopathology,and expression levels of c-Fos,VIP,NOS,and CHAT in the hippocampus and colon were assessed.The model group showed significant gut and brain changes,while the combination group(XB+QM)improved fecal characteristics,reduced inflammation,regulated brain-gut peptide expression,and alleviated visceral hypersensitivity and colon tissue damage(P<0.05).展开更多
BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholan...BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.展开更多
文摘BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy(SWL).Recently a new factor called variation coefficient of stone density(VCSD)is being considered to have an impact on stone free rates.AIM To assess the role of VCSD in determining success of SWL in urinary calculi.METHODS Charts review was utilized for collection of data variables.The patients were subjected to SWL,using an electromagnetic lithotripter.Mean stone density(MSD),stone heterogeneity index(SHI),and VCSD were calculated by generating regions of interest on computed tomography(CT)images.Role of these factors were determined by applying the relevant statistical tests for continuous and categorical variables and a P value of<0.05 was gauged to be statistically significant.RESULTS There were a total of 407 patients included in the analysis.The mean age of the subjects in this study was 38.89±14.61 years.In total,165 out of the 407 patients could not achieve stone free status.The successful group had a significantly lower stone volume as compared to the unsuccessful group(P<0.0001).Skin to stone distance was not dissimilar among the two groups(P=0.47).MSD was significantly lower in the successful group(P<0.0001).SHI and VCSD were both significantly higher in the successful group(P<0.0001).CONCLUSION VCSD,a useful CT based parameter,can be utilized to gauge stone fragility and hence the prediction of SWL outcomes.
文摘In this article,we comment on an article published in a recent issue of the World Journal of Gastroenterology.We specifically focus on the roles of human leukocyte antigen(HLA)and donor-specific antibodies(DSAs)in pediatric liver transpl-antation(LT),as well as the relationship between immune rejection after LT and DSA.Currently,LT remains the standard of care for pediatric patients with end-stage liver disease or severe acute liver failure.However,acute and chronic re-jection continues to be a significant cause of graft dysfunction and loss.HLA mismatch significantly reduces graft survival and increases the risk of acute rejection.Among them,D→R one-way mismatch at three loci was significantly related to graft-versus-host disease incidence after LT.The adverse impact of HLA-DSAs on LT recipients is already established.Therefore,the evaluation of HLA and DSA is crucial in pediatric LT.
文摘BACKGROUND The categorization and assessment of diabetes-related risks during Ramadan have evolved significantly over three decades.Research interest in the health effects of fasting has grown significantly,with diabetes emerging as the most extensively studied condition.AIM To explore the historical development of risk stratification approaches for Ramadan fasting in people with diabetes,culminating in the 2021 International Diabetes Federation-Diabetes and Ramadan(IDF-DAR)risk assessment tool.We also evaluated the evidence for its validation and real-world utility.METHODS The PubMed and Google Scholar databases were searched using the term“Diabetes AND Ramadan AND Risk Assessment”.Eligible studies included fulltext articles on risk stratification concept and tools for diabetes during Ramadan.Selected studies were reviewed and synthesized thematically.RESULTS Risk categorization began with a dichotomy and tripartite models and progressed to a four-tier narrative scale.In 2021,the IDF-DAR tool introduced a point-based system with three risk categories.Validation studies across diverse populations demonstrated strong predictive value,though moderate inter-clinician variability and potential overestimation in type 2 diabetes cases were noted.CONCLUSION The IDF-DAR risk stratification tool significantly advances individualized diabetes care during Ramadan.Its conservative bias in some populations and variability in physician scoring suggests the need for standardized training.
文摘BACKGROUND The optimal duration of antimicrobial treatment for acute cholangitis complicated by gram-positive coccus(GPC)bacteremia remains unclear.The Tokyo Guidelines 2018 recommended 14 days of antimicrobial treatment following adequate source control measures;however,evidence supporting this recommendation is limited,and deviations from real-world practice are often observed.AIM To evaluate the efficacy and safety of shorter antimicrobial treatments for acute cholangitis complicated by GPC bacteremia.METHODS Adult patients with acute cholangitis complicated by GPC bacteremia who underwent endoscopic retrograde cholangiopancreatography between July 2003 and December 2023 were included.Patients were categorized into two groups based on the duration of effective antimicrobial treatment:(1)Short-course treatment(SCT)(<14 days);and(2)Long-course treatment(LCT)(≥14 days).The outcomes assessed included mortality,recurrence,reinfection with the same organism related to the cholangitis,and length of hospital stay.RESULTS A total of 44 patients were included in the study:(1)19 patients in the SCT group;and(2)25 patients in the LCT group.The median duration of antimicrobial treatment was 9 days[interquartile range(IQR):2.5-11.0 days]and 16 days(IQR:15.0-19.0 days)in the SCT and LCT groups,respectively,with a statistically significant difference(P<0.05).No significant differences were observed in 30-day mortality,cholangitis recurrence,or reinfection with the same organisms within 3 months.However,the length of hospital stay was shorter in the SCT group(median:12.0 days vs 14.0 days,P=0.092).CONCLUSION For acute cholangitis complicated by GPC bacteremia,shorter antimicrobial treatment may be a viable option following appropriate biliary drainage.Further studies with larger sample sizes are warranted.
文摘BACKGROUND Tramadol is a synthetic opioid analgesic commonly employed in postoperative pain control due to its moderate efficacy and comparatively favorable safety profile.Nonetheless,overdose can result in significant adverse effects,notably central nervous system depression.This risk is amplified in individuals with chronic kidney disease(CKD),where reduced renal clearance may potentiate drug accumulation and toxicity.Elderly patients are particularly at risk owing to ageassociated alterations in pharmacokinetics and pharmacodynamics.We describe a case of tramadol overdose in a 77-year-old male with stage 3 CKD following total knee arthroplasty.CASE SUMMARY A 77-year-old male with diabetes mellitus and CKD stage 3 underwent elective right total knee arthroplasty for grade 4 osteoarthritis under spinal anesthesia.Preoperative evaluation revealed deranged renal function tests but no other significant abnormalities.Postoperative pain was managed with multimodal analgesics,including intravenous tramadol and a buprenorphine skin patch.On postoperative third day,the patient was found unconscious(Glasgow Coma Scale 8/15)with mild respiratory depression.Investigations ruled out stroke,pulmonary embolism,or other cardiopulmonary events.Elevated serum tramadol levels suggested opioid toxicity exacerbated by impaired renal clearance.The buprenorphine patch was removed,and diuresis was initiated.Supportive management,including prophylactic intubation,led to recovery of consciousness within 48 hours,and the patient was extubated and mobilized by postoperative sixth day.Pain control was maintained with oral paracetamol and pregabalin.The patient was discharged on postoperative tenth day in stable condition with improved pain scores and mobility.This case underscores the need for cautious use of tramadol in elderly patients with CKD due to impaired drug clearance and the potential for toxicity.It highlights the importance of close monitoring,judicious analgesic use,and prompt management of complications to ensure favorable postoperative outcomes in high-risk populations.CONCLUSION This case underscores the necessity for judicious tramadol administration in elderly patients with CKD,as diminished renal function markedly impairs drug clearance,predisposing to toxicity.Vigilant assessment of renal function and individualized dose adjustments are essential to mitigate the risk of adverse events in this demographic.Clinicians should maintain a heightened awareness of potential opioid toxicity in postoperative patients presenting with unexplained neurological manifestations.Timely identification and initiation of appropriate supportive measures are pivotal in achieving favorable clinical outcomes.
基金Supported by the Priority Project of the Multi-Source Investment Fund Program,China,No.S21DYZD3172the Tianjin Key Medical Discipline(Specialty)Construction Project,China,No.TJYXZDXK-020A.
文摘BACKGROUND Data on adsorptive extracorporeal membrane oxygenation(ECMO)(combined with HA380 hemoperfusion column)on the inflammatory factors in patients with cardiogenic shock(CS)remains limited.AIM To investigate the effects of adsorptive ECMO on the inflammatory factors in patients with CS.METHODS A retrospective analysis was performed on 81 patients with CS caused by acute myocardial infarction,fulminant myocarditis,or cardiac surgery who required venoarterial ECMO support at TEDA International Cardiovascular Hospital from December 2020 to December 2024.Patients were divided into the conventional ECMO group(42 cases)and the adsorptive ECMO group(ECMO combined with hemoperfusion,39 cases).The adsorptive ECMO group received 2 columns of HA380 initiation on the first day(the first column connected within 2 hours of ECMO and the second after 12 hours of ECMO),followed by 1 column each day,with each column used for 4–6 hours,totaling 24–30 hours of treatment.Baseline data were compared between the two groups:Inflammatory factor levels(at 0,6,12,24,48,and 72 hours after ECMO or hemoperfusion initiation);ECMO support duration;successful weaning rate;continuous renal replacement therapy(CRRT)utilization;Sequential Organ Failure Assessment(SOFA)score;Vasoactive-Inotropic Score(VIS);systemic inflammatory response syndrome(SIRS)incidence;and in-hospital survival and 30-/90-day survival after discharge.RESULTS The adsorptive ECMO group showed significantly lower levels of C-reactive protein,interleukin(IL)-6,tumor necrosis factor(TNF)-α,and lactate from 6 to 72 hours compared with the conventional ECMO group(all P<0.05),with IL-6 decreasing by 94.4%and tumour necrosis factor alpha by 70.1%from baseline at 72 hours.The adsorptive ECMO group had a significantly shorter ECMO duration[114.0(75.0–139.0)hours vs 135.0(73.0–199.3)hours,P=0.032];higher successful weaning rate(66.7%vs 42.9%,P=0.032);a trend toward lower CRRT utilization(54.8%vs 38.5%,P=0.070);lower post-weaning SOFA score[7(6–8)vs 9(8–10),P<0.001];significantly reduced VIS(8.4±1.3 vs 9.8±1.6,P<0.001);and a trend toward lower SIRS incidence(10.3%vs 26.2%,P=0.065).There were no significant differences in complications,in-hospital survival(64.1%vs 52.4%,P=0.285);or 30-/90-day survival between the two groups(all P>0.05).CONCLUSION Adsorptive ECMO efficiently clears IL-6 and TNF-α,significantly improving ECMO weaning success rate and hemodynamics.However,it has no significant impact on survival,and its efficacy requires validation through prospective studies.
文摘Proton pump inhibitors(PPIs)are widely utilized in oncology to treat gastroeso-phageal reflux disease,peptic ulcer disease,and chemotherapy-induced mucosal injury.Emerging evidence has suggested that prolonged use of PPIs is associated with increased mortality in patients with cancer.The findings of Krishnan et al are proof of this but need to be considered cautiously due to potential confounding factors.This letter raised important methodological concerns,including con-founding by indication,reverse causality,and polypharmacy that can influence the observed association.While PPIs are important in oncology,their advantages and disadvantages should be weighed judiciously by clinicians.Future prospective studies with robust analytical approaches will be required to ascertain more definite causality.
基金Supported by 2023 Hebei Provincial Medical Scientific Research Project Plan,No.20231304.
文摘Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.
文摘BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.
基金Supported by Science and Technology Program of Inner Mongolia Autonomous Region"Clinical Observation of Warm Needling Acupuncture of Mongolian Medicine in the Treatment of Lumbar Disc Herniation"(2019GG125).
文摘Traditional Mongolian Medicine(TMM)therapies have emerged as a prominent therapeutic option for Cervical Spondylotic Radiculopathy(CSR),owing to their demonstrated efficacy,cost-effectiveness,and high clinical accessibility.This study systematically reviews classical Mongolian medical texts to synthesize CSR-related knowledge,including disease profiles,pathogenesis,and therapeutic strategies—through dual analytical perspectives from modern medicine and TMM theory.Furthermore,it critically evaluates recent clinical research on TMM interventions for CSR,encompassing manual therapies,herbal formulations,and holistic regimens.The integrated analysis aims to provide references for optimizing TMM clinical practices in CSR treatment.
文摘AIM:To evaluate the efficacy and safety of microcatheterassisted 360-degree trabeculotomy combined with trabeculectomy(MATT-Trab)for treating refractory glaucoma.METHODS:Patients with refractory glaucoma who underwent MATT-Trab were retrospectively examined.Efficacy indicators for research statistics included the intraocular pressure(IOP)level,degree of decrease,changes in medication dosage,and success rate.Safety indicators included the best-corrected visual acuity and incidence of complications.RESULTS:This study comprised 31 patients,including 11 males and 20 females,with ages ranging from 8mo to 67y(mean age:29.40±22.10y).The average postoperative IOP at 1d,1wk,1mo,3mo,6mo,1y,and the last followup was significantly lower than the average preoperative IOP(31.33±9.24 mm Hg,P<0.05).The average number of postoperative medications at 1y was 0.48±1.51,which was significantly reduced compared to that used preoperatively(3.77±0.99,P=0.00).The absolute and qualified success rates were 45.16% and 83.87%,respectively.Visual acuity exhibited no statistically significant difference between the postoperative and preoperative follow-up time points,except for the first day after surgery.The most common postoperative complications were anterior chamber hemorrhage(25 cases,86.21%)and high IOP(10 cases,34.48%).CONCLUSION:Our results indicate that MATT-Trab is effective and safe for treating refractory glaucoma.
文摘This study aimed to explore the specific application effect of specialist nursing intervention in intravenous therapy on elderly patients with peripherally inserted central catheters(PICC).From November 2023 to November 2024,a total of 60 elderly patients with PICC admitted to Guiqian International General Hospital were selected as research subjects.Using a digital random table method,these patients were randomly divided into a control group and an experimental group,with 30 patients in each.The control group received routine nursing care,while the experimental group received specialized intravenous therapy nursing intervention in addition to routine care.The nursing effects of both groups were comprehensively evaluated,including treatment compliance,psychological state,quality of life,incidence of complications,and satisfaction with nursing care.The results showed that after the intervention,the treatment compliance in the experimental group was significantly higher than that of the control group(P<0.05).Additionally,scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were markedly lower in the experimental group compared to the control group(P<0.05),indicating improved psychological well-being.The experimental group also scored higher in all dimensions of quality of life(P<0.05),and had a lower complication rate and higher satisfaction with nursing care(P<0.05).In conclusion,the application of specialized intravenous therapy nursing intervention in the care of elderly patients with PICC can significantly enhance treatment compliance,improve psychological status,elevate quality of life,and reduce complications,demonstrating strong clinical value and providing important guidance for future treatment and nursing of such patients.
基金Supported by Project of Science and Technology Department of Inner Mongolia Autonomous Region(2019GG125).
文摘[Objectives]To observe the clinical efficacy of Mongolian medicine silver needle combined with cupping and bloodletting therapy in the treatment of cervical spondylotic radiculopathy(CSR).[Methods]A total of 120 patients diagnosed with CSR who received treatment at the International Mongolian Hospital of Inner Mongolia between October 2021 and October 2022 were selected and randomly divided into two groups:A test group and a control group,with 60 patients in each group.The patients in the test group received Mongolian medicine silver needle combined with cupping and bloodletting therapy,following the principles of syndrome differentiation in Mongolian medicine.In contrast,the patients in the control group received only the Mongolian medicine silver needle therapy.After treatment,the Mongolian medicine syndrome scores,visual analogue scale(VAS)scores,and total clinical therapeutic effects in the two groups of patients were compared both prior to and following the treatment.[Results]The improvement in VAS and Mongolian medicine syndrome scores in the test group was greater than that in the control group,with a statistically significant difference(P<0.05).The scores of the test group surpassed those of the control group,and this difference was also statistically significant(P<0.05).Furthermore,the overall therapeutic effect in the test group was 93.33%,which was markedly higher than 76.67%observed in the control group(P<0.05).[Conclusions]The therapeutic effect of Mongolian medicine silver needle combined with cupping and bloodletting therapy in the treatment of CSR is remarkable.This approach has demonstrated efficacy in alleviating patient pain and improving the functionality of the cervical vertebrae,thereby warranting clinical promotion and application.
基金supported by the National Natural Science Foundation of China(82270626)China Mega-Project for Infectious Diseases(2017ZX10203202,2013ZX10002005)the Project of Beijing Science and Technology Committee(Z191100007619037).
文摘Background:Whether chronic hepatitis B or C virus infection is a risk factor for autoimmune liver diseases(AILDs)remains unclear.This study aimed to investigate the causal relationship between the two disease entities and underlying mechanisms.Methods:Bidirectional Mendelian randomization analysis was performed using genome-wide association study summary statistics for hepatitis B or C virus infection and AILDs in individuals of European ancestry.Statistically significant findings underwent meta-analysis for validation and single-cell RNA-seq were conducted to explore the potential mechanisms.Results:A causal relationship was observed between chronic hepatitis B virus(HBV)infection and an elevated risk of primary biliary cholangitis(PBC).Meta-analysis of all PBC-outcome findings confirmed the association(Odds ratio:1.32,95%confidence interval:1.23–1.42)without a reverse causal effect.Chronic HBV infection was also potentially associated with an increased risk of autoimmune hepatitis,but not with primary sclerosing cholangitis.No causal relationship was found between hepatitis C virus infection and AILDs.Single-cell RNA-seq revealed HLA gene activated in liver and impaired innate immune suppressive function in chronic hepatitis B patients.Conclusion:This study demonstrates a one-way causal association between chronic HBV infection and certain AILDs(PBC and autoimmune hepatitis),but not chronic hepatitis C virus infection.Single-cell transcriptome analysis revealed immune dysfunction caused by chronic HBV infection persists and is difficult to resolve even after HBV clearance,potentially leading to autoimmune hepatic diseases.
文摘Nonobstructive azoospermia(NOA)affects about 60%of men with azoospermia,representing a severe form of male infertility.The current approach to manage NOA primarily involves testicular sperm retrieval methods such as conventional testicular sperm extraction(c-TESE)and microdissection testicular sperm extraction(micro-TESE).While combining testicular sperm retrieval with intracytoplasmic sperm injection(ICSI)offers hope for patients,the overall sperm retrieval rate(SRR)stands at around 50%.In cases where micro-TESE fails to retrieve sperm,limited options,like donor sperm or adoption,can be problematic in certain cultural contexts.This paper delves into prospective treatments for NOA management.Gene editing technologies,particularly clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated(Cas)protein 9(CRISPR/Cas9),hold potential for correcting genetic mutations underlying testicular dysfunction.However,these technologies face challenges due to their complexity,potential off-target effects,ethical concerns,and affordability.This calls for research to address key challenges associated with NOA management within the clinical settings.This also necessitate ongoing research essential for developing more sensitive diagnostic tests,validating novel treatments,and customizing current treatment strategies for individual patients.This review concluded that the future of NOA management may entail a combination of these treatment options,tailored to each patient’s unique circumstances,providing a comprehensive approach to address NOA challenges.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.
文摘This article provides an in-depth analysis of the study conducted by Wang et al,which explores hepatic arterial infusion chemotherapy and its synergistic strategies in managing advanced hepatocellular carcinoma(HCC).HCC ranks as the fourth most common cause of cancer-related mortality globally and is frequently associated with portal vein tumor thrombus(PVTT).The approach to managing HCC,particularly when PVTT is present,diverges markedly between Eastern and Western practices.These differences are rooted in variations in epidemiology,etiology,pathology,comorbidities,and prognosis.The paper delves into the diagnosis,classification,and treatment strategies for HCC with PVTT,as well as the evolving role and advancements of hepatic arterial infusion chemotherapy in the therapeutic landscape of HCC.
基金Science and Technology Fund Project of Guizhou Provincial Health Commission(Project No.:gawkj2021-225).
文摘This study explored the therapeutic effect of trimebutine maleate dispersible tablets combined with berberine on PI-IBS rats with liver depression and spleen deficiency.Fifty male rats were divided into five groups:normal,model,berberine(XB),trimebutine(QM),and combination(XB+QM).The PI-IBS model was established using maternal separation,TNBS perfusion,and chronic restraint.After 20 days of drug intervention,DAI,CMDI,TDI,AWR scores,histopathology,and expression levels of c-Fos,VIP,NOS,and CHAT in the hippocampus and colon were assessed.The model group showed significant gut and brain changes,while the combination group(XB+QM)improved fecal characteristics,reduced inflammation,regulated brain-gut peptide expression,and alleviated visceral hypersensitivity and colon tissue damage(P<0.05).
文摘BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.
