BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention...BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention for its role in influencing their function,accessibility,and readiness for clinical use.AIM To identify the most suitable adipose source for MSC isolation and expansion for further applications.METHODS We isolated MSCs from solid adipose tissue and liposuction aspirates using the enzyme method.The MSCs were examined for their expansion using population doubling time,differentiation capacity using multilineage differentiation induction,surface markers using flow cytometry,and stability of chromosomes using the karyotyping method.Growth factors and cytokines in MSC-conditioned media were analyzed using the Luminex assay.RESULTS MSCs were isolated from solid adipose tissue and lipoaspirates and expanded from passage 0 to passage 2.All adipose-derived MSCs(AD-MSCs)exhibited the typical elongated,spindle-shaped morphology and comparable proliferation rate.They expressed positive surface markers(cluster of differentiation 73[CD73]:>97%,CD90:>98%,and CD105:>95%),and negative markers(<1%).All MSCs expressed similar levels of stemness genes(octamer-binding transcription factor 4,SRY-box 2,Krüppel-like factor,and MYC),colonyforming,and trilineage differentiation potential.Karyotyping analysis revealed normal chromosomal patterns in all samples,except one sample exhibiting a polymorphism(1qh+).Furthermore,the growth factors and cytokines of hepatocyte growth factor,vascular endothelial growth factor A,interleukin 6(IL-6),and IL-8 were detected in all AD-MSC conditioned media;but fibroblast growth factor-2 and keratinocyte growth factor were selectively expressed in conditioned media from solid or lipoaspirate AD-MSCs,respectively.CONCLUSION These findings indicate that AD-MSCs from both adipose sources possess all of the characteristic features of MSCs with source-specific secretome differences,which are suitable for further expansion and various clinical applications.展开更多
Serbisütherapy(ST)is a distinctive external treatment modality within traditional Mongolian medicine(TMM),historically developed within a nomadic cultural framework.This study presents a comprehensive philologica...Serbisütherapy(ST)is a distinctive external treatment modality within traditional Mongolian medicine(TMM),historically developed within a nomadic cultural framework.This study presents a comprehensive philological and historical analysis of ST,tracing its evolution from early battlefield applications to contemporary clinical use.By critically examining classical Mongolian medical texts alongside modern case studies,we aim to systematize ST’s therapeutic methods,indications,and limitations,while exploring its mechanisms of action through both traditional theory and modern biomedical perspectives.ST has undergone significant transformation,shifting from whole-body cavity immersion in the 13th century to targeted,organ-specific applications in modern practice.Its four primary methods–Covering,Mounted,Organ Placement,and Suction–demonstrate efficacy in treating cold-natured diseases,musculoskeletal disorders,gynecological conditions,and certain emergencies.ST embodies the core principles of TMM,particularly the balance of the“Three Roots”and the correction of cold-induced pathologies through heat.Despite challenges related to standardization,cultural translation,and regulatory acceptance,ST holds translational potential for integrative medicine.Future research should prioritize mechanistic validation,clinical standardization,and the development of biocompatible thermal technologies to bridge traditional practice with modern healthcare systems.展开更多
BACKGROUND: Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries(LMICs). We report the establishment of a trauma registry at the...BACKGROUND: Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries(LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre(AETC) at Queen Elizabeth Central Hospital(QECH) in Blantyre, Malawi and identify high risk geographic areas. METHODS: We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS(16) software respectively.RESULTS: There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault(38.2%), and road traffi c injuries(31.6%). The majority had soft tissue injury(53.1%), while 23.8% had no diagnosis indicated. Fractures(OR 19.94 [15.34–25.93]), head injury and internal organ injury(OR 29.5 [16.29–53.4]), and use of ambulance(OR 1.57 [1.06–2.33]) were found to be predictive of increased odds of being admitted to hospital while assault(OR 0.69 [0.52–0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence. CONCLUSION: We have described the process of establishing an integrated and potentially sustainable trauma registry. Signifi cant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.展开更多
BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphinct...BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients).展开更多
AIM:To investigate the clinical characteristics,treatment,medication use,and treatment response in patients with ulcerative colitis(UC)across ethnic groups.METHODS:This study retrospectively analyzed medical records o...AIM:To investigate the clinical characteristics,treatment,medication use,and treatment response in patients with ulcerative colitis(UC)across ethnic groups.METHODS:This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010.The demographics,clinical characteristics,medication use,results of investigations,and medical and surgical management for patients with UC were evaluated.Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines.Patient ethnicities were categorized into seven groups:Thai,Oriental,South Asian(SA),Middle Eastern(ME),Caucasian,African,and Hispanic.UC pathological severity was classified into inactive,mild,moderate,and severe.Associations between categorical variables were analyzed using theχ2 or Fischer's exact test.Associations between categorical and interval variables were analyzed usingStudent's t-test and/or analysis of covariance.RESULTS:UC was diagnosed in 371 of the 268465 patients:male 56.33%;ME 42%,Caucasian 23%,and Thai 19%.Annual incidence of UC was 82 cases per 100000 with wide ethnic variation,ranging from 29 to 206 cases per 100000 in Oriental and ME patients,respectively.Of the patients with UC,16.71%had severe UC with highest incidence among the patients from ME(20.39%)and lowest among the Caucasian population(11.90%).ME had highest proportion of pancolitis(52.90%),followed by Caucasian(45.35%)and Asian(34.40%).Only 20.93%of Caucasian patients received steroid,compared with 26.40%and 27.10%of Asian and Middle Eastern,respectively(P=0.732).Overall,13.72%of UC patients did not respond to steroid therapy,with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients(15.22%and 15.04%,respectively)(P=0.781).On average,5.93%underwent surgical management with ethnic variation,ranging from 0%in African to 18%in SA.Cancer was found in three(Thai,ME,and African)cases(0.82 institution-specific incidence).CONCLUSION:Incidence,symptom duration,pathological severity,clinical manifestations,medication use,treatment response,need for surgical consultation,and cancer incidence of patients with UC potentially vary by ethnicity.展开更多
<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Intensity M...<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Intensity Modulated Radiation Therapy (IMRT) is currently employed as a major arm of treatment in multiforme glioblastoma (GBM). The present study aimed to compare 3D-CRT with IMRT to assess tumor volume coverage and OAR sparing for </span><span style="font-family:Verdana;">the </span><span "=""><span style="font-family:Verdana;">treatment of malignant gliomas. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">methods:</span></b><span style="font-family:Verdana;"> We assessed 22 anonymized patients datasets with High Grade Glioblastoma who had undergone post</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">operative Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3D-CRT), This study will compare and contrast treatment plans Rapidarc and 3D-CRT to determine w</span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;">ich techn</span><span style="font-family:Verdana;">ology</span><span "=""><span style="font-family:Verdana;"> improves significantly dosimetric parameters. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Plans will be assessed by reviewing the coverage of the PTV using mean, maximum and minimum doses while the OAR doses will be compared using the maximal doses for each, as set out in the QUANTEC dose limits. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The use of IMRT seems a superior technique as compared to 3D-CRT for the treatment of malignant gliomas having the potential to increase </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">dose to the PTV while sparing OARs optimally.</span> </div>展开更多
Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was ...Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was to examine the patients with clinically presumed lumbar radiculopathy and find the correlation between their electrodiagnostic study and magnetic resonance imaging. Setting, duration and study type: Retrospective cross-sectional study of one year (January 2019 - February 2020) in Shifa International Hospital Islamabad. Methods: A total of 96 patients with clinically suspected lumbar radiculopathy were included. Chi-square test, international business machines (IBM) SPSS rendition 21.0 was applied on the clinical information, electrodiagnostic study and MRI were coordinated and affectability and particularity were judged. Selected patients were undergone both electrodiagnostic study and magnetic imaging resonance in the selected 1-year span. The study investigated correlation between both diagnostic tools in lumbar radiculopathy patients. Expected outcomes: Anatomical specificity in seen through magnetic resonance imaging while physiological through electrodiagnostic study, which may not correlate in the evaluation of lumbar radiculopathy.展开更多
AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnos...AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions)in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTSEndoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67%of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2%of the hospitals.Of the hospitals,83.8%performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20%rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds)and low-volume hospitals.More emergency visits(P=0.012)and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045)were observed in the high-volume hospitals.CONCLUSIONSome practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.展开更多
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
Dear Editor,I am responding to Zou and Li's,The missing perilymph sign on MRI indicates a perilymphatic fistula:A case report Zou J,Li H.Journal of Otology,2025, 20(1):1-4.https://doi.org/10.26599/JOTO.2025.954000...Dear Editor,I am responding to Zou and Li's,The missing perilymph sign on MRI indicates a perilymphatic fistula:A case report Zou J,Li H.Journal of Otology,2025, 20(1):1-4.https://doi.org/10.26599/JOTO.2025.9540001 proposing the"missing perilymph"sign on MRI as a novel radiological indicator of perilymphatic fistula(PLF).This study adds to the growing body of work seeking objective,non-invasive diagnostic methods for PLF,a condition that has long eluded definitive radiological confirmation.The avoidance of gadolinium contrast in the imaging technique is an additional strength,given increasing awareness of gadoliniumassociated risks (Starekova et al.,2024).展开更多
This letter critiques the article by Xu et al in World Journal of Psychiatry,which developed a nomogram to predict cognitive impairment in elderly hypertensive patients using nutritional and biochemical parameters.Whi...This letter critiques the article by Xu et al in World Journal of Psychiatry,which developed a nomogram to predict cognitive impairment in elderly hypertensive patients using nutritional and biochemical parameters.While the model's use of variables like body mass index,albumin,hemoglobin,alkaline phosphatase,and mini-nutritional assessment scores is promising,we raise concerns about the small validation cohort size,potential reverse causality in cross-sectional data,insufficiently discussed mechanisms for alkaline phosphatase as a risk factor,omission of key cognitive predictors,and possible overfitting given high area under the curve values.We suggest external validation,longitudinal studies,and calibration metrics to enhance the model's robustness and clinical utility.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
文摘BACKGROUND Mesenchymal stem cells(MSCs)are considered a promising therapy for various diseases due to their strong potential in regenerative medicine and immunomodulation.The tissue source of MSCs has gained attention for its role in influencing their function,accessibility,and readiness for clinical use.AIM To identify the most suitable adipose source for MSC isolation and expansion for further applications.METHODS We isolated MSCs from solid adipose tissue and liposuction aspirates using the enzyme method.The MSCs were examined for their expansion using population doubling time,differentiation capacity using multilineage differentiation induction,surface markers using flow cytometry,and stability of chromosomes using the karyotyping method.Growth factors and cytokines in MSC-conditioned media were analyzed using the Luminex assay.RESULTS MSCs were isolated from solid adipose tissue and lipoaspirates and expanded from passage 0 to passage 2.All adipose-derived MSCs(AD-MSCs)exhibited the typical elongated,spindle-shaped morphology and comparable proliferation rate.They expressed positive surface markers(cluster of differentiation 73[CD73]:>97%,CD90:>98%,and CD105:>95%),and negative markers(<1%).All MSCs expressed similar levels of stemness genes(octamer-binding transcription factor 4,SRY-box 2,Krüppel-like factor,and MYC),colonyforming,and trilineage differentiation potential.Karyotyping analysis revealed normal chromosomal patterns in all samples,except one sample exhibiting a polymorphism(1qh+).Furthermore,the growth factors and cytokines of hepatocyte growth factor,vascular endothelial growth factor A,interleukin 6(IL-6),and IL-8 were detected in all AD-MSC conditioned media;but fibroblast growth factor-2 and keratinocyte growth factor were selectively expressed in conditioned media from solid or lipoaspirate AD-MSCs,respectively.CONCLUSION These findings indicate that AD-MSCs from both adipose sources possess all of the characteristic features of MSCs with source-specific secretome differences,which are suitable for further expansion and various clinical applications.
基金supported by The China Ethnic Medicine Association Research Grant(No.2023MY055-81)Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Inner Mongolia Academy of Medical Sciences(2023GLLHD177,2023GLLH0174)Inner Mongolia Autonomous Region Regional Medical Center for Specialized Care(2025).
文摘Serbisütherapy(ST)is a distinctive external treatment modality within traditional Mongolian medicine(TMM),historically developed within a nomadic cultural framework.This study presents a comprehensive philological and historical analysis of ST,tracing its evolution from early battlefield applications to contemporary clinical use.By critically examining classical Mongolian medical texts alongside modern case studies,we aim to systematize ST’s therapeutic methods,indications,and limitations,while exploring its mechanisms of action through both traditional theory and modern biomedical perspectives.ST has undergone significant transformation,shifting from whole-body cavity immersion in the 13th century to targeted,organ-specific applications in modern practice.Its four primary methods–Covering,Mounted,Organ Placement,and Suction–demonstrate efficacy in treating cold-natured diseases,musculoskeletal disorders,gynecological conditions,and certain emergencies.ST embodies the core principles of TMM,particularly the balance of the“Three Roots”and the correction of cold-induced pathologies through heat.Despite challenges related to standardization,cultural translation,and regulatory acceptance,ST holds translational potential for integrative medicine.Future research should prioritize mechanistic validation,clinical standardization,and the development of biocompatible thermal technologies to bridge traditional practice with modern healthcare systems.
基金The trauma registry project was supported financially by the Health Partnership Scheme funded by the Tropical Health and Education Trust(THET)funded by the UK Department for International Development(DFID)
文摘BACKGROUND: Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries(LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre(AETC) at Queen Elizabeth Central Hospital(QECH) in Blantyre, Malawi and identify high risk geographic areas. METHODS: We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS(16) software respectively.RESULTS: There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault(38.2%), and road traffi c injuries(31.6%). The majority had soft tissue injury(53.1%), while 23.8% had no diagnosis indicated. Fractures(OR 19.94 [15.34–25.93]), head injury and internal organ injury(OR 29.5 [16.29–53.4]), and use of ambulance(OR 1.57 [1.06–2.33]) were found to be predictive of increased odds of being admitted to hospital while assault(OR 0.69 [0.52–0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence. CONCLUSION: We have described the process of establishing an integrated and potentially sustainable trauma registry. Signifi cant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.
文摘BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients).
文摘AIM:To investigate the clinical characteristics,treatment,medication use,and treatment response in patients with ulcerative colitis(UC)across ethnic groups.METHODS:This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010.The demographics,clinical characteristics,medication use,results of investigations,and medical and surgical management for patients with UC were evaluated.Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines.Patient ethnicities were categorized into seven groups:Thai,Oriental,South Asian(SA),Middle Eastern(ME),Caucasian,African,and Hispanic.UC pathological severity was classified into inactive,mild,moderate,and severe.Associations between categorical variables were analyzed using theχ2 or Fischer's exact test.Associations between categorical and interval variables were analyzed usingStudent's t-test and/or analysis of covariance.RESULTS:UC was diagnosed in 371 of the 268465 patients:male 56.33%;ME 42%,Caucasian 23%,and Thai 19%.Annual incidence of UC was 82 cases per 100000 with wide ethnic variation,ranging from 29 to 206 cases per 100000 in Oriental and ME patients,respectively.Of the patients with UC,16.71%had severe UC with highest incidence among the patients from ME(20.39%)and lowest among the Caucasian population(11.90%).ME had highest proportion of pancolitis(52.90%),followed by Caucasian(45.35%)and Asian(34.40%).Only 20.93%of Caucasian patients received steroid,compared with 26.40%and 27.10%of Asian and Middle Eastern,respectively(P=0.732).Overall,13.72%of UC patients did not respond to steroid therapy,with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients(15.22%and 15.04%,respectively)(P=0.781).On average,5.93%underwent surgical management with ethnic variation,ranging from 0%in African to 18%in SA.Cancer was found in three(Thai,ME,and African)cases(0.82 institution-specific incidence).CONCLUSION:Incidence,symptom duration,pathological severity,clinical manifestations,medication use,treatment response,need for surgical consultation,and cancer incidence of patients with UC potentially vary by ethnicity.
文摘<div style="text-align:justify;"> <strong><span style="font-family:Verdana;">Background:</span></strong><span style="font-family:Verdana;"> Intensity Modulated Radiation Therapy (IMRT) is currently employed as a major arm of treatment in multiforme glioblastoma (GBM). The present study aimed to compare 3D-CRT with IMRT to assess tumor volume coverage and OAR sparing for </span><span style="font-family:Verdana;">the </span><span "=""><span style="font-family:Verdana;">treatment of malignant gliomas. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">methods:</span></b><span style="font-family:Verdana;"> We assessed 22 anonymized patients datasets with High Grade Glioblastoma who had undergone post</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">operative Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3D-CRT), This study will compare and contrast treatment plans Rapidarc and 3D-CRT to determine w</span><span style="font-family:Verdana;">h</span><span style="font-family:Verdana;">ich techn</span><span style="font-family:Verdana;">ology</span><span "=""><span style="font-family:Verdana;"> improves significantly dosimetric parameters. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Plans will be assessed by reviewing the coverage of the PTV using mean, maximum and minimum doses while the OAR doses will be compared using the maximal doses for each, as set out in the QUANTEC dose limits. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The use of IMRT seems a superior technique as compared to 3D-CRT for the treatment of malignant gliomas having the potential to increase </span></span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">dose to the PTV while sparing OARs optimally.</span> </div>
文摘Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was to examine the patients with clinically presumed lumbar radiculopathy and find the correlation between their electrodiagnostic study and magnetic resonance imaging. Setting, duration and study type: Retrospective cross-sectional study of one year (January 2019 - February 2020) in Shifa International Hospital Islamabad. Methods: A total of 96 patients with clinically suspected lumbar radiculopathy were included. Chi-square test, international business machines (IBM) SPSS rendition 21.0 was applied on the clinical information, electrodiagnostic study and MRI were coordinated and affectability and particularity were judged. Selected patients were undergone both electrodiagnostic study and magnetic imaging resonance in the selected 1-year span. The study investigated correlation between both diagnostic tools in lumbar radiculopathy patients. Expected outcomes: Anatomical specificity in seen through magnetic resonance imaging while physiological through electrodiagnostic study, which may not correlate in the evaluation of lumbar radiculopathy.
文摘AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions)in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTSEndoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67%of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2%of the hospitals.Of the hospitals,83.8%performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20%rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds)and low-volume hospitals.More emergency visits(P=0.012)and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045)were observed in the high-volume hospitals.CONCLUSIONSome practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.
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Dear Editor,I am responding to Zou and Li's,The missing perilymph sign on MRI indicates a perilymphatic fistula:A case report Zou J,Li H.Journal of Otology,2025, 20(1):1-4.https://doi.org/10.26599/JOTO.2025.9540001 proposing the"missing perilymph"sign on MRI as a novel radiological indicator of perilymphatic fistula(PLF).This study adds to the growing body of work seeking objective,non-invasive diagnostic methods for PLF,a condition that has long eluded definitive radiological confirmation.The avoidance of gadolinium contrast in the imaging technique is an additional strength,given increasing awareness of gadoliniumassociated risks (Starekova et al.,2024).
文摘This letter critiques the article by Xu et al in World Journal of Psychiatry,which developed a nomogram to predict cognitive impairment in elderly hypertensive patients using nutritional and biochemical parameters.While the model's use of variables like body mass index,albumin,hemoglobin,alkaline phosphatase,and mini-nutritional assessment scores is promising,we raise concerns about the small validation cohort size,potential reverse causality in cross-sectional data,insufficiently discussed mechanisms for alkaline phosphatase as a risk factor,omission of key cognitive predictors,and possible overfitting given high area under the curve values.We suggest external validation,longitudinal studies,and calibration metrics to enhance the model's robustness and clinical utility.
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.
