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Nin OC, Hutnik R, Chheda NN, Hutchinson D. Airway management of a patient with linear immunoglobulin A bullous dermatosis: A case report. World J Clin Cases 2024; 12:2263-2268. [DOI: 10.12998/wjcc.v12.i13.2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A (IgA) bullous dermatosis, a rare mucocutaneous disorder that leads to the development of friable bullae. Careful clinical decision making is necessary when there is a risk of bleeding into the airway, and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios, especially when confronted with an unusual cause for bleeding.
CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis. The diagnosis of IgA dermatosis was recent, and the patient had been lost to follow-up. The severity of the disease and extent of airway involvement was unknown at the time of the surgery. Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room. The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case. The patient was extubated on postoperative day 4.
CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure. In our case, key communication between the surgery, anesthesia, and dermatology teams led to the quick and safe treatment of our patient’s disease. Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.
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Affiliation(s)
- Olga C Nin
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Robert Hutnik
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Neil N Chheda
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - David Hutchinson
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States
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Lin HG, Liu M, Huang XY, Liu DS. Intra-thyroid esophageal duplication cyst: A case report. World J Clin Cases 2024; 12:2231-2236. [DOI: 10.12998/wjcc.v12.i13.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/09/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Esophageal cysts are relatively rare in clinical practice, with most of the literature comprising case reports. Esophageal cysts protruding into the thyroid gland are easily misdiagnosed as thyroid tumors. No such cases have been reported so far.
CASE SUMMARY This article reports the case of a 31-year-old adult male diagnosed with thyroid nodules before admission. The patient underwent left thyroidectomy and isthmusectomy. During the surgery, esophageal cysts were identified in the esophageal muscle and thyroid glands. The pathology results confirmed a nodular goiter combined with esophageal cysts. Postoperatively, the patient developed a neck infection and underwent another operation and broad-spectrum antibiotic treatment for recovery.
CONCLUSION We report the first clinical case of an esophageal cyst located within the thyroid gland that was successfully treated surgically. Esophageal cyst located within the thyroid gland cause difficulties in diagnosis. In the present study, the contents of the esophageal cysts were calcified foci, and a small amount of fluid mixture, which were easily misdiagnosed as thyroid nodules and misled the surgical methods.
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Affiliation(s)
- Hong-Guo Lin
- Department of Vascular Thyroid Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Ming Liu
- Department of Vascular Thyroid Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Xue-Yang Huang
- Department of Vascular Thyroid Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Da-Sheng Liu
- Department of Vascular Thyroid Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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Dragonieri S. Pioneering role of machine learning in unveiling intensive care unit-acquired weakness. World J Clin Cases 2024; 12:2157-2159. [DOI: 10.12998/wjcc.v12.i13.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
In the research published in the World Journal of Clinical Cases, Wang and Long conducted a quantitative analysis to delineate the risk factors for intensive care unit-acquired weakness (ICU-AW) utilizing advanced machine learning methodologies. The study employed a multilayer perceptron neural network to accurately predict the incidence of ICU-AW, focusing on critical variables such as ICU stay duration and mechanical ventilation. This research marks a significant advancement in applying machine learning to clinical diagnostics, offering a new paradigm for predictive medicine in critical care. It underscores the importance of integrating artificial intelligence technologies in clinical practice to enhance patient management strategies and calls for interdisciplinary collaboration to drive innovation in healthcare.
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Affiliation(s)
- Silvano Dragonieri
- Department of Respiratory Diseases, University of Bari, Bari 70124, Italy
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Chen WQ, Fan QF, He YJ, Li F, Wu X, Li YP, Yang XJ. Yiwei Xiaoyu granules for treatment of chronic atrophic gastritis with deficiency syndrome of the spleen and stomach. World J Clin Cases 2024; 12:2201-2209. [DOI: 10.12998/wjcc.v12.i13.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/03/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND The Correa sequence, initiated by Helicobacter pylori (H. pylori), commonly progresses to gastric cancer through the stage of chronic atrophic gastritis (CAG). Although eradication of H. pylori only reduces the risk of gastric cancer, it does not eliminate the risk for neoplastic progression. Yiwei Xiaoyu granules (YWXY) are a commonly used composite preparation in Chinese clinics. However, the pursuit of excellence in clinical trials and the establishment of standardized animal experiments are still needed to contribute to full understanding and application of traditional Chinese medicine in the treatment of CAG.
AIM To demonstrate the effectiveness of YWXY in patients with CAG and spleen-stomach deficiency syndrome (DSSS), by alleviating histological scores, improving response rates for pathological lesions, and achieving clinical efficacy in relieving DSSS symptoms.
METHODS We designed a double-blind, randomized, controlled trial. The study enrolled seventy-two H. pylori-negative patients (mean age, 52.3 years; 38 men) who were randomly allocated to either the treatment group or control group in a 1:1 ratio, and treated with 15 g YWXY or 0.36 g Weifuchun (WFC) tablet combined with the respective dummy for 24 wk. The pre-randomization phase resulted in the exclusion of 72 patients: 50 participants did not meet the inclusion criteria, 12 participants declined to participate, and 10 participants were excluded for various other reasons. Seven visits were conducted during the study, and histopathological examination with target endoscopic biopsy of narrow-band imaging was requested before the first and seventh visits. We also evaluated endoscopic performance scores, total symptom scores, serum pepsinogen and gastrin-17.
RESULTS Six patients did not complete the trial procedures. Treatment with YWXY improved the Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stage, compared with WFC (P < 0.05). YWXY provided better relief from symptoms of DSSS and better improvement in serum gastric function, compared with WFC (P < 0.05).
CONCLUSION YWXY compared with WFC significantly reduced the risk of mild or moderate atrophic disease, according to OLGIM stage, significantly relieved symptoms of DSSS, and improved serum gastric function.
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Affiliation(s)
- Wan-Qun Chen
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Qing-Feng Fan
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Yuan-Jun He
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Fei Li
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Xin Wu
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Yan-Ping Li
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
| | - Xiao-Jun Yang
- Department of Gastroenterology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400000, China
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Wishahi M. Treatment-induced neuroendocrine prostate cancer and de novo neuroendocrine prostate cancer: Identification, prognosis and survival, genetic and epigenetic factors. World J Clin Cases 2024; 12:2143-2146. [DOI: 10.12998/wjcc.v12.i13.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/10/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
Neuroendocrine prostate cancer (NEPC) shows an aggressive behavior compared to prostate cancer (PCa), also known as prostate adenocarcinoma. Scanty foci in PCa can harbor genetic alternation that can arise in a heterogeneity of prostate cancer. NEPC may arise de novo or develop following androgen deprivation therapy (ADT). NEPC that arise following ADT has the nomenclature “treatment-emerging/induced NEPC (t-NEPC)”. t-NEPC would be anticipated in castration resistant prostate cancer (CRPC) and metastatic PCa. t-NEPC is characterized by low or absent androgen receptor (AR) expression, independence of AR signaling, and gain of neuroendocrine phenotype. t-NEPC is an aggressive metastatic tumor, develops from PCa in response to drug induced ADT, and shows very short response to conventional therapy. t-NEPC occurs in 10%-17% of patients with CRPC. De novo NEPC is rare and is accounting for less than 2% of all PCa. The molecular mechanisms underlying the trans-differentiation from CRPC to t-NEPC are not fully elucidated. Sphingosine kinase 1 plays a significant role in t-NEPC development. Although neuroendocrine markers: Synaptophysin, chromogranin A, and insulinoma associated protein 1 (INSM1) are expressed in t-NEPC, they are non-specific for diagnosis, prognosis, and follow-up of therapy. t-NEPC shows enriched genomic alteration in tumor protein P53 (TP53) and retinoblastoma 1 (RB1). There are evidences suggest that t-NEPC might develop through epigenetic evolution. There are genomic, epigenetic, and transcriptional alterations that are reported to be involved in development of t-NEPC. Knock-outs of TP53 and RB1 were found to contribute in development of t-NEPC. PCa is resistant to immunotherapy, and at present there are running trials to approach immunotherapy for PCa, CRPC, and t-NEPC.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
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Chang ZY, Gao WX, Zhang Y, Zhao W, Wu D, Chen L. Establishment and evaluation of a prognostic model for patients with unresectable gastric cancer liver metastases. World J Clin Cases 2024; 12:2182-2193. [DOI: 10.12998/wjcc.v12.i13.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Liver metastases (LM) is the primary factor contributing to unfavorable outcomes in patients diagnosed with gastric cancer (GC). The objective of this study is to analyze significant prognostic risk factors for patients with GCLM and develop a reliable nomogram model that can accurately predict individualized prognosis, thereby enhancing the ability to evaluate patient outcomes.
AIM To analyze prognostic risk factors for GCLM and develop a reliable nomogram model to accurately predict individualized prognosis, thereby enhancing patient outcome assessment.
METHODS Retrospective analysis was conducted on clinical data pertaining to GCLM (type III), admitted to the Department of General Surgery across multiple centers of the Chinese PLA General Hospital from January 2010 to January 2018. The dataset was divided into a development cohort and validation cohort in a ratio of 2:1. In the development cohort, we utilized univariate and multivariate Cox regression analyses to identify independent risk factors associated with overall survival in GCLM patients. Subsequently, we established a prediction model based on these findings and evaluated its performance using receiver operator characteristic curve analysis, calibration curves, and clinical decision curves. A nomogram was created to visually represent the prediction model, which was then externally validated using the validation cohort.
RESULTS A total of 372 patients were included in this study, comprising 248 individuals in the development cohort and 124 individuals in the validation cohort. Based on Cox analysis results, our final prediction model incorporated five independent risk factors including albumin levels, primary tumor size, presence of extrahepatic metastases, surgical treatment status, and chemotherapy administration. The 1-, 3-, and 5-years Area Under the Curve values in the development cohort are 0.753, 0.859, and 0.909, respectively; whereas in the validation cohort, they are observed to be 0.772, 0.848, and 0.923. Furthermore, the calibration curves demonstrated excellent consistency between observed values and actual values. Finally, the decision curve analysis curve indicated substantial net clinical benefit.
CONCLUSION Our study identified significant prognostic risk factors for GCLM and developed a reliable nomogram model, demonstrating promising predictive accuracy and potential clinical benefit in evaluating patient outcomes.
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Affiliation(s)
- Zheng-Yao Chang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Xing Gao
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yue Zhang
- Department of Endocrinology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Wen Zhao
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Di Wu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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Roganovic J. Parenteral iron therapy in children with iron deficiency anemia. World J Clin Cases 2024; 12:2138-2142. [DOI: 10.12998/wjcc.v12.i13.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
Iron deficiency anemia (IDA) continues to be a global public health problem. Oral iron is the universally accepted first-line therapy, and most children have a prompt and favorable response to oral formulations. In subsets of children who fail to respond due to intolerance, poor adherence, or inadequate intestinal absorption, parenteral iron is indicated. Despite numerous studies in adults with IDA of diverse etiologies, pediatric studies on parenteral iron use are very limited. Although mostly retrospective and small, these studies have documented the efficacy and safety profile of intravenous iron formulations. In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.
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Affiliation(s)
- Jelena Roganovic
- Department of Pediatric Hematology and Oncology, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
- Faculty of Biotechnology and Drug Development, University of Rijeka, Rijeka 51000, Croatia
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Narotam A, Archary M, Naidoo P, Naidoo Y, Naidu V. Atypical presentation of a posterior fossa tumour: A case report. World J Clin Cases 2024; 12:2281-2285. [DOI: 10.12998/wjcc.v12.i13.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress. This is of interest as the patient had no other symptomatology, especially given the size of the mass, which would typically cause a pressure effect leading to neurological and auditory symptoms.
CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard. He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler. He initially presented to our facility with severe respiratory distress. He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator. He had no constitutional symptoms or impairment of hearing. On clinical examination, the patient’s chest was “silent.” Our initial assessment was status asthmaticus with type 2 respiratory failure, based on the history of asthma, a “silent chest,” and the arterial blood gas results.
CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy. The patient’s chief presenting feature was severe respiratory distress, which combined with his background medical history of asthma, was misleading. Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.
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Affiliation(s)
- Alisha Narotam
- Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Mikara Archary
- Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Poobalan Naidoo
- Department of Internal Medicine, Nelson R Mandela, School of Medicine, University of Kwa-Zulu Natal, Durban 4001, Kwa-Zulu Natal, South Africa
| | - Yeshkhir Naidoo
- Department of Radiology, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwazulu-Natal, South Africa
| | - Vanesha Naidu
- Department of Radiology, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwazulu-Natal, South Africa
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Zhang J, Qiao YR, Yang YD, Pan GZ, Lv CQ. Recovering from prolonged cardiac arrest induced by electric shock: A case report. World J Clin Cases 2024; 12:2248-2253. [DOI: 10.12998/wjcc.v12.i13.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Cardiac arrest (CA) induced by electric shock is a rare occurrence, particularly in cases of prolonged CA. Currently, there is limited literature on similar incidents, and we present a relevant case report.
CASE SUMMARY A 27-year-old Asian male man, experiencing respiratory CA due to electric shock, was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation sessions. In the subsequent stages, the patient received multiple organ function protection measures, leading to a successful recovery and eventual discharge from the hospital.
CONCLUSION Prolonging resuscitation time can enhance the chances of survival for patients, this study provide valuable insights into the management of electric shock-induced CA.
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Affiliation(s)
- Jian Zhang
- Department of General Surgery, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
| | - Yan-Ru Qiao
- Department of General Surgery, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
| | - Ya-Dong Yang
- Department of Emergency Medicine, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
| | - Guo-Zheng Pan
- Department of General Surgery, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
| | - Chong-Qing Lv
- Department of General Surgery, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
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Tosounidis T, Chalidis B. Management of geriatric acetabular fractures: Contemporary treatment strategies. World J Clin Cases 2024; 12:2151-2156. [DOI: 10.12998/wjcc.v12.i13.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/15/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population’s concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.
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Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, Heraklion University Hospital, University of Crete, Greece, Heraklion 71500, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Xu HC, Cui Y, Wang XY, Wu HB, Li W, Wang D, Lin N, Lin L, Zhang YH. Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria. World J Clin Cases 2024; 12:2173-2181. [DOI: 10.12998/wjcc.v12.i13.2173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Multidrug-resistant Gram-negative bacteria, exacerbated by excessive use of antimicrobials and immunosuppressants, are a major health threat.
AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia, and to provide theoretical reference for clinical diagnosis and treatment.
METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022. After bacteriological culture, the patients' airway secretions were collected to confirm the presence of Gram-negative bacilli. The patients were divided into the experimental and control groups according to the medication used. The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous, nebulization, or intravenous combined with nebulization, with a daily dosage of 1.5–3.0 million units. The control group consisted of 26 patients who received standard dosages of other antibiotics (including sulbactam sodium for injection, cefoperazone sodium sulbactam for injection, tigecycline, meropenem, or vaborbactam).
RESULTS Of the 28 patients included in the research group, 26 patients showed improvement, treatment was ineffective for two patients, and one patient died, with the treatment efficacy rate of 92.82%. Of the 26 patients in the control group, 18 patients improved, treatment was ineffective for eight patients, and two patients died, with the treatment efficacy rate of 54.9%; significant difference was observed between the two groups (P < 0.05). The levels of white blood cell (WBC), procalcitonin (PCT), and C-reactive protein (CRP) in both groups were significantly lower after treatment than before treatment (P < 0.05), and the levels of WBC, PCT, and CRP in the research group were significantly lower than those in the control group (P < 0.05). Compared with before treatment, there were no significant changes in aspartate aminotransferase, creatinine, and glomerular filtration rate in both groups, while total bilirubin and alanine aminotransferase decreased after treatment (P < 0.05) with no difference between the groups. In patients with good clinical outcomes, the sequential organ failure assessment (SOFA) score was low when treated with inhaled polymyxin sulfate, and specific antibiotic treatment did not improve the outcome. Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.
CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable. Moreover, the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions, providing new ideas for clinical administration.
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Affiliation(s)
- Hai-Chang Xu
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Yan Cui
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Xue-Ying Wang
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Hai-Bo Wu
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Wei Li
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Dan Wang
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Na Lin
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Lin Lin
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
| | - Ying-Hui Zhang
- Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
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12
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Nag DS, Chatterjee A, Mahanty PR, Sam M, Bharadwaj MK. Perioperative cardiac risks in myasthenia gravis. World J Clin Cases 2024; 12:2147-2150. [DOI: 10.12998/wjcc.v12.i13.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/13/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors (AChRs), which results in qualitative and quantitative reductions in the availability of functional AChRs. Cardiac muscles are also affected, resulting in various perioperative cardiac complications. Antistriational antibodies are commonly reported in MG cases with cardiac involvement. In the presence of thymoma, the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%. Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure, and sudden death. Increased incidence of atrial fibrillation, ventricular and supraventricular extra systoles, and prolonged QTc have also been reported in patients with MG. Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG .
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
| | - Abhishek Chatterjee
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Pratap Rudra Mahanty
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anaesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Merina Sam
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
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Chen DX, Wu Y, Zhang SF, Yang XJ. Refractory autoimmune hemolytic anemia in a patient with systemic lupus erythematosus and ulcerative colitis: A case report. World J Clin Cases 2024; 12:2286-2292. [DOI: 10.12998/wjcc.v12.i13.2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Ulcerative colitis (UC) and systemic lupus erythematosus (SLE) are both systemic immunoreactive diseases, and their pathogenesis depends on the interaction between genes and environmental factors. There are no reports of UC with SLE in China, but six cases of SLE with UC have been reported in China. The combination of these two diseases has distinct effects on the pathogenesis of both diseases.
CASE SUMMARY A female patient (30 years old) came to our hospital due to dull umbilical pain, diarrhea and mucous bloody stool in August 2018 and was diagnosed with UC. The symptoms were relieved after oral administration of mesalazine (1 g po tid) or folic acid (5 mg po qd), and the patient were fed a control diet. On June 24, 2019, the patient was admitted for treatment due to anemia and tinnitus. During hospitalization, the patient had repeated low-grade fever and a progressively decreased Hb level. Blood tests revealed positive antinuclear antibody test, positive anti-dsDNA antibody, 0.24 g/L C3 (0.9-1.8 g/L), 0.04 g/L C4 (0.1-0.4 g/L), 32.37 g/L immunoglobulin (8-17 g/L), and 31568.1 mg/24 h total 24-h urine protein (0-150 mg/24 h). The patient was diagnosed with SLE involving the joints, kidneys and blood system. Previously reported cases of SLE were retrieved from PubMed to characterize clinicopathological features and identify prognostic factors for SLE.
CONCLUSION The patient was discharged in remission after a series of treatments, such as intravenous methylprednisolone sodium succinate, intravenous human immunoglobulin, cyclophosphamide injection, and plasma exchange. After discharge, the patient took oral prednisone acetate tablets, cyclosporine capsules, hydroxychloroquine sulfate tablets and other treatments for symptoms and was followed up regularly for 1 month, after which the patient's condition continued to improve and stabilize.
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Affiliation(s)
- Dai-Xing Chen
- Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Yue Wu
- Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Sui-Feng Zhang
- Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
| | - Xiao-Jun Yang
- Department of Digestive System, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400021, China
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Ji X, Chen H. Detection and analysis of serum bile acid profile in patients with colonic polyps. World J Clin Cases 2024; 12:2160-2172. [DOI: 10.12998/wjcc.v12.i13.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/21/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Analyzing the variations in serum bile acid (BA) profile can provide a certain biological basis for early warning and prevention of various diseases. There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.
AIM To study the serum BA profile detection results of patients with colonic polyps, and analyze the correlation between BA and colonic polyps.
METHODS From January 1, 2022, to June 1, 2023, 204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects, and 135 non-polyp people who underwent physical examination were chosen as the control group. Gathering all patients' clinical information, typical biochemical indicators, and BA profile.
RESULTS Compared with the control group, the serum levels of taurocholic acid, glycocholic acid, glycochenodeoxycholic acid, and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group, while the content of deoxycholic acid (DCA) was lower than that in the control group (P < 0.05). When colonic polyps were analyzed as subgroups, it was shown that there was a strong correlation between changes in the BA profile and polyp diameter, location, morphology, pathological kind, etc.
CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps, with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content. There is a certain correlation between primary free BA and pathological parameters of polyps.
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Affiliation(s)
- Xin Ji
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Hong Chen
- Department of Gastroenterology, Zhongda Hospital Southeast University, Nanjing 210009, Jiangsu Province, China
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15
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Chen CQ, Huang MY, Pan M, Chen QQ, Wei FF, Huang H. Thymic carcinoid with multiple bone metastases: A case report. World J Clin Cases 2024; 12:2275-2280. [DOI: 10.12998/wjcc.v12.i13.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/09/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Thymic carcinoid (TC) is a rare entity among anterior mediastinal malignancies. TCs are neuroendocrine carcinomas that constitute approximately 2%–5% of all thymic epithelial tumors.
CASE SUMMARY The study reported a rare TC with multiple bone metastases. A 77-year-old man presented with a 2-month history of lower back pain and weight loss of 5 kg. Magnetic resonance imaging scans revealed damage to the lumbar spine, sacrocaudal vertebrae and iliac crest, suggesting bone metastasis; computed tomography (CT) scan of the thorax showed a calcified anterior mediastinal mass; positron emission tomography-CT demonstrated multiple abnormal bone signals; and laboratory work-up showed no endocrine abnormalities. Fine-needle aspiration biopsy revealed predominantly single small, round to oval cells with scant cytoplasm and some loose clusters, suggesting endocrine manifestations. The pathological diagnosis was atypical carcinoid, which tend to originate from the thymus and was classified as intermediate-highly invasive. The patient underwent anlotinib-targeted therapy. Anlotinib (12 mg) was administered daily for 2 wk, after which the patient was allowed to rest for 21 d. Follow-up CT after one year demonstrated that the tumor had shrunk by approximately 29% after therapy. Treatment has a long stable disease benefit of more than 2.5 years.
CONCLUSION These findings demonstrated that anlotinib is a promising treatment regimen for patients with TC and multiple bone metastases.
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Affiliation(s)
- Chun-Qiao Chen
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
| | - Ming-Yue Huang
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
| | - Min Pan
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
| | - Qiu-Qiu Chen
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
| | - Fei-Fei Wei
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
| | - Hui Huang
- Department of Oncology, People’s Hospital of Guilin, Guilin 541000, Guangxi Zhuang Autonomous Region, China
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Al Nooryani A, Aboushokka W, Beleslin B, Nedeljkovic-Beleslin B. Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data: A case report. World J Clin Cases 2024; 12:2269-2274. [DOI: 10.12998/wjcc.v12.i13.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing.
CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications.
CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.
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Affiliation(s)
- Arif Al Nooryani
- Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates
| | - Wael Aboushokka
- Department of Cardiology, Al Qassimi Hospital, Sharjah 1234, United Arab Emirates
| | - Branko Beleslin
- Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade 11000, Serbia
| | - Biljana Nedeljkovic-Beleslin
- Institute of Endocrinology, Diabetes and Metabolic Disorders, Univeristy Clinical Center of Serbia, Belgrade 11000, Serbia
- Department of Internal Medicine/Endocrinology, Medical faculty, University of Belgrade, Belgrade 11000, Serbia
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17
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Wu WP, Lee CW. Magnetic resonance imaging findings of radiation-induced breast angiosarcoma: A case report. World J Clin Cases 2024; 12:2237-2242. [DOI: 10.12998/wjcc.v12.i13.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/17/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Breast conservation surgery (BCS) with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer, significantly reducing the risk of tumor recurrence. However, this treatment is associated with adverse effects, including the rare but aggressive radiation-induced angiosarcoma (RIAS). Despite its rarity and nonspecific initial presentation, RIAS presents a challenging diagnosis, emphasizing the importance of imaging techniques for early detection and accurate diagnosis.
CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer. Initial mammography and ultrasound were inconclusive, showing post-treatment changes but failing to identify the underlying angiosarcoma. Contrast-enhanced breast magnetic resonance imaging (MRI) revealed diffuse skin thickening and nodularity with distinctive enhancement kinetics, leading to the diagnosis of RIAS. This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS, facilitating timely and appropriate surgical intervention.
CONCLUSION Breast MRI is crucial for detecting RIAS, especially when mammography and ultrasound are inconclusive.
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Affiliation(s)
- Wen-Pei Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Chih-Wei Lee
- Department of Radiology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua 50006, Taiwan
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Zhang YJ, Wu SP. Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery. World J Clin Cases 2024; 12:2194-2200. [DOI: 10.12998/wjcc.v12.i13.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/09/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage. Wendan Decoction (WDD) is a traditional Chinese herbal formula used to treat various gastrointestinal disorders, such as gastritis, functional dyspepsia, and irritable bowel syndrome. Mosapride, a prokinetic agent, functions as a selective 5-hydroxytryptamine 4 agonist, enhancing gastrointestinal motility.
AIM To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery.
METHODS Eighty patients with GERD were randomly divided into treatment (receiving WDD combined with mosapride) and control (receiving mosapride alone) groups. The treatment was conducted from January 2021 to January 2023. The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire (RDQ). The secondary outcomes were improved esophageal motility (measured using esophageal manometry), gastric emptying (measured using gastric scintigraphy), and quality of life [measured via the Short Form-36 (SF-36) Health Survey].
RESULTS The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters, such as lower esophageal sphincter pressure, peristaltic amplitude, and peristaltic velocity compared to the control group. The treatment group showed significantly higher gastric emptying rates and SF-36 scores (in both physical and mental domains) compared to the control group. No serious adverse effects were observed in either group.
CONCLUSION WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery. It can improve GERD symptoms, esophageal motility, gastric emptying, and the quality of life of patients. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.
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Affiliation(s)
- Yu-Jing Zhang
- Department of Oncology, Beijing Integrated Traditional Chinese and Western Medicine Hospital, Beijing 100039, China
| | - Shen-Ping Wu
- Department of Oncology, Beijing Integrated Traditional Chinese and Western Medicine Hospital, Beijing 100039, China
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Lu XR, Jiao XG, Sun QH, Li BW, Zhu QS, Zhu GX, Qu JJ. Young patient with a giant gastric bronchogenic cyst: A case report and review of literature. World J Clin Cases 2024; 12:2254-2262. [DOI: 10.12998/wjcc.v12.i13.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions that were first reported in 1956; as of 2023, only 33 cases are available in the PubMed online database. BCs usually have no clinical symptoms in the early stage, and imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination.
CASE SUMMARY A 34-year-old woman with respiratory distress presented at our hospital. Endoscopic ultrasound revealed an anechoic mass between the spleen, left kidney and gastric fundus, with hyperechogenic and soft elastography textures and with a size of approximately 6.5 cm × 4.0 cm. Furthermore, a computed tomography scan demonstrated high density between the posterior stomach and the spleen and the left kidney, with uniform internal density and a small amount of calcification. The maximum cross section was approximately 10.1 cm × 6.1 cm, and the possibility of a cyst was high. Because the imaging findings did not suggest a malignancy and because the patient required complete resection, she underwent laparotomy surgery. Intraoperatively, this cystic lesion was found to be located in the posterior wall of the large curvature of the fundus and was approximately 8 cm × 6 cm in size. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well, her symptoms of chest tightness disappeared, and the abdominal drain was removed on postoperative day 6, after which she was discharged on day 7 for 6 months of follow-up. She had no tumor recurrence or postoperative complications during the follow-up.
CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this was a very young patient with a large BC in the stomach.
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Affiliation(s)
- Xu-Ren Lu
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Xu-Guang Jiao
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Qi-Hang Sun
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Bo-Wen Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Qing-Shun Zhu
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Guang-Xu Zhu
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Jian-Jun Qu
- Department of Gastrointestinal Surgery Medical Center, The First Affiliated Hospital, Shandong Second Medical University, Weifang 261000, Shandong Province, China
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Lu SH, Yu YF, Dai SS, Hu YQ, Liu JH. Efficacy and safety of Yangxinshi tablet for chronic heart failure: A systematic review and meta-analysis. World J Clin Cases 2024; 12:2218-2230. [DOI: 10.12998/wjcc.v12.i13.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/10/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND The specific benefits of Yangxinshi tablet (YXST) in the treating chronic heart failure (CHF) remain uncertain.
AIM To systematically evaluate the efficacy and safety of YXST in the treatment of CHF.
METHODS Randomized controlled trials (RCTs) investigating YXST for CHF treatment were retrieved from eight public databases up to November 2023. Meta-analyses of the included clinical studies were conducted using Review Manager 5.3.
RESULTS Twenty RCTs and 1845 patients were included. The meta-analysis results showed that the YXST combination group, compared to the conventional drug group, significantly increased the clinical efficacy rate by 23% [relative risk (RR) = 1.23, 95%CI: 1.17-1.29], P < 0.00001), left ventricular ejection fraction by 6.69% [mean difference (MD) = 6.69, 95%CI: 4.42-8.95, P < 0.00001] and 6-min walk test by 49.82 m (MD = 49.82, 95%C: 38.84-60.80, P < 0.00001), and reduced N-terminal pro-B-type natriuretic peptide by 1.03 ng/L [standardized MD (SMD) = -1.03, 95%CI: -1.32 to -0.74, P < 0.00001], brain natriuretic peptide by 80.95 ng/L (MD = -80.95, 95%CI: -143.31 to -18.59, P = 0.01), left ventricular end-diastolic diameter by 3.92 mm (MD = -3.92, 95%CI: -5.06 to -2.78, P < 0.00001), and left ventricular end-systolic diameter by 4.34 mm (MD = -4.34, 95%CI: -6.22 to -2.47, P < 0.00001). Regarding safety, neither group reported any serious adverse events during treatment (RR = 0.54, 95%CI: 0.15-1.90, P = 0.33). In addition, Egger's test results indicated no significant publication bias (P = 0.557).
CONCLUSION YXST effectively improves clinical symptoms and cardiac function in patients with CHF while maintaining a favorable safety profile, suggesting its potential as a therapeutic strategy for CHF.
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Affiliation(s)
- Sheng-Hua Lu
- The First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
- Branch of National Clinical Research Center for Chinese Medicine Cardiology, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Yun-Feng Yu
- The First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Si-Si Dai
- The First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Ya-Qi Hu
- The First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Jian-He Liu
- The First Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
- Branch of National Clinical Research Center for Chinese Medicine Cardiology, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
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Hu YA, Guo YX, Huang QF. Rim 18F-fluorodeoxyglucose uptake of hepatic cavernous hemangioma on positron emission tomography/computed tomography: A case report. World J Clin Cases 2024; 12:2243-2247. [DOI: 10.12998/wjcc.v12.i13.2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Peripheral FDG accumulation in a hepatic hemangioma presenting in a patient with prolonged fever is rare. Therefore, clinicians should pay close attention to patients with hepatic mass.
CASE SUMMARY A 54-year-old woman with a 4-wk history of daily fevers was admitted to our hospital. A whole body 18F-Fluordesoxyglucose (PET-FDG) positron emission tomography/computed tomography (PET/CT) was performed to elucidate the source of the fever. However, whole body 18F-FDG PET/CT raised the suspicion of a malignant lesion because of peripheral FDG accumulation (SUVmax 3.5 g/mL) higher than that of the normal liver parenchyma (SUVmax 1.6 g/mL) surrounding a hypoactive area, and no other abnormalities were showed. Subsequently, the patient underwent liver mass resection. Histopathology showed a hepatic cavernous hemangioma with fatty infiltration around the lesion. The fever disappeared four days after surgery and the patient did not present any complications during follow-up.
CONCLUSION Fatty infiltration in the peripheral parts of hepatic cavernous hemangioma may lead to subacute inflammation which further activate the Kupffer cells. This may cause prolonged fever and peripheral rim FDG accumulation on PET/CT.
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Affiliation(s)
- Yong-An Hu
- Department of Nuclear Medicine, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
| | - Ya-Xin Guo
- Department of Nuclear Medicine, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
| | - Qi-Feng Huang
- Department of Nuclear Medicine, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
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Zhang G, Huang SJ, Li SF. Relationship between clinical belonging, professional identity, and nursing information ability among nursing interns: Model construction. World J Clin Cases 2024; 12:2210-2217. [DOI: 10.12998/wjcc.v12.i13.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/23/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Clinical belonging refers to the feeling that clinical medical staff feel recognized and accepted by others or groups. The level of clinical belonging of nursing interns affects students’ learning motivation and confidence, which in turn affects their clinical practice behavior.
AIM To explore the effects of professional identity and nursing information ability on clinical belonging among nursing interns and establish a relationship model for these factors.
METHODS The researchers used the convenience sampling method to select 682 nursing interns from China. The survey was conducted using a general information questionnaire, clinical sense of belonging scale, nursing information ability self-assessment scale, and a nursing student professional identity questionnaire. The mediating effect of nursing information ability between their professional identity and clinical sense of belonging was analyzed using SPSS 21.0 and the path analysis in structural equation modeling.
RESULTS The total scores of clinical belonging, professional identity, and nursing information ability of nursing interns were (104.29 ± 13.11) points, (57.89 ± 7.16) points, and (70.29 ± 6.20) points, respectively. Nursing information ability had a direct effect on the clinical sense of belonging (effect value = 0.46, P < 0.05). Occupational identity had a direct effect (effect value = 0.52, P < 0.05) and an indirect effect (effect value = 0.21, P < 0.05) on clinical belonging.
CONCLUSION Nursing administrators in nursing colleges and hospitals should take effective measures to improve the professional identity and nursing information ability of nursing interns, as well as the clinical sense of belonging among nursing interns.
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Affiliation(s)
- Gai Zhang
- Department of Nursing, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Shao-Juan Huang
- Department of Nursing, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
| | - Shu-Fang Li
- Department of Nursing, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
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Mitrev N, Kariyawasam V. Treatment endpoints in ulcerative colitis: Does one size fit all? World J Gastrointest Pharmacol Ther 2024; 15:91591. [DOI: 10.4292/wjgpt.v15.i2.91591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
A treat-to-target strategy in inflammatory bowel disease (IBD) involves treatment intensification in order to achieve a pre-determined endpoint. Such uniform and tight disease control has been demonstrated to improve clinical outcomes compared to treatment driven by a clinician’s subjective assessment of symptoms. However, choice of treatment endpoints remains a challenge in management of IBD via a treat-to-target strategy. The treatment endpoints for ulcerative colitis (UC), recommended by the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) consensus have changed somewhat over time. The latest STRIDE-II consensus advises immediate (clinical response), intermediate (clinical remission and biochemical normalisation) and long-term treatment (endoscopic healing, absence of disability and normalisation of health-related quality of life, as well as normal growth in children) endpoints in UC. However, achieving deeper levels of remission, such as histologic normalisation or healing of the gut barrier function, may further improve outcomes among UC patients. Generally, all medical therapy should seek to improve short- and long-term mortality and morbidity. Hence treatment endpoints should be chosen based on their ability to predict for improvement in short- and long-term mortality and morbidity. Potential benefits of treatment intensification need to be weighed against the potential harms within an individual patient. In addition, changing therapy that has achieved partial response may lead to worse outcomes, with failure to recapture response on treatment reversion. Patients may also place different emphasis on certain potential benefits and harms of various treatments than clinicians, or may have strong opinions re certain therapies. Potential benefits and harms of therapies, incremental benefits of achieving deeper levels of remission, as well as uncertainties of the same, need to be discussed with individual patients, and a treatment endpoint agreed upon with the clinician. Future research should focus on quantifying the incremental benefits and risks of achieving deeper levels of remission, such that clinicians and patients can make an informed decision about appropriate treatment end-point on an individual basis.
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Affiliation(s)
- Nikola Mitrev
- Department of Gastroenterology, Blacktown Hospital, Blacktown 2148, NSW, Australia
- Blacktown/Mt Druitt Clinical School, University of Western Sydney, Blacktown 2148, NSW, Australia
- Department of Gastroenterology, Wollongong Hospital, Loftus St, Wollongong 2500, NSW, Australia
| | - Viraj Kariyawasam
- Department of Gastroenterology, Blacktown Hospital, Blacktown 2148, NSW, Australia
- Blacktown/Mt Druitt Clinical School, University of Western Sydney, Blacktown 2148, NSW, Australia
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Tantău A, Sutac C, Pop A, Tantău M. Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion. World J Radiol 2024; 16:72-81. [DOI: 10.4329/wjr.v16.i4.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
In patients with liver tumors, the histopathology examination can assist in diagnosis, staging, prognosis, and therapeutic management strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition using fine needle aspiration (FNA) or more newly fine needle biopsy (FNB) is a well-developed technique in order to evaluate and differentiate the liver masses. The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination. Therefore, malignant tumors such as hepatocarcinoma, cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma, focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition. EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA. Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously, ultrasound, computer tomography or transjugulary-guided liver biopsies. This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples. The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented. The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis, especially for those who require endoscopy.
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Affiliation(s)
- Alina Tantău
- Department of Internal Medicine and Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, The 4th Medical Clinic CF Hospital, Cluj-Napoca 400012, Cluj, Romania
| | - Cosmina Sutac
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor”, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Cluj, Romania
| | - Anamaria Pop
- Department of Gastroenterology and Hepatology, Gastroenterology and Hepatology Medical Center, Digenio Hospital, Cluj-Napoca 400058, Cluj, Romania
| | - Marcel Tantău
- Department of Internal Medicine and Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, “Prof. Dr. Octavian Fodor”, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Cluj, Romania
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Iampreechakul P, Wangtanaphat K, Chuntaroj S, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P, Puthkhao P, Siriwimonmas S. Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study. World J Radiol 2024; 16:94-108. [DOI: 10.4329/wjr.v16.i4.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND The goal of therapy for traumatic carotid-cavernous fistula (TCCF) is the elimination of fistula while maintaining patency of the parent artery. The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons, coils, liquid embolic agents, covered stents, or flow-diverter stent through arterial or venous approaches. Despite the withdrawal of detachable balloons from the market in the United States since 2004, transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries. However, the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up.
AIM To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF.
METHODS Between January 2009 and December 2019, 79 patients diagnosed with TCCF were treated using detachable latex balloons (GOLDBAL) of four sizes. Pseudoaneurysm sizes were stratified into five grades for analysis. Initial and follow-up assessments involved computed tomography angiography at 1 month, 6 month, 1 year, and longer intervals for significant cases. Clinical follow-ups occurred semi-annually for 2 years, then annually. Factors analyzed included sex, age, fistula size and location, and balloon size.
RESULTS In our cohort of 79 patients treated for TCCF, pseudoaneurysms formed in 67.1%, with classifications ranging from grade 0 to grade 3; no grade 4 or giant pseudoaneurysms were observed. The majority of pseudoaneurysms did not progress in size, and some regressed spontaneously. Calcifications developed in most large pseudoaneurysms over 5-10 years. Parent artery occlusion occurred in 7.6% and recurrent fistulas in 16.5%. The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes, with balloon SP and No. 6 significantly associated with its occurrence (P = 0.005 and P = 0.002, respectively), whereas sex, age, fistula size, location, and the number of balloons used were not significant predictors.
CONCLUSION Pseudoaneurysm formation following detachable balloon embolization for TCCF is common, primarily influenced by the size of the balloon used. Despite this, all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.
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Affiliation(s)
- Prasert Iampreechakul
- Department of Neurosurgery, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | | | - Songpol Chuntaroj
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Sunisa Hangsapruek
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | | | - Pimchanok Puthkhao
- Department of Medical Services, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Somkiet Siriwimonmas
- Department of Radiology, Bumrungrad International Hospital, Bangkok 10110, Thailand
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Viswanathan DJ, Bhalla AS, Manchanda S, Roychoudhury A, Mishra D, Mridha AR. Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography. World J Radiol 2024; 16:82-93. [DOI: 10.4329/wjr.v16.i4.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/16/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] [Imported: 04/25/2024] Open
Abstract
BACKGROUND Currently, the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics, which are important in the differentiation of neoplasms across the body. There is a paucity of literature on the enhancement characteristics of jaw tumors. This is mainly because, even though computed tomography (CT) is used to evaluate these lesions, they are often imaged without intravenous contrast. This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT, therefore improving the ability to differentiate between various pathologies.
AIM To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.
METHODS Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT. Morphological analysis of the tumor, including the enhancing solid component, was done, followed by quantitative analysis of iodine concentration (IC), water concentration (WC), HU, and normalized IC. The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma (CGCG), ameloblastoma, odontogenic keratocyst (OKC), and other jaw tumors. A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for non-parametric variables were used. If significant differences were found, a series of independent t-tests or Mann-Whitney U tests were used.
RESULTS Ameloblastoma was the most common pathology (n = 20), followed by CGCG (n = 11) and OKC. CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas (P < 0.05). An IC threshold of 31.35 × 100 μg/cm3 had the maximum sensitivity (81.8%) and specificity (65%). Between ameloblastomas and OKC, the former showed a higher mean concentration of all quantitative parameters (P < 0.001), however when comparing unilocular ameloblastomas with OKCs, the latter showed significantly higher WC. Also, ameloblastoma had a higher IC and lower WC compared to “other jaw tumors” group.
CONCLUSION Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.
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Affiliation(s)
- Deepak Justine Viswanathan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Zheng Y, Zheng YH, Wang JH, Zhao TJ, Wang L, Liang TJ. Progress of mitochondrial and endoplasmic reticulum-associated signaling and its regulation of chronic liver disease by Chinese medicine. World J Hepatol 2024; 16:494-505. [DOI: 10.4254/wjh.v16.i4.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
The endoplasmic reticulum (ER) is connected to mitochondria through mitochondria-associated ER membranes (MAMs). MAMs provide a framework for crosstalk between the ER and mitochondria, playing a crucial role in regulating cellular calcium balance, lipid metabolism, and cell death. Dysregulation of MAMs is involved in the development of chronic liver disease (CLD). In CLD, changes in MAMs structure and function occur due to factors such as cellular stress, inflammation, and oxidative stress, leading to abnormal interactions between mitochondria and the ER, resulting in liver cell injury, fibrosis, and impaired liver function. Traditional Chinese medicine has shown some research progress in regulating MAMs signaling and treating CLD. This paper reviews the literature on the association between mitochondria and the ER, as well as the intervention of traditional Chinese medicine in regulating CLD.
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Affiliation(s)
- Yang Zheng
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
| | - Yi-Hui Zheng
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
| | - Jia-Hui Wang
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
| | - Tie-Jian Zhao
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
| | - Lei Wang
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
| | - Tian-Jian Liang
- Department of Medicine, Faculty of Chinese Medicine Science, Guangxi University of Chinese Medicine, Nanning 530222, Guangxi Zhuang Autonomous Region, China
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Ali H, Inayat F, Moond V, Chaudhry A, Afzal A, Anjum Z, Tahir H, Anwar MS, Dahiya DS, Afzal MS, Nawaz G, Sohail AH, Aziz M. Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning. World J Gastrointest Surg 2024; 16:1097-1108. [DOI: 10.4240/wjgs.v16.i4.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity. It aids in significant weight loss and improves obesity-related medical conditions. Despite its effectiveness, postoperative care still has challenges. Clinical evidence shows that venous thromboembolism (VTE) is a leading cause of 30-d morbidity and mortality after RYGB. Therefore, a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.
AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.
METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program, data from 6526 patients (body mass index ≥ 40 kg/m2) who underwent RYGB were analyzed. A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB. The resultant risk scores were derived from the coefficients of statistically significant variables. The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.
RESULTS Of the 26 initial variables, six predictors were identified. These included a history of chronic obstructive pulmonary disease with a regression coefficient (Coef) of 2.54 (P < 0.001), length of stay (Coef 0.08, P < 0.001), prior deep venous thrombosis (Coef 1.61, P < 0.001), hemoglobin A1c > 7% (Coef 1.19, P < 0.001), venous stasis history (Coef 1.43, P < 0.001), and preoperative anticoagulation use (Coef 1.24, P < 0.001). These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB. The risk model's area under the curve (AUC) was 0.79 [95% confidence interval (CI): 0.63-0.81], showing good discriminatory power, achieving a sensitivity of 0.60 and a specificity of 0.91. Without training, the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63 (95%CI: 0.62-0.64) and endoscopic sleeve gastroplasty with an AUC of 0.76 (95%CI: 0.75-0.78).
CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients, offering insights into factors that heighten the risk of VTE events.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Vishali Moond
- Department of Internal Medicine, Saint Peter's University Hospital and Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
| | - Arslan Afzal
- Department of Gastroenterology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Zauraiz Anjum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Hamza Tahir
- Department of Internal Medicine, Jefferson Einstein Hospital, Philadelphia, PA 19141, United States
| | - Muhammad Sajeel Anwar
- Department of Internal Medicine, UHS Wilson Medical Center, Johnson, NY 13790, United States
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas, KS 66160, United States
| | - Muhammad Sohaib Afzal
- Department of Internal Medicine, Louisiana State University Health, Shreveport, LA 71103, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Amir H Sohail
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, United States
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
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Dong TX, Wang D, Zhao Q, Zhang ZD, Zhao XF, Tan BB, Liu Y, Liu QW, Yang PG, Ding PA, Zheng T, Li Y, Liu ZJ. Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy. World J Gastrointest Surg 2024; 16:1109-1120. [DOI: 10.4240/wjgs.v16.i4.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND The incidence of gastric cancer has significantly increased in recent years. Surgical resection is the main treatment, but the method of digestive tract reconstruction after gastric cancer surgery remains controversial. In the current study, we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery. To this end, we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY).
AIM To explore the application effect of DTR in total laparoscopic radical total gastrectomy (TLTG) and evaluate its safety and efficacy.
METHODS We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023. Among them, 35 cases were treated with DTR, and the remaining 42 cases were treated with traditional RY. After 1:1 propensity score matching, the cases were grouped into 31 cases per group, with evenly distributed data. The clinical characteristics and short- and long-term clinical outcomes of the two groups were statistically analyzed.
RESULTS The two groups showed no significant differences in basic data, intraoperative blood loss, number of lymph node dissections, first defecation time after operation, postoperative hospital stay, postoperative complications, and laboratory examination results on the 1st, 3rd, and 5th days after operation. The operation time of the DTR group was longer than that of the RY group [(307.58 ± 65.14) min vs (272.45 ± 62.09) min, P = 0.016], but the first intake of liquid food in the DTR group was shorter than that in the RY group [(4.45 ± 1.18) d vs (6.0 ± 5.18) d, P = 0.028]. The incidence of reflux heartburn (Visick grade) and postoperative gallbladder disease in the DTR group was lower than that in the RY group (P = 0.033 and P = 0.038). Although there was no significant difference in body weight, hemoglobin, prealbumin, and albumin between the two groups at 1,3 and 6 months after surgery, the diet of patients in the DTR group was better than that in the RY group (P = 0.031).
CONCLUSION The clinical effect of DTR in TLTG is better than that of RY, indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery.
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Affiliation(s)
- Tian-Xiang Dong
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Dong Wang
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Qun Zhao
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Zhi-Dong Zhang
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Xue-Feng Zhao
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Bi-Bo Tan
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Yu Liu
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Qing-Wei Liu
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Pei-Gang Yang
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Ping-An Ding
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Tao Zheng
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Yong Li
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
| | - Zi-Jing Liu
- Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
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Ren SJ, Feng JT, Xiang T, Liao CL, Zhou YP, Xuan RR. Expression and clinical significance of short-chain fatty acids in patients with intrahepatic cholestasis of pregnancy. World J Hepatol 2024; 16:601-611. [DOI: 10.4254/wjh.v16.i4.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/04/2024] [Accepted: 03/07/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver condition that typically arises in the middle and late stages of pregnancy. Short-chain fatty acids (SCFAs), prominent metabolites of the gut microbiota, have significant connections with various pregnancy complications, and some SCFAs hold potential for treating such complications. However, the metabolic profile of SCFAs in patients with ICP remains unclear.
AIM To investigate the metabolic profiles and differences in SCFAs present in the maternal and cord blood of patients with ICP and determine the clinical significance of these findings.
METHODS Maternal serum and cord blood samples were collected from both patients with ICP (ICP group) and normal pregnant women (NP group). Targeted metabolomics was used to assess the SCFA levels in these samples.
RESULTS Significant differences in maternal SCFAs were observed between the ICP and NP groups. Most SCFAs exhibited a consistent declining trend in cord blood samples from the ICP group, mirroring the pattern seen in maternal serum. Correlation analysis revealed a positive correlation between maternal serum SCFAs and cord blood SCFAs [r (Pearson) = 0.88, P = 7.93e-95]. In both maternal serum and cord blood, acetic and caproic acids were identified as key metabolites contributing to the differences in SCFAs between the two groups (variable importance for the projection > 1). Receiver operating characteristic analysis demonstrated that multiple SCFAs in maternal blood have excellent diagnostic capabilities for ICP, with caproic acid exhibiting the highest diagnostic efficacy (area under the curve = 0.97).
CONCLUSION Compared with the NP group, significant alterations were observed in the SCFAs of maternal serum and cord blood in the ICP group, although they displayed distinct patterns of change. Furthermore, the SCFA levels in maternal serum and cord blood were significantly positively correlated. Notably, certain maternal serum SCFAs, specifically caproic and acetic acids, demonstrated excellent diagnostic efficiency for ICP.
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Affiliation(s)
- Shuai-Jun Ren
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
| | - Jia-Ting Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
- Health Science Center, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Ting Xiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
- Health Science Center, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Cai-Lian Liao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
- Health Science Center, Ningbo University, Ningbo 315211, Zhejiang Province, China
| | - Yu-Ping Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315211, Zhejiang Province, China
- Institute of Digestive Disease, Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Rong-Rong Xuan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Ningbo University, Ningbo 315100, Zhejiang Province, China
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Li JJ, Mao JX, Zhong HX, Zhao YY, Teng F, Lu XY, Zhu LY, Gao Y, Fu H, Guo WY. Multifaceted roles of lymphatic and blood endothelial cells in the tumor microenvironment of hepatocellular carcinoma: A comprehensive review. World J Hepatol 2024; 16:537-549. [DOI: 10.4254/wjh.v16.i4.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/11/2024] [Accepted: 03/18/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
The tumor microenvironment is a complex network of cells, extracellular matrix, and signaling molecules that plays a critical role in tumor progression and metastasis. Lymphatic and blood vessels are major routes for solid tumor metastasis and essential parts of tumor drainage conduits. However, recent studies have shown that lymphatic endothelial cells (LECs) and blood endothelial cells (BECs) also play multifaceted roles in the tumor microenvironment beyond their structural functions, particularly in hepatocellular carcinoma (HCC). This comprehensive review summarizes the diverse roles played by LECs and BECs in HCC, including their involvement in angiogenesis, immune modulation, lymphangiogenesis, and metastasis. By providing a detailed account of the complex interplay between LECs, BECs, and tumor cells, this review aims to shed light on future research directions regarding the immune regulatory function of LECs and potential therapeutic targets for HCC.
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Affiliation(s)
- Jing-Jing Li
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jia-Xi Mao
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Han-Xiang Zhong
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Yuan-Yu Zhao
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Fei Teng
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xin-Yi Lu
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Li-Ye Zhu
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Yang Gao
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Hong Fu
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Wen-Yuan Guo
- Department of Liver Surgery and Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, China
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Li XP, Bao ZT, Wang L, Zhang CY, Yang W. Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score. World J Gastrointest Surg 2024; 16:1087-1096. [DOI: 10.4240/wjgs.v16.i4.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/18/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a common cause of postoperative death in patients with hepatocellular carcinoma (HCC) and is a serious threat to patient safety. The neutrophil-to-lymphocyte ratio (NLR) is a common inflammatory indicator that is associated with the prognosis of various diseases, and the albumin-bilirubin score (ALBI) is used to evaluate liver function in liver cancer patients. Therefore, this study aimed to construct a predictive model for postoperative ALF in HCC tumor integrity resection (R0) based on the NLR and ALBI, providing a basis for clinicians to choose appropriate treatment plans.
AIM To construct an ALF prediction model after R0 surgery for HCC based on NLR and ALBI.
METHODS In total, 194 patients with HCC who visited The First People’s Hospital of Lianyungang to receive R0 between May 2018 and May 2023 were enrolled and divided into the ALF and non-ALF groups. We compared differences in the NLR and ALBI between the two groups. The risk factors of ALF after R0 surgery for HCC were screened in the univariate analysis. Independent risk factors were analyzed by multifactorial logistic regression. We then constructed a prediction model of ALF after R0 surgery for HCC. A receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the value of the prediction model.
RESULTS Among 194 patients with HCC who met the standard inclusion criteria, 46 cases of ALF occurred after R0 (23.71%). There were significant differences in the NLR and ALBI between the two groups (P < 0.05). The univariate analysis showed that alpha-fetoprotein (AFP) and blood loss volume (BLV) were significantly higher in the ALF group compared with the non-ALF group (P < 0.05). The multifactorial analysis showed that NLR, ALBI, AFP, and BLV were independent risk factors for ALF after R0 surgery in HCC. The predictive efficacy of NLR, ALBI, AFP, and BLV in predicting the occurrence of ALT after R0 surgery for HCC was average [area under the curve (AUC)NLR = 0.767, AUCALBI = 0.755, AUCAFP = 0.599, AUCBLV = 0.718]. The prediction model for ALF after R0 surgery for HCC based on NLR and ALBI had a better predictive efficacy (AUC = 0.916). The calibration curve and actual curve were in good agreement. DCA showed a high net gain and that the model was safer compared to the curve in the extreme case over a wide range of thresholds.
CONCLUSION The prediction model based on NLR and ALBI can effectively predict the risk of developing ALF after HCC R0 surgery, providing a basis for clinical prevention of developing ALF after HCC R0 surgery.
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Affiliation(s)
- Xiao-Pei Li
- Department of Family Planning and Assisted Reproductive Technology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Zeng-Tao Bao
- Department of Gastrointestinal Surgery, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Li Wang
- Department of Family Planning and Assisted Reproductive Technology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Chun-Yan Zhang
- Department of Laboratory Medicine, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
| | - Wen Yang
- Department of Gynecology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
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Tropeano G, Chiarello MM, Fico V, Brisinda G. How to identify early complications in patients undergoing distal gastrectomy? World J Gastrointest Surg 2024; 16:974-981. [DOI: 10.4240/wjgs.v16.i4.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal Surgery. Gastrectomy with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric cancer. Several studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and mortality. Many factors can contribute to the onset of complications with consequent effects on prognosis and increased mortality. The complications can be divided in complications related to anastomosis, to motility and to surgical site infection. The study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative morbidity. The study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with D2 lymph node dissection. Of these patients, 16% developed early postoperative complications. The univariate analysis showed that prealbumin level, hypertension, diabetes, history of abdominal surgery, R0 resection, and blood transfusion were factors influencing early postoperative complications after distal gastrectomy. Moreover, the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension, diabetes, a history of abdominal surgery, and blood transfusion were independent predictors of postoperative complications. In conclusion, preoperative and intraoperative factors can be used to establish an early postoperative nomogram model. The results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.
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Affiliation(s)
- Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | | | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Liu Y, El Jabbour T, Somma J, Nakanishi Y, Ligato S, Lee H, Fu ZY. Blastomas of the digestive system in adults: A review. World J Gastrointest Surg 2024; 16:1030-1042. [DOI: 10.4240/wjgs.v16.i4.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
Blastomas, characterized by a mixture of mesenchymal, epithelial, and undifferentiated blastematous components, are rare malignant neoplasms originating from precursor blast cells. This review focuses on digestive system blastomas in adult patients, including gastroblastoma, hepatoblastoma, and pancreatoblastoma. Gastroblastoma is a biphasic, epitheliomesenchymal tumor, with only sixteen cases reported to date. In addition to the characteristic histology, metastasis-associated lung adenocarcinoma transcript 1 - glioma-associated oncogene homolog 1 gene fusion is typical, although recently novel ewing sarcoma breakpoint region 1 - c-terminal binding protein 1 and patched 1 - glioma-associated oncogene homolog 2 fusions have been described. Hepatoblastoma is exceptionally rare in adults and can show a variety of histologic patterns which may cause diagnostic difficulty. Pancreatoblastoma, primarily a pediatric tumor, displays acinar differentiation and squamoid nests with other lines of differentiation also present, especially neuroendocrine. Diagnostic approaches for these blastomas include a combination of imaging modalities, histopathological examination, and molecular profiling. The treatment generally involves surgical resection, which may be supplemented by chemotherapy or radiotherapy in some cases. Prognoses vary with gastroblastoma generally showing favorable outcomes post-surgery whereas hepatoblastoma and pancreatoblastoma often have poorer outcomes, particularly in the setting of metastases. This review highlights the complexity of diagnosing and managing these rare adult blastomas as well as the need for ongoing research to better understand their pathogenesis and improve treatment strategies.
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Affiliation(s)
- Yu Liu
- Department of Pathology, LSU Health Sciences Center School of Medicine, New Orleans, LA 70112, United States
| | - Tony El Jabbour
- Department of Pathology, Hartford HealthCare, Hartford, CT 06102, United States
| | - Jonathan Somma
- Department of Pathology, LSU Health Sciences Center School of Medicine, New Orleans, LA 70112, United States
| | - Yukihiro Nakanishi
- Department of Pathology, Moffitt Cancer Center, Tampa, FL 33612, United States
| | - Saverio Ligato
- Department of Pathology, Hartford HealthCare, Hartford, CT 06102, United States
| | - Hwajeong Lee
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States
| | - Zhi-Yan Fu
- Department of Pathology, LSU Health Sciences Center School of Medicine, New Orleans, LA 70112, United States
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Kumar A, Goyal A. Emerging molecules, tools, technology, and future of surgical knife in gastroenterology. World J Gastrointest Surg 2024; 16:988-998. [DOI: 10.4240/wjgs.v16.i4.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/18/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
The 21st century has started with several innovations in the medical sciences, with wide applications in health care management. This development has taken in the field of medicines (newer drugs/molecules), various tools and technology which has completely changed the patient management including abdominal surgery. Surgery for abdominal diseases has moved from maximally invasive to minimally invasive (laparoscopic and robotic) surgery. Some of the newer medicines have its impact on need for surgical intervention. This article focuses on the development of these emerging molecules, tools, and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.
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Affiliation(s)
- Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Anirudh Goyal
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Han L, Tang K, Fang XL, Xu JX, Mao XY, Li M. Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates inflammatory response ulcerative colitis through TLR4/NF-κB signaling pathway. World J Gastrointest Surg 2024; 16:1149-1154. [DOI: 10.4240/wjgs.v16.i4.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/08/2024] [Accepted: 03/07/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Ulcer colitis (UC) is a chronic, nonspecific, and noninfectious inflammatory bowel disease. Recently, Toll-like receptors (TLRs) have been found to be closely associated with clinical inflammatory diseases. Achieving complete remission in patients with intermittent periods of activity followed by dormancy is challenging. Moreover, no study has explored the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.
AIM To explore the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.
METHODS This prospective clinical study included patients who met the exclusion criteria in 2020 and 2021. The patients with UC were divided into two groups (control and experimental). The peripheral blood of the experimental and control groups were collected under aseptic conditions. The expression of TLR4 protein, NF-κB, IL-6, and IL-17 was detected in the peripheral blood of patients in the experimental group and control group before and 1 month after taking the drug. Linear correlation analysis was used to analyze the relationship between the expression level of TLR4 protein and the expression levels of downstream signal NF-κB and inflammatory factors IL-6 and IL-17, and P < 0.05 was considered statistically significant.
RESULTS There were no significant differences in the patient characteristics between the control and experimental groups. The results showed that the expression levels of TLR4 and NF-κB in the experimental group were significantly lower than those in the control group (P < 0.05). The levels of IL-6 and IL-17 in the experimental group were significantly lower than those in the control group (P < 0.05). The TLR4 protein expression in the experimental group was positively correlated with the expression level of downstream signal NF-κB and was positively correlated with the levels of downstream inflammatory cytokines IL-6 and IL-17 (r = 0.823, P < 0.05).
CONCLUSION Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates the inflammatory response of UC through the TLR4/NF-κB signaling pathway.
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Affiliation(s)
- Li Han
- Department of Anorectal, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Anhui Hospital, Hefei 230001, Anhui Province, China
| | - Kun Tang
- Anorectal Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230001, Anhui Province, China
| | - Xiao-Li Fang
- Anorectal Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230001, Anhui Province, China
| | - Jing-Xi Xu
- Department of Spleen and Stomach Diseases, Department of Gastroenterology, Affiliated Wuhu Hospital of Traditional Chinese Medicine of Anhui College of Traditional Chinese Medicine, Wuhu 241000, Anhui Province, China
| | - Xi-Yun Mao
- Anorectal Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230001, Anhui Province, China
| | - Ming Li
- Anorectal Center, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230001, Anhui Province, China
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Leowattana W, Leowattana P, Leowattana T. Quantitative hepatitis B core antibody and quantitative hepatitis B surface antigen: Novel viral biomarkers for chronic hepatitis B management. World J Hepatol 2024; 16:550-565. [DOI: 10.4254/wjh.v16.i4.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
The management of hepatitis B virus (HBV) infection now involves regular and appropriate monitoring of viral activity, disease progression, and treatment response. Traditional HBV infection biomarkers are limited in their ability to predict clinical outcomes or therapeutic effectiveness. Quantitation of HBV core antibodies (qAnti-HBc) is a novel non-invasive biomarker that may help with a variety of diagnostic issues. It was shown to correlate strongly with infection stages, hepatic inflammation and fibrosis, chronic infection exacerbations, and the presence of occult infection. Furthermore, qAnti-HBc levels were shown to be predictive of spontaneous or treatment-induced HBeAg and HBsAg seroclearance, relapse after medication termination, re-infection following liver transplantation, and viral reactivation in the presence of immunosuppression. qAnti-HBc, on the other hand, cannot be relied on as a single diagnostic test to address all problems, and its diagnostic and prognostic potential may be greatly increased when paired with qHBsAg. Commercial qAnti-HBc diagnostic kits are currently not widely available. Because many methodologies are only semi-quantitative, comparing data from various studies and defining universal cut-off values remains difficult. This review focuses on the clinical utility of qAnti-HBc and qHBsAg in chronic hepatitis B management.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Pathomthep Leowattana
- Department of Clinical Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Srinakharinwirot University, Wattana 10110, Bangkok, Thailand
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Bisbinas V, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy. World J Gastrointest Surg 2024; 16:1017-1029. [DOI: 10.4240/wjgs.v16.i4.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) remains one of the most commonly performed procedures in adult and paediatric populations. Despite the advances made in intraoperative biliary anatomy recognition, iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems. A series of methods have been proposed to prevent bile duct injury, among them the use of indocyanine green (ICG) fluorescence. The most commonly reported method of ICG injection is the intravenous administration, while literature is lacking studies investigating the direct intragallbladder ICG injection. This narrative mini-review aims to assess the potential applications, usefulness, and limitations of intragallbladder ICG fluorescence in LC. Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy, as well as special issues regarding its use. Literature search retrieved four prospective cohort studies, three case-control studies, and one case report. In the three case-control studies selected, intragallbladder near-infrared cholangiography (NIRC) was compared with standard LC under white light, with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography (IOC). In total, 133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC. Literature includes several reports of intragallbladder ICG administration, but a standardized technique has not been established yet. Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping, overwhelming limitations of IOC including intervention and radiation exposure, as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence. Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.
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Affiliation(s)
- Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ioannis Mantzoros
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Panagiotis Christidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasiliki Bisbinas
- ENT Department, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
| | - Konstantinos Zapsalis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Trigona Karastergiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitra Athanasiou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stylianos Apostolidis
- 1st Propedeutic Surgical Department, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Yu HC, Pu TW, Kang JC, Chen CY, Hu JM, Su RY. Stercoral perforation of the cecum: A case report. World J Gastrointest Surg 2024; 16:1189-1194. [DOI: 10.4240/wjgs.v16.i4.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/11/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND With less than 90 reported cases to date, stercoral perforation of the colon is a rare occurrence. Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall, which is caused by the presence of a stercoraceous mass. To underscore this urgent surgical situation concerning clinical presentation, surgical treatment, and results, we present the case of a 66-year-old man with a stercoral perforation.
CASE SUMMARY A 66-year-old man with a history of hypertension, hyperlipidemia, and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours. Abdominal computed tomography indicated a suspected bezoar (approximately 7.6 cm) in the dilated cecum, accompanied by pericolic fat stranding, mild proximal dilatation of the ileum, pneumoperitoneum, and minimal ascites. Intraoperatively, feculent peritonitis with isolated cecal perforation were observed. Consequently, a right hemicolectomy with peritoneal lavage was performed. A histopathological examination supported the intraoperative findings.
CONCLUSION In stercoral perforations, a diagnosis should be diligently pursued, especially in older adults, and prompt surgical intervention should be implemented.
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Affiliation(s)
- Hung-Chun Yu
- Department of Surgery, Taichung Armed Forces General Hospital, Taichung 411228, Taiwan
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105, Taiwan
| | - Jung-Cheng Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 105, Taiwan
| | - Chao-Yang Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105, Taiwan
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ruei-Yu Su
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
- Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
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Unalp-Arida A, Ruhl CE. Burden of gallstone disease in the United States population: Prepandemic rates and trends. World J Gastrointest Surg 2024; 16:1130-1148. [DOI: 10.4240/wjgs.v16.i4.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 03/20/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization.
AIM To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases.
METHODS The National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the United States, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care including cholecystectomy, and mortality with a primary or other gallstone diagnosis. Rates were age-adjusted (for national databases) and shown per 100000 population.
RESULTS Gallstone disease prevalence (claims-based, 2019) was 0.70% among commercial insurance enrollees, 1.03% among Medicaid beneficiaries, and 2.09% among Medicare beneficiaries and rose over the previous decade. Recently, in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625000 hospital discharges, and 2000 deaths annually. Women had higher medical care rates with a gallstone disease diagnosis, but mortality rates were higher among men. Hispanics had higher ambulatory care visit and hospital discharge rates compared with Whites, but not mortality rates. Blacks had lower ambulatory care visit and mortality rates, but similar hospital discharge rates compared with whites. During the study period, ambulatory care and emergency department visit rates with a gallstone disease diagnosis rose, while hospital discharge and mortality rates declined. Among commercial insurance enrollees, rates were higher compared with national data for ambulatory care visits and hospitalizations, but lower for emergency department visits. Cholecystectomies performed in the United States included 605000 ambulatory laparoscopic, 280000 inpatient laparoscopic, and 49000 inpatient open procedures annually. Among commercial insurance enrollees, rates were higher compared with national data for laparoscopic procedures.
CONCLUSION The gallstone disease burden in the United States is substantial and increasing, particularly among women, Hispanics, and older adults with laparoscopic cholecystectomy as the mainstay treatment. Current practice patterns should be monitored for better health care access.
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Affiliation(s)
- Aynur Unalp-Arida
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5458, United States
| | - Constance E Ruhl
- Social & Scientific Systems, Inc., DLH Holdings Corp Company, Silver Spring, MD 20910, United States
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Das SK, Sen K, Ghosh B, Ghosh N, Sinha K, Sil PC. Molecular mechanism of nanomaterials induced liver injury: A review. World J Hepatol 2024; 16:566-600. [DOI: 10.4254/wjh.v16.i4.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/05/2024] [Accepted: 03/19/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
The unique physicochemical properties inherent to nanoscale materials have unveiled numerous potential applications, spanning beyond the pharmaceutical and medical sectors into various consumer industries like food and cosmetics. Consequently, humans encounter nanomaterials through diverse exposure routes, giving rise to potential health considerations. Noteworthy among these materials are silica and specific metallic nanoparticles, extensively utilized in consumer products, which have garnered substantial attention due to their propensity to accumulate and induce adverse effects in the liver. This review paper aims to provide an exhaustive examination of the molecular mechanisms underpinning nanomaterial-induced hepatotoxicity, drawing insights from both in vitro and in vivo studies. Primarily, the most frequently observed manifestations of toxicity following the exposure of cells or animal models to various nanomaterials involve the initiation of oxidative stress and inflammation. Additionally, we delve into the existing in vitro models employed for evaluating the hepatotoxic effects of nanomaterials, emphasizing the persistent endeavors to advance and bolster the reliability of these models for nanotoxicology research.
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Affiliation(s)
- Sanjib Kumar Das
- Department of Zoology, Jhargram Raj College, Jhargram 721507, India
| | - Koushik Sen
- Department of Zoology, Jhargram Raj College, Jhargram 721507, India
| | - Biswatosh Ghosh
- Department of Zoology, Bidhannagar College, Kolkata 700064, India
| | - Nabanita Ghosh
- Department of Zoology, Maulana Azad College, Kolkata 700013, India
| | - Krishnendu Sinha
- Department of Zoology, Jhargram Raj College, Jhargram 721507, India
| | - Parames C Sil
- Department of Molecular Medicine, Bose Institute, Calcutta 700054, India
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Liu Y, Yang DQ, Jiang JN, Jiao Y. Relationship between Helicobacter pylori infection and colorectal polyp/colorectal cancer. World J Gastrointest Surg 2024; 16:1008-1016. [DOI: 10.4240/wjgs.v16.i4.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/01/2024] [Accepted: 03/13/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
Helicobacter pylori (H. pylori) plays an important role in the development of gastric cancer, although its association to colorectal polyp (CP) or colorectal cancer (CRC) is unknown. In this issue of World Journal of Gastrointestinal Surgery, Zhang et al investigated the risk factors for H. pylori infection after colon polyp resection. Importantly, the researchers used R software to create a prediction model for H. pylori infection based on their findings. This editorial gives an overview of the association between H. pylori and CP/CRC, including the clinical significance of H. pylori as an independent risk factor for CP/CRC, the underlying processes of H. pylori-associated carcinogenesis, and the possible risk factors and identification of H. pylori.
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Affiliation(s)
- Ying Liu
- Department of General Surgery, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Jun-Nan Jiang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Wang ZZ, Zhao CH, Shen H, Dai GP. Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis. World J Gastrointest Surg 2024; 16:1165-1175. [DOI: 10.4240/wjgs.v16.i4.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract, often requiring intestinal resection as a common treatment. However, recurrence after surgery is common. The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD. Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate. However, the results remain controversial. Therefore, evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.
AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.
METHODS PubMed, Scopus, and Cochrane Library were searched until October 8, 2023. Patients who underwent intestinal resection due to CD were included. The intervention measures included Kono-S anastomosis, whereas the control group received traditional anastomosis such as end-to-end, end-to-side, and side-to-side anastomosis. Only randomized clinical trials and observational studies were included. The primary outcome measures were hospital stay post-surgery, overall postoperative complication incidence, the proportion of Clavien-Dindo grade IIIa or higher, overall postoperative recurrence rate, and Rutgeerts score.
RESULTS From 2011 to 2023, six articles met the inclusion and exclusion criteria. The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD [MD = -0.26, 95%CI: -0.42 to -0.10, P = 0.002] than other traditional anastomosis methods. Compared to other traditional anastomosis methods, Kono-S anastomosis can significantly reduce the total recurrence rate [MD = 0.40, 95%CI: 0.17 to 0.98, P = 0.05] and postoperative Rutgeerts score [MD = -0.81, 95%CI: -0.96 to -0.66, P < 0.001] in patients with CD. However, there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo ≥ IIIa.
CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards; however, additional larger trials are necessary to authenticate its effectiveness.
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Affiliation(s)
- Zheng-Zuo Wang
- Department of Anorectal, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
| | - Chun-Hua Zhao
- Department of Oncology, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
| | - Hui Shen
- Department of Gastroenterology, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
| | - Gui-Ping Dai
- Department of Oncology, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
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Lin C, Wang ZY, Dong LB, Wang ZW, Li ZH, Wang WB. Percutaneous transhepatic stenting for acute superior mesenteric vein stenosis after pancreaticoduodenectomy with portal vein reconstruction: A case report. World J Gastrointest Surg 2024; 16:1195-1202. [DOI: 10.4240/wjgs.v16.i4.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein (PV)/superior mesenteric veins (SMV) stenosis/occlusion. It has been widely used after liver transplantation surgery; however, reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare.
CASE SUMMARY Herein, we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery. The patient was successfully treated using stent grafts. Although the stenosis resolved after stent placement, complications, including bleeding, pancreatic fistula, bile leakage, and infection, made the treatment highly challenging. The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding. After careful treatment, the patient stabilized, and stent placement effectively managed postoperative PV/SMV stenosis.
CONCLUSION Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.
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Affiliation(s)
- Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yan Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Liang-Bo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhi-Wei Wang
- Interventional Section, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Ze-Hui Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Wei-Bin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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Covantsev S. New frontiers in ectopic pancreatic tissue management. World J Gastrointest Surg 2024; 16:1215-1217. [DOI: 10.4240/wjgs.v16.i4.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/28/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
The pancreatic development variations are relatively frequent but are often overlooked in clinical practice. This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic. It also refers to the ectopic pancreatic tissue in the stomach. This anomaly can be diagnosed in any part of the digestive system, but it is mostly seen in the upper gastrointestinal tract, especially in the stomach, duodenum and jejunum. The management of this condition has evolved due to the development of minimally invasive procedures.
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Affiliation(s)
- Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, Moscow 125284, Russia
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Zhu GZ, Ji DH. Successful splenic artery embolization in a patient with Behçet’s syndrome-associated splenic rupture: A case report. World J Gastrointest Surg 2024; 16:1184-1188. [DOI: 10.4240/wjgs.v16.i4.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/02/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
BACKGROUND Splenic rupture associated with Behçet’s syndrome (BS) is extremely rare, and there is no consensus on its management. In this case report, a patient with BS-associated splenic rupture was successfully treated with splenic artery embolization (SAE) and had a good prognosis after the intervention.
CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant. He was diagnosed with splenic rupture. Multiple oral and genital aphthous ulcers were observed, and acne scars were found on his back. He had a 2-year history of BS diagnosis, with symptoms of oral and genital ulcers. At that time, he was treated with oral corticosteroids for 1 month, but the symptoms did not alleviate. He underwent SAE to treat the rupture. On the first day after SAE, the patient reported a complete resolution of abdominal pain and was discharged 5 d later. Three months after the intervention, a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion, suggesting a good prognosis.
CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.
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Affiliation(s)
- Guang-Zhao Zhu
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Dong-Hua Ji
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Morarasu S, Livadaru C, Dimofte GM. Quality assessment of surgery for colorectal cancer: Where do we stand? World J Gastrointest Surg 2024; 16:982-987. [DOI: 10.4240/wjgs.v16.i4.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 03/21/2024] [Indexed: 04/22/2024] [Imported: 04/22/2024] Open
Abstract
Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past decade. It has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units today. Total mesorectal excision, complete mesocolic excision (CME), and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical societies. However, there are still ongoing discrepancies in outcomes largely based on surgeon performance. This is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume centers. Defining markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional level. With the evolution of CME surgery, various quality markers have been described, mostly based on measurements on the surgical specimen and lymph node yield, while others have proposed radiological markers (i.e. arterial stumps) measured on postoperative scans as part of the routine cancer follow-up. There is no ideal marker; however, taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.
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Affiliation(s)
- Stefan Morarasu
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
| | - Cristian Livadaru
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
| | - Gabriel-Mihail Dimofte
- The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
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Iacob S, Gheorghe L, Onica M, Huiban L, Pop CS, Brisc C, Sirli R, Ester C, Brisc CM, Diaconu S, Rogoveanu I, Sandulescu L, Vuletici D, Trifan A. Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update. World J Hepatol 2024; 16:640-649. [DOI: 10.4254/wjh.v16.i4.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
BACKGROUND The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death.
AIM To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients.
METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study.
RESULTS The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV.
CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.
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Affiliation(s)
- Speranta Iacob
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Liana Gheorghe
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Mirela Onica
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Laura Huiban
- Department of Gastroenterology, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
| | - Corina Silvia Pop
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Medical Oncology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ciprian Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Roxana Sirli
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Carmen Ester
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cristina Mihaela Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410087, Romania
- Department of Gastroenterology, Emergency County Hospital, Oradea 410169, Romania
| | - Sorina Diaconu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Internal Medicine II and Gastroenterology, University Emergency Clinical Hospital, Bucharest 050098, Romania
| | - Ion Rogoveanu
- Department of Gastroenterology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Cardiology, Emergency County Hospital, Craiova 200642, Romania
| | - Larisa Sandulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200349, Romania
- Department of Gastroenterology, Emergency County Hospital, Craiova 200642, Romania
| | - Deiana Vuletici
- Center for Advanced Research in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timisoara 300041, Romania
- Department of Gastroenterology and Hepatology, Timiş County Emergency Clinical Hospital "Pius Branzeu", Timisoara 300723, Romania
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Saint Spiridon County Hospital, Iasi 700111, Romania
- Department of Gastroenterology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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Singh L, Kumar A, Rai M, Basnet B, Rai N, Khanal P, Lai KS, Cheng WH, Asaad AM, Ansari S. Spectrum of COVID-19 induced liver injury: A review report. World J Hepatol 2024; 16:517-536. [DOI: 10.4254/wjh.v16.i4.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused changes in the global health system, causing significant setbacks in healthcare systems worldwide. This pandemic has also shown resilience, flexibility, and creativity in reacting to the tragedy. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection targets most of the respiratory tract, resulting in a severe sickness called acute respiratory distress syndrome that may be fatal in some individuals. Although the lung is the primary organ targeted by COVID-19 viruses, the clinical aspect of the disease is varied and ranges from asymptomatic to respiratory failure. However, due to an unorganized immune response and several affected mechanisms, the liver may also experience liver cell injury, ischemic liver dysfunction, and drug-induced liver injury, which can result in respiratory failure because of the immune system’s disordered response and other compromised processes that can end in multisystem organ failure. Patients with liver cirrhosis or those who have impaired immune systems may be more likely than other groups to experience worse results from the SARS-CoV-2 infection. We thus intend to examine the pathogenesis, current therapy, and consequences of liver damage concerning COVID-19.
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Affiliation(s)
- Lokjan Singh
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Anil Kumar
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Maya Rai
- Department of Microbiology, Karnali Academy of Health Science, Teaching Hospital, Jumla 21200, Karnali, Nepal
| | - Bibek Basnet
- Health Sciences, Asian College of Advance Studies, Purbanchal University, Satdobato 24122, Lalitpur, Nepal
| | - Nishant Rai
- Department of Biotechnology, Graphic Era (Deemed to be University), Dehradun 248002, Uttarakhand, India
| | - Pukar Khanal
- Department of Pharmacology & Toxicology, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India
| | - Kok-Song Lai
- Division of Health Sciences, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates
| | - Wan-Hee Cheng
- Health and Life Sciences, INTI International University, Nilai 71800, Malaysia
| | - Ahmed Morad Asaad
- Department of Microbiology, College of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Shamshul Ansari
- Division of Health Sciences, Abu Dhabi Women's College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates
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Guo L, Peng P, Peng WT, Zhao J, Wan QQ. Klebsiella pneumoniae infections after liver transplantation: Drug resistance and distribution of pathogens, risk factors, and influence on outcomes. World J Hepatol 2024; 16:612-624. [DOI: 10.4254/wjh.v16.i4.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/01/2024] [Accepted: 03/08/2024] [Indexed: 04/24/2024] [Imported: 04/24/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is the only curative treatment for end-stage liver disease. However, LT recipients are susceptible to infection, which is the leading cause of early mortality after LT. Klebsiella pneumoniae infections (KPIs) in the bloodstream are common in LT recipients. We hypothesized that KPIs and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections may affect the outcomes of LT recipients.
AIM To assess KPI incidence, timing, distribution, drug resistance, and risk factors following LT and its association with outcomes.
METHODS This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University, a tertiary hospital, from January 2015 to January 2023. We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.
RESULTS KPI incidence was 7.9% (n = 32), with lung/thoracic cavity the most frequent site of infection; the median time from LT to KPI onset was 7.5 d. Of 44 Klebsiella pneumoniae isolates, 43 (97.7%) and 34 (77.3%) were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline, respectively; > 70% were resistant to piperacillin/ tazobactam, ceftazidime, cefepime, aztreonam, meropenem, and levofloxacin. Female sex [odds ratio (OR) = 2.827, 95% confidence interval (CI): 1.256-6.364; P = 0.012], pre-LT diabetes (OR = 2.794, 95%CI: 1.070-7.294; P = 0.036), day 1 post-LT alanine aminotransferase (ALT) levels ≥ 1500 U/L (OR = 3.645, 95%CI: 1.671-7.950; P = 0.001), and post-LT urethral catheter duration over 4 d (OR = 2.266, 95%CI: 1.016-5.054; P = 0.046) were risk factors for KPI. CRKP infections, but not KPIs, were risk factors for 6-month all-cause mortality post-LT.
CONCLUSION KPIs occur frequently and rapidly after LT. Risk factors include female sex, pre-LT diabetes, increased post-LT ALT levels, and urethral catheter duration. CRKP infections, and not KPIs, affect mortality.
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Affiliation(s)
- Long Guo
- Department of Respiratory and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Peng Peng
- Clinical Laboratory Medicine Center, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 421007, Hunan Province, China
| | - Wei-Ting Peng
- The Second Affiliated Hospital Class, Xiangya School of Medicine, Central South University, Changsha 410013, Hunan Province, China
| | - Jie Zhao
- Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Qi-Quan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
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