Mindfulness and mindful parenting: Strategies for preschoolers with behavioral issues

The behavior issues of preschoolers are closely related to their parents' parenting styles. This editorial discusses the value and strategies for solving behavior issues in preschoolers from the perspectives of mindfulness and mindful parenting. We expect that upcoming studies will place greater emphasis on the behavioral concerns of preschoolers and the parenting practices that shape them, particularly focusing on proactive interventions for preschoolers' behavioral issues.

Diagnostic and management challenges in primary cutaneous anaplastic large cell lymphoma with necrosis, inflammation, and surgical intervention: A case report

BACKGROUND

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) poses significant diagnostic difficulties due to its similarity in the appearance of skin lesions with chronic inflammatory disorders and other dermatological conditions. This study aims to investigate these challenges by conducting a comprehensive analysis of a case presenting with PC-ALCL, emphasizing the necessity of accurate differentiation for appropriate management.

CASE SUMMARY

An 89-year-old female patient with diabetes and hypertension presented with arm and abdominal ulcerated mass lesions. Diagnostic procedures included skin biopsies, histopathological assessments, and immunohistochemistry, complemented by advanced imaging techniques to confirm the diagnosis. The patient’s lesions were determined as PC-ALCL, characterized by necrosis, chronic inflammation, and a distinct immunophenotypic profile, including CD30, CD3, CD4, and EBER, CD56, MUM-1, Ki 67-positive in > 80% of tumor cells, CD10, but negative for anaplastic lymphoma kinase, CD5, CD20, PAX-5, Bcl-2, Bcl-6, CD8, and CD15. Recurrence was not reported at the 6-month follow-up.

CONCLUSION

Accurate PC-ALCL differentiation from similar conditions is crucial for effective management and requires a multidisciplinary approach.

How to manage and avoid revision after unicompartmental knee arthroplasty?

The article by Zhao et al presents a retrospective case series on the reasons for initial revision after unicompartmental knee arthroplasty (UKA). Clarifying the reasons that may cause UKA revision can further reduce the rate of revision UKA, focusing on gasket dislocation, osteophytes, intra-articular loose bodies, and tibial prosthesis loosening. This article provides valuable insights, not only by detailing the revision status of 13 patients who underwent revision after initial UKA but also by providing a comprehensive analysis of the incidence of revision after initial UKA. By reviewing and analyzing the causes, they established references for the early detection of risk factors for revision in clinical practice and for formulating surgical strategies and rehabilitation programmes. This commentary emphasizes the need for a meticulous understanding and an analysis of the revision rate following initial UKA and related management strategies. The implant rates, regional variation, and benefits of uncemented Oxford UKA have been explored, particularly in terms of bone preservation, appropriate surgical techniques, and weight management to control complications and improve patient prognosis.

Rare incidence of mucosa-associated lymphoid tissue lymphoma presenting as buccal fat pad tumor: A case report

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma, a type of non-Hodgkin lymphoma, originates in the mucosal lining of body organs and internal cavities, including the nose, mouth, lungs, and digestive tract. The lymphoma develops when the body produces abnormal B lymphocytes. These lymphomas develop at the edge of the lymphoid tissue, called the marginal zone, and, hence, are classified as a type of marginal zone lymphomas. They are the most common type of marginal zone lymphomas although their occurrence is rare. To date, no previous cases of MALT lymphoma in the buccal fat pad have been reported.

CASE SUMMARY

We report the case of a patient who presented with a mass on the frontal cheek. Magnetic resonance imaging revealed a tumor in the buccal fat pad, and histopathological and immunohistochemical findings confirmed the diagnosis of MALT lymphoma. The patient had a history of Helicobacter pylori and hepatitis C virus infection, suggesting an association between these infective agents and MALT lymphoma.

CONCLUSION

Consideration of MALT lymphoma is essential in the differential diagnosis of frontal cheek masses.

Delayed postpancreatectomy hemorrhage as the role of endovascular approach: Four case reports

BACKGROUND

Pancreatic resection is still associated with high morbidity rates and delayed postpancreatectomy hemorrhage (PPH) is the most feared complication as it may lead to hemorrhagic shock or serious septic complications. Today, endovascular approach represent safe and efficient method for minimally invasive management of extraluminal PPH.

CASE SUMMARY

We describe four patients whose postoperative recovery after pancreatic resection was complicated by postoperative pancreatic fistula (POPF) and visceral artery hemorrhage. In all cases endovascular approach was utilized and it resulted in satisfactory outcomes. We discuss modern diagnostic and therapeutic approach in this clinical scenario.

CONCLUSION

PPH is relatively uncommon, but it is a leading cause of surgical mortality after pancreatic surgery. Careful monitoring and meticulous follow-up are required for all patients post-operatively, especially in the case of confirmed POPF, which is the most significant risk factor for the development of a PPH. Angiography as a diagnostic and therapeutic method may be an optimal first-line treatment for the management of delayed PPHs. In our experience, endovascular treatment for hemorrhagic complications of pancreatic resections has shown satisfactory results.

Miller fisher syndrome with positive anti-GQ1b/GT1a antibodies associated with COVID-19 infection: A case report

BACKGROUND

Miller fisher syndrome (MFS) is a variant of Guillain-Barré syndrome, an acute immune-mediated peripheral neuropathy that is often secondary to viral infections. Anti-ganglioside antibodies play crucial roles in the development of MFS. The positive rate of ganglioside antibodies is exceptionally high in MFS patients, particularly for anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS.

CASE SUMMARY

We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes. There were flu symptoms prior to onset, and a coronavirus disease 2019 test was positive. On physical examination, the patient exhibited bilateral extraocular muscle paralysis, weakened reflexes in both limbs, and impaired coordination. The cerebrospinal fluid examination results showed no obvious abnormalities. Bilateral peroneal nerve F-waves were not extracted. Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive. The patient received intravenous methylprednisolone (1000 mg/day), with the dosage gradually decreased. Additionally, intravenous high-dose immunoglobulin treatment was administered for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. The patient’s symptoms improved after treatment with immunoglobulins and hormones.

CONCLUSION

Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more reliant on clinical symptoms.

Molecular diagnostic approaches in detecting rearranged during transfection oncogene mutations in multiple endocrine neoplasia type 2

Different types of neuroendocrine cancer, including medullary thyroid cancer (MTC) and thyroid C-cell hyperplasia, are part of multiple endocrine neoplasia type 2 (MEN2). A proto-oncogene mutation of the rearranged during transfection (RET) gene changes the way that receptor tyrosine kinases work. Multiple endocrine neoplasia, a pathological condition, involves these kinases. When the RET protooncogene changes, it can cause endocrine adenomas and hyperplasia to happen at the same time or one after the other. Pheochromocytoma, medullary thyroid carcinoma, and hyperparathyroidism, alone or in combination, are present in MEN2A patients. Some patients may also have skin lichen amyloidosis or Hirschsprung's disease. Patients with MEN2A often present with MTC. MTC is aggressive and has the worst prognosis, as most patients exhibit lymph node metastasis. MTC is one of the important causes of death in patients with MEN2A. RET mutation analysis aids in identifying MEN2A symptoms and monitoring levels of calcium, thyroid hormones, calcitonin, normetanephrine, fractionated metanephrines, and parathyroid hormone. The earlier diagnosis of MTC significantly improves survival and prompts better management of MEN2A. In this editorial, we will discuss the significance of molecular diagnostic approaches in detecting RET oncogene mutations in MEN2A.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture

The internal carotid artery occlusion caused by head and neck trauma, also known as traumatic intracranial artery occlusion, is relatively rare clinically. Traumatic skull base fracture is a common complication of traumatic brain injury. Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion. If not detected early and treated in time, the prognosis of patients is poor. This editorial makes a relevant analysis of this disease.

Infantile bacterial meningitis combined with sepsis caused by Streptococcus gallolyticus subspecies pasteurianus: A case report

BACKGROUND

Streptococcus gallolyticus subspecies pasteurianus (SGSP) is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings. Hence, we present a case of SGSP-induced infant meningitis and sepsis, accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus (MRSA), providing insights into the identification, management, and prognosis of this bacterial infection.

CASE SUMMARY

A 45-day-old female infant presented with two episodes of high fever (maximum temperature: 39.5 °C) and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms. Postadmission, the patient’s C-reactive protein level was 40.73 mg/L, white blood cell count was 13.42 × 10⁹/L, neutrophil ratio was 78.4%, procalcitonin level was 7.89 μg/L, cerebrospinal fluid (CSF) white cell count was 36 × 10⁶/L, multinucleated cell ratio was 95.2%, and protein concentration was 0.41 g/L. Blood and CSF culture revealed that the pathogen was SGSP. The bacterium was sensitive to ampicillin, furazolidone, penicillin, lincomycin, moxifloxacin, rifampicin, vancomycin, and levofloxacin but resistant to clindamycin and tetracycline. Sputum culture revealed the presence of MRSA, which was sensitive to vancomycin. The patient was diagnosed with meningitis and sepsis caused by SGSP, accompanied by bronchopneumonia induced by MRSA. Ceftriaxone (100 mg/kg/d) combined with vancomycin (10 mg/kg/dose, q6h) was given as an anti-infective treatment postadmission. After 12 days of treatment, the infant was discharged from the hospital with normal CSF, blood culture, and routine blood test results, and no complications, such as subdural effusion, were observed on cranial computed tomography. No growth retardation or neurological sequelae occurred during follow-up.

CONCLUSION

SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures, and a sensitive antibiotic therapy to ensure a favorable prognosis.

Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy: A case report

BACKGROUND

High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease (VKH). Nonetheless, administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus. We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.

CASE SUMMARY

The patient was a 26-year-old nulliparous woman. At 33 weeks and 1 day of her pregnancy, she experienced a decline in visual acuity and noticed metamorphopsia in her left eye. Examination revealed bilateral serous retinal detachment, leading to VKH diagnosis. A collaborative effort involving the departments of ophthalmology, internal medicine, and neonatology was initiated. Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision. Complications, such as threatened preterm labor and gestational diabetes, emerged, necessitating the initiation of oral ritodrine hydrochloride and insulin therapy. Then, serous retinal detachment was resolved, and visual acuity was restored. Labor pains initiated 32 days post-initiation of steroid pulse therapy (at 38 weeks and 4 days of gestation), culminating in a normal delivery. Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.

CONCLUSION

VKH management in pregnancy requires multidisciplinary coordination, emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

Complexity in interpreting cardiac valve-associated thrombus from tumors in Li-Fraumeni syndrome

Li-Fraumeni syndrome (LFS) is a well-defined autosomal dominant predisposition syndrome due to TP53 germline mutation that causes many cancer malignancies. This early-onset syndrome poses a state of widespread malignancy. Such an inherited condition possessing defective p53, guardian of the genome, in the germline has the potential to cause multiple cancers by predominantly affecting mesenchyme (connective tissues, blood cells), breast, brain, and adrenal cortex organs. The tumors initially identified in LFS can eventually propagate to cause secondary malignancies. LFS contributes to multiple cancers in individuals with defective p53 inheritance. When suspected to possess any mass, patients with other co-morbidities, in particular those with certain cardiovascular conditions, undergo screening using high-throughput techniques like transthoracic and transesophageal echocardiography or cardiothoracic magnetic resonance imaging to locate and interpret the size of the mass. In LFS cases, it is certain to presume these masses as cancers and plan their management employing invasive surgeries after performing all efficient diagnostic tools. There are only poor predictions to rule out the chances of any other pathology. This criterion emphasizes the necessity to speculate alternative precision diagnostic methods to affirm such new growth or masses encountered in LFS cases. Moreover, it has all the possibilities to ultimately influence surgical procedures that may be invasive or complicate operative prognosis. Hence, it is essential to strategize an ideal protocol to diagnose any new unexplored mass in the LFS community. In this editorial, we discuss the importance of diagnostic approaches on naïve pristine masses in LFS.

Miller fisher syndrome with positive anti-GQ1b/GT1a antibodies associated with COVID-19 infection: A case report

BACKGROUND

Miller fisher syndrome (MFS) is a variant of Guillain-Barré syndrome, an acute immune-mediated peripheral neuropathy that is often secondary to viral infections. Anti-ganglioside antibodies play crucial roles in the development of MFS. The positive rate of ganglioside antibodies is exceptionally high in MFS patients, particularly for anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS.

CASE SUMMARY

We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes. There were flu symptoms prior to onset, and a coronavirus disease 2019 test was positive. On physical examination, the patient exhibited bilateral extraocular muscle paralysis, weakened reflexes in both limbs, and impaired coordination. The cerebrospinal fluid examination results showed no obvious abnormalities. Bilateral peroneal nerve F-waves were not extracted. Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive. The patient received intravenous methylprednisolone (1000 mg/day), with the dosage gradually decreased. Additionally, intravenous high-dose immunoglobulin treatment was administered for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. The patient’s symptoms improved after treatment with immunoglobulins and hormones.

CONCLUSION

Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more reliant on clinical symptoms.

Advancing the understanding and management of blastic plasmacytoid dendritic cell neoplasm: Insights from recent case studies

We specifically discuss the mechanisms of the pathogenesis, diagnosis, and management of blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare but aggressive haematologic malignancy characterized by frequent skin manifestations and systemic dissemination. The article enriches our understanding of BPDCN through detailed case reports showing the clinical, immunophenotypic, and histopathological features that are critical for diagnosing this disease. These cases highlight the essential role of pathologists in employing advanced immunophenotyping techniques to accurately identify the disease early in its course and guide treatment decisions. Furthermore, we explore the implications of these findings for management strategies, emphasizing the use of targeted therapies such as tagraxofusp and the potential of allogeneic haematopoietic stem cell transplantation in achieving remission. The editorial underscores the importance of interdisciplinary approaches in managing BPDCN, pointing towards a future where precision medicine could significantly improve patient outcomes.

Recipient artery dissection during extracranial-intracranial bypass surgery: Two case reports

BACKGROUND

Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a valuable treatment for preventing ischemia and hemorrhage in occlusive cerebrovascular disease. Anastomosis site dissection is rarely reported among the various bypass-related complications.

CASE SUMMARY

In this case report, we describe two patients, who were 63- and 59-years-old with middle cerebral artery occlusion treated by STA-MCA bypass. During bypass surgery, the recipient M4 artery intima was dissected. We sacrificed the dissecting portion, and no complications occurred during the follow-up period. Postoperative brain imaging revealed improved brain perfusion. We report rare cases of recipient artery dissection located in the extracranial to intracranial bypass site, and we suggest atherosclerotic changes in the recipient artery and insufficient puncture as the causes.

CONCLUSION

Appropriate recipient artery selection is critical, and if dissection occurs, it is essential to sacrifice the dissecting portion quickly.

Recent developments in immunotherapy approaches for allergic rhinitis

Allergic rhinitis (AR) poses a significant global health burden, with the potential to progress to asthma, thereby impacting patients’ quality of life. Immunotherapy has demonstrated effectiveness in mitigating clinical symptoms by altering the underlying disease mechanisms of AR. This article provides a thorough review of the current state of immunotherapy for AR, encompassing various facets of immunotherapeutic strategies, elucidating their mechanisms and clinical implications. By presenting a nuanced understanding of the present landscape of immunotherapy for AR, this review aims to serve as a valuable reference for informing clinical treatment strategies. The subsequent analysis of diverse immunotherapeutic pathways offers a comprehensive understanding of their mechanisms and clinical implications. A meticulous examination is conducted on subcutaneous immunotherapy, sublingual immunotherapy, oral immunotherapy, intralymphatic immunotherapy, and innovative intravenous gold-induced autologous serum injection therapy. Each pathway is systematically elucidated, with its distinctive features and potential contributions to managing AR emphasized. In conclusion, synthesizing epidemiological insights, immunotherapeutic nuances, and pathway-specific analyses encapsulates a profound understanding of immunotherapy for AR.

Refractory ulcerative colitis: Upadacitinib versus other biologics

In this editorial we comment on an article published in World Journal of Clinical Cases in 2024, in which a case of refractory ulcerative colitis (UC) was discussed based on the response to different lines of biologics. Different studies showed that different classes of biologics have their advantages and disadvantages in the treatment of refractory UC. Certain classes are superior to others and if tried earlier on would lead to a possible change in the outcome.

Unraveling autophagy-related pathogenesis in active ulcerative colitis: A bioinformatics approach

In this editorial, we provide commentary on the study by Gong et al. In this original research article, Gong et al employed a bioinformatics approach to investigate the involvement of autophagy in active ulcerative colitis (UC). Through differential gene expression analysis, they identified 58 differentially expressed autophagy-related genes in UC patients compared to healthy controls. Notably, HSPA5, CASP1, SERPINA1, CX3CL1, and BAG3, were found to be upregulated in active UC patients, suggesting their significance as core autophagy-related targets. Enrichment analysis unveiled associations with crucial signaling pathways and diseases such as middle cerebral artery occlusion and glomerulonephritis. Moreover, immune cell infiltration analysis revealed notable differences in immune cell composition between UC patients and healthy controls. These findings offer valuable insights into the role of autophagy in UC pathogenesis and potential therapeutic targets.

Rethinking Kawasaki disease diagnosis: Continuing the search for new biomarkers

Recent findings by Yamashita et al report a Kawasaki disease (KD) case with normal biomarker levels, challenging traditional diagnostic paradigms. This editorial explores the implications of such atypical KD presentations, emphasizing the need for novel biomarkers and revised diagnostic guidelines. The case underscores the limitations of current biomarkers, the importance of clinical judgment, and the necessity for comprehensive research to identify new diagnostic tools. Emerging technologies in proteomics and genomics offer potential avenues for discovering reliable biomarkers. Revisiting clinical guidelines to incorporate flexibility for atypical presentations is crucial. Ensuring timely and accurate KD diagnosis, even without elevated traditional biomarkers, prevents severe complications. Future advancements should focus on novel biomarkers to improve patient outcomes.

Advances in the diagnosis and treatment of heterotopic pancreas

Heterotopic pancreas, a rare congenital malformation, manifests outside the normal pancreas. Research suggests that abnormal embryonic development is linked to the presence of heterotopic pancreas. Three prevailing theories explain its mechanism: Dislocation theory, metaplasia theory, and totipotent stem cell theory. Clinical presentations of heterotopic pancreas are often nonspecific, with most patients being asymptomatic and incidentally discovered during unrelated surgeries or examinations. Endoscopic ultrasound, computed tomography, and magnetic resonance imaging are commonly employed diagnostic tools for heterotopic pancreas. However, the accuracy of diagnosis based on these methods is not consistently high, necessitating histopathological confirmation in many cases. Treatment options for heterotopic pancreas typically involve endoscopic resection, surgical resection, or observation through follow-up.

Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis

BACKGROUND

We planned this study considering that complications of deep neck infections can be seriously life threatening.

AIM

To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity.

METHODS

This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications.

RESULTS

There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years.

CONCLUSION

Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.

Clinical approach for pulmonary alveolar proteinosis in children

In this editorial, we discuss the clinical implications of the article by Zhang et al. Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by excessive surfactant accumulation in the alveoli. It is classified into four categories: Primary, secondary, congenital, and unclassified forms. Primary PAP is caused by the disruption of granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor signaling, which is necessary for the clearance of surfactant by alveolar macrophages. It is further divided into autoimmune PAP, caused by anti-GM-CSF antibodies blocking alveolar macrophage activation, and hereditary PAP, resulting from mutations in genes encoding GM-CSF receptors. Secondary PAP develops due to conditions affecting the number or function of alveolar macrophages, such as infections, immunodeficiency, hematological disorders, or exposure to inhaled toxins. Congenital PAP is linked to mutations in genes involved in surfactant protein production. Notably, the causes of PAP differ between children and adults. Diagnostic features include a characteristic "crazy-paving" pattern on high-resolution computed tomography, accompanied by diffuse ground-glass opacities and interlobular septal thickening. The presence of PAP can be identified by the milky appearance of bronchoalveolar lavage fluid and histological evaluation. However, these methods cannot definitively determine the cause of PAP. Whole lung lavage remains the standard treatment, often combined with specific therapies based on the underlying cause.

Clinical characteristics of renal anastomotic hemangioma

In this editorial, we comment on the article by Chen and Cai. We focus on renal anastomotic hemangioma, which is a rare benign hemangiomatous disease. This disease has unique clinical characteristics. Its biological behavior is benign, but its imaging results are similar to those of renal cancer. Renal anastomotic hemangioma is easy to misdiagnose and can lead to unnecessary radical nephrectomy. Therefore, urologists need a better understanding of this disease. We believe that patients with renal anastomotic hemangioma should receive individualized diagnosis and treatment to avoid overtreatment.

Additional comments on foot reflexology treatment for sensorineural hearing loss in infant

Currently, treatment options for infant sensorineural hearing loss (SNHL) are limited. This article describes a novel case of SNHL in an infant successfully treated with foot reflexology, along with observed brain activity changes before and after treatment, as indicated by functional magnetic resonance imaging. Hence, this commentary discusses the case and our viewpoints regarding foot reflexology for treating SNHL.

Functional investigation and two-sample Mendelian randomization study of primary biliary cholangitis hub genes

BACKGROUND

The identification of specific gene expression patterns is crucial for understanding the mechanisms underlying primary biliary cholangitis (PBC) and finding relevant biomarkers for diagnosis and therapeutic evaluation.

AIM

To determine PBC-associated hub genes and assess their clinical utility for disease prediction.

METHODS

PBC expression data were obtained from the Gene Expression Omnibus database. Overlapping genes from differential expression analysis and weighted gene co-expression network analysis (WGCNA) were identified as key genes for PBC. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses were performed to explore the potential roles of key genes. Hub genes were identified in protein-protein interaction (PPI) networks using the Degree algorithm in Cytoscape software. The relationship between hub genes and immune cells was investigated. Finally, a Mendelian randomization study was conducted to determine the causal effects of hub genes on PBC.

RESULTS

We identified 71 overlapping key genes using differential expression analysis and WGCNA. These genes were primarily enriched in pathways related to cytokine-cytokine receptor interaction, and Th1, Th2, and Th17 cell differentiation. We utilized Cytoscape software and identified five hub genes (CD247, IL10, CCL5, CCL3, and STAT3) in PPI networks. These hub genes showed a strong correlation with immune cell infiltration in PBC. However, inverse variance weighting analysis did not indicate the causal effects of hub genes on PBC risk.

CONCLUSION

Hub genes can potentially serve as valuable biomarkers for PBC prediction and treatment, thereby offering significant clinical utility.

Percutaneous transhepatic cholangiography: An effective option for endo-biliary radiofrequency ablation before stent insertion in unresectable biliary cancer?

Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option. In these cases, palliative care and mechanical widening of the blocked biliary system are preferred. The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression. Prior to stent placement, endo-biliary radiofrequency ablation (EB-RFA) appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications. However, its impact on overall survival is not yet clear. Additionally, while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA, percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative, particularly for long, angulated, or significantly narrowed bile ducts.