Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors

In this editorial, we comment on the article by Liu et al. Based on our analysis of a case report, we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor (TNFi). While TNFi therapy increases the risk of reactivating latent tuberculosis, primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa. Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery, diabetes, and human immunodeficiency virus. Patients with early symptoms such as nasal congestion, rhinorrhea, altered olfaction, epistaxis, or ulceration, and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy, possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary. When diagnosis is challenging, it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic anti-tuberculosis treatment. The preferred method for tuberculosis screening is the Interferon Gamma Release Assay, with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months. However, the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.

Secondary diabetes due to different etiologies: A problem worthy of attention

There are many factors in the occurrence of diabetes, which can result in insufficient insulin secretion and insulin receptor resistance. Including pituitary tumors, can also lead to the occurrence of diabetes, if the primary disease can not be well controlled in time, such secondary diabetes control is more difficult. In the process of clinical diagnosis and treatment, these factors need to be taken into account, timely detection and treatment of primary diseases, so as to reduce the possibility of clinical missed diagnosis.

Flexner's legacy and the future of medical education: Embracing challenge and opportunity

This editorial comments on the article by Alzerwi. We focus on the development course, present challenges, and future perspectives of medical education. Modern medical education is gradually undergoing significant and profound changes worldwide. The emergence of new ideas, methodologies, and techniques has created opportunities for medical education developments and brought new concerns and challenges, ultimately promoting virtuous progress in medical education reform. The sustainable development of medical education needs joint efforts and support from governments, medical colleges, hospitals, researchers, administrators, and educators.

Targeting nuclear factor erythroid 2-related factor 2-regulated ferroptosis to treat nervous system diseases

By critically examining the work, we conducted a comprehensive bibliometric analysis on the role of nuclear factor erythroid 2-related factor 2 (NRF2) in nervous system diseases. We also proposed suggestions for future bibliometric studies, including the integration of multiple websites, analytical tools, and analytical approaches, The findings presented provide compelling evidence that ferroptosis is closely associated with the therapeutic challenges of nervous system diseases. Targeted modulation of NRF2 to regulate ferroptosis holds substantial potential for effectively treating these diseases. Future NRF2-related research should not only focus on discovering new drugs but also on designing rational drug delivery systems. In particular, nanocarriers offer substantial potential for facilitating the clinical translation of NRF2 research and addressing existing issues related to NRF2-related drugs.

Current evidence on artificial intelligence in regional anesthesia

The recent advancement in regional anesthesia (RA) has been largely attributed to ultrasound technology. However, the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer. Even with adequate training, experience, and knowledge, human-related limitations such as fatigue, failure to recognize the correct anatomical structure, and unintentional needle or probe movement can hinder the overall effectiveness of RA. The amalgamation of artificial intelligence (AI) to RA practice has promised to override these human limitations. Machine learning, an integral part of AI can improve its performance through continuous learning and experience, like the human brain. It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA. AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images, and it can also assist in needle tracking and accurate deposition of local anesthetics. The future of RA with AI integration appears promising, yet obstacles such as device malfunction, data privacy, regulatory barriers, and cost concerns can deter its clinical implementation. The current mini review deliberates the current application, future direction, and barrier to the application of AI in RA practice.

Managing uterine artery pseudoaneurysm post-hysteroscopic surgery: Clinical insights and future directions

This editorial discusses the case report by Kakinuma et al, which details a rare occurrence of uterine artery pseudoaneurysm following hysteroscopic surgery. The case highlights diagnostic challenges and management strategies for this uncommon complication. The editorial explores the implications for clinical practice, emphasizing the importance of early recognition and appropriate intervention to prevent potential severe outcomes. Future research directions to increase the understanding and management of uterine artery pseudoaneurysm in similar clinical settings.

Revisiting tuberculosis as a cause of gastric outlet obstruction: Insights from a case report

Gastroduodenal tuberculosis (GD-TB) is exceptionally rare. The clinical manifestations of gastrointestinal TB are diverse and non-specific, which makes diagnosis difficult, leading to delayed diagnosis and high mortality. As a peer-reviewer of World Journal of Clinical Cases, I would like to share my opinion on the article published by this journal. The patient had no family history of TB or contact with people with TB. Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient. The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Virtual reality: The bridge between medical education and clinical practice

After perusing the paper by Kim et al, I discovered that this is an interesting manuscript and a successful study. Virtual reality (VR) is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade. In the era of big data, VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment. As a novel scientific and technological tool, VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment. VR can simulate the real clinical situation, stimulate the enthusiasm of young doctors and nurses for clinical study, and simultaneously safeguard and promote medical safety and doctor-patient harmony. Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities. While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching, the risks resulting from improper clinical diagnosis and treatment have been circumvented. All of this is evident and comprehensible.

Foregut tuberculosis: Too close but miles apart

The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.

Advanced lung adenocarcinoma with EGFR 19-del mutation transforms into squamous cell carcinoma after EGFR tyrosine kinase inhibitor treatment

In this editorial we comment on the article by Ji et al. We focus specifically on the EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment and the development of drug resistance to EGFR-TKIs.

Butorphanol in epidural: Could this be the breakthrough solution for safe and effective labor analgesia that we've been waiting for?

The authors have conducted a comprehensive investigation into the safety and effectiveness of butorphanol for epidural analgesia during labor. Their critical analysis of the paper and discussion of the technique's advantages and disadvantages provide a thorough understanding of the topic.

Classification and detection of dental images using meta-learning

Meta-learning of dental X-rays is a machine learning technique that can be used to train models to perform new tasks quickly and with minimal input. Instead of just memorizing a task, this is accomplished through teaching a model how to learn. Algorithms for meta-learning are typically trained on a collection of training problems, each of which has a limited number of labelled instances. Multiple X-ray classification tasks, including the detection of pneumonia, coronavirus disease 2019, and other disorders, have demonstrated the effectiveness of meta-learning. Meta-learning has the benefit of allowing models to be trained on dental X-ray datasets that are too few for more conventional machine learning methods. Due to the high cost and lengthy collection process associated with dental imaging datasets, this is significant for dental X-ray classification jobs. The ability to train models that are more resistant to fresh input is another benefit of meta-learning.

Evolving of treatment options for cerebral infarction

In this editorial, we comment on a recent article which addressed the therapeutic effect of aspirin plus edaravone in patients with cerebral infarction (CI). Herein, we outline the progress in therapy of CI. Apart from thrombolysis, aspirin is the most effective treatment for CI. Edaravone, a free radical scavenger, reduces endothelial cell damage and delays neuronal cell death. Aspirin plus edaravone mitigates damage to brain tissue by different mechanisms, thereby expediting the reinstation of neurological function. However, the nephrotoxic effect of edaravone, along with gastrointestinal bleeding associated with aspirin, may restrict this combination therapy. Although clinical studies have demonstrated the efficacy of thrombolytic therapy and mechanical thrombectomy, patients receiving these treatments experience modest efficacy and many adverse events. Moreover, interest in exploring natural medicines for CI is increasing, and they appear to have a high potential to protect against CI. The evolution of therapeutic strategies is expected to improve clinical outcomes of patients with CI.

Optimal traditional Chinese medicine formulas in treating ulcerative colitis: Choose one or take it all?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity, especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease. Traditional Chinese medicine (TCM) has emerged as a promising complementary therapy for UC. Based on the latest research, our editorial explored the current issues and potential essential research directions for TCM in treating UC. We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

Immunoglobulin G4-related spinal pachymeningitis: A case report

BACKGROUND

Immunoglobulin G4-related disease (IgG4-RD) is a complex immune-mediated condition that causes fibrotic inflammation in several organs. A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis, which manifests as inflammation of the dura mater in intracranial or spinal regions. Although IgG4-RD can affect multiple areas, the spine is a relatively rare site compared to the more frequent involvement of intracranial structures.

CASE SUMMARY

A 70-year-old male presented to our hospital with a two-day history of fever, altered mental status, and generalized weakness. The initial brain magnetic resonance imaging (MRI) revealed multiple small infarcts across various cerebral regions. On the second day after admission, a physical examination revealed motor weakness in both lower extremities and diminished sensation in the right lower extremity. Electromyographic evaluation revealed findings consistent with acute motor sensory neuropathy. Despite initial management with intravenous immunoglobulin for presumed Guillain-Barré syndrome, the patient exhibited progressive worsening of motor deficits. On the 45^th day of hospitalization, an enhanced MRI of the entire spine, focusing specifically on the thoracic 9 to lumbar 1 vertebral level, raised the suspicion of IgG4-related spinal pachymeningitis. Subsequently, the patient was administered oral prednisolone and participated in a comprehensive rehabilitation program that included gait training and lower extremity strengthening exercises.

CONCLUSION

IgG4-related spinal pachymeningitis, diagnosed on MRI, was treated with corticosteroids and a structured rehabilitation regimen, leading to significant improvement.

Timing impact on the initiation of pirfenidone therapy on idiopathic pulmonary fibrosis disease progression

In this editorial, we comment on the article by Lei et al, with a specific focus on the timing of the initiation of the antifibrotic agent pirfenidone (PFD) in the management of idiopathic pulmonary fibrosis (IPF) and its impact on lung function of IPF patients. PFD is an antifibrotic agent that is widely used in the management of IPF in both early and advanced stages. It inhibits various pathways and has antifibrotic, anti-inflammatory, and antioxidant properties. Despite dosage lowering, PFD slowed IPF progression and maintained functional capacity. The 6-min walk distance test indicated that patients tolerated adverse events well, and PFD significantly reduced the incidence of progression episodes and death. Even when a single disease-progression event occurred, continuing PFD treatment had benefits.

Diagnostic and therapeutic challenges of myeloid sarcoma in the oral cavity

Myeloid sarcoma (MS) is a rare neoplasm characterized by the proliferation of immature myeloid precursor cells outside the bone marrow. The pathogenesis of MS is complex and not completely understood. Moreover, it develops in any extramedullary site of the body. In this editorial, we discuss the article published by Li et al, which presents a clinical case involving a 32-year-old man who exhibited gingival inflammation in the maxillary region. It was initially diagnosed as periodontal disease. However, clinical evaluation revealed a firm, grayish-white mass which underscored the need for comprehensive diagnostics to distinguish MS from other oral conditions. This article emphasizes the different clinical presentations of similar case studies in the literature, and highlights the difficulty in diagnosing oral MS due to its rarity and variability in clinical manifestation. The treatment of MS depends on the clinical presentation, tumor location, and the patient's response to conventional therapies. The various therapeutic options currently available are analyzed and discussed. Early intervention and multidisciplinary management are crucial for improving treatment outcomes. Increased awareness and education about the various clinical presentations of MS lead to earlier diagnosis and timely treatment, thereby enhancing patients' survival and quality of life. Continued research is essential for optimizing therapeutic strategies and addressing the challenges presented by this rare neoplasm.

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.

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.

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.