Effect of brush rinse on the diagnostic accuracy of biliary stricture evaluation: A multicenter trial

BACKGROUND

Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures. Nonetheless, brush cytology is limited by its low sensitivity due to insufficient cellular yield.

AIM

To evaluate the impact of the sheath-rinse technique on improving the cellularity yield.

METHODS

A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South Korea. The sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were compared.

RESULTS

A significantly increased number of total cell clusters per representative 20 × field was recorded in the sheath-rinse compared with the brush-wash specimens (median: 12 vs 3, P < 0.001). This trend persisted when large (> 50 cells) clusters (median: 8 vs 3, P < 0.001), medium (6-49 cells) (median: 7 vs 3, P < 0.001), and small (2-5 cells) clusters (median: 9 vs 3, P < 0.001) were evaluated. Diagnostic accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method (72.3% vs 62.5%, P < 0.001 and 69.9% vs 59.2%, P < 0.001, respectively).

CONCLUSION

Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush cytology. Sheath-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.

Reference diagnosis and treatment process of juvenile hemochromatosis patients

The compelling case report by Xie et al, published in a renowned medical journal, is an excellent example of meticulous clinical evaluation, comprehensive laboratory testing, advanced imaging, and genetic analysis. The authors identified novel compound heterozygous mutations in the hemojuvelin gene of a patient diagnosed with juvenile hemochromatosis. They suggested that long-term, strategic phlebotomy might offer a novel therapeutic strategy for severe juvenile hemochromatosis, challenging the traditional treatment paradigms.

Stoma occlusion caused by abdominal cocoon after abdominal abscess surgery: A case report

BACKGROUND

Abdominal cocoons (ACs) lack characteristic clinical manifestations and are mainly intestinal obstructions that are difficult to distinguish from intestinal obstruction caused by other causes, resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment. There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.

CASE SUMMARY

Here, we report a 16-year-old female patient with intestinal obstruction due to AC. She was treated with abdominal surgery three times. First, she underwent a laparotomy for peritonitis after trauma from a traffic accident. During the procedure, pelvic empyema, severe intestinal adhesions, and damage to the serous layer of the rectum were found, but no significant intestinal rupture and perforation were found. As a precaution, she underwent a prophylactic ileostomy after a flush in her abdomen. The second and third surgeries were for treatment of recurrent stoma obstruction. The patient’s condition was complicated for a long period, but after comprehensive treatment by our department, the patient was successfully discharged from the hospital and is currently recovering well.

CONCLUSION

Currently, abdominal contrast-enhanced computed tomography is the best imaging modality for preoperative evaluation of AC, but most patients are diagnosed only after intraoperative exploration. For the treatment of typical or severe ACs, the primary method of removal and healing of ACs is complete removal of the abdominal fibrous membrane. Finding a breakthrough in the anatomy is the key to the success of the surgery.

Artificial intelligence and the impact of multiomics on the reporting of case reports

The integration of artificial intelligence (AI) and multiomics has transformed clinical and life sciences, enabling precision medicine and redefining disease understanding. Scientific publications grew significantly from 2.1 million in 2012 to 3.3 million in 2022, with AI research tripling during this period. Multiomics fields, including genomics and proteomics, also advanced, exemplified by the Human Proteome Project achieving a 90% complete blueprint by 2021. This growth highlights opportunities and challenges in integrating AI and multiomics into clinical reporting. A review of studies and case reports was conducted to evaluate AI and multiomics integration. Key areas analyzed included diagnostic accuracy, predictive modeling, and personalized treatment approaches driven by AI tools. Case examples were studied to assess impacts on clinical decision-making. AI and multiomics enhanced data integration, predictive insights, and treatment personalization. Fields like radiomics, genomics, and proteomics improved diagnostics and guided therapy. For instance, the “AI radiomics, genomics, oncopathomics, and surgomics project” combined radiomics and genomics for surgical decision-making, enabling preoperative, intraoperative, and postoperative interventions. AI applications in case reports predicted conditions like postoperative delirium and monitored cancer progression using genomic and imaging data. AI and multiomics enable standardized data analysis, dynamic updates, and predictive modeling in case reports. Traditional reports often lack objectivity, but AI enhances reproducibility and decision-making by processing large datasets. Challenges include data standardization, biases, and ethical concerns. Overcoming these barriers is vital for optimizing AI applications and advancing personalized medicine. AI and multiomics integration is revolutionizing clinical research and practice. Standardizing data reporting and addressing challenges in ethics and data quality will unlock their full potential. Emphasizing collaboration and transparency is essential for leveraging these tools to improve patient care and scientific communication.

MYH7 mutation in a pedigree with familial dilated hypertrophic cardiomyopathy: A case report and review of literature

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is one of the most prevalent inherited myocardial disorders and is characterized by considerable genetic and phenotypic heterogeneity. A subset of patients with HCM progress to a dilated phase of HCM (DPHCM), which is associated with a poor prognosis; however, the underlying pathogenesis remains inadequately understood.

CASE SUMMARY

In this study, we present a case involving a pedigree with familial DPHCM and conduct a retrospective review of patients with DPHCM with identified gene mutations. Through panel sequencing targeting the coding regions of 312 genes associated with inherited cardiomyopathy, a heterozygous missense mutation (c.746G>A, p.Arg249Glu) in the MYH7 gene was identified in the proband (III-5). Sanger sequencing subsequently confirmed this pathogenic mutation in three additional family members (II-4, III-4, and IV-3). A total of 26 well-documented patients with DPHCM were identified in the literature. Patients with DPHCM are commonly middle-aged and male. The mean age of patients with DPHCM was 53.43 ± 12.79 years. Heart failure, dyspnoea, and atrial fibrillation were the most prevalent symptoms observed, accompanied by an average left ventricular end-diastolic size of 58.62 mm.

CONCLUSION

Our findings corroborate the pathogenicity of the MYH7 (c.746G>A, p.Arg249Glu) mutation for DPHCM and suggest that the Arg249Gln mutation may be responsible for high mortality.

Improved super-elastic Ti-Ni alloy wire for the angle class III patient with anterior open bite: A case report

BACKGROUND

Orthodontic treatment for open bite and crossbite cases is always challenging. In this paper, we demonstrate a skeletal class III patient with anterior open bite and crossbite whose problem was successfully corrected with improved super-elastic Ti-Ni alloy wire (ISW).

CASE SUMMARY

A 19 years old male came to our clinic with a chief complaint of anterior open bite and crossbite and not able to chew food well. Clinical examination revealed an angle class III malocclusion with anterior open bite, crossbite and spaced arch. Radiographic and clinical examination showed a skeletal class III pattern. We used ISW to level the upper and lower arch and to correct the anterior open bite and crossbite. Intermaxillary elastics were also used to achieve a better interdigitation. Finally, adequate overbite, overjet and a desirable occlusion were achieved. The active treatment time took 2 years and 2 months.

CONCLUSION

In a case of class III angular malocclusion with open bite and crossbite in the anterior teeth, ideal results were achieved using the ISW technique and the patient was satisfied with the outcome.

Mitochondrial myopathy revealed postoperative acute respiratory failure: A case report

BACKGROUND

Mitochondrial myopathies are characterized by primary dysfunction of the mitochondrial respiratory chain; they typically present as chronic muscle weakness. Clinically visible acute respiratory dysfunctions associated with mitochondrial myopathies occur rarely.

CASE SUMMARY

In this report, we present the case of a patient who developed postoperative hypoventilation after undergoing an uneventful administration of general anesthesia. A 34-year-old woman with no family history of myopathy underwent laparoscopic removal of a right-sided ureteric stone. Two days postoperatively, her oxygen saturation decreased rapidly, and blood gas analysis revealed hypercapnia. We promptly intubated and initiated the patient and initiated her on mechanical ventilation as she remained awake. Clinical examination findings were unremarkable; the results of laboratory investigations, including those for thyroid, hepatic, renal, and neuromuscular functions, were within normal limits. Muscle biopsy revealed muscle fibers of varying sizes as well as several degenerating and regenerating myofibers. Modified Gomori trichrome staining of the cross-sections revealed ragged red fibers. Based on these findings, we diagnosed the patient with mitochondrial myopathy. The patient’s condition gradually improved, and she was discharged on a home ventilator 73 days postoperatively.

CONCLUSION

Our case highlights that mitochondrial myopathy should be considered in the differential diagnosis of patients with postoperative respiratory failure.

Revitalizing upper blepharoplasty: Preserving volume

Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes. The traditional method of subtraction blepharoplasty, which involved removing fat and excess skin, is now considered outdated. This letter explores Gorgy et al's commentary on Miotti et al's study, highlighting a shift in upper eyelid blepharoplasty towards a more conservative, volume-preserving approach. The study systematically reviewed 10 publications, including three retrospective studies, five comparative studies, and two clinical trials. It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration. However, the study's limitations, such as the lack of long-term comparative research, a relatively small sample size, and a single-center design, indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques. The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.

Extracorporeal membrane oxygenation combined with intra-aortic balloon counterpulsation for pheochromocytoma: A case report

BACKGROUND

Pheochromocytoma (PHEO) is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma. PHEOs can secrete catecholamines, leading to a variety of symptoms. Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.

CASE SUMMARY

The patient presented with unexplained chest tightness, palpitations, and pink sputum. Upon examination and analysis of laboratory results, a diagnosis of adrenal PHEO was established. The PHEO secreted high levels of catecholamines, causing sudden fluctuations in blood pressure and heart rate, leading to extremely unstable hemodynamics. Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs, allowing for timely surgical intervention.

CONCLUSION

The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion, thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.

Granulomatosis with polyangiitis induced by the anti-programmed cell death-1 inhibitor tislelizumab: A case report

BACKGROUND

Immune checkpoint inhibitors (ICIs) are a new class of antitumor agents. They enhance antitumor effects by blocking inhibitory receptors and related ligands expressed on T cells. ICIs also modulate regular immune cell activity, affecting the immune system and causing immune-related adverse events. The renal system is sometimes affected by these adverse events. Currently, the literature on ICIs-related glomerular injuries is scarce.

CASE SUMMARY

We present a patient who developed granulomatosis with polyangiitis (GPA) 3 weeks after treatment with the anti-programmed cell death-1 inhibitor, tislelizumab. The patient experienced proteinuria, hematuria, and acute kidney injury without pulmonary hemorrhage and tested positive for anti-neutrophil cytoplasmic antibody (ANCA)-cytoplasmic type. Renal biopsy confirmed ANCA-associated vasculitis, and GPA was finally diagnosed. The patient received pulse treatment with glucocorticoids and cyclophosphamide, and renal function improved. After self-discontinuation of the drug, the disease recurred, and the original treatment regimen was continued. However, the patient’s renal function continued to deteriorate.

CONCLUSION

Glucocorticoids plus cyclophosphamide are effective for treating GPA induced by tislelizumab. However, follow-up and patient education are needed.

Role of disturbance coefficient in monitoring and treatment of cerebral edema in patients with cerebral hemorrhage

BACKGROUND

At present, the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography (CT) and magnetic resonance imaging (MRI), which can evaluate the location and degree of peripheral cerebral edema, but cannot realize quantification. When patients have symptoms of diffuse cerebral edema or high cranial pressure, CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time. Intracranial pressure monitoring is the gold standard, but it is an invasive operation with high cost and complications. For clinical purposes, the ideal cerebral edema monitoring should be non-invasive, real-time, bedside, and continuous dynamic monitoring. The disturbance coefficient (DC) was used in this study to dynamically monitor the occurrence, development, and evolution of cerebral edema in patients with cerebral hemorrhage in real time, and review head CT or MRI to evaluate the development of the disease and guide further treatment, so as to improve the prognosis of patients with cerebral hemorrhage.

AIM

To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

METHODS

A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery, Second Affiliated Hospital of Xi’an Medical University from September 2018 to September 2019 were recruited. The patients were randomly divided into a control group (n = 80) and an experimental group (n = 80). Patients in the control group received conventional empirical treatment, while those in the experimental group were treated with mannitol dehydration under the guidance of DC. Subsequently, we compared the two groups with regards to the total dosage of mannitol, the total course of treatment, the incidence of complications, and prognosis.

RESULTS

The mean daily consumption of mannitol, the total course of treatment, and the mean hospitalization days were 362.7 ± 117.7 mL, 14.8 ± 5.2 days, and 29.4 ± 7.9 in the control group and 283.1 ± 93.6 mL, 11.8 ± 4.2 days, and 23.9 ± 8.3 in the experimental group (P < 0.05). In the control group, there were 20 patients with pulmonary infection (25%), 30 with electrolyte disturbance (37.5%), 20 with renal impairment (25%), and 16 with stress ulcer (20%). In the experimental group, pulmonary infection occurred in 18 patients (22.5%), electrolyte disturbance in 6 (7.5%), renal impairment in 2 (2.5%), and stress ulcers in 15 (18.8%) (P < 0.05). According to the Glasgow coma scale score 6 months after discharge, the prognosis of the control group was good in 20 patients (25%), fair in 26 (32.5%), and poor in 34 (42.5%); the prognosis of the experimental group was good in 32 (40%), fair in 36 (45%), and poor in 12 (15%) (P < 0.05).

CONCLUSION

Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential. It reduces mannitol dosage, treatment duration, complication rates, and hospital stays, ultimately lowering hospitalization costs. Additionally, it improves overall patient prognosis, offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

Diffuse panbronchiolitis in children misdiagnosed as asthma: A case report

BACKGROUND

Diffuse panbronchiolitis (DPB) is a rare, chronic inflammatory lung disease marked by chronic cough, breathlessness, and preceding sinusitis. Symptoms often persist for years and can be misdiagnosed as asthma, particularly in children. This report describes a DPB case resolved with long-term azithromycin therapy, emphasizing the need for a timely and accurate diagnosis.

CASE SUMMARY

A 12-year-old girl, diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists, developed a history of chronic productive cough and chronic sinusitis for a year. On examination, she exhibited wheezing and coarse crackles. Despite receiving treatment for an asthma exacerbation, her symptoms did not improve. A chest X-ray revealed reticulonodular infiltration in both lower lungs, prompting further evaluation with high-resolution computed tomography (HRCT). The HRCT confirmed centrilobular nodule opacities, a 'tree-in-bud' pattern, and non-tapering bronchi, suggesting DPB. Elevated cold hemagglutinin titers at 128 further supported the diagnosis. Her cough and sinusitis resolved within a month after starting azithromycin therapy, chosen for its anti-inflammatory and immunomodulatory effects. Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.

CONCLUSION

This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.

Lymphogranuloma venereum proctosigmoiditis misdiagnosed as inflammatory bowel disease: A case report

BACKGROUND

There has been a rise in the number of cases diagnosed as lymphogranuloma venereum (LGV), caused by the transmission of Chlamydia trachomatis, specifically serotypes L1, L2, and L3, mostly in men who have sex with men (MSM). LGV can clinically manifest as rectal discomfort, bleeding, and mucoid discharge mimicking inflammatory bowel disease (IBD). Therefore, the role of a wholesome collection of patient history along with gaining patient trust and ease in reporting different elements of their life— whether social or sexual history-could greatly guide physician’s investigations leading to timely and more efficient diagnosis.

CASE SUMMARY

A 38-year-old male presenting with symptoms of rectal bleeding, mucoid discharge, and abdominal pain during the past month. Initial treatment for hemorrhoids given at an outpatient clinic did not improve the patient’s complaints warranting further examinations, whereby endoscopy revealed the presence of mucosal edema and ulcerations in the rectosigmoid area rendering IBD a plausible diagnosis theoretically, but practically refuted due to the negative biopsy results, and positive result of nucleic acid amplification testing of the rectal swab sample for Chlamydia trachomatis. The latter results are in accordance with the diagnosis of LGV proctosigmoiditis. Accordingly, medical therapy with doxycycline was instituted, which yielded a notable symptomatic relief, and an education on safe sexual practices.

CONCLUSION

LGV proctosigmoiditis is a crucial differential diagnosis in high risk patients, such as MSM that should be differentiated from IBD. Obtaining a thorough sexual history is pivotal to prevent misdiagnosis and guarantee prompt, effective therapy.

Dual benefits of sodium-glucose cotransporter 2 inhibitors in metabolic diseases: Diabetes control and gout management

The study by Lin et al delves into the clinical impact of dapagliflozin, a representative sodium-glucose cotransporter 2 (SGLT2) inhibitor, on chronic heart failure complicated by hyperuricemia. This investigation highlights dapagliflozin’s efficacy in lowering serum uric acid levels, enhancing cardiac function, and reducing cardiovascular events. This work not only provides a comprehensive analysis of dapagliflozin’s sustained benefits in these patients but also introduces novel insights for managing chronic heart failure exacerbated by elevated uric acid. Furthermore, this review examines the potential role of SGLT2 inhibitor in the context of gout, evaluating its mechanisms and clinical application prospects in the management of hyperuricemia, thereby further enriching the medical community’s understanding of SGLT2 inhibitor.

Severe upper gastrointestinal hemorrhage due to milk protein allergy: A case report

BACKGROUND

Upper gastrointestinal hemorrhage is a life-threatening manifestation of cow’s milk protein allergy (CMPA). We analyze the clinical characteristics of a case of milk protein allergy manifested as severe upper gastrointestinal hemorrhage.

CASE SUMMARY

The hospital admitted a 2-month-old male infant due to “melena for 6 days, hematemesis twice”. The main symptom was melena, initially occurring once or twice per day, then gradually increasing to five or six times per day at their peak. During the course of the illness, the infant vomited blood, but there were no reports of vomiting, fever, pale complexion, dyspnea, wheezing, or difficulty breathing. Laboratory tests showed hemoglobin level of 87 g/L, platelet count of 349 × 10⁹/L, and eosinophil percentage of 0.031. Coagulation studies were normal. After avoiding certain foods and feeding with an amino acid formula for 2 weeks, a repeat gastroscopy revealed less bleeding. After six weeks, a positive oral food challenge test confirmed a severe CMPA. At the 4-month follow-up, there was no gastrointestinal bleeding, and the infant was growing and developing well.

CONCLUSION

The manifestations of milk protein allergy are diverse and nonspecific, with gastrointestinal bleeding being less common, especially in infants. When infants present with unexplained massive hematemesis, it’s critical to investigate the possibility of CMPA.

Electromyography biofeedback training for post-stroke dysphagia

Dysphagia is a common complication of ischemic stroke and is usually difficult to treat. The mainstay of standard therapy of post-stroke dysphagia (PSD) is effortful swallowing. Since its introduction in 2004, there is increasing evidence that surface electromyography-guided biofeedback training (EMGBT) can enhance the therapeutic effect of standard LE. In this editorial, we comment on the article by Meng et al published in the recent issue of the World Journal of Clinical Cases, which provided evidence that particularly extensive EMGBT with an increased number of sessions is definitively more effective than the standard speech therapy or ordinary EMGBT. Among the 90 PSD patients with ischemic stroke or intracerebral bleeding, those who underwent EMGBT in more sessions than usual particularly benefited from the approach. It was concluded that EMGBT is more effective than traditional swallowing training in improving dysphagia and swallowing disorders as well as hyoid-laryngeal complex movement speed in PSD patients.

Vitiligo-like rash in a patient with lung cancer caused by sintilimab: A case report

BACKGROUND

This article discusses a case involving a 63-year-old man with non-small cell lung cancer, who was treated with a combination of chemotherapy and immunotherapy. The patient was treated with five cycles of chemotherapy (pemetrexed and carboplatin) combined with sintilimab, a programmed death 1 inhibitor.

CASE SUMMARY

After the fifth cycle of treatment, the patient developed skin itching and a vitiligo-like rash, which are known side effects of immunotherapy. Despite dermatological consultation and treatment with topical corticosteroids, the rash worsened while the itching subsided. The patient continued with the treatment, and after 15 cycles, the tumor showed a response with a reduction in size. The vitiligo-like rash increased, but the antitumor treatment remained effective.

CONCLUSION

The case highlights the use of immunotherapy in patients with non-small cell lung cancer and the potential side effect of vitiligo-like rash. The patient’s tumor responded well to the treatment, and despite the skin reaction, the treatment was not discontinued due to its effectiveness. The article suggests that further studies are needed to understand the mechanism behind vitiligo in patients with lung cancer receiving immune checkpoint inhibitors and whether the development of vitiligo-like rash after immune checkpoint inhibitor therapy is associated with improved prognosis. The case also underscores the importance of managing immune-related adverse events in the context of effective antitumor treatment.

Insight into the efficacy and safety of pirfenidone: The treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) has a poor prognosis if left untreated; therefore, early treatment with pirfenidone is crucial. Lei et al conducted a retrospective analysis to evaluate the effectiveness of early pirfenidone treatment on lung function in 113 patients with IPF. In addition to other research, pirfenidone has demonstrated efficacy in patients at all stages of IPF once correct diagnosis has been made. In advanced IPF, we include the requirement for pirfenidone. Therefore, it is essential to choose an appropriate method of administration method, such as inhalation. This may circumvent the drawbacks of the high cost and possible adverse effects of this drug.

Clinical, radiologic, and pathologic study of intraosseous lipoma of the tibia: A case report

BACKGROUND

Intraosseous lipoma of bone is one of the rarest benign bone tumors, which often involves the metaphysis of long tubular bones, especially the femur, tibia, fibula, and calcaneus. Bone lipoma can be characterized by chronic dull pain but can also be asymptomatic most of the time. As a result, it is less likely to attract people’s attention and is occasionally diagnosed through imaging examination during routine physical health check-up.

CASE SUMMARY

We describe a clinical case of intraosseous lipoma in a 21-year-old patient with chronic pain in the left lower limb for four years without any significant physical findings apart from the minimal swelling and local tenderness over the median ankle. Computerized tomography suggested the possibility of a lipoma on the left distal tibia, but the pathological examination could make a definite diagnosis. The intraosseous lipoma of the left distal tibia was treated by surgical curettage, bone graft, and internal fixation with steel plate, since the conservative treatment is often ineffective. Postoperatively, the patient made an uneventful recovery and was able to do daily activities without any restrictions. In addition, local recurrence of the intraosseous lipoma was not reported in subsequent reexamination.

CONCLUSION

Bone lipoma is very rare and often exhibits no characteristic clinical manifestation. The confirmative diagnosis of lipoma largely relies on a combination of imageology and biopsy. Surgical intervention is often recommended as a conventional therapy for bone lipoma. Postoperatively, the patient makes an uneventful recovery with a good prognosis, and the local recurrence of the tumor is also a low probability event.

Relevant clinical factors for early extubation in living-donor liver transplantation: A single-center retrospective cohort study

BACKGROUND

Clinical guidelines for early extubation after liver transplantation remain lacking, with significant variations in the rates of early extubation across transplantation centers.

AIM

To identify clinical factors, including the use of epidural analgesia, associated with early extubation in living-donor liver transplantation (LDLT).

METHODS

The medical records of LDLT recipients were analyzed in this study, categorizing them based on extubation timing as delayed (leaving the operating room without extubation) or early (tracheal tube removed immediately after surgery). A multivariate binary logistic regression analysis was performed. Subgroup analysis was conducted, excluding patients contraindicated for epidural analgesia owing to significant coagulopathy.

RESULTS

Total of 159 patients, 93 (58.5%) underwent early extubation. Relevant clinical factors of early extubation were shorter anhepatic time [adjusted odds ratio (OR) = 0.439, 95% confidence interval (CI): 0.232-0.831; P = 0.011], absence of high-dose vasoactive drug use at the end of surgery (OR = 0.235, 95%CI: 0.106-0.519; P < 0.001), and the use of epidural analgesia (OR = 15.730, 95%CI: 1.919-128.919; P = 0.010). In a subgroup analysis of 67 patients, epidural analgesia remained a relevant clinical factor for early extubation (adjusted OR = 19.381, 95%CI: 2.15-174.433; P = 0.008).

CONCLUSION

Shorter anhepatic time, absence of high-dose vasoactive drug use at the end of surgery, and the use of epidural analgesia are relevant clinical factors of early extubation following LDLT.

Cerebral complications after unilateral biportal endoscopic surgery: A case report

BACKGROUND

Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.

CASE SUMMARY

A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.

CONCLUSION

Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.

Difficulty removing a totally implantable venous access port: A case report

BACKGROUND

This case report examines the challenges associated with removing a totally implantable venous access port (TIVAP) used for long-term chemotherapy in a patient with breast cancer. Prolonged use of TIVAPs can result in complications such as catheter kinking, thrombosis, and adhesions between the catheter and surrounding tissues, potentially complicating their removal.

CASE SUMMARY

A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years. Initial removal attempts at the Department of Venous Access Center were unsuccessful, likely due to adhesions, necessitating a subsequent successful catheter extraction in a hybrid operating room. Imaging revealed no abnormalities, and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.

CONCLUSION

This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein, particularly when the catheter traverses the sternocleidomastoid muscle. Repeated neck movements might lead to significant adhesions around the catheter, complicating its removal. Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.

Bivalirudin for anticoagulation in elderly acute coronary syndrome: Effects on myocardial microcirculation and adverse events

The management of acute coronary syndrome (ACS) in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes. Bivalirudin, a direct inhibitor of thrombin, serves as an alternative to traditional therapies. This drug is particularly effective in enhancing myocardial microcirculation and reducing adverse events after clinical interventions. The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS. Compared with unfractionated heparin, bivalirudin markedly reduced the emergency response time and improved cardiac function indicators. It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions. These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications, thus serving as a safe, effective anticoagulation agent for older patients with ACS. Nonetheless, further large-scale, high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes. Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care, balancing efficacy and safety. Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.

Correction to: High expression of autophagy-related gene EIF4EBP1 could promote tamoxifen resistance and predict poor prognosis in breast cancer

This is an erratum to the published paper titled, “High expression of autophagy-related gene EIF4EBP1 could promote tamoxifen resistance and predict poor prognosis in breast cancer.” We have removed the citations to certain articles in subsequent revisions of the manuscript. However, owing to our oversight, the citation marker in the upper right corner was not removed. We apologize for any confusion this may have caused.

Bronchopleural fistula following application of Hem-o-lock clip at bronchial stump after lobectomy: A case report

BACKGROUND

Hem-o-lock clip, a versatile and reliable non-absorbable tissue clip, has gained widespread acceptance in laparoscopic surgeries for vessel ligation and tissue approximation. Its efficacy and safety have been well-documented.

CASE SUMMARY

This case report describes the occurrence of a bronchopleural fistula following the application of the Hem-o-lock clip for the treatment of a lobar bronchial stump after lobectomy.

CONCLUSION

This case underscores the importance of exercising caution when using the Hem-o-lock clip for the management of non-vascular tissues during thoracic surgery.