Re-evaluating the necessity of routine laboratory monitoring during isotretinoin therapy for acne

In this letter, we discuss the topic of necessity of routine laboratory monitoring during isotretinoin treatment for acne. According to Park and colleagues, it is advisable to monitor the levels of triglycerides, alanine aminotransferase, and aspartate aminotransferase every 5 to 6 months. Additionally, the levels of total cholesterol and low-density lipoprotein should be checked within the first two months of treatment. Isotretinoin is a commonly prescribed agent mainly used to treat acne. Despite its high effectiveness, it necessitates regular monitoring of laboratory parameters due to its side effect profile. Currently, there remains a lack of consensus on the appropriate frequency for monitoring these parameters during treatment with isotretinoin. This letter will provide insight into this complex and controversial topic. Based on existing literature, we concluded that the incidence of changes in lipid and liver aminotransferase levels during isotretinoin treatment for acne was low and likely clinically insignificant. For generally healthy people, we recommend testing lipid and liver profiles once at baseline and a second time at the peak dosage. However, frequent testing might still be beneficial in certain populations of patients.

Toripalimab in combination with chemotherapy effectively suppresses local recurrence and metastatic sarcomatoid renal cell carcinoma: A case report

BACKGROUND

Sarcomatoid renal cell carcinoma (SRCC) is a rare variant of renal cell carcinoma associated with an unfavorable prognosis. The efficacy of conventional chemotherapy and targeted therapies are limited, whereas the emergence of immune checkpoint inhibitor has introduced new avenues for managing advanced SRCC.

CASE SUMMARY

A 77-year-old female patient was referred to our hospital following the incidental detection of a right kidney tumor without specific symptoms. The tumor was successfully resected, and subsequent pathological examination confirmed SRCC. She experienced both local recurrence and distant metastasis eight months after the initial laparoscopic resection. Following six cycles of toripalimab combined with pirarubicin chemotherapy, the patient achieved a partial response. Subsequently, the patient attained an almost-complete continuous response to toripalimab monotherapy maintenance for an additional six cycles. She has not experienced disease progression for 15 months, and her overall survival has reached 24 months thus far.

CONCLUSION

Combination therapy with programmed death 1 antibodies and cytotoxic agents may be a recommended first-line treatment approach for SRCC.

Effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section

BACKGROUND

Following cesarean section, a significant number of women encounter moderate to severe pain. Inadequate management of acute pain post-cesarean section can have far-reaching implications, adversely impacting maternal emotional well-being, daily activities, breastfeeding, and neonatal care. It may also impede maternal organ function recovery, leading to escalated opioid usage, heightened risk of postpartum depression, and the development of chronic postoperative pain. Both the Chinese Enhanced Recovery After Surgery (ERAS) guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management. Esketamine, functioning as an antagonist of the N-Methyl-D-Aspartate receptor, has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment. Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes. This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.

AIM

To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.

METHODS

A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups: low-dose esketamine (0.15 mg/kg), high-dose esketamine (0.25 mg/kg), and control (saline). Postoperative Visual Analog Scale (VAS) scores were recorded at 6 hours, 12 hours, 24 hours, and 48 hours. Edinburgh Postnatal Depression Scale (EPDS) scores were noted on 2 days, 7 days and 42 days. Ramsay sedation scores were assessed at specified intervals post-injection. Postoperative adverse reactions were also recorded.

RESULTS

Low-dose group and high-dose group compared to control group, had significantly lower postoperative VAS pain scores at 6 hours 12 hours, and 24 hours (P < 0.05), with reduced analgesic usage (P < 0.05). EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days (P < 0.05). No significant differences in first exhaust and defecation times were observed (P > 0.05), but ambulation times were shorter (P < 0.05). Ramsay scores were higher at 5 minutes, 15 minutes, and upon room exit (P < 0.05). Low-dose group and high-dose group had higher incidences of hallucination, lethargy, and diplopia within 2 hours (P < 0.05), and with low-dose group had lower incidences of hallucination, lethargy, and diplopia than high-dose group (P < 0.05).

CONCLUSION

Esketamine enhances analgesia and postpartum recovery; a 0.15 mg/kg dose is optimal for cesarean sections, balancing efficacy with minimized adverse effects.

Hidden army within: Harnessing the microbiome to improve cancer treatment outcomes

The gut microbiome has emerged as a critical player in cancer pathogenesis and treatment response. Dysbiosis, an imbalance in the gut microbial community, impacts tumor initiation, progression, and therapy outcomes. Specific bacterial species have been associated with either promoting or inhibiting tumor growth, offering potential targets for therapeutic intervention. The gut microbiome influences the efficacy and toxicity of conventional treatments and cutting-edge immunotherapies, highlighting its potential as a therapeutic target in cancer care. However, translating microbiome research into clinical practice requires addressing challenges such as standardizing methodologies, validating microbial biomarkers, and ensuring ethical considerations. Here, we provide a comprehensive overview of the gut microbiome's role in cancer highlighting the need for ongoing research, collaboration, and innovation to harness its full potential for improving patient outcomes in oncology. The current editorial aims to explore these insights and emphasizes the need for standardized methodologies, validation of microbial biomarkers, and interdisciplinary collaboration to translate microbiome research into clinical applications. Furthermore, it underscores ethical considerations and regulatory challenges surrounding the use of microbiome-based therapies. Together, this article advocates for ongoing research, collaboration, and innovation to realize the full potential of microbiome-guided oncology in improving patient care and outcomes.

Stroke: Evolution of newer treatment modalities for acute ischemic stroke

Acute ischemic stroke is one of the leading causes of morbidity and mortality worldwide. Restoration of cerebral blood flow to affected ischemic areas has been the cornerstone of therapy for patients for eligible patients as early diagnosis and treatment have shown improved outcomes. However, there has been a paradigm shift in the management approach over the last decade, and with the emphasis currently directed toward including newer modalities such as neuroprotection, stem cell treatment, magnetic stimulation, anti-apoptotic drugs, delayed recanalization, and utilization of artificial intelligence for early diagnosis and suggesting algorithm-based management protocols.

Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease

BACKGROUND

Renal cell carcinoma (RCC) is more common in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts, often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage.

AIM

To analyze the prevalence and characterize the clinical features of RCC in patients with ADPKD undergoing simultaneous bilateral native nephrectomy.

METHODS

Between May 2017 and April 2024, 19 ADPKD patients undergoing hemodialysis and awaiting kidney transplantation due to end-stage renal disease (ESRD) underwent bilateral nephrectomies in a single center. Parameters such as patient characteristics, intraoperative blood loss, blood transfusion volume, length of hospital stay, and postoperative complications were documented. Pathological findings for RCC were reviewed.

RESULTS

A total of 38 kidneys were excised from 19 patients, with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months. Eight patients underwent open nephrectomies, and 11 underwent hand-assisted laparoscopic nephrectomies. RCC was detected in 15.8% of kidneys, affecting 21.1% of patients. Two patients had multifocal RCC in both kidneys. All RCC cases were pT1 stage, with the largest lesion averaging 16.5 mm in diameter. The average operative duration was 120 minutes, with intraoperative blood loss averaging 184.2 mL. Five patients required blood transfusions. Postoperative complications occurred in five patients, with a mean hospital stay of 17.1 days. The mean follow-up period was 28.1 months.

CONCLUSION

The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone. Thus, clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD, particularly those on dialysis.

Risk of appendiceal neoplasm in patients with appendix disorders

The most common appendicular disease is acute appendicitis, with a lifetime risk of 7%–8%. Complicated cases, which can occur in 2%–7% of patients, can significantly impact the severity of the condition and may require different management approaches. Nonoperative management with possible delayed appendectomy has been suggested for selected patients, however, there is a non-negligible risk of missing an underlying malignancy, which is reported to be as high as 11%. Diagnostic work-up is paramount to achieve optimal treatment with good results.

Approach to cardiac masses: Thinking inside and outside the box

In this editorial we comment on the article by Huffaker et al, published in the current issue of the World Journal of Clinical Cases. Cardiac masses encompass a broad range of lesions, potentially involving any cardiac structure, and they can be either neoplastic or non-neoplastic. Primitive cardiac tumors are rare, while metastases and pseudotumors are relatively common. Cardiac masses frequently pose significant diagnostic and therapeutic challenges. Multimodality imaging is fundamental for differential diagnosis, treatment, and surgical planning. In particular cardiac magnetic resonance (CMR) is currently the gold standard for noninvasive tissue characterization. CMR allows evaluation of the relationship between the tumor and adjacent structures, detection of the degree of infiltration or expansion of the mass, and prediction of the possible malignancy of a mass with a high accuracy. Different flow charts of diagnostic work-up have been proposed, based on clinical, laboratory and imaging findings, with the aim of helping physicians approach the problem in a pragmatic way (“thinking inside the box”). However, the clinical complexity of cancer patients, in particular those with rare syndromes, requires a multidisciplinary approach and an open mind to go beyond flow charts and diagnostic algorithms, in other words the ability to “think outside the box”.

Uveitis glaucoma hyphema syndrome as a result of glaucoma implant: A case report

BACKGROUND

Glaucoma is caused by increased intraocular pressure (IOP) that damages the optic nerve, leading to blindness. The Ahmed glaucoma valve (AGV) is a glaucoma drainage implant device that is used in glaucoma patients with uncontrolled IOP. A possible complication after any ocular surgery however is hyphema, which can itself progress to uveitis glaucoma hyphema (UGH) syndrome on rare occasions. UGH syndrome has not yet been reported as a complication of AGV implantation.

CASE SUMMARY

Here, we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation. We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube. After the second surgery, the patient’s IOP was reduced, and she had a clear cornea and no signs of hyphema.

CONCLUSION

This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.

Efficacy of graphene nanocomposites for air disinfection in dental clinics: A randomized controlled study

BACKGROUND

Aerosols containing disease-causing microorganisms are produced during oral diagnosis and treatment can cause secondary contamination.

AIM

To investigate the use of graphene material for air disinfection in dental clinics by leveraging its adsorption and antibacterial properties.

METHODS

Patients who received ultrasonic cleaning at our hospital from April 2023 to April 2024. They were randomly assigned to three groups (n = 20 each): Graphene nanocomposite material suction group (Group A), ordinary filter suction group (Group B), and no air suction device group (Group C). The air quality and air colony count in the clinic rooms were assessed before, during, and after the procedure. Additionally, bacterial colony counts were obtained from the air outlets of the suction devices and the filter screens in Groups A and B.

RESULTS

Before ultrasonic cleaning, no significant differences in air quality PM_2.5 and colony counts were observed among the three groups. However, significant differences in air quality PM_2.5 and colony counts were noted among the three groups during ultrasonic cleaning and after ultrasonic treatment. Additionally, the number of colonies on the exhaust port of the suction device and the surface of the filter were significantly lower in Group A than in Group B (P = 0.000 and P = 0.000, respectively).

CONCLUSION

Graphene nanocomposites can effectively sterilize the air in dental clinics by exerting their antimicrobial effects and may be used to reduce secondary pollution.

Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND

Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training. In this situation, virtual reality technology can help the new nurses. Despite its potential benefits, there are studies on patient satisfaction but there is limited information on the usability of virtual reality (VR) technology for new nurses in giving preoperative education to patients.

AIM

To investigate the impact on satisfaction, usability, and burnout of a system using VR technology in preoperative patient education.

METHODS

The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019. Each nurse taught four patients: Two using traditional verbal education and two using virtual reality. The System Usability Scale, After-Scenario Questionnaire, and Maslach Burnout Inventory (MBI) were employed to evaluate the impact of these education methods.

RESULTS

The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups. Among the three subscales of the MBI, emotional exhaustion and personal accomplishment improved statistically significantly. VR was also better in terms of usability.

CONCLUSION

This study suggests VR enhances usability and reduces burnout in nurses, but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Effects of traditional Chinese medicine on symptoms of patients with spleen and stomach deficiency-related tinnitus

BACKGROUND

Tinnitus affects 10%-30% of the population. Recent evidence suggests that tinnitus is associated with spleen deficiency. However, compared with kidney deficiency-related tinnitus, less research has been conducted on the impact of spleen deficiency-related tinnitus.

AIM

To investigate the clinical efficacy of using Guipi Wan and dietary and lifestyle modification based on traditional Chinese medicine for treatment of patients with spleen and stomach deficiency-related tinnitus.

METHODS

We enrolled 110 patients with spleen and stomach deficiency-related tinnitus who were distributed into treatment (58 cases) and control (52 cases) groups. Tinnitus severity, sleep quality and emotional state were assessed by questionnaires [Tinnitus Evaluation Questionnaire (TEQ); Pittsburgh Sleep Quality Index (PSQI); Depression-Anxiety-Stress Scale-21 (DASS-21)] that were used for analysis in the two groups during the initial and intervention and after. In the treatment group, patients were treated with oral administration of Guipi Wan and consulted for healthy dietary and lifestyle modification. In the control group, patients were only assessed and not treated.

RESULTS

At the end of the 6-months, TEQ scores decreased significantly in the treatment group (P = 0.021) but not in the Control group. Significant effects in the treatment group were noted for PSQI total score (P = 0.043) and several PSQI component scores in the treatment group (P < 0.05). After treatment, the DASS-21 scores were significantly reduced in the treatment group (P < 0.05).

CONCLUSION

Guipi Wan combined with dietary and lifestyle modification based on regulating the spleen and stomach can be considered core to the treatment of tinnitus related to spleen and stomach deficiency.

Pituitary metastasis from lung adenocarcinoma

Pituitary tumor is a common neuroendocrine tumor, but there are also rare clinical metastases at this site, which are generally transferred from extrabellar tumors. Although the clinical incidence is low, the prognosis is poor. The purpose of this editorial is to discuss further the relevant knowledge of pituitary metastases and remind clinicians to prevent missed diagnosis and improve the prognosis of these patients.

Vascular medicine in the 21st century: Embracing comprehensive vasculature evaluation and multidisciplinary treatment

The field of vascular medicine has undergone a profound transformation in the 21^st century, transforming our approach to assessment and treatment. Atherosclerosis, a complex inflammatory disease that affects medium and large arteries, presents a major challenge for researchers and healthcare professionals. This condition, characterized by arterial plaque formation and narrowing, poses substantial challenges to vascular health at individual, national, and global scales. Its repercussions are far-reaching, with clinical outcomes including ischemic heart disease, ischemic stroke, and peripheral arterial disease—conditions with escalating global prevalence. Early detection of vascular changes caused by atherosclerosis is crucial in preventing these conditions, reducing morbidity, and averting mortality. This article underscored the imperative of adopting a holistic approach to grappling with the intricacies, trajectories, and ramifications of atherosclerosis. It stresses the need for a thorough evaluation of the vasculature and the implementation of a multidisciplinary treatment approach. By considering the entire vascular system, healthcare providers can explore avenues for prevention, early detection, and effective management of this condition, ultimately leading to improved patient outcomes. We discussed current practices and proposed new directions made possible by emerging diagnostic modalities and treatment strategies. Additionally, we considered healthcare expenditure, resource allocation, and the transformative potential of new innovative treatments and technologies.

Insights into upper blepharoplasty: Conservative volume-preserving techniques

This editorial commentary critically examines the systematic review by Miotti et al, which discusses the evolving trends in upper lid blepharoplasty towards a conservative, volume-preserving approach. The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity, paralleling broader trends in panfacial rejuvenation. Miotti et al delve into the nuances of fat pad management, advocating for conservation over reduction to sustain natural contours and improve long-term aesthetic outcomes. This perspective is supported by comparative studies and empirical data, such as those from Massry and Alghoul et al, highlighting the benefits of conservative approaches in terms of patient satisfaction and aesthetic longevity. The review also stresses the importance of surgeon discretion in adapting procedures to diverse patient demographics, particularly in addressing distinct features such as the Asian upper eyelid. However, it identifies a significant gap in long-term comparative research, underscoring the need for future studies to substantiate the safety and efficacy of these minimalist techniques. Overall, Miotti et al.'s work contributes profoundly to the discourse on personalized, conservative cosmetic surgery, urging ongoing research to refine and validate surgical best practices in upper eyelid blepharoplasty.

Oral candidiasis and potential risk factors among disabled and non-disabled in Al-Baha region, Saudi Arabia

BACKGROUND

Oral candidiasis (OC) is an oral health disease that could influence patients’ oral health quality of life.

AIM

To estimate prevalence of OC among disabled and non-disabled individuals and its potential risk factors in the Al-Baha region, Saudi Arabia.

METHODS

An observational cross-sectional study was carried out among 148 disabled and non-disabled participants. The technique of concentrated oral rinse employing the Sabouraud Dextrose Agar medium accompanied with 0.05% chloramphenicol was conducted to assess and isolate candida. Oral examination using the World Health Organization guidelines was conducted to examine participants’ oral health status. A pre-designed questionnaire was also used to evaluate sociodemographic, medical history, and oral hygiene habits of the studied population.

RESULTS

Out of 148 participants (n = 57, 38%) had colonized candida. None of the studied population had visible Candida lesions. However, Candida was found in the oral rinses without the subject presenting any lesions or issues caused by Candida (asymptomatic colonization). The most common prevalent OC among participants were Candida albicans,Candida glabrata, Candida dubliniensis, Candida krusei, Candida tropicalis, and Candida parapsilosis (n = 35, 61%; n = 8, 14%; n = 6, 10%; n = 5, 9%; n = 2, 4%; and n = 1, 2%) respectively. Diabetes, smoking, poor plaque, and gingival status were key potential risk factors that significantly associated with candida’s density and presence (P = 0.001, P = 0.001, P = 0.01, and P = 0.01) respectively. Disability status had no statistically significant effect on presence and density of Candida.

CONCLUSION

The prevalence of OC is almost third of the studied population; thus, may provoke a need to develop preventive strategies to reduce the OC rate and establish solid treatment plans.

Deciphering the iron enigma: Navigating the complexities of iron metabolism in critical illness

Iron is a double-edged sword! Despite being essential for numerous physiological processes of the body, a dysregulated iron metabolism can result in tissue damage, exaggerated inflammatory response, and increased susceptibility to infection with certain pathogens that thrive in iron-rich environment. During sepsis, there is an alteration of iron metabolism, leading to increased transport and uptake into cells. This increase in labile iron may cause oxidative damage and cellular injury (ferroptosis) which progresses as the disease worsens. Critically ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis, a common cause of mortality in intensive care unit. Originally, ferritin was known to play an important role in the hematopoietic system for its iron storage capacity. Recently, its role has emerged as a predictor of poor prognosis in chronic inflammation and critical illnesses. Apart from predicting the disease outcome, serum ferritin can potentially reflect disease activity as well.

Obstructive sleep apnea-hypopnea syndrome immunological relationship

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a complex disorder characterized by symptoms resulting from intermittent hypoxia and hypopnea, with research indicating a crucial role of immune system dysregulation and genetic variations in its pathogenesis. A recent Zhao et al study utilizes Mendelian randomization analysis to explore the causal relationship between immune cell characteristics and OSAHS. The study identifies specific lymphocyte subsets associated with OSAHS, providing valuable insights into the disease's pathophysiology and potential targets for therapeutic intervention. The findings underscore the significance of genetic and immunological factors in sleep disorders, offering a fresh perspective on OSAHS's complexities. Compared to existing literature, Zhao et al's study stands out for its focus on genetic markers and specific immune responses associated with OSAHS, expanding upon previous research primarily centered on systemic inflammation. In conclusion, the study represents a significant advancement in the field, shedding light on the causal role of immune cells in OSAHS and paving the way for future research and targeted treatments.

Interferon-gamma release assays as a tool for differential diagnosis of gastrointestinal tuberculosis

In this editorial, we comment on an article published in a recent issue of the World Journal of Clinical Cases. There is a pressing need for reliable tools for diagnosing tuberculosis (TB) of the gastrointestinal tract. Despite advancements in the diagnosis and treatment, TB remains a global health challenge. Ali et al demonstrated that TB may mimic gastrointestinal conditions, such as gastric outlet obstruction, causing a delay in the diagnosis. Furthermore, the latter complication is frequently observed during infections, including Helicobacter pylori, and rarely is related to TB, as in the presented case. In line with this, we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract. Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.

Application effect of case management nursing based on patient safety in patients with prostate cancer

BACKGROUND

Globally, prostate cancer has become a major threat to men's health, with an increasing incidence and causes serious effects on the quality and length of life of patients. Despite the rapid development of medical technology, which provides treatments, including surgery, radiotherapy, and endocrine therapy, the treatment of patients with prostate cancer, especially with endocrine therapy, has become a major challenge in clinical treatment owing to the lengthy course of treatment, side effects of drugs, and impact of the disease on the psychological and physiological functioning of the patient, producing poor treatment adherence and a decline in quality of life.

AIM

To explore effects of nursing intervention prioritizing patient safety and case management in patients with prostate cancer undergoing endocrine therapy.

METHODS

Eighty patients with prostate cancer who received endocrine therapy at our hospital between January 2022 and January 2024 were divided into observation and control groups with 40 cases per group. The control group was treated using a routine nursing workflow while the observation group received case management nursing guidance prioritizing patient safety. Scores for anxiety and depression, prostate cancer symptoms, and quality of life and patient compliance and satisfaction were compared between the groups after three months of intervention.

RESULTS

After the nursing intervention, the anxiety and depression scores of the observation group were significantly lower than those of the control group (P < 0.05). The quality of life score, sexual function, and hormone function were significantly higher than those in the control group (P < 0.05).

CONCLUSION

Case management guidance based on patient safety effectively reduced anxiety and depression in patients undergoing endocrine therapy for prostate cancer and improved their quality of life, treatment compliance, and satisfaction.

HDR syndrome presented with nephrotic syndrome in a Chinese boy: A case report

BACKGROUND

HDR syndrome is a rare genetic disease caused by variants in the GATA3 gene and is phenotypically defined by the triad of hypoparathyroidism (H), deafness (D), and renal disease (R). Renal disorders of HDR are mainly developmental abnormalities, although renal functional abnormalities can also be observed. Nephrotic syndrome or nephrotic-level proteinuria is rare in HDR syndrome. Here, we report a Chinese infant with HDR syndrome who presented with early-onset nephrotic syndrome. We suggest that variants in the GATA3 gene might be associated with nephrotic syndrome.

CASE SUMMARY

A 9-month-old boy was hospitalized with a complaint of diarrhea. Proteinuria was detected in the patient by routine testing for 3 days. No edema, oliguria, fever or abnormal urine color were observed. Routine urinary tests at a local hospital revealed proteinuria (protein 3 +) and microscopic hematuria (red blood cells 5-10/HP). The patient was born by cesarean delivery due to placental abruption at 35 weeks + 4 days of gestation. Intrauterine growth retardation was detected beginning at 6 months of gestation. His birth weight was 1.47 kg (< P3^th), length was 39 cm (< P3^th), and head circumference was 28 cm (< P3^th). His motor developmental milestones were obviously delayed. Clinical data were analyzed, and genetic analysis for hereditary nephrotic syndrome was performed by next-generation sequencing. The clinical data showed that the boy exhibited growth retardation, early-onset nephrotic syndrome, microscopic hematuria, sensorineural deafness, T-cell immunodeficiency and congenital heart disease. Genetic tests revealed that the boy carried a de novo hemizygous variant, c.704C>T (p.Pro235 Leu), in exon 3 of the GATA3 gene.

CONCLUSION

We report an infant with HDR syndrome who presented with early-onset nephrotic syndrome in China. We suggest that variants in the GATA3 gene might be associated with infant-onset nephrotic syndrome.

Trends in upper gastrointestinal bleeding management

Upper gastrointestinal bleeding (UGIB) can be attributed to either non-variceal or variceal causes. The latter is more aggressive with hemodynamic instability secondary to decompensated cirrhosis and portal hypertension. Non-variceal UGIB (NVUGIB) occurs due to impaired gastroprotective mechanisms attributed to several drugs such as anticoagulants and nonsteroidal anti-inflammatory drugs. Helicobacter pylori infection contributes to the development of peptic ulcer bleeding as well. NVUGIB presentation can be either hemodynamically stable or unstable. During the initial assessment a scoring system including patient-related factors (current cardiac, renal, and liver diseases and hemodynamic and laboratory parameters) is used to determine the patient’s prognosis. The Glasgow Blatchford score has been shown to be the most useful and precise. Those with high-risk NVUGIB require urgent assessment and upper endoscopy to achieve better short-term and long-term outcomes such as less hospitalization, blood transfusion, and surgery.

Successful endoscopic treatment of superficial esophageal cancer in a patient with esophageal variceal bleeding: A case report

BACKGROUND

The coexistence of esophageal variceal bleeding and superficial esophageal cancer (SEC) is relatively rare in clinical practice. Moreover, there have been few reports of SEC overlying esophageal varices (EVs). Herein, we report our successful use of endoscopic submucosal dissection (ESD), esophageal solitary venous dilatation (ESVD), and endoscopic injection sclerotherapy (EIS) to treat a 75-year-old man who was diagnosed with SEC coexisting with esophageal variceal bleeding.

CASE SUMMARY

A 75-year-old man was admitted to the hospital due to black stool for 4 days. The patient had a history of liver cancer, cirrhosis, and portal hypertension. Endoscopic examination revealed esophageal and gastric varicose veins, as well as esophageal carcinoma in situ. We first treated esophageal variceal bleeding by ESVD and EIS. One week later, ESD treatment was done, and the complete resection of early esophageal cancer was successfully completed via endoscopy. There were no postoperative complications, such as bleeding, infection, or perforation.

CONCLUSION

The sequential treatment of ESVD, EIS, and ESD is an effective method for treating EVs with early esophageal cancer.

Review of the potential value of serum interleukin levels as prognostic biomarkers of liver failure

Liver failure (LF) is prevalent in China and is characterized by complex pathogenesis, challenging clinical management, poor prognosis, and rising incidence and mortality rates. The immune status is an important factor affecting LF prognosis. Interleukins (Ils) are a type of cytokine that act and interact with multiple cells, including immune cells. These signaling molecules play important roles in intercellular information transmission, including the regulation of immune cells; mediation of the activation, proliferation, and differentiation of T and B cells; and orchestration of the inflammatory response. To date, many studies have explored the correlation between IL expression and liver disease prognosis, but few studies have evaluated Ils as the prognostic biomarkers of LF. This article reviews the potential use of Ils as the prognostic biomarkers of LF. Particularly, it evaluates the predictive values of IL-21, IL-22, and IL-31, the three often overlooked yet promising prognostic biomarkers, in predicting susceptibility to LF. Harnessing biomarkers for early prognostic insights can facilitate tailored treatment strategies and enhance patient survival. Thus, this article focuses on the identification of IL-21, IL-22, and IL-33 as biomarkers in preclinical and clinical studies on LF and reviews their role as biomarkers in the pathogenesis and diagnosis of LF.

Effect of sequential nursing care combined with communication intervention on visual recovery and pain after cataract ultrasound emulsification

BACKGROUND

Cataracts are a common ophthalmic disease and postoperative vision recovery is crucial to patient quality of life. Rational and efficient care models play an important role in promoting vision recovery.

AIM

To evaluate the clinical effectiveness of procedural nursing care combined with communication intervention in vision recovery after cataract ultrasound emulsification.

METHODS

A randomized controlled study was conducted on 100 patients with cataracts who underwent ultrasound emulsification surgery. They were randomly assigned to an experimental group or a control group. The experimental group received procedural nursing combined with Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication intervention, whereas the control group received conventional nursing. The effectiveness of the nursing model was assessed by comparing differences in vision recovery, pain scores, and mental health status between the two groups.

RESULTS

It was found that over time the visual acuity of patients in both groups gradually recovered and patients in the experimental group had lower pain scores and superior mental health status than the control group (P < 0.05).

CONCLUSION

Procedural nursing combined with CICARE communication intervention has positive effects on vision recovery in patients after cataract ultrasound emulsification.