Searching for new drugs to treat Alzheimer’s disease dementia through multiple pathways

Dementia is a group of diseases, including Alzheimer's disease (AD), vascular dementia, Lewy body dementia, frontotemporal dementia, Parkinson's disease dementia, metabolic dementia and toxic dementia. The treatment of dementia mainly includes symptomatic treatment by controlling the primary disease and accompanying symptoms, nutritional support therapy for repairing nerve cells, psychological auxiliary treatment, and treatment that improves cognitive function through drugs. Among them, drug therapy to improve cognitive function is important. This review focuses on introducing and commenting on some recent progress in exploring drugs to improve cognitive function, especially the new progress in drug treatment for AD. We mainly discuss the opportunities and challenges in finding and developing new therapeutic drugs from the aspects of acetylcholinesterase, N-methyl-D-aspartate glutamate receptor, amyloid protein, tau protein and chronic immune inflammation.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period: A questionnaire-based study

BACKGROUND

Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure. Some oculoplastic conditions, like nasolacrimal duct obstruction, have been extensively studied, whereas others, like eyelid malposition and thyroid eye disease, have received minimal or no research.

AIM

To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.

METHODS

A cross-sectional survey was disseminated among ophthalmologists all over India. The survey included questions related to pre-operative evaluation, anaesthetic and surgical techniques preferred, post-operative care, the use of adjunctive therapies, and patient follow-up patterns.

RESULTS

A total of 180 ophthalmologists responded to the survey. Most practitioners (89%) felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised. The most common surgical techniques employed were lacrimal drainage procedures (Dacryocystorhinostomy) (63.3%), eyelid malposition repair (36.9%), and ptosis repair (58.7%). Post-operatively, 47.7 % of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries. Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.

CONCLUSION

Approximately 50% of ophthalmologists handle prevalent oculoplastic issues themselves, seeking the expertise of an oculoplastic surgeon under particular conditions. Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery. Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

Assessing healthcare workers’ knowledge and confidence in the diagnosis, management and prevention of Monkeypox

BACKGROUND

Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.

AIM

To assess Burundi healthcare workers (HCWs)s’ level of knowledge and confidence in the diagnosis and management of Mpox.

METHODS

We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023. The questionnaire comprises 8 socioprofessional-related questions, 22 questions about Mpox disease knowledge, and 3 questions to assess confidence in Mpox diagnosis and management. The data were analyzed via SPSS software version 25.0. A P value < 0.05 was considered to indicate statistical significance.

RESULTS

The study sample comprised 471 HCWs who were mainly medical doctors (63.9%) and nurses (30.1%). None of the 22 questions concerning Mpox knowledge had at least 50% correct responses. A very low number of HCWs (17.4%) knew that Mpox has a vaccine. The confidence level to diagnose (21.20%), treat (18.00%) or prevent (23.30%) Mpox was low among HCWs. The confidence level in the diagnosis of Mpox was associated with the HCWs’ age (P value = 0.009), sex (P value < 0.001), work experience (P value = 0.002), and residence (P value < 0.001). The confidence level to treat Mpox was significantly associated with the HCWs’ age (P value = 0.050), sex (P value < 0.001), education (P value = 0.033) and occupation (P value = 0.005). The confidence level to prevent Mpox was associated with the HCWs’ education (P value < 0.001), work experience (P value = 0.002), residence (P value < 0.001) and type of work institution (P value = 0.003).

CONCLUSION

This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose, treat or prevent it. There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs. We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

New exploration on pathogenesis and early diagnosis of gestational diabetes

Gestational diabetes mellitus (GDM) refers to varying degrees of abnormal glucose metabolism that occur during pregnancy and excludes patients previously diagnosed with diabetes. GDM is a unique among the four subtypes of diabetes classified by the international World Health Organization standards. Although GDM patients constitute a small proportion of the total number of diabetes cases, the incidence of GDM has risen significantly over the past decade, posing substantial risk to pregnant women and infants. Therefore, it warrants considerable attention. The pathogenesis of GDM is generally considered to resemble that of type II diabetes, though it may have distinct characteristics. Analyzing blood biochemical proteins in the context of GDM can help elucidate its pathogenesis, thereby facilitating more effective prevention and management strategies. This article reviews this critical clinical issue to enhance the medical community's sufficient understanding of GDM.

Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy: A case report

BACKGROUND

Malignant transformation (MT) of mature cystic teratoma (MCT) has a poor prognosis, especially in advanced cases. Concurrent chemoradiotherapy (CCRT) has an inhibitory effect on MT.

CASE SUMMARY

Herein, we present a case in which CCRT had a reduction effect preoperatively. A 73-year-old woman with pyelonephritis was referred to our hospital. Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) revealed squamous cell carcinoma. The patient was diagnosed with MT of MCT. Due to her poor general condition and renal malfunction, we selected CCRT, expecting fewer adverse effects. After CCRT, her performance status improved, and the tumor size was reduced; surgery was performed. Five months postoperatively, the patient developed dissemination and lymph node metastases. Palliative chemotherapy was ineffective. She died 18 months after treatment initiation.

CONCLUSION

EUS-FNB was useful in the diagnosis of MT of MCT; CCRT suppressed the disease and improved quality of life.

MiRNA-200a and miRNA-200b expression, and vitamin-D level: Prognostic significance in obese non-diabetic and obese type 2 diabetes mellitus individuals

BACKGROUND

Obesity and type 2 diabetes mellitus (T2DM) are frequent co-occurring disorders that affect regular metabolic functions. Obesity has also been linked to an increased risk of developing diabetes. Obesity and diabetes are on the rise, increasing healthcare costs and raising mortality rates. Research has revealed that the expression profile of microRNAs (miRNAs) changes as diabetes progresses. Furthermore, vitamin D may have an anti-obesity effect and inverse association with body weight and body mass index (BMI). Low vitamin D levels do not solely cause obesity, which could be a factor in the etiology of T2DM.

AIM

To evaluate miRNA-200a and miRNA-200b expression, and vitamin-D levels in obese and obese T2DM individuals.

METHODS

This study included 210 participants, of which, 82 were obese (BMI > 30 kg/m²) without T2DM, 28 were obese with T2DM, and 100 were healthy controls. BMI was evaluated and both fasting and postprandial blood glucose were used to confirm T2DM. Exosomal miRNA-200a and miRNA-200b expression were analyzed using real-time PCR using Taqman probes, and vitamin-D levels were evaluated using an electrochemiluminescence-based immunoassay technique. All data analyses were performed using SPSS 20.0 and GraphPad Prism 5 software.

RESULTS

Overall, a 2.20- and 4.40-fold increase in miRNA-200a and miRNA-200b expression was observed among participants compared to healthy controls. MiRNA-200a and miRNA-200b expression among obese participants increased 2.40-fold and 3.93-fold, respectively, while in obese T2DM participants these values were 2.67-fold, and 5.78-fold, respectively, and these differences were found to be statistically significant (P = 0.02) (P < 0.0001). Obese participants showed a vitamin D level of 34.27 ng/mL, while in obese-T2DM participants vitamin D level was 22.21 ng/mL (P < 0.0001). Vitamin D was negatively correlated with miRNA-200a (r = -0.22, P = 0.01) and miRNA-200b (r = -0.19, P = 0.04). MiRNA-200a sensitivity was 75%, and specificity was 57%, with a cutoff value of 2.07-fold. MiRNA-200b sensitivity was 75%, and specificity was 71% with a cutoff value of 4.12-fold, suggesting that miRNA-200a and miRNA-200b with an increased expression of 2.07- and 4.12-fold could be predictive indicators for the risk of diabetes in obese participants.

CONCLUSION

MiRNA-200a and miRNA-200b were higher in diabetic obese participants vs non-diabetic obese participants, and insufficient vitamin D levels in obese T2DM participants may be involved in poor clinical outcome.

Navigating postoperative complications: Uveitis-glaucoma-hyphema syndrome after Ahmed glaucoma valve implantation

Altwijri and Alsirhy reported a case of uveitis-glaucoma-hyphema syndrome after an Ahmed glaucoma valve implantation surgery in an advanced primary open-angle glaucoma patient, being the first ever recorded of its kind. The author describes the position of the tube as the origin of the anterior chamber inflammation and hyphema, which resolved shortly after shortening and relocating it. This publication emphasizes the importance of precise implant positioning and close-up patient follow-up after glaucoma filtration surgery as an important standard for healthcare providers.

Advancing cardiovascular outcomes with dapagliflozin and sacubitril in post-acute myocardial infarction heart failure and type 2 diabetes mellitus

Coronary heart disease and type 2 diabetes mellitus (T2DM) often co-occur, presenting substantial health risks, particularly following acute myocardial infarction (AMI). While percutaneous coronary intervention (PCI) is a prevalent treatment, complications such as microvascular dysfunction may lead to heart failure, necessitating additional therapies. This editorial examines the emerging roles of sacubitril/valsartan and sodium-glucose co-transporter 2 inhibitors in managing post-PCI. Recent research investigates the combined effects of dapagliflozin and telmisartan on myocardial microperfusion in post-AMI heart failure patients with T2DM. The findings suggest that this combination enhances myocardial microcirculation, improves cardiac function, and achieves better glycemic control, with a reduced incidence of major adverse cardiovascular events. Despite ongoing challenges, the integration of dapagliflozin and sacubitril/valsartan represents a significant advancement in post-AMI care. Further investigation in larger cohorts and more diverse patient populations is required to confirm its long-term clinical outcomes.

Advances in the management of arteriosclerosis of the lower extremity: Integrating Western and Chinese medicine approaches

This editorial provides a commentary on the recent article. The paper reviews current literature and explores innovative treatment strategies for lower extremity arteriosclerosis obliterans (LEASO) through an integrative approach. It highlights the effectiveness of combination therapies that merge traditional Chinese medicine (TCM) with Western medical practices, suggesting that such integrative methods may improve patient compliance and outcomes through personalized care. This paper stresses the importance of rigorous clinical trials to evaluate the efficacy and safety of TCM interventions within LEASO treatment protocols, advocating for evidence-based validation of these combined therapies. Our recommendations emphasize accurate diagnosis, appropriate pharmacological interventions, the use of advanced surgical and endovascular techniques, and the inclusion of TCM to address underlying dysfunctions. Additionally, continuous monitoring, patient education, and lifestyle modifications are essential to slow disease progression and achieve optimal patient outcomes. The paper concludes by calling for further research to develop standardized treatment protocols that effectively integrate both Western and Chinese medical approaches in managing LEASO.

Merits and demerits of administering esketamine in preventing postpartum depression following cesarean section

Emergency cesarean section is associated with the development of postpartum depression. Esketamine has been demonstrated to have a rapid onset of antidepressant effects. Randomized controlled trials and meta-analyses have demonstrated the efficacy of esketamine in preventing postpartum depression after cessarean section. However, the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine administration. Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms, including hallucinations. In the setting of cesarean section, esketamine should be administered with caution and only if the potential benefits outweigh the risks.

Oral blood pressure augmenting agents for intravenous vasopressor weaning

Intravenous (IV) vasopressors are essential in the management of hypotension and shock. Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice. While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose, its adverse effect profile may preclude its use in certain populations. In addition, some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine. The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging. This article provides a comprehensive review of the pharmacology, clinical uses, dosing strategies, and safety considerations of oral vasoactive agents and their application in the intensive care setting.

Potential of traditional Chinese medicine lyophilized powder of Poecilobdella manillensis in the treatment of hyperuricemia

Traditional Chinese medicine has a long and illustrious history, and with the development of modern science and technology, the research and application of traditional Chinese medicines have continued to progress significantly. Many traditional Chinese medicinal herbs have undergone scientific validation, reinvigorating with new life and vitality, and contributing unique strengths to the advancement of human health. Recently, the discovery that leech total protein extracted from Poecilobdella manillensis lyophilized powder reduces blood uric acid (UA) levels by inhibiting the activity of xanthine oxidase to decrease UA synthesis and promotes UA excretion by regulating different UA transporters in the kidney and intestine has undoubtedly injected new vitality and hope into this field of research. The purpose of this editorial is to comment on this study, explore its strengths and weaknesses, and there is a hope to treat a range of metabolic-related syndromes, including hyperuricemia, by targeting the gut microbiota.

Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint: A case report

BACKGROUND

Musculoskeletal nontuberculous Mycobacterium (NTM) infections are rare, particularly post-acupuncture therapy, and present diagnostic challenges due to their infrequency and potential severity. Prompt recognition and appropriate management are crucial for optimal outcomes. NTM-infected wounds involving the joints are difficult to treat, and only a few cases have been reported.

CASE SUMMARY

We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment. An 81-year-old woman presented with a chronic, ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain. Magnetic resonance imaging revealed synovial thickening, effusion, and subcutaneous cystic lesions. An orthopedic surgeon performed open synovectomy and serial debridement. However, 1 month postoperatively, the wound had not healed and became chronic. A wound culture revealed NTM (Mycobacterium abscessus), and the patient was referred to the Department of Plastic and Reconstructive Surgery. Instead of surgical intervention, conservative wound care with intravenous antibiotics was provided, considering the wound status and the patient’s poor general condition. Complete wound healing was achieved in 12 months, with no impact on the range of motion of the elbow joint.

CONCLUSION

With clinical awareness, musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.

Practical surgical tips on performing upper blepharoplasty

Upper lid blepharoplasty is a surgical procedure that requires meticulous planning and execution. It is not a standalone procedure but can be combined with ptosis correction surgery. Prior to surgery, thorough lid examinations are essential to determine the appropriate approaches. Skin markings for incision sites should be drawn before anesthesia injection to avoid distortion of lid wrinkles and creases. The design of the lid crease is crucial, with a nasal tapered crease serving as a guide for subsequent parallel crease drawings. Incisions should be made with care to avoid excessive bleeding, particularly from the orbicularis muscles. It is important to control bleeding promptly to prevent secondary ptosis during the early post-operative period. When releasing the orbital septum, care should be taken to avoid injury to surrounding structures, particularly the trochlea nasally and the lacrimal gland laterally. Moist cotton tip applicators can be used to safely separate fat from the underlying aponeurosis.

CICARE based communication technique: A passage to faster and smoother visual rehabilitation in post cataract surgery patients

Visual rehabilitation following cataract surgery is often an overlooked aspect. Healthcare providers have an important role in the counselling of the patients undergoing cataract surgery in clearing all their doubts thus alleviating all their fears and anxiety related to the procedure which will eventually lead to faster and smoother visual rehabilitation. Using standardised communication techniques like CICARE combined with conventional nursing and pain scoring systems can provide an objective and effective method in patient counselling and building a rapport with the patient for a faster visual recovery.

Secondary organizing pneumonia after infection

This editorial explores the clinical implications of organizing pneumonia (OP) secondary to pulmonary tuberculosis, as presented in a recent case report. OP is a rare condition characterized by inflammation in the alveoli, which spreads to alveolar ducts and terminal bronchioles, usually after lung injuries caused by infections or other factors. OP is classified into cryptogenic (idiopathic) and secondary forms, the latter arising after infections, connective tissue diseases, tumors, or treatments like drugs and radiotherapy. Secondary OP may be triggered by infections caused by bacteria, viruses, fungi, mycobacteria, or parasites. Key diagnostic features include subacute onset of nonspecific respiratory symptoms such as dry cough, chest pain, and exertional dyspnea. Imaging with computed tomography scans typically reveals three patterns: (1) Bilateral subpleural consolidation; (2) Nodular consolidation; and (3) A reticular pattern. Bronchoscopy with bronchoalveolar lavage helps exclude other causes. Standard treatment consists of corticosteroid therapy tapered over 6 months to 12 months. This editorial highlights clinical and diagnostic strategies to ensure timely and effective patient care.

Correction to: Marker Ki-67 is a potential biomarker for the diagnosis and prognosis of prostate cancer based on two cohorts

This is an erratum to the published paper titled “Marker Ki-67 is a potential biomarker for the diagnosis and prognosis of prostate cancer based on two cohorts”. We have discovered that Reference 4 was cited incorrectly. We sincerely apologize for this inadvertent error. Please note that these corrections do not impact our results.

Safety and efficacy of posterior approach for resection of spinal meningioma: Impact of dural attachment location

BACKGROUND

Spinal meningiomas (SMs) are common benign tumors that are typically treated with surgical resection. The choice of surgical approach may vary depending on the location of dural attachment of the SM, with a posterior approach being the traditional preference. However, there is limited research available on the impact of dural attachment location on outcomes following posterior approach for SM resection.

AIM

To investigate the outcomes of posterior approach for SM resection, and compare the results among different dural attachment location subgroups.

METHODS

Between January 2013 and February 2023, a total of 34 SM patients were included in the study. Various clinical and radiologic features, functional states before and after surgery, operating time, intraoperative blood loss, tumor recurrence, and perioperative complications were assessed and compared.

RESULTS

The average age of the included 34 patients’ (10 males and 24 females) age was 62.09 years. Mean follow-up duration was 22.65 months. The location of SM was the thoracic spine in 32 cases, with only 2 in the cervical spine. On average, intraoperative blood loss was 520.59 mL, and operating time was 176.76 minutes. Thirty three cases had successful outcomes while only 1 experienced an unexpected outcome. The tumor recurrence rate was 2.9%. After surgery, there were 3 cases of cerebral spinal fluid leakage, 1 case of pneumonia, and 1 case of urinary tract infection. Dural attachments were predominantly found dorsal or dorsolateral (13 cases), followed by ventral or ventrolateral (14 cases), and lateral (7 cases). The outcomes among these subgroups were similar.

CONCLUSION

The posterior approach for SM resection is safe and effective, yielding comparable surgical and neurological outcomes regardless of the dural attachment location.

Role of diaphragmatic ultrasound in patients with acute exacerbation of chronic obstructive pulmonary disease

Assessing diaphragm function status is vital for diagnosing and treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Diaphrag-matic ultrasound has become increasingly important due to its non-invasive nature, absence of radiation exposure, widespread availability, prompt results, high accuracy, and repeatability at the bedside. The diaphragm is a crucial respiratory muscle. Decline or dysfunction of the diaphragm can lead to dyspnea and even respiratory failure in AECOPD patients. In this editorial, we comment on an article, retrospectively analyzed ninety-four acute exacerbations of chronic obstructive pulmonary disease patients who received mechanical ventilation from January 2022 to December 2023. The study found that the diaphragm thickening fraction, an index from diaphragm ultrasound, can better predict the outcome of non-invasive ventilation in patients with AECOPD. The value of non-invasive ventilation in treating respiratory failure caused by AECOPD has been widely acknowledged. Diaphragmatic dysfunction diagnosed with ultrasound is associated with prolonged mechanical ventilation and weaning times and higher mortality.

Traditional Chinese medicine treatment of insomnia based on microbial-gut-brain axis theory

In recent years, insomnia has gradually become a common disease in society, which seriously affects people's quality of life. At present, with the deepening of research on intestinal microbiota-gut-brain axis in Western medicine, many studies suggest that regulating the gastrointestinal tract can treat brain-related diseases. It is found that brain-gut-bacteria axis plays an important role in the prevention and treatment of primary insomnia. At present, although the clinical treatment of insomnia with Western medicine can improve the insomnia symptoms of patients to a certain extent, there are still obvious adverse reactions, such as anxiety and depression, drug addiction, etc., so long-term oral drug therapy cannot be carried out. Traditional Chinese medicine (TCM) and acupuncture techniques have certain therapeutic effects on insomnia. TCM believes that the brain and gastrointestinal system are connected through the meridian, and the pathophysiology is closely related. This paper will discuss the theory and feasibility of TCM for the treatment of insomnia from the pathological relationship between brain-gut axis, intestinal flora and insomnia.

Cytokine release syndrome induced by anti-programmed death-1 treatment in a psoriasis patient: A dark side of immune checkpoint inhibitors

In recent years, cancer immunotherapy has introduced novel treatments, such as monoclonal antibodies, which have facilitated targeted therapies against tumor cells. Programmed death-1 (PD-1) is an immune checkpoint expressed in T cells that regulates the immune system’s activity to prevent over-activation and tissue damage caused by inflammation. However, PD-1 is also expressed in tumor cells and functions as an immune evasion mechanism, making it a therapeutic target to enhance the immune response and eliminate tumor cells. Consequently, immune checkpoint inhibitors (ICIs) have emerged as an option for certain tumor types. Nevertheless, blocking immune checkpoints can lead to immune-related adverse events (irAEs), such as psoriasis and cytokine release syndrome (CRS), as exemplified in the clinical case presented by Zhou et al involving a patient with advanced gastric cancer who received sintilimab, a monoclonal antibody targeting PD-1. Subsequently, the patient experienced exacerbation of psoriasis and CRS. The objective of this editorial article is to elucidate potential immunologic mechanisms that may contribute to the development of CRS and psoriasis in patients receiving ICIs. It is crucial to acknowledge that while ICIs offer superior safety and efficacy compared to conventional therapies, they can also manifest irAEs affecting the skin, gastrointestinal tract, or respiratory system. In severe cases, these irAEs can lead to life-threatening complications such as circulatory shock or multiorgan failure. Consequently, it is recommended that patients receiving ICIs undergo regular monitoring to identify and manage these adverse events effectively.

Update on the aetiopathogenesis of obstructive sleep apnea: Role of inflammatory and immune mediated mechanisms

Obstructive sleep apnea (OSA) is often a lifestyle disease associated with obesity, which is rapidly evolving as a major health concern with diverse multisystemic implications. To prevent and mitigate its adverse effects and reduce its burden on society, its aetiopathogeneses must be precisely understood. Numerous studies focusing on the range of diverse anatomic, functional, and lifestyle factors have already been carried out to determine the possible contributory roles of these factors in OSA. Recently, evidence to validate the role of inflammatory pathways and immune mechanisms in the aetiopathogeneses of OSA is being developed. This allows for further research and translation of such knowledge for targeted therapeutic and preventive interventions in patients with or who are at risk of developing OSA.

Role of high-dose amoxicillin dual therapy for Helicobacter pylori eradication in an Irish cohort: A prospective study

Helicobacter pylori (H. pylori) infections may cause chronic gastritis, peptic ulcer disease, gastric cancers, and other conditions outside of the gastrointestinal tract. Hence, it is important to diagnose and treat it early. H. pylori is resistant to certain drugs in traditional eradication therapy, so alternative therapy protocols are needed, such as high-dose amoxicillin dual therapy (HDADT). This article aims to comment on a recent paper by Costigan et al in the World Journal of Clinical Cases. In this study, the authors recruited 139 patients diagnosed with H. pylori, all treated with HDADT. Of these, 93 were treatment-naïve and 46 had received at least one alternative treatment in the past. Four weeks after the end of the treatment, the urea breath test was administered to estimate the eradication rate. The total eradication rate was 56% (78/139), 62% for the treatment-naïve arm and 43% for the previous treatment arm, thus indicating a lower success rate for the arm that had previously received a different treatment regimen. In conclusion, a therapeutic approach with first-line HDADT may potentially be a better treatment, but the results are not sufficient to recommend the use of this regimen in a country with high levels of dual resistance.

Effects of atrial septal defects on the cardiac conduction system

The case report presented in this edition by Mu et al. The report presents a case of atrial septal defect (ASD) associated with electrocardiographic changes, noting that the crochetage sign resolved after Selective His Bundle Pacing (S-HBP) without requiring surgical closure. The mechanisms behind the appearance and resolution of the crochetage sign remain unclear. The authors observed the disappearance of the crochetage sign post-S-HBP, suggesting a possible correlation between these specific R waves and the cardiac conduction system. This editorial aims to explore various types of ASD and their relationship with the cardiac conduction system, highlighting the diagnostic significance of the crochetage sign in ASD.

psk1 virulence gene-induced pulmonary and systemic tuberculosis in a young woman with normal immune function: A case report

BACKGROUND

Tuberculosis is a chronic infectious disease and an important public health problem. Despite progress in controlling tuberculosis, the incidence of tuberculosis in China is still very high, with 895000 new cases annually. This case report describes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function, conducted to ascertain why a Mycobacterium tuberculosis (M. tuberculosis) strain caused such severe disease.

CASE SUMMARY

A previously healthy 28-year-old woman presented to our hospital with a 1-month history of fever and fatigue. She was diagnosed with severe disseminated pulmonary tuberculosis, spinal tuberculosis with paravertebral abscesses, and tuberculous meningitis. M. tuberculosis was isolated from bronchoalveolar lavage fluid. She was treated with standard antituberculous therapy and underwent debridement, bone graft, and internal fixation surgery for spinal tuberculosis. She responded to therapy and regained her ability to walk following the surgery. We analysed the whole-genome sequence of the strain and designated it BLM-A21. Additional M. tuberculosis genomes were selected from the Virulence Factor Database (http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium) for comparison. An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software. Further gene analysis revealed that, except for the pks1 gene, BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains, which have lower dissemination.

CONCLUSION

We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the widespread dissemination of M. tuberculosis infection in this previously healthy adult with normal immune function.