As important messengers of intercellular communication,exosomes can regulate local and distant cellular communication by transporting specific exosomal con-tents and can also promote or suppress the development and pr...As important messengers of intercellular communication,exosomes can regulate local and distant cellular communication by transporting specific exosomal con-tents and can also promote or suppress the development and progression of gas-tric cancer(GC)by regulating the growth and proliferation of tumor cells,the tumor-related immune response and tumor angiogenesis.Exosomes transport bioactive molecules including DNA,proteins,and RNA(coding and noncoding)from donor cells to recipient cells,causing reprogramming of the target cells.In this review,we will describe how exosomes regulate the cellular immune respon-se,tumor angiogenesis,proliferation and metastasis of GC cells,and the role and mechanism of exosome-based therapy in human cancer.We will also discuss the potential application value of exosomes as biomarkers in the diagnosis and treat-ment of GC and their relationship with drug resistance.展开更多
BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive inte...BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.展开更多
AIM: To evaluate the association between gastroesophageal re? ux diseases (GERD) and coronary heart diseases. METHODS: One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled...AIM: To evaluate the association between gastroesophageal re? ux diseases (GERD) and coronary heart diseases. METHODS: One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography (ECG) was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as STsegment depression based on the Minnesota code. RESULTS: Among 712 patients (36%) with GERD, ECG was performed in 171 (24%), and ischemic changes were detected in eight (5%). Four (50%) of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients (0.6%; 4/712) were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 (7%) had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients).CONCLUSION: The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.展开更多
A plant fermentation was carried out by Lactobaccilli against the Rhizome from Pueraria milifica (f-PMF). This material was evidenced by safe in animal toxic study. The main aim of this study was to revise the traditi...A plant fermentation was carried out by Lactobaccilli against the Rhizome from Pueraria milifica (f-PMF). This material was evidenced by safe in animal toxic study. The main aim of this study was to revise the traditional way of hot water extraction to fermentation so as to use up the original material and finding new activity. We tried to show the new activity through phytoestrogen and immune-competent cells from the host that administrated either of original remedy and the new fermented sample, plus activated water SRE. In mice, compromised host was prepared by cancer chemotherapeutic agent (Mitomycin-C). After administration of f-PMF to immno-suppressed animals, the effects by both samples were augmented by lymphocyte in number and functions, macrophage activities, anti-oxidative activity. However, the intense of effect was much more by fermented one but not by conventional one. The anti-oxidative assay was also carried out ex-vivo system by peritoneal macrophage that we proposed as suitable system for evaluating anti-oxidative assay. In our clinical study by 20 healthy volunteers, granulocyte and lymphocyte ratio was regulated as neutral in peripheral white blood cells, increasing one, two and three weeks after the administration of f-PMF. We have found the significant regulation of blood chemical factors that were important makers for the lifestyle-related diseases. The mechanism of augmentation by probing directory with immuno-electrophoretic method, generating new complement component, especially found by alternative pathway of complement. So we discussed the process concerning designed f-PMF molecule for activation of complement component and bound for the biological activity of each physical component. In a limited condition, fewer numbers of volunteers, the breast size was tending to increase along with the administration time. Including these evidences, we discussed the possibility of this traditional ethnic medicine, originally found and spread in the highland area in Thailand and Myanmar.展开更多
Human immunodeficiency virus(HIV) infection among men who have sex with men(MSM) has increased to a drastic proportion throughout India in the last couple of years due to a lack of productive identification and manage...Human immunodeficiency virus(HIV) infection among men who have sex with men(MSM) has increased to a drastic proportion throughout India in the last couple of years due to a lack of productive identification and management framework. In apprehension of social disgrace these men attempt to live a normal hetero conjugal life and, in the process, act as a bridge in spreading the virus to their women partners. In this case report we have highlighted two cases which clearly distinguished the adequacy of HIV treatment among MSM when they are diagnosed during early or late phases of infection. An intensive and ample counseling to comprehend the psychology and sexual behavior of these men was found to be critically important in both the cases. Our study, which is actually the first of its kind, recorded and documented evidence of HIV infected MSM from Eastern India and renders a ray of hope among this marginally isolated group to comprehend the challenges and health risks faced by the MSM population. It also provides a format for the medical practitioners here in managing and treating related cases.展开更多
BACKGROUND Alcoholism is regarded as a risk factor for vitamin B_(12)(VB_(12))deficiency.Because V B_(12) serves as a coenzyme of methylmalonyl-CoA mutase,a key enzyme in propionate metabolism,the ^(13)C-propionate br...BACKGROUND Alcoholism is regarded as a risk factor for vitamin B_(12)(VB_(12))deficiency.Because V B_(12) serves as a coenzyme of methylmalonyl-CoA mutase,a key enzyme in propionate metabolism,the ^(13)C-propionate breath test(PBT)has been studied as a non-invasive diagnostic modality for VB_(12) deficiency.However,the conventional PBT requires 2 h,which is inconvenient in clinical practice.We hypothesized that a faster PBT can be used to evaluate propionate metabolism and is more easily adaptable for clinical practice.AIM To evaluate a faster PBT for assessing the effects of long-term ethanol consumption on propionate metabolism in ethanol-fed rats(ERs).METHODS ERs were obtained by replacing standard drinking water(for control rats,CRs)with 16%ethanol solution in descendants of F344/DuCrj rats.Faster PBT was performed by administering ^(13)C-propionate aqueous solution to male and female ERs and CRs by inserting a metal tubule from the mouth to the stomach;exhaled gas was collected in a bag to measure its ^(13)CO_(2)/12CO_(2) isotope ratio via infrared isotope spectrometry.Serum VB_(12) and alanine transaminase(ALT)levels were measured via chemiluminescence immunoassay and the lactate dehydrogenaseultraviolet method,respectively.We evaluated statistical differences in mean body weight,change in ^(13)CO_(2)(Δ^(13)CO_(2)‰),peakΔ^(13)CO_(2)‰,and serum VB_(12) and ALT,between males and females and between ERs and CRs using the t-test and Mann-Whitney U test for normally and non-normally distributed variables,respectively.RESULTS Males weighed significantly more than females(P<0.001);CRs weighed significantly more than ERs(P<0.008).Δ^(13)CO_(2) reached a peak(C_(max))at 20 min and 30 min in females and males,respectively,decreasing after 20-30 min without rebound in all groups.Males had significantly higher C_(max) andΔ^(13)CO_(2) at 15-45 min than females(P<0.05;for all pairs).Propionate metabolism was enhanced in male ERs relative to male CRs,whereas metabolism did not differ markedly between ERs and CRs for females.Males had higher serum VB_(12) levels than females,without prominent differences between the ER and CR groups.Male CRs had notably higher ALT levels than male ERs.Thus,chronic ethanol consumption may trigger fatty acid production via intestinal bacteria and changes in gut microbiome composition.CONCLUSION Faster PBT shows that 16%ethanol consumption promotes propionate metabolism without inducing liver injury.This PBT may be used clinically to evaluate gut flora status.展开更多
Objective:To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning.Methods:This was a hospital-based prospective,observ...Objective:To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning.Methods:This was a hospital-based prospective,observational study.Various biochemical tests viz.complete blood count,random blood sugar,liver and renal function tests,creatine phosphokinase,and electrolytes were performed.Patients were assessed based on the Peradeniya Organophosphate Poisoning scale.All the patients were followed till the end point like recovery/death.Results:Out of the 100 patients,72%were males and 28%were females.The majority of the patients were farmers and 21 to 30 years of age.Suicidal was the most common manner(92,92%).Based on the Peradeniya Organophosphate Poisoning scale,47%were mild,34%moderate,and 19%severe.Serum creatinine,creatine phosphokinase,serum glutamic-oxaloacetic transaminase,serum glutamic pyruvic transaminase,and alkaline phosphatase levels showed a significant correlation with severity.Conclusions:Some biochemical indicators such as creatine phosphokinase,alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning.The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.展开更多
Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicalt...Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicaltrails.gov,were searched for articles published between 2012 and 2022.The risk of bias in the present study was evaluated by employing randomized controlled trials(RCTs)checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups.The two-part tool was used to address the five specific domains such as selection bias,performance bias,detection bias,attrition bias,and selective reporting bias.Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software(version 5.4),a quality assessment tool.Results:A total of 13 studies were included in the present review,in which there were 5 retrospective studies,3 randomized-control studies,2 prospective studies,1 multicenter pharmacodynamics study,1 multicenter cardiac magnetic resonance imaging study,and 1 open-label,cross-over study.The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.Conclusions:Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine.Considering the adverse effects,including mortality associated with morphine,there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.展开更多
Nicotine use is more prevalent in patients with psychiatric disorders,especially those diagnosed with psychotic illnesses.Previously,this higher prevalence has been partially attributed to the potential ameliorative e...Nicotine use is more prevalent in patients with psychiatric disorders,especially those diagnosed with psychotic illnesses.Previously,this higher prevalence has been partially attributed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment.Some healthcare professionals and patients perceive there is a beneficial effect of nicotine on mental health.Emerging data show that the harm associated with nicotine in the population of patients with mental health conditions outweighs any potential benefit.This paper will review the evidence surrounding the nicotinic system and schizophrenia,with a focus on any causality between nicotine and psychosis.展开更多
Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus betw...Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022.Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody.The data about demography,vital parameters,and lab investigations were collected and analyzed.Results:Ninety-two percent of the patients were from a rural background(92%),86% were farmers and the majority were females.Most patients were 40-60 years old.The major complaints were fever(100%),myalgia(100%),headache(82%),and body swelling(80%).Major complications were pneumonia(68%),multiple organ dysfunction syndrome(62%),hepatitis(44%),and acute kidney injury(42%).Triglyceride levels were>200 mg/dL in 80% of patients,albumin<3.5 g/dL in 98% and eschar mark was present in 24%of patients.Conclusions:Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality.Increasing awareness regarding disease in endemic regions,early screening of patients,and treatment as early as possible could help prevent the patient from severe life-threatening complications.展开更多
BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes...BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.展开更多
Objective:To study the laboratory and clinical predictors of hemorrhagic manifestations in dengue virus-infected patients.Methods:This was a single-center hospital-based prospective observational study.200 Dengue sero...Objective:To study the laboratory and clinical predictors of hemorrhagic manifestations in dengue virus-infected patients.Methods:This was a single-center hospital-based prospective observational study.200 Dengue seropositive patients were included in the study.A detailed clinical examination was done and comprehensive laboratory investigations were done.These parameters were compared between patients with and without hemorrhagic manifestations.Results:Out of the 200 patients,47(23.5%)had bleeding.64.5%Patients were males and 76.0%were under the age of 40 years.The most common presenting symptoms were fever(100.0%)followed by myalgia(77.0%),nausea and vomiting(56.0%).Leukocytosis,neutrophilia,thrombocytopenia,hyperbilirubinemia,transaminitis,decreased serum albumins,and raised D-dimer can serve as hematological,biochemical,and coagulation predictors of hemorrhagic manifestations for dengue.Conclusions:Dengue is a tropical infection with various complications.Bleeding complications are one of them.Laboratory parameters like white blood cells,platelets,bilirubin level,liver enzymes,and D-dimer can help to identify patients at risk for bleeding.Early identification and appropriate management can save a lot of resources and lives.展开更多
BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue nec...BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.展开更多
BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adver...BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adverse effects on glucose metabolism.Disorders associated with glucose metabolism are established risk factors of cardiovascular events,one of the life-threatening ramifications.AIM To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone(Pred)replacement,and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes.METHODS Twenty patients with hypopituitarism receiving Pred replacement[patient group(PG)]and 20 normal controls(NCs)were recruited.A flash glucose monitoring system was used to record continuous glucose levels during the day,which provided information on glucose-target-rate,glucose variability(GV),period glucose level,and hypoglycemia occurrence at certain periods.Islet β-cell function was also assessed.Based on the administered Pred dose per day,the PG was then regrouped into Pred>5 mg/d and Pred≤5 mg/d subgroups.Comparative analysis was carried out between the PG and NCs.RESULTS Significantly altered glucose metabolism profiles were identified in the PG.This includes significant reductions in glucose-target-rate and nocturnal glucose level,along with elevations in GV,hypoglycemia occurrence and postprandial glucose level,when compared with those in NCs.Subgroup analysis indicated more significant glucose metabolism impairment in the Pred>5 mg/d group,including significantly decreased glucose-target-rate and nocturnal glucose level,along with increased GV,hypoglycemia occurrence,and postprandial glucose level.With regard to islet β-cell function,PG showed significant difference in homeostasis model assessment(HOMA)-β compared with that of NCs;a notable difference in HOMA-βwas identified in Pred>5 mg/d group when compared with those of NCs;as for Pred≤5 mg/d group,significant differences were found in HOMA-β,and fasting glucose/insulin ratio when compared with NCs.CONCLUSION Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism.A Pred dose of>5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of≤5 mg/d.Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen,wherein,flash glucose monitoring system is a kind of promising and reliable assessment device.The present data allows us to thoroughly examine our modern treatment standards,especially in difficult cases such as hormonal replacement mimicking delicate natural cycles,in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence.展开更多
BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive orga...BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.展开更多
BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilat...BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.展开更多
The incidence of cholecystitis is relatively high in developed countries and may usually be attributed to gallstones,the treatment for which involves complete surgical removal of the gallbladder(cholecystectomy).Bile ...The incidence of cholecystitis is relatively high in developed countries and may usually be attributed to gallstones,the treatment for which involves complete surgical removal of the gallbladder(cholecystectomy).Bile acids produced following cholecystectomy continue to flow into the duodenum but are poorly absorbed by the colon.Excessive bile acids in the colon stimulate mucosal secretion of water and electrolytes leading,in severe cases,to diarrhoea.Bile acid diarrhoea(BAD)is difficult to diagnose,requiring a comprehensive medical history and physical examination in combination with laboratory evaluation.The current work reviews the diagnosis and treatment of BAD following chole-cystectomy.展开更多
Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs ...Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon. Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires;data on the demographics and risk factors were collected using a well-designed questionnaire, while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 21 (80.8%) for Physiotherapists (PTs) and 78.8% (41) for Medical Doctors (MDs). There was a significant difference (p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9%, while Healthcare workers from NBDH were 2.91 times at risk (AOR = 2.91;95% CI: 1.32 - 6.41;p = 0.001) to develop WRMSDs than healthcare workers in the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% with the lowest at the elbows 11.2%. The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p Conclusion: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are;lower back, neck and upper back. Working on the same posture, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals.展开更多
BACKGROUND The prognosis of gastric cancer is extremely poor.Metabolic reprogramming involving lipids has been associated with cancer occurrence and progression.AIM To illustrate fatty acid metabolic mechanisms in gas...BACKGROUND The prognosis of gastric cancer is extremely poor.Metabolic reprogramming involving lipids has been associated with cancer occurrence and progression.AIM To illustrate fatty acid metabolic mechanisms in gastric cancer,detect core genes,develop a prognostic model,and provide treatment options.METHODS Raw data from The Cancer Genome Atlas and Gene Expression Omnibus databases were collected and analyzed.Differentially expressed fatty acid metabolism genes were identified and incorporated into a risk model based on least absolute shrinkage and selection operator regression analysis.Then,patients from The Cancer Genome Atlas were assigned to high-and low-risk cohorts according to the mean value of the risk score as the threshold,which was verified in the Gene Expression Omnibus database.Relationships between chemotherapeutic sensitivity and tumor microenvironment features were assessed.RESULTS An integrated evaluation was performed in this study.Fatty acid metabolismrelated genes were used to construct the risk model.Patients classified into the high-risk cohort were considered to be resistant to chemotherapy based on results of the“pRRophetic”R package.Patients in the high-risk cohort were associated with type Ⅰ/Ⅱ interferon activation,increased inflammation level,immune cell infiltration,and tumor immune dysfunction based on the exclusion algorithm,indicating the potential benefit of immunotherapy in these patients.CONCLUSION We constructed a fatty acid-related risk score model to assess the comprehensive fatty acid features in gastric cancer and validated its vital role in prognosis,chemotherapy sensitivity,and immunotherapy.展开更多
Artificial intelligence(AI)tools,like OpenAI's Chat Generative Pre-trained Transformer(ChatGPT),hold considerable potential in healthcare,academia,and diverse industries.Evidence demonstrates its capability at a m...Artificial intelligence(AI)tools,like OpenAI's Chat Generative Pre-trained Transformer(ChatGPT),hold considerable potential in healthcare,academia,and diverse industries.Evidence demonstrates its capability at a medical student level in standardized tests,suggesting utility in medical education,radiology reporting,genetics research,data optimization,and drafting repetitive texts such as discharge summaries.Nevertheless,these tools should augment,not supplant,human expertise.Despite promising applications,ChatGPT confronts limitations,including critical thinking tasks and generating false references,necessitating stringent cross-verification.Ensuing concerns,such as potential misuse,bias,blind trust,and privacy,underscore the need for transparency,accountability,and clear policies.Evaluations of AI-generated content and preservation of academic integrity are critical.With responsible use,AI can significantly improve healthcare,academia,and industry without compromising integrity and research quality.For effective and ethical AI deployment,collaboration amongst AI developers,researchers,educators,and policymakers is vital.The development of domain-specific tools,guidelines,regulations,and the facilitation of public dialogue must underpin these endeavors to responsibly harness AI's potential.展开更多
文摘As important messengers of intercellular communication,exosomes can regulate local and distant cellular communication by transporting specific exosomal con-tents and can also promote or suppress the development and progression of gas-tric cancer(GC)by regulating the growth and proliferation of tumor cells,the tumor-related immune response and tumor angiogenesis.Exosomes transport bioactive molecules including DNA,proteins,and RNA(coding and noncoding)from donor cells to recipient cells,causing reprogramming of the target cells.In this review,we will describe how exosomes regulate the cellular immune respon-se,tumor angiogenesis,proliferation and metastasis of GC cells,and the role and mechanism of exosome-based therapy in human cancer.We will also discuss the potential application value of exosomes as biomarkers in the diagnosis and treat-ment of GC and their relationship with drug resistance.
文摘BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.
文摘AIM: To evaluate the association between gastroesophageal re? ux diseases (GERD) and coronary heart diseases. METHODS: One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography (ECG) was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as STsegment depression based on the Minnesota code. RESULTS: Among 712 patients (36%) with GERD, ECG was performed in 171 (24%), and ischemic changes were detected in eight (5%). Four (50%) of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients (0.6%; 4/712) were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 (7%) had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients).CONCLUSION: The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.
文摘A plant fermentation was carried out by Lactobaccilli against the Rhizome from Pueraria milifica (f-PMF). This material was evidenced by safe in animal toxic study. The main aim of this study was to revise the traditional way of hot water extraction to fermentation so as to use up the original material and finding new activity. We tried to show the new activity through phytoestrogen and immune-competent cells from the host that administrated either of original remedy and the new fermented sample, plus activated water SRE. In mice, compromised host was prepared by cancer chemotherapeutic agent (Mitomycin-C). After administration of f-PMF to immno-suppressed animals, the effects by both samples were augmented by lymphocyte in number and functions, macrophage activities, anti-oxidative activity. However, the intense of effect was much more by fermented one but not by conventional one. The anti-oxidative assay was also carried out ex-vivo system by peritoneal macrophage that we proposed as suitable system for evaluating anti-oxidative assay. In our clinical study by 20 healthy volunteers, granulocyte and lymphocyte ratio was regulated as neutral in peripheral white blood cells, increasing one, two and three weeks after the administration of f-PMF. We have found the significant regulation of blood chemical factors that were important makers for the lifestyle-related diseases. The mechanism of augmentation by probing directory with immuno-electrophoretic method, generating new complement component, especially found by alternative pathway of complement. So we discussed the process concerning designed f-PMF molecule for activation of complement component and bound for the biological activity of each physical component. In a limited condition, fewer numbers of volunteers, the breast size was tending to increase along with the administration time. Including these evidences, we discussed the possibility of this traditional ethnic medicine, originally found and spread in the highland area in Thailand and Myanmar.
文摘Human immunodeficiency virus(HIV) infection among men who have sex with men(MSM) has increased to a drastic proportion throughout India in the last couple of years due to a lack of productive identification and management framework. In apprehension of social disgrace these men attempt to live a normal hetero conjugal life and, in the process, act as a bridge in spreading the virus to their women partners. In this case report we have highlighted two cases which clearly distinguished the adequacy of HIV treatment among MSM when they are diagnosed during early or late phases of infection. An intensive and ample counseling to comprehend the psychology and sexual behavior of these men was found to be critically important in both the cases. Our study, which is actually the first of its kind, recorded and documented evidence of HIV infected MSM from Eastern India and renders a ray of hope among this marginally isolated group to comprehend the challenges and health risks faced by the MSM population. It also provides a format for the medical practitioners here in managing and treating related cases.
基金the Japan Society for the Promotion of Science KAKENHI Grant, No. JP21K18089
文摘BACKGROUND Alcoholism is regarded as a risk factor for vitamin B_(12)(VB_(12))deficiency.Because V B_(12) serves as a coenzyme of methylmalonyl-CoA mutase,a key enzyme in propionate metabolism,the ^(13)C-propionate breath test(PBT)has been studied as a non-invasive diagnostic modality for VB_(12) deficiency.However,the conventional PBT requires 2 h,which is inconvenient in clinical practice.We hypothesized that a faster PBT can be used to evaluate propionate metabolism and is more easily adaptable for clinical practice.AIM To evaluate a faster PBT for assessing the effects of long-term ethanol consumption on propionate metabolism in ethanol-fed rats(ERs).METHODS ERs were obtained by replacing standard drinking water(for control rats,CRs)with 16%ethanol solution in descendants of F344/DuCrj rats.Faster PBT was performed by administering ^(13)C-propionate aqueous solution to male and female ERs and CRs by inserting a metal tubule from the mouth to the stomach;exhaled gas was collected in a bag to measure its ^(13)CO_(2)/12CO_(2) isotope ratio via infrared isotope spectrometry.Serum VB_(12) and alanine transaminase(ALT)levels were measured via chemiluminescence immunoassay and the lactate dehydrogenaseultraviolet method,respectively.We evaluated statistical differences in mean body weight,change in ^(13)CO_(2)(Δ^(13)CO_(2)‰),peakΔ^(13)CO_(2)‰,and serum VB_(12) and ALT,between males and females and between ERs and CRs using the t-test and Mann-Whitney U test for normally and non-normally distributed variables,respectively.RESULTS Males weighed significantly more than females(P<0.001);CRs weighed significantly more than ERs(P<0.008).Δ^(13)CO_(2) reached a peak(C_(max))at 20 min and 30 min in females and males,respectively,decreasing after 20-30 min without rebound in all groups.Males had significantly higher C_(max) andΔ^(13)CO_(2) at 15-45 min than females(P<0.05;for all pairs).Propionate metabolism was enhanced in male ERs relative to male CRs,whereas metabolism did not differ markedly between ERs and CRs for females.Males had higher serum VB_(12) levels than females,without prominent differences between the ER and CR groups.Male CRs had notably higher ALT levels than male ERs.Thus,chronic ethanol consumption may trigger fatty acid production via intestinal bacteria and changes in gut microbiome composition.CONCLUSION Faster PBT shows that 16%ethanol consumption promotes propionate metabolism without inducing liver injury.This PBT may be used clinically to evaluate gut flora status.
文摘Objective:To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning.Methods:This was a hospital-based prospective,observational study.Various biochemical tests viz.complete blood count,random blood sugar,liver and renal function tests,creatine phosphokinase,and electrolytes were performed.Patients were assessed based on the Peradeniya Organophosphate Poisoning scale.All the patients were followed till the end point like recovery/death.Results:Out of the 100 patients,72%were males and 28%were females.The majority of the patients were farmers and 21 to 30 years of age.Suicidal was the most common manner(92,92%).Based on the Peradeniya Organophosphate Poisoning scale,47%were mild,34%moderate,and 19%severe.Serum creatinine,creatine phosphokinase,serum glutamic-oxaloacetic transaminase,serum glutamic pyruvic transaminase,and alkaline phosphatase levels showed a significant correlation with severity.Conclusions:Some biochemical indicators such as creatine phosphokinase,alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning.The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.
文摘Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicaltrails.gov,were searched for articles published between 2012 and 2022.The risk of bias in the present study was evaluated by employing randomized controlled trials(RCTs)checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups.The two-part tool was used to address the five specific domains such as selection bias,performance bias,detection bias,attrition bias,and selective reporting bias.Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software(version 5.4),a quality assessment tool.Results:A total of 13 studies were included in the present review,in which there were 5 retrospective studies,3 randomized-control studies,2 prospective studies,1 multicenter pharmacodynamics study,1 multicenter cardiac magnetic resonance imaging study,and 1 open-label,cross-over study.The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.Conclusions:Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine.Considering the adverse effects,including mortality associated with morphine,there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.
文摘Nicotine use is more prevalent in patients with psychiatric disorders,especially those diagnosed with psychotic illnesses.Previously,this higher prevalence has been partially attributed to the potential ameliorative effects of nicotine on symptom severity and cognitive impairment.Some healthcare professionals and patients perceive there is a beneficial effect of nicotine on mental health.Emerging data show that the harm associated with nicotine in the population of patients with mental health conditions outweighs any potential benefit.This paper will review the evidence surrounding the nicotinic system and schizophrenia,with a focus on any causality between nicotine and psychosis.
文摘Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022.Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody.The data about demography,vital parameters,and lab investigations were collected and analyzed.Results:Ninety-two percent of the patients were from a rural background(92%),86% were farmers and the majority were females.Most patients were 40-60 years old.The major complaints were fever(100%),myalgia(100%),headache(82%),and body swelling(80%).Major complications were pneumonia(68%),multiple organ dysfunction syndrome(62%),hepatitis(44%),and acute kidney injury(42%).Triglyceride levels were>200 mg/dL in 80% of patients,albumin<3.5 g/dL in 98% and eschar mark was present in 24%of patients.Conclusions:Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality.Increasing awareness regarding disease in endemic regions,early screening of patients,and treatment as early as possible could help prevent the patient from severe life-threatening complications.
基金The study was reviewed and approved by The First People’s Hospital of Wenling City(Approval No.KY-2019-1024-01).
文摘BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.
文摘Objective:To study the laboratory and clinical predictors of hemorrhagic manifestations in dengue virus-infected patients.Methods:This was a single-center hospital-based prospective observational study.200 Dengue seropositive patients were included in the study.A detailed clinical examination was done and comprehensive laboratory investigations were done.These parameters were compared between patients with and without hemorrhagic manifestations.Results:Out of the 200 patients,47(23.5%)had bleeding.64.5%Patients were males and 76.0%were under the age of 40 years.The most common presenting symptoms were fever(100.0%)followed by myalgia(77.0%),nausea and vomiting(56.0%).Leukocytosis,neutrophilia,thrombocytopenia,hyperbilirubinemia,transaminitis,decreased serum albumins,and raised D-dimer can serve as hematological,biochemical,and coagulation predictors of hemorrhagic manifestations for dengue.Conclusions:Dengue is a tropical infection with various complications.Bleeding complications are one of them.Laboratory parameters like white blood cells,platelets,bilirubin level,liver enzymes,and D-dimer can help to identify patients at risk for bleeding.Early identification and appropriate management can save a lot of resources and lives.
文摘BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
基金Supported by National Natural Science Foundation of China,No.81770776,No.81973378,and No.82073909The Shanxi Provincial Central Leading Local Science and Technology Development Fund Project,No.YDZJSX2022A059Postgraduate Education Innovation Project of Shanxi Province,No.2022Y354.
文摘BACKGROUND Commonly used glucocorticoids replacement regimens in patients with hypopituitarism have difficulty mimicking physiological cortisol rhythms and are usually accompanied by risks of over-treatment,with adverse effects on glucose metabolism.Disorders associated with glucose metabolism are established risk factors of cardiovascular events,one of the life-threatening ramifications.AIM To investigate the glycometabolism profile in patients with hypopituitarism receiving prednisone(Pred)replacement,and to clarify the impacts of different Pred doses on glycometabolism and consequent adverse cardiovascular outcomes.METHODS Twenty patients with hypopituitarism receiving Pred replacement[patient group(PG)]and 20 normal controls(NCs)were recruited.A flash glucose monitoring system was used to record continuous glucose levels during the day,which provided information on glucose-target-rate,glucose variability(GV),period glucose level,and hypoglycemia occurrence at certain periods.Islet β-cell function was also assessed.Based on the administered Pred dose per day,the PG was then regrouped into Pred>5 mg/d and Pred≤5 mg/d subgroups.Comparative analysis was carried out between the PG and NCs.RESULTS Significantly altered glucose metabolism profiles were identified in the PG.This includes significant reductions in glucose-target-rate and nocturnal glucose level,along with elevations in GV,hypoglycemia occurrence and postprandial glucose level,when compared with those in NCs.Subgroup analysis indicated more significant glucose metabolism impairment in the Pred>5 mg/d group,including significantly decreased glucose-target-rate and nocturnal glucose level,along with increased GV,hypoglycemia occurrence,and postprandial glucose level.With regard to islet β-cell function,PG showed significant difference in homeostasis model assessment(HOMA)-β compared with that of NCs;a notable difference in HOMA-βwas identified in Pred>5 mg/d group when compared with those of NCs;as for Pred≤5 mg/d group,significant differences were found in HOMA-β,and fasting glucose/insulin ratio when compared with NCs.CONCLUSION Our results demonstrated that Pred replacement disrupted glycometabolic homeostasis in patients with hypopituitarism.A Pred dose of>5 mg/d seemed to cause more adverse effects on glycometabolism than a dose of≤5 mg/d.Comprehensive and accurate evaluation is necessary to consider a suitable Pred replacement regimen,wherein,flash glucose monitoring system is a kind of promising and reliable assessment device.The present data allows us to thoroughly examine our modern treatment standards,especially in difficult cases such as hormonal replacement mimicking delicate natural cycles,in conditions such as diabetes mellitus that are rapidly growing in worldwide prevalence.
文摘BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.
文摘BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.
文摘The incidence of cholecystitis is relatively high in developed countries and may usually be attributed to gallstones,the treatment for which involves complete surgical removal of the gallbladder(cholecystectomy).Bile acids produced following cholecystectomy continue to flow into the duodenum but are poorly absorbed by the colon.Excessive bile acids in the colon stimulate mucosal secretion of water and electrolytes leading,in severe cases,to diarrhoea.Bile acid diarrhoea(BAD)is difficult to diagnose,requiring a comprehensive medical history and physical examination in combination with laboratory evaluation.The current work reviews the diagnosis and treatment of BAD following chole-cystectomy.
文摘Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon. Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires;data on the demographics and risk factors were collected using a well-designed questionnaire, while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 21 (80.8%) for Physiotherapists (PTs) and 78.8% (41) for Medical Doctors (MDs). There was a significant difference (p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9%, while Healthcare workers from NBDH were 2.91 times at risk (AOR = 2.91;95% CI: 1.32 - 6.41;p = 0.001) to develop WRMSDs than healthcare workers in the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% with the lowest at the elbows 11.2%. The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p Conclusion: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are;lower back, neck and upper back. Working on the same posture, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals.
文摘BACKGROUND The prognosis of gastric cancer is extremely poor.Metabolic reprogramming involving lipids has been associated with cancer occurrence and progression.AIM To illustrate fatty acid metabolic mechanisms in gastric cancer,detect core genes,develop a prognostic model,and provide treatment options.METHODS Raw data from The Cancer Genome Atlas and Gene Expression Omnibus databases were collected and analyzed.Differentially expressed fatty acid metabolism genes were identified and incorporated into a risk model based on least absolute shrinkage and selection operator regression analysis.Then,patients from The Cancer Genome Atlas were assigned to high-and low-risk cohorts according to the mean value of the risk score as the threshold,which was verified in the Gene Expression Omnibus database.Relationships between chemotherapeutic sensitivity and tumor microenvironment features were assessed.RESULTS An integrated evaluation was performed in this study.Fatty acid metabolismrelated genes were used to construct the risk model.Patients classified into the high-risk cohort were considered to be resistant to chemotherapy based on results of the“pRRophetic”R package.Patients in the high-risk cohort were associated with type Ⅰ/Ⅱ interferon activation,increased inflammation level,immune cell infiltration,and tumor immune dysfunction based on the exclusion algorithm,indicating the potential benefit of immunotherapy in these patients.CONCLUSION We constructed a fatty acid-related risk score model to assess the comprehensive fatty acid features in gastric cancer and validated its vital role in prognosis,chemotherapy sensitivity,and immunotherapy.
文摘Artificial intelligence(AI)tools,like OpenAI's Chat Generative Pre-trained Transformer(ChatGPT),hold considerable potential in healthcare,academia,and diverse industries.Evidence demonstrates its capability at a medical student level in standardized tests,suggesting utility in medical education,radiology reporting,genetics research,data optimization,and drafting repetitive texts such as discharge summaries.Nevertheless,these tools should augment,not supplant,human expertise.Despite promising applications,ChatGPT confronts limitations,including critical thinking tasks and generating false references,necessitating stringent cross-verification.Ensuing concerns,such as potential misuse,bias,blind trust,and privacy,underscore the need for transparency,accountability,and clear policies.Evaluations of AI-generated content and preservation of academic integrity are critical.With responsible use,AI can significantly improve healthcare,academia,and industry without compromising integrity and research quality.For effective and ethical AI deployment,collaboration amongst AI developers,researchers,educators,and policymakers is vital.The development of domain-specific tools,guidelines,regulations,and the facilitation of public dialogue must underpin these endeavors to responsibly harness AI's potential.
