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Non-operative management of rectal cancer: Highlighting the controversies

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1501-1506页

作者： Sameh Hany Emile Anjelli Wignakumar Department of Colorectal Surgery Cleveland Clinic FloridaWestonFL 33331United States

There remains much ambiguity on what non-operative management(NOM)of rectal cancer truly entails in terms of the methods to be adopted and the best algorithm to *** is clearly shown by the discordance between various national and international guidelines on NOM of rectal *** main aim of the NOM strategy is organ preservation and avoiding unnecessary surgical in-tervention,which carries its own risk of morbidity.A highly specific and sensitive surveillance program must be devised to avoid patients undergoing unnecessary surgical *** many studies,NOM,often interchangeably called the Watch and Wait strategy,has been shown as a promising treatment option when undertaken in the appropriate patient population,where a clinical complete res-ponse is ***,there are no clear guidelines on patient selection for NOM along with the optimal method of surveillance.

关键词： Non-operative management Rectal cancer Highlighting Controversies

Intraplaque injections of hyaluronic acid for the treatment of stable-phase Peyronie’s disease:a retrospective single-center experience

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Asian Journal of Andrology 2024年第3期26卷 268-271页

作者： Simone Cilio Roberto La Rocca Giuseppe Celentano Claudio Marino Massimiliano Creta Gianluigi Califano Celeste Manfredi Giorgio Ivan Russo Afonso Morgado Marco Falcone Marco Capece YAU Working Group Sexual and Reproductive Health Department of Neurosciences Reproductive Sciences and OdontostomatologyUrology UnitUniversity of Naples“Federico II”Naples 80131Italy Urology unit Department of WomenChild and General and Specialized Surgery“Luigi Vanvitelli”UniversityNaples 80131Italy Urology Section Department of SurgeryUniversityof CataniaCatania 95131Italy Department of Urology Centro Hospitalar Universitário São JoãoPorto 4200-319Portugal Urology clinic-A.O.U.“Cittàdella Salute edella Scienza”-Molinette Hospital University of TurinTurin 10100Italy 不详

Peyronie’s disease(PD)is a condition of penile connective tissue affecting up to 10%of men *** the complexity ofits management,nonsurgical treatments,such as intraplaque injections,are gaining *** current literature shows dataon the efficacy of intraplaque injections of hyaluronic acid(HA)mainly in acute-phase ***,data on injections of HA instable-phase PD are *** for this retrospective study were derived from a prospectively maintained database of privatepatients presenting at a private medical practice affiliated to the University of Naples“Federico II”(Naples,Italy)with stable-phasePD between January 2020 and March *** underwent a standard protocol of three injections,each administered at atwo-week *** the intervals,patients performed vacuum device therapy,penile stretching,and modeling *** compiled the Peyronie’s Disease Questionnaire(PDQ)and Global Assessment of Peyronie’s Disease(GAPD)at baselineand 2 weeks after the third injection.A penile Doppler ultrasound was performed 2 weeks after the last injection to record thefinal ***,we recruited 62 patients with stable-phase PD and a mean(±standard deviation[s.d.])curvature of52.7°(±9.7°).After 6 weeks,eight(12.9%)patients did not experience any curvature *** remaining 54 patientshad a final mean(±s.d.)curvature of 40.3°(±9.1°)with P<0.001,compared to that before *** found improvement inall PDQ domains(all P≤0.01),and 50(80.6%)patients reported subjective improvement of the penile curvature according to *** conclusion,we demonstrated that after three injections of HA administered according to the adopted protocol,patientswith stable-phase PD could experience significant improvements in penile curvature,and physical and psychological consequencesof the disease without significantly relevant side effects.

关键词： hyaluronic acid intraplaque injection Peyronie’s disease stable-phase therapy

Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step

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World Journal of Gastroenterology 2024年第6期30卷 516-522页

作者： Peter Liptak Martin Duricek Peter Banovcin clinic of Internal Medicine-Gastroenterology University Hospital in MartinJessenius Faculty of Medicine in MartinComenius UniversityMartin 03601Slovakia

The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:*** original research presents a new scoring system for fecal *** incontinence is a chronic disease with a severe impact on the quality of life of the *** social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further misman-agement or non-existent management of the *** important fact is that patients are often unable to describe their condition when not asked precisely defined *** problem is partially resolved by scoring *** scoring systems are commonly used;however,each of them has their *** example,the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence ***,there has long been a call for a more precise scoring *** correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy *** editorial describes fecal incontinence,its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.

关键词： Incontinence Fecal Scoring system Questionary Quality of life

Mechanical upper bowel obstruction caused by a large trichobezoar in a young woman: A very unusual case report

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World Journal of clinical Cases 2024年第4期12卷 777-781页

作者： Magdalena Scherrer Peter Kornprat Robert Sucher Johanna Muehlsteiner Doris Wagner Department of Surgery Division for GeneralVisceral and Transplantation SurgeryMedical University of GrazGraz 8036Austria Department of Surgery Clinic RohrbachRohrbach 4150Austria

BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the *** consists of voluntarily swallowed hair bulks and is normally removed via *** leading to ileus have rarely been *** SUMMARY A 24-year-old female patient presented to the emergency room with abdominal pain,nausea,and vomiting for 3 *** previous medical and psychiatric history was *** analysis showed iron deficiency anemia,leukocytosis,and elevated liver *** abdominal CT scan revealed a dense structure in the patients’stomach which turned out to be a huge trichobezoar completely obstructing the *** trichobezoar had to be removed *** her postoperative course,a subcutaneous seroma *** a single puncture,the rest of the recovery process was unremarkable,and the patient recovered *** A mechanical bowel obstruction is a potentially life-threatening event for every *** our case a young female was suffering from severe symptoms of an obstruction which might have resulted in serious harm without successful surgical management.

关键词： Rapunzel syndrome Hair ingestion Gastroscopy Bezoar Case report

Severe acute kidney injury due to oxalate crystal induced severe interstitial nephritis:A case report

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World Journal of Nephrology 2024年第2期13卷 24-30页

作者： Maulik K Lathiya Praveen Errabelli Sasmit Roy Neeharik Mareedu Department of Emergency Medicine Mayo Clinic Health SystemEau ClaireWI 54703United States Department of Nephrology Mayo Clinic Health SystemEau ClaireWI 54703United States Department of Nephrology Centra Lynchburg General HospitalLynchburgVA 24551United States Department of Nephrology UPMC Western MarylandCumberlandMD 21502United States

BACKGROUND Acute kidney injury(AKI)due to interstitial nephritis is a known condition primarily attributed to various *** medication-induced interstitial nephritis is common,occurrences due to non-pharmacological factors are *** report presents a case of severe AKI triggered by intratubular oxalate crystal deposition,leading to interstitial *** aim is to outline the case and its management,emphasizing the significance of recognizing uncommon causes of interstitial *** SUMMARY A 71-year-old female presented with stroke-like symptoms,including weakness,speech difficulties,and cognitive *** hypertension had been managed with hydrochlorothiazide(HCTZ)for over two *** admis-sion,severe hypokalemia and AKI were noted,prompting discontinuation of HCTZ and initiation of prednisolone for acute interstitial *** investigations,including kidney biopsy,confirmed severe acute interstitial nephritis with oxalate crystal deposits as the underlying *** treatment,initial renal function showed minimal ***,with prednisolone therapy and supportive measures,her condition gradually improved,high-lighting the importance of comprehensive *** This case underscores the importance of a thorough diagnostic approach in identifying and addressing uncommon causes of interstitial *** occurrence of interstitial nephritis due to oxalate crystal deposition,especially without typical risk factors,emphasizes the need for vigilance in clinical practice.

关键词： Acute kidney injury Interstitial nephritis Oxalate crystal Hydrochlorothiazide Hypokalemia Case report

Optimizing artificial intelligence in sepsis management: Opportunities in the present and looking closely to the future

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Journal of Intensive Medicine 2024年第1期4卷 34-45页

作者： Darragh O’Reilly Jennifer McGrath Ignacio Martin-Loeches Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization(MICRO)St James’HospitalDublinIreland Department of Respiratory Intensive care Hospital ClinicUniversitat de BarcelonaIDIBAPSCIBERESBarcelonaSpain

Sepsis remains a major challenge internationally for healthcare *** incidence is rising due to poor public awareness and delays in its recognition and subsequent *** sepsis,mortality increases with every hour left *** intelligence(AI)is transforming worldwide healthcare delivery at *** review has outlined how AI can augment strategies to address this global disease *** and machine learning(ML)algorithms can analyze vast quantities of increasingly complex clinical datasets from electronic medical records to assist clinicians in diagnosing and treating sepsis earlier than traditional *** review highlights how these models can predict the risk of sepsis and organ failure even before it *** gives providers additional time to plan and execute treatment plans,thereby avoiding increasing complications associated with delayed diagnosis of *** potential for cost savings with AI implementation is also discussed,including improving workflow efficiencies,reducing administrative costs,and improving healthcare *** these advantages,clinicians have been slow to adopt AI into clinical *** of the limitations posed by AI solutions include the lack of diverse data sets for model building so that they are widely applicable for routine clinical ***,the subsequent algorithms are often based on complex mathematics leading to clinician hesitancy to embrace such ***,we highlight the need for robust political and regulatory frameworks in this area to achieve the trust and approval of clinicians and patients to implement this transformational technology。

关键词： Artificial intelligence Data science Machine learning Intensive care unit(ICU) Critical care Sepsis

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

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World Journal of Psychiatry 2024年第7期14卷 1027-1033页

作者： Hong-Ru Li Yu Guo Emergency Intensive Care unit The Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital)Suzhou 215000Jiangsu ProvinceChina

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other *** with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate *** To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of *** General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU *** were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the *** Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU *** results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient *** logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU *** Patients

关键词： Critical illness Delirium Risk factor Intensive care unit Emotional nursing Pain nursing

Remission of type 2 diabetes mellitus

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World Journal of Diabetes 2024年第7期15卷 1384-1389页

作者： Afif Nakhleh Elya Halfin Naim Shehadeh Institute of Endocrinology Diabetes and MetabolismRambam Health Care CampusHaifa 3109601Israel Diabetes and Endocrinology clinic Maccabi Healthcare ServicesHaifa 3299001Israel The Azrieli Faculty of Medicine Bar-Ilan UniversitySafed 1311502Israel

The surge in type 2 diabetes mellitus(T2DM)is tightly linked to obesity,leading to ectopic fat accumulation in internal *** management has become a cornerstone of T2DM treatment,with evidence suggesting that significant weight loss can induce ***,defined as sustained hemoglobin(HbA1c)below 6.5% for at least 3 months without medication,can be achieved through various approaches,including lifestyle,medical,and surgical *** bariatric surgery offers significant remission rates,particularly for patients with severe *** lifestyle modifications,including lowcalorie diets and exercise,have also demonstrated significant *** like incretin-based agents show robust results in improving beta-cell function,achieving glycemic control,and promoting weight *** complete remission without medication may not be attainable for everyone,especially those with severe insulin resistance or deficiency,early and aggressive glycemic control remains a crucial *** HbA1c below 6.5%from the time of diagnosis reduces the risk of long-term complications and ***,considering a broader definition of remission,encompassing individuals with sustained control on medication,could offer a more comprehensive and inclusive approach to managing this chronic disease.

关键词： Type 2 diabetes mellitus Remission Lifestyle intervention Metabolic bariatric surgery Glucose-lowering medications Weight management medications

Spontaneous Infection of Ascites Fluid at the National and University Hospital Hubert Koutoukou Maga in Cotonou: Prevalence and Associated Factors

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Open Journal of Gastroenterology 2024年第1期14卷 1-10页

作者： Aboudou Raïmi Kpossou Comlan N’dehougbèa Martin Sokpon Chloé Andréa Obekandon Opè Mahouton Jacques Tovizounkou Kadiatou Diallo Rodolph Koffi Vignon Jean Séhonou University clinic of Hepato-Gastroenterology National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) Cotonou Benin University clinic of Internal Medicine CNHU-HKM Cotonou Benin Department of Internal Medicine Donka National Hospital Conakry Guinea

Background: Spontaneous ascites fluid infection (SAFI) is an extremely serious and frequently encountered complication in cirrhotic patients. We aimed to determine the prevalence of SAFI and the factors associated with it in the largest hospital in Cotonou. Methods: This was a retrospective descriptive and analytical study conducted from January 2013 to July 2019, at the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, Benin. All patients followed in the University clinic of Hepato-Gastroenterology and diagnosed with SAFI were included. Results: Eighty-two patients were included, predominantly males (69.5%), with a mean age of 51.5 ± 14.5 years. Among them, 32 had SAFI, i.e., a prevalence of 39%. Of the 32 cases of SAFI, the culture of ascites fluid was positive in 6 cases (18.7%). The most frequent germ found in SAFI was Escherichia coli (5 patients, 83.3%). The factors associated with SAFI in this study were: abdominal pain (p = 0.004), increased bilirubinemia (p = 0.009), decreased prothrombin level 20 (p = 0.001). Conclusion: SAFI was common in cirrhotic patients in the department. Certain clinical and paraclinical factors were associated with it, as was the severity of cirrhosis. Early diagnosis and aetiological management of cirrhosis could reduce its frequency.

关键词： Ascites Infection Cirrhosis Cotonou