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Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

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World Journal of Hepatology 2024年第3期16卷 379-392页

作者： Sarah Khan Hanna Hong Stephanie Bass Yifan Wang Xiao-Feng Wang Omar T Sims Christine E Koval Aanchal Kapoor Christina C Lindenmeyer Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Cleveland clinic Lerner College of Medicine Cleveland ClinicClevelandOH 44195United States Department of Pharmacy Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences/Biostatistics Section Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Infectious Disease Cleveland ClinicClevelandOH 44195United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as *** data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver *** To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial *** From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial *** compared outcomes between patients admitted to the MILU with fungal infections to bacterial *** was extracted through chart *** All fungal infections were due to Candida species,and were most frequently blood *** among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical *** Mortality was worse among patients with fungal infections,likely attributable to severe ACLF *** studies examinin

关键词： Fungal Infection Sepsis Acute on chronic liver failure Intensive care

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Adenovirus F40/41 Gastroenteritis-Associated Emphysematous Gastritis:A Case Report

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Infectious Diseases & Immunity 2024年第2期4卷 93-95页

作者： Maulik K.Lathiya Abigail T.La Nou Maria E.Linnaus Susan M.Cullinan Emergency Department Mayo Clinic Health SystemEau Claire 54703WIUSA Critical Care Medicine Mayo Clinic Health SystemEau Claire 54703WIUSA General Surgery Department Mayo Clinic Health SystemEau Claire 54703WIUSA

Emphysematous gastritis(EG)is a rare form of gastritis characterized by gastric wall *** is associated with a high mortality *** case report describes a patient with a history of atrial fibrillation treated with apixaban,prior stroke,and schizoaffective disorder who showed epigastric tenderness on ***,no peritonitis signs were recorded,and laboratory values revealed high lactate levels and the presence of adenovirus F40/*** computed tomography scan showed extensive portal venous gas in the left hepatic lobe of the liver,as well as pneumatosis involving the entire stomach,indicating *** diagnosis was histologically confirmed and initially managed medically,which proved inefficacious,necessitating surgical intervention in the form of a laparotomy and esophagojejunostomy with Roux-en-Y *** case report suggests a potential association between EG and adenovirus F40/41–induced gastroenteritis,thereby emphasizing the challenging nature of *** underscores the need for comprehensive research to enhance our understanding of its underlying causes and effective treatment strategies.

关键词： Emphysema Gastritis Human adenovirus F40/41 Immunocompromised

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Toward less invasive coloproctology: The future is out there

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World Journal of Gastroenterology 2024年第3期30卷 199-203页

作者： Sameh Hany Emile Jonathan Ragheb Department of Colorectal Surgery Cleveland Clinic FloridaWestonFL 33331United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States

Medical care has undergone remarkable improvements over the past few *** of the most important innovative breakthroughs in modern medicine is the advent of minimally and less invasive *** trend towards employing less invasive treatment has been vividly shown in the field of gastroenterology,particularly *** to foregut interventions,colorectal surgery has shifted towards a minimally invasive ***,including both medical and surgical management of colorectal diseases,has undergone a remarkable paradigm *** treatment of both benign and malignant colorectal conditions has gradually transitioned towards more conservative and less inva-sive *** interesting paradigm shift was the trend to avoid the need for radical resection of rectal cancer altogether in patients who showed complete response to neoadjuvant *** trend of adopting less invasive appro-aches to treat various colorectal conditions does not seem to be stopping soon as further research on novel,more effective and safer methods is ongoing.

关键词： Toward Less invasive Minimally invasive Coloproctology Future Colorectal surgery

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Effects of Tai Chi in diabetes patients: Insights from recent research

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World Journal of Diabetes 2024年第1期15卷 1-10页

作者： Hidetaka Hamasaki Department of Endocrinology and Metabolism Internal MedicineHamasaki ClinicKagoshima 890-0046Japan

Tai Chi,a practice that combines elements of both exercise and mindfulness,offers a wide range of health *** body of evidence concerning the impact of Tai Chi on diabetes has recently been *** editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes(T2D).The review includes 3 randomized controlled trials(RCTs)and 5 systematic reviews and meta-analyses,all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with *** Chi demonstrates a significant effect to enhance glycemic control,lower blood pressure,improve serum lipid profiles,reduce insulin resistance,positively influence obesity-related indices,and improve overall quality of life in individuals with ***,it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin *** author also delves into potential mechanisms by which Tai Chi may exert its influence on the human ***,the editorial highlights the critical issues that warrant further exploration in the future.

关键词： Type 2 diabetes Tai Chi Exercise Mind-body exercise Chinese traditional exercise Randomized controlled trial Systematic review and meta-analysis

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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

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A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

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Chinese Journal of Plastic and Reconstructive Surgery 2024年第3期6卷 116-123页

作者： Nie K. Chen L. Qi X. Zhang S. Yin X. Zhao M. Du Y. Shanghai EyesShine BeauCare Medical Aesthetic clinic Shanghai 201107 China

Background: Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty. To avoid extra trauma, we developed a new technique for correcting iatrogenic upper eyelid retraction by post-migrating a compound flap of the orbicularis muscle and fascia (OFC) on the anterior surface of the tarsal plate. This method extends the aponeurosis of the levator palpebrae superioris muscle (LPS), which can achieve a good correction for post-blepharoplasty retraction. Methods: We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019. The OFC was used to replace the missing part of the LPS, and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted. Postoperative outcome measurements included postoperative binocular symmetry, double eyelid smoothness, eyelid fullness, margin reflex distance (MRD1), degree of eyelid closure, and exposure keratitis. The patients were followed-up at seven days, one month, and six months postoperatively. Results: One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively, with the upper eyelid margin located at the upper edge of the pupil. The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin. Other observational indicators were satisfactory, including binocular symmetry, double eyelid fluency, and eyelid fullness. During the follow-up, no exposure keratitis was identified. The MRD1 indexes after the operation were significantly different (P<0.001) from those before the procedure. Conclusions: Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function. © 2024 China Medical Cosmetology Press Co. Ltd.

关键词： Levator palpebrae superioris Migration Orbicularis muscle and fascia Upper eyelid retraction

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Esophageal inserted subclavian catheter:a rare complication

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World Journal of Emergency Medicine 2024年第3期15卷 243-245页

作者： DilberÜçöz Kocaşaban SertaçGüler Emergency Medicine clinic Health Sciences University Ankara Training and Research HospitalAnkara 06930Turkey

Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemakers in intensive care units and all specialties,from anesthesia to emergency medicine,for the treatment of trauma and hemodynamically unstable pediatric and adult patients.[1,2]Complications have been observed in more than 15% of patients who underwent ***,infectious,and thrombotic complications have been reported in 5%–19%,5%–26%,and 2%–26% of patients,respectively.[3] Malposition,on the other hand,is common in subclavian catheter insertion and is usually associated with an initially misplaced guidewire.[4]

关键词： unstable insertion initially

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Recent advances in treatment of follicular lymphoma: efficacy of PI3Kα/δ inhibitor (TQ-B3525)

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2341-2343页

作者： Takuya Watanabe Department of Internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata-city 9502002Japan

The commented study reports the results of monotherapy using TQ-B3525,a novel phosphatidylinositol-3 kinase(PI3K)inhibitor developed in China,in patients with refractory/relapsed follicular lymphoma(r/r FL).

关键词： PI3K lymphoma treatment

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Importance of diet and intestinal microbiota in the prevention of colorectal cancer-colonoscopy early screening diagnosis

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World Journal of Gastrointestinal Oncology 2024年第8期16卷 3428-3435页

作者： Miljana Z Jovandaric Department of Neonatology Clinic for Gynecology and ObstetricsUniversity Clinical Center of SerbiaBelgrade 11070Serbia

Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,using keywords relevant to the topic of the *** analyzing the aim of the searched studies and manuscripts,adequate articles were included that described the stated *** frequency of colorectal cancer varies with climate,nutrition,and many other factors,primarily endogenous,hereditary,intestinal microbiome,as well as external factors,such as exposure of the individual to stress,and bad eating *** cancer and rectal cancer or colorectal cancer in general in the early stages of the disease,may not show symptoms or are barely *** cancer symptoms will most often not develop until the disease has progressed to stage 2 or *** screening tests for colon or rectal cancer,especially colonoscopy,are recommended as part of a regular checkup for people aged 50 years or younger who are at high risk due to a family history of the disease or other *** and colonoscopy as an early screening method play an important role in the prevention of colorectal cancer.

关键词： Colorectal cancer Causes Symptoms Screening Diet and colonoscopy

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Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

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World Journal of Gastroenterology 2024年第14期30卷 1934-1940页

作者： Osamu Toyoshima Toshihiro Nishizawa Keisuke Hata Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Nihonbashi Muromachi Mitsui Tower Midtown ClinicTokyo 103-0022Japan

Olympus Corporation developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic *** topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting.A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate(ADR)and the mean number of adenomas per procedure(MAP)of TXI compared with those of white-light imaging(WLI)observation(58.7%vs 42.7%,adjusted relative risk 1.35,95%CI:1.17-1.56;1.36 vs 0.89,adjusted incident risk ratio 1.48,95%CI:1.22-1.80,respectively).A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI(1.5 vs 1.0,adjusted odds ratio 1.4,95%CI:1.2-1.6;58.2%vs 46.8%,1.5,1.0-2.3,respectively).A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure(0.29 vs 0.30,difference for non-inferiority-0.01,95%CI:-0.10 to 0.08).A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis.A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI(0.71%vs 0.29%).A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI(69.2%vs 52.5%and 85.3%vs 78.7%,res-pectively).In conclusion,TXI can improve gastrointestinal lesion detection and qualitative ***,further studies on the efficacy of TXI in clinical practice are required.

关键词： Endoscopy Texture and color enhancement imaging White-light imaging Narrow-band imaging Colorectal neoplasm Gastric cancer Adenoma Ulcerative colitis Helicobacter infections Colonoscopy

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