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Perforated gastric ulcer causing mediastinal emphysema: A case report

World Journal of Clinical Cases 2024年第4期12卷 859-864页

作者： Zhi-Cheng Dai Xun-Wu Gui Feng-He Yang Hao-yuan Zhang Wen-Feng Zhang Department of General Surgery Mengcheng County First People's HospitalMengcheng 233500Anhui ProvinceChina Department of Medical Imaging Mengcheng County First People's HospitalMengcheng 233500Anhui ProvinceChina

BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of *** can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,*** common symptoms are chest pain,tightness in the chest,and respiratory *** mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious *** SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking *** to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease *** tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous *** gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was ***,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous *** operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was *** a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological ***,the patient received high-flow oxygen and cough *** CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually *** After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of *** pat

关键词： Gastric ulcer Perforated Mediastinal emphysema Case report

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Link between mutations in ACVRL1 and PLA2G4A genes and chronic intestinal ulcers:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 932-943页

作者： Yong-Jing Tang Jian Zhang Jie Wang Ren-Dong Tian Wei-Wei Zhong Ben-Sheng Yao Bing-yu Hou Ying-Hua Chen Wei He Yi-Huai He Department of Infectious Diseases The Affiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina Department of Gastroenterology Dafang County People's HospitalBijie 551600Guizhou ProvinceChina Department of Internal Medicine Puchang BranchMedical CommunitySuiyang County People's HospitalZunyi 563300Guizhou ProvinceChina Department of Infectious Diseases Jingmen Central HospitalJingmen 448000Hubei ProvinceChina Department of Infectious Diseases Dafang County People's HospitalBijie 551600Guizhou ProvinceChina

BACKGROUND Genetic factors of chronic intestinal ulcers are increasingly garnering *** present a case of chronic intestinal ulcers and bleeding associated with mu-tations of the activin A receptor type II-like 1(ACVRL1)and phospholipase A2 group IVA(PLA2G4A)genes and review the available relevant *** SUMMARY A 20-year-old man was admitted to our center with a 6-year history of recurrent abdominal pain,diarrhea,and dark *** the onset 6 years ago,the patient had received treatment at a local hospital for abdominal pain persisting for 7 d,under the diagnosis of diffuse peritonitis,acute gangrenous appendicitis with perforation,adhesive intestinal obstruction,and pelvic *** surgical treat-ment included exploratory laparotomy,appendectomy,intestinal adhesiolysis,and pelvic abscess *** patient’s condition improved and he was ***,the recurrent episodes of abdominal pain and passage of black stools started again one year after *** the basis of these features and results of subsequent colonoscopy,the clinical diagnosis was established as in-flammatory bowel disease(IBD).Accordingly,aminosalicylic acid,immunotherapy,and related symptomatic treatment were administered,but the symptoms of the patient did not improve *** investigations revealed mutations in the ACVRL1 and PLA2G4A ***1 and PLA2G4A are involved in angiogenesis and coagulation,*** suggests that the chronic intestinal ulcers and bleeding in this case may be linked to mutations in the ACVRL1 and PLA2G4A *** Kangfuxin liquid was administered to promote healing of the intestinal mucosa and effectively manage clinical *** Mutations in the ACVRL1 and PLA2G4A genes may be one of the causes of chronic intestinal ulcers and bleeding in *** administered Kangfuxin liquid may have therapeutic potential.

关键词： Intestinal ulcers Crohn’s disease Ulcerative colitis Activin A receptor type II-like 1 Phospholipase A2 group 4A Case report

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Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

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Oncology Research 2024年第5期32卷 807-815页

作者： MARKO SKELIN BRUNA PERKOV-STIPIČIN SANJA VUŠKOVIĆ MARINAŠANDRK PLEHAČEK ANE BAŠIĆ DAVIDŠARČEVIĆ MAJA ILIĆ IVAN KREČAK Pharmacy Department General Hospital ofŠibenik-Knin CountyŠibenikCroatia Faculty of Medicine University of RijekaRijekaCroatia Undergraduate Study in Nursing University of Applied SciencesŠibenikCroatia Department of Oncology University Hospital Center ZagrebZagrebCroatia Pharmacies Joukhadar Sveta NedeljaCroatia Pharmacies Prima Pharme ZagrebCroatia Pharmacy Department General Hospital ZadarZadarCroatia Pharmacy Department General Hospital PulaPulaCroatia Department of Internal Medicine General Hospital ofŠibenik-Knin CountyŠibenikCroatia

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)***,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically *** study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer ***:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each *** examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer ***:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR ***,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous *** proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current *** the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)*** variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer ***:One-third of the current ESMO CPG recommendations are supported by the highest level of *** well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

关键词： ESMO guidelines Clinical practice guidelines Level of evidence Grade of recommendation

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Cholic acid mitigates osteoarthritis by inhibiting the NF-κB/PERK/ SIRT1 signaling pathway

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BIOCELL 2024年第7期48卷 1095-1104页

作者： JIAOE SHENG ZUMIN YI SANSHAN HE QINGCHAO WU XIA HUANG GUOQING YAN yuFANG DAI LINCHONG SU The Minda hospital of Hubei Minzu University Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic DiseaseEnshi445000China The Obstetrics and Gynecology of Jianshi county hospital of Traditional Chinese Medicine Enshi445300China

Introduction:Cholic acid(CA)is a natural steroid useful in treating chronic bronchitis and *** the other hand,its potential impact on osteoarthritis(OA)is ***:Using an in vitro and in vivo osteoarthritis model,we sought to assess the chondroprotective properties of ***:We employed the Cell Counting Kit-8 to measure the impact of CA on chondrocyte activity to assess the toxicity of the *** molecular biology experimental techniques were used to investigate potential signaling pathways that CA may use to prevent inﬂammation and give chondrocytes ***,how CA affects the OA model in Sprague-Dawley(SD)rats was ***:CA signiﬁcantly suppressed the up-regulation of the interleukin-1β(IL-1β),cyclooxygenase-2(COX-2),and matrix metalloproteinase 13(MMP-13)and the downregulation of aggrecan and type II collagen A1(COL2A)in chondrocytes treated tumor necrosis factor-alpha(TNF-α).Differentially expressed genes(DEG)enrichment revealed IL-17,TNF,chemokine,cytokine-cytokine receptor,toll-like receptor,and nucleotide oligomerization domain-like receptor were the primary signaling *** enriched DEGs included CXCL6,CCL20,MMP3,CXCL3,CXCL11,CCL5,CXCL10,MMP9,MMP13,and CXCL2;these DEGs are involved in inﬂammatory responses and their expression induced by TNF-αwas reversed by CA *** inhibits p65 nuclear translocation and inhibitory subunit kappa B alpha(IκBα)phosphorylation induced by TNF-α.Furthermore,CA attenuated protein expression of protein kinase RNA-like endoplasmic reticulum kinase(PERK),inositol-requiring transmembrane kinase/endoribonuclease 1α(IRE1α),glucose regulatory protein 78(GRP78),and sirtuin 1(SIRT1),and down-regulation of phosphorylation of AMP-activated protein kinase-α(p-AMPKα)in TNF-α-treated ***:CA signiﬁcantly ameliorated cartilage degradation in the OA rat *** alleviated the inﬂammatory response through the nuclear factor kappa B/PERK/SIRT1 axis and

关键词： Cholic acid Cartilage Inﬂammation RNA sequencing Differentially expressed genes

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Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

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World Journal of Gastroenterology 2024年第5期30卷 440-449页

作者： yue Deng Ya Jiang Tong Jiang Ling Chen Hai-Jun Mou Bi-Guang Tuo Guo-Qing Shi Department of Gastroenterology Digestive Disease HospitalThe Affiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina Department of Gastroenterology Guizhou Hospital of the First Affiliated HospitalSun Yat-sen UniversityGuiyang 550000Guizhou ProvinceChina Department of Gastroenterology Yinjiang Autonomous County People’s HospitalTongren 554300Guizhou ProvinceChina

BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric ***,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from ***,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been ***,the aim of this study was to discover an individualized treatment for mild to moderate *** To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate *** A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also *** were allocated to an EBL group or an endoscopic TAI *** differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of *** The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was *** average cost and other related economic factors were g

关键词： Gastric varices Type 1 gastric variceal hemorrhage Endoscopic band ligation Tissue adhesive injection

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Energy spectrum computed tomography multi-parameter imaging in preoperative assessment of vascular and neuroinvasive status in gastric cancer

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2511-2520页

作者： Jing Wang Jian-Cheng Liang Fa-Te Lin Jun Ma Department of Radiology Pingluo County People's HospitalShizuishan 753400Ningxia Hui Autonomous RegionChina Department of Gastrointestinal Surgery Jiangsu Provincial People's HospitalNanjing 210029Jiangsu ProvinceChina

BACKGROUND Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer(GC),but traditional imaging methods have some limitations in preoperative *** recent years,energy spectrum computed tomography(CT)multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail *** To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion(LVI)and nerve invasion(PNI)in GC *** Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023,including 46 males and 16 females aged 36-71(57.5±9.1)years,were retrospectively *** patients were divided into a positive group(42 patients)and a negative group(20 patients)according to the presence of LVI/*** CT values(CT40 keV,CT70 keV),iodine concentration(IC),and normalized IC(NIC)of lesions in the upper energy spectrum CT images of the arterial phase,venous phase,and delayed phase 40 and 70 keV were measured,and the slopes of the energy spectrum curves[K(40-70)]from 40 to 70 keV were *** Core Tip:To investigate the application value of multiparameter energy spectrum computed tomography(CT)imaging in the preoperative assessment of vascular and nerve infiltration in patients with gastric cancer(GC).The imaging data of GC patients were retrospectively analyzed to evaluate the accuracy and sensitivity of CT for identifying and quantifying vascular and nerve infiltration and for comparison with postoperative pathological *** purpose of this study was to verify the clinical feasibility and potential advantages of multiparameter energy spectrum CT imaging in guiding preoperative diagnosis and treatment decision-making and to provide a new imaging basis for improving the diagnostic accuracy

关键词： Tomography X-ray computer Energy spectrum computed tomography Gastric cancer Vascular invasion Nerve invasion Cross-sectional study

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Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 364-371页

作者： Ji-Chun Tang Jia-Wei Ma Jin-Jin Jian Jie Shen Liang-Liang Cao Department of Anesthesiology The Affiliated Hospital of Jiangnan UniversityWuxi 214122Jiangsu ProvinceChina Department of Anesthesiology People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture 843599Xinjiang Uygur Autonomous RegionChina Department of Critical Care Medicine Jiangnan University Medical CenterWuxi 214122Jiangsu ProvinceChina Department of Critical Care Medicine People's Hospital of Aheqi CountyKizilsu Kirgiz Autonomous Prefecture843599Xinjiang Uygur Autonomous RegionChina

BACKGROUND According to clinical data,a significant percentage of patients experience pain after surgery,highlighting the importance of alleviating postoperative *** current approach involves intravenous self-control analgesia,often utilizing opioid analgesics such as morphine,sufentanil,and *** for colo-rectal cancer typically involves general ***,optimizing anes-thetic management and postoperative analgesic programs can effectively reduce perioperative stress and enhance postoperative *** study aims to analyze the impact of different anesthesia modalities with multimodal analgesia on patients'postoperative *** To explore the effects of different anesthesia methods coupled with multi-mode analgesia on postoperative pain in patients with colorectal *** Following the inclusion criteria and exclusion criteria,a total of 126 patients with colorectal cancer admitted to our hospital from January 2020 to December 2022 were included,of which 63 received general anesthesia coupled with multi-mode labor pain and were set as the control group,and 63 received general anesthesia associated with epidural anesthesia coupled with multi-mode labor pain and were set as the research *** data collection,the effects of postoperative analgesia,sedation,and recovery were *** Compared to the control group,the research group had shorter recovery times for orientation,extubation,eye-opening,and spontaneous respiration(P<0.05).The research group also showed lower Visual analog scale scores at 24 h and 48 h,higher Ramany scores at 6 h and 12 h,and improved cognitive function at 24 h,48 h,and 72 h(P<0.05).Additionally,interleukin-6 and interleukin-10 levels were significantly reduced at various time points in the research group compared to the control group(P<0.05).Levels of CD3+,CD4+,and CD4+/CD8+were also lower in the research group at multiple time points(P<0.05).CONCLUSION For patients with colorectal cancer,g

关键词： Multimodal analgesia Anesthesia Colorectal cancer Postoperative pain

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Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

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World Journal of Cardiology 2024年第7期16卷 402-411页

作者： Taha Teaima Gianfranco Bittar Carlini Rohan A Gajjar Imran Aziz Sami J Shoura Abdul-Rahim Shilbayeh Naim Battikh Tareq Alyousef Division of Cardiology Department of MedicineJohn H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States

BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic *** coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient *** To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 *** We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage *** Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular *** readmission predictors with very close followup is warranted to prevent such high rate of readmission.

关键词： Chronic kidney disease Transcatheter aortic valve replacement Readmission Predictors Rates

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Correlation between Neutrophil Percentage-to-albumin Ratio and Coronary Heart Disease Complicated with Diabetes Mellitus

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Medicinal Plant 2024年第2期15卷 43-47页

作者： Wenjing ZHANG yuhong SHI Guilan ZHANG Minghui ZHANG Zhoukai CUI Jiaying WANG Anjun ZHU Pingquan county hospital Pingquan 067500China

[Objectives]This study was conducted to explore the relationship between neutrophil percentage-to-albumin ratio(NPAR)and coronary heart disease complicated with diabetes.[Methods]A total of 603 patients with coronary heart disease who underwent coronary angiography in Pingquan county hospital from January,2023 to December,2023 and met the inclusion criteria were included as the research *** the patients were divided into a coronary heart disease complicated with diabetes group(CAD+T2DM group)(n=298 cases)and a control group(CAD group)(n=305 cases),according to patients medical history,heart color ultrasound and biochemical test *** clinical data,biochemical test results and coronary artery imaging data of patients were recorded,and the Gensini score was *** neutrophil percentage(NEUT%)and albumin count were determined to calculate NPAR.[Results]The NPAR value of the coronary heart disease complicated with diabetes mellitus group was(1.6±0.42),which was significantly higher than that of the control group(1.47±0.49),and the difference was statistically significant(P<0.05).The area under the ROC curve was 0.619(95%CI:0.591-0.675,P<0.05),and the prediction of coronary heart disease complicated with diabetes using NPAR showed a Youden index of 0.31,a sensitivity of 60.4%,a specificity of 40.3%,and a best cut-off score of 1.4506.[Conclusions]The neutrophil percentage-to-albumin ratio(NPAR)is closely related to coronary heart disease complicated with diabetes mellitus,and NPAR has clinical application value in the diagnosis of coronary heart disease complicated with diabetes mellitus.

关键词： Neutrophil percentage-to-albumin ratio(NPAR) Gensini score Coronary heart disease Coronary angiography

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Identification and Validation of Novel Biomarkers Related to the Calcium Metabolism Pathway in Hypertension Patients Based on Comprehensive Bioinformatics Methods

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Health 2024年第3期16卷 173-186页

作者： Xiangguang Chang Lei Guo Liying Zou Yazhao Ma Jilin Feng Department of Laboratory Yangbi Yi Autonomous County People’s Hospital Dali China Department of Obstetrics and Gynecology Yangbi Yi Autonomous County People’s Hospital Dali China Department of Infectious Diseases Yangbi Yi Autonomous County People’s Hospital Dali China Medical Community Office Yangbi Yi Autonomous County People’s Hospital Dali China

Background: Hypertension is a universal risk factor for cardiovascular diseases and is thus the leading cause of death worldwide. The identification of novel prognostic and pathogenesis biomarkers plays a key role in disease management. Methods: The GSE145854 and GSE164494 datasets were downloaded from the Gene Expression Omnibus (GEO) database and used for screening and validating hypertension signature genes, respectively. Gene Ontology (GO) enrichment analysis was performed on the differentially expressed genes (DEGs) related to calcium ion metabolism in patients with hypertension. The core genes related to immune infiltration were analyzed and screened, and the activity of the signature genes and related pathways was quantified using gene set enrichment analysis (GSEA). The infiltration of immune cells in the blood samples was analyzed, and the DEGs that were abnormally expressed in the clinical blood samples of patients with hypertension were verified via RT-qPCR. Results: A total of 176 DEGs were screened. GO showed that DEGs was involved in the regulation of calcium ion metabolism in biological processes (BP), actin mediated cell contraction, negative regulation of cell movement, and calcium ion transmembrane transport, and in the regulation of protease activity in molecular functions (MF). KEGG analysis revealed that the DEGs were involved mainly in the cGMP-PKG signaling pathway, ubiquitin-protein transferase, tight junction-associated proteins, and the regulation of myocardial cells. MF analysis revealed the immune infiltration function of the cells. RT-qPCR revealed that the expression of Cacna1d, Serpine1, Slc8a3, and Trpc4 was up regulated in hypertension, the expression of Myoz2 and Slc25a23 was down regulated. Conclusion: Cacna1d, Serpine1, Slc8a3, Trpc4, Myoz2 and Slc25a23 may be involved in the regulation of calcium metabolism pathways and play key roles in hypertension. These differentially expressed calcium metabolism-related genes may serve as pr

关键词： Hypertension Biomarkers Differentially Expressed Genes Ca2+ Metabo-lism Bioinformatics Analysis

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