bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatic head cancer with gastrointestinal bleeding as the initial manifestation: a case report and literature review
Authors: Zheng Minghui , Fu Zhiping , Niu Ting , Liu Anan , Chen Danlei , Peng Junfeng , Li Judong , Hao Zhiyuan , Yu Qingyang , Lyu Zechao , Shao Chenghao
Published: April 2023

Gastrointestinal bleeding (GIB) as the initial symptom is rare in patients with pancreatic cancer, which is prone to misdiagnosis and should be paid attention to by clinicians. Here, we present a patient with pancreatic head cancer whose first symptom was only severe upper gastrointestinal bleeding, which initially led to misdiagnosis. However, subsequent imaging revealed a mass in the pancreatic head which was considered a malignant tumor. After surgical resection, the pathology confirmed that the mass in the pancreatic head was pancreatic ductal adenocarcinoma, and the duodenal bulb’s full thickness was infiltrated. A literature review found that pancreatic cancer can present gastrointestinal bleeding by invading the digestive tract and blood vessels, left-sided portal hypertension (LSPH), digestive tract metastasis, and canceration of ectopic pancreatic tissue in the digestive tract. For these cases, clinicians should utilize multidisciplinary diagnosis and treatment based on digestive endoscopy, imaging, interventional therapy, and surgery to control bleeding, identify etiology, and remove tumors.
A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study
Authors: Wassmer Charles-Henri , Revol Rebecca , Uhe Isabelle , Chevallay Mickaël , Toso Christian , Gervaz Pascal , Morel Philippe , Poletti Pierre-Alexandre , Platon Alexandra , Ris Frederic , Schwenter Frank , Perneger Thomas , Meier Raphael P.H.
Published: April 2023

Background:

Small bowel obstruction (SBO) is a common hospital admission diagnosis. Identification of patients who will require a surgical resection because of a nonviable small bowel remains a challenge. Through a prospective cohort study, the authors aimed to validate risk factors and scores for intestinal resection, and to develop a practical clinical score designed to guide surgical versus conservative management.

Patients and Methods:

All patients admitted for an acute SBO between 2004 and 2016 in the center were included. Patients were divided in three categories depending on the management: conservative, surgical with bowel resection, and surgical without bowel resection. The outcome variable was small bowel necrosis. Logistic regression models were used to identify the best predictors.

Results:

Seven hundred and thirteen patients were included in this study, 492 in the development cohort and 221 in the validation cohort. Sixty-seven percent had surgery, of which 21% had small bowel resection. Thirty-three percent were treated conservatively. Eight variables were identified with a strong association with small bowel resection: age 70 years of age and above, first episode of SBO, no bowel movement for greater than or equal to 3 days, abdominal guarding, C-reactive protein greater than or equal to 50, and three abdominal computer tomography scanner signs: small bowel transition point, lack of small bowel contrast enhancement, and the presence of greater than 500 ml of intra-abdominal fluid. Sensitivity and specificity of this score were 65 and 88%, respectively, and the area under the curve was 0.84 (95% CI: 0.80–0.89).

Conclusion:

The authors developed and validated a practical clinical severity score designed to tailor management of patients presenting with an SBO.
The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study – a cross-sectional study
Authors: Ma Qiuyue , Jing Wenzhan , Liu Xiaoli , Liu Jue , Liu Min , Chen Jie
Published: April 2023

Background:

Inguinal, femoral, and abdominal hernia repairs are the most common surgical procedure worldwide. However, studies on hernia disease burden are notably limited, in both developed and low-income and middle-income countries (LMICs). We investigated temporal trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias at global, regional, and national levels in 204 countries and territories from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019).

Materials and Methods:

Annual incident cases, prevalent cases, age-standardized incidence rates (ASIRs), and age-standardized prevalence rates (ASPRs) of inguinal, femoral, and abdominal hernias between 1990 and 2019 were extracted from the GBD 2019 study and stratified by sex, age, and location. Percentage changes in incident cases and prevalent cases, and the estimated annual percentage changes of ASIRs and ASPRs were calculated to quantify the trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias. Data analysis for the present study was conducted from 15 June 2022 to 15 July 2022.

Results:

Globally, there were 32.53 million [95% uncertainty interval (UI): 27.71–37.79] prevalent cases and 13.02 million (10.68–15.49) incident cases of inguinal, femoral, and abdominal hernias in 2019, which increased by 36.00% and 63.67%, respectively, compared with 1990. Eighty-six percent of the incident cases were males, the male-to-female ratio was 6 : 1, and most patients were aged 50–69 years. India (2.45 million), China (1.95 million), and Brazil (0.71 million) accounted for more than one-third (39%) of the incident cases worldwide. From 1990 to 2019, the ASIR and ASPR showed a decreasing trend worldwide, except in Central Sub-Saharan Africa, which had an increasing trend in ASIR and ASPR.

Conclusion:

The global incident cases and prevalent cases of inguinal, femoral, and abdominal hernias increased substantially from 1990 to 2019, with a heavier burden observed in males, older adults, and in LMICs such as India and China. In addition, the ASIR and ASPR increased substantially in Central Sub-Saharan Africa. More efforts are warranted for hernia management to reduce the burden of inguinal, femoral, and abdominal hernias, such as by providing safe hernia surgical treatment for males, older adults, and LMICs.
Circulating fibrocyte percentage and neutrophil-lymphocyte ratio are accurate biomarkers of uncomplicated and complicated appendicitis: a prospective cohort study
Authors: Zarog Mohamed , O’Leary Peter , Kiernan Miranda , Bolger Jarlath , Tibbitts Paul , Coffey Stephen , Byrnes Gerard , Peirce Colin , Dunne Colum , Coffey Calvin
Published: April 2023

Background:

There is increasing evidence that uncomplicated appendicitis (UA) may be treated nonoperatively in cases of UA. This study aimed to evaluate and compare the diagnostic accuracy of circulating fibrocyte percentage (CFP), white blood cell count, C-reactive protein, and neutrophil-lymphocyte ratio (NLR) in diagnosing uncomplicated and complicated appendicitis.

Materials and methods:

Eighty consecutive adult patients presenting with suspected appendicitis were recruited in a cohort-based prospective study between June 2015 and February 2016 at University Hospital Limerick in Ireland. Peripheral venous samples were obtained at the presentation. Clinical, biochemical, radiological, and histopathological parameters were recorded. The CFP was determined by dual-staining for CD45 and collagen-I using flow cytometry analysis and correlated with histopathological diagnoses.

Results:

Of the 46 patients who underwent appendicectomy, 34 (73.9%) had histologically proven acute appendicitis. A comparison of the diagnostic accuracy of biomarkers demonstrated the CFP had the highest diagnostic accuracy for UA (area under the curve=0.83, sensitivity=72.7%, specificity=83.3%, P=0.002). The NLR had the highest diagnostic accuracy in relation to complicated appendicitis (area under the curve=0.84, sensitivity=75.5%, specificity=83.3%, P=0.005).

Conclusions:

CFP and NLR are accurate biomarkers of UA and complicated appendicitis.
What is the ideal mesh location for incisional hernia prevention during elective laparotomy? A network meta-analysis of randomized trials
Authors: Aiolfi Alberto , Bona Davide , Gambero Fabio , Sozzi Andrea , Bonitta Gianluca , Rausa Emanuele , Bruni Piero G. , Cavalli Marta , Campanelli Giampiero
Published: April 2023

Background:

Incisional hernia (IH) represents an important complication after surgery. Prophylactic mesh reinforcement (PMR) with different mesh locations [onlay (OL), retromuscular (RM), preperitoneal (PP), and intraperitoneal (IP)] has been described to possibly reduce the risk of postoperative IH. However, data reporting the ‘ideal’ mesh location are sparse. The aim of this study was to evaluate the optimal mesh location for IH prevention during elective laparotomy.

Methods:

Systematic review and network meta-analysis of randomized controlled trials (RCTs). OL, RM, PP, IP, and no mesh (NM) were compared. The primary aim was postoperative IH. Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.

Results:

Fourteen RCTs (2332 patients) were included. Overall, 1052 (45.1%) had no mesh (NM) while 1280 (54.9%) underwent PMR stratified in IP (n=344 pts), PP (n=52 pts), RM (n=463 pts), and OL (n=421 pts) placement. Follow-up ranged from 12 months to 67 months. RM (RR=0.34; 95% CrI: 0.10–0.81) and OL (RR=0.15; 95% CrI: 0.044–0.35) were associated with significantly reduced IH RR compared to NM. A tendency toward reduced IH RR was noticed for PP versus NM (RR=0.16; 95% CrI: 0.018–1.01), while no differences were found for IP versus NM (RR=0.59; 95% CrI: 0.19–1.81). Seroma, hematoma, surgical site infection, 90-day mortality, operative time and hospital length of stay were comparable among treatments.

Conclusions:

RM or OL mesh placement seems associated with reduced IH RR compared to NM. PP location appears promising; however, future studies are warranted to corroborate this preliminary indication.
TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: a propensity score matching study
Authors: Yuan Yichuan , He Wei , Yang Zhiwen , Qiu Jiliang , Huang Zhenkun , Shi Yunxing , Lin Zhu , Zheng Yun , Chen Minshan , Lau Wan Yee , Li Binkui , Yuan Yunfei
Published: April 2023

Background:

The long-term survival of patients with hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) is poor. Systemic therapy, transcatheter arterial chemoembolization (TACE), and hepatic artery infusion chemotherapy are widely used in HCC patients with PVTT. This study aims to explore the efficacy of combining systemic therapy with transarterial-based therapy in HCC patients with PVTT.

Materials and methods:

The authors retrospectively reviewed data of HCC patients with PVTT treated with combination therapy (TACE-hepatic artery infusion chemotherapy with tyrosine kinase inhibitors and PD-1 inhibitors) or TACE alone in SYSUCC from 2011 to 2020. The overall survival (OS), progression-free survival, and overall response rate were compared. Propensity score matching was used to minimize confounding bias.

Results:

A total of 743 HCC patients with PVTT received combination therapy (n=139) or TACE alone (n=604). After propensity score matching, the overall response rate was significantly higher in the combination group than in the TACE group [42.1% vs. 5.0%, P < 0.001 (response evaluation criteria in solid tumours); 53.7% vs. 7.8%, P < 0.001 (modified response evaluation criteria in solid tumours)]. The combination group showed significantly better OS than the TACE group (median OS not reached vs. 10.4 months, P < 0.001). The median progression-free survival of the combination and TACE groups was 14.8 and 2.3 months (P < 0.001), respectively. Tumour downstaging followed by salvage liver resection was significantly more common for the combination therapy group than for TACE group (46.3% vs. 4.5%, P < 0.001). After salvage liver resection, 31.6% (30/95) and 1.7% (3/179) of the patients achieved a pathological complete response in the combination and TACE groups, respectively (P < 0.001). The grade 3/4 adverse events rates were similar between the two groups (28.1% vs. 35.9%, P=0.092).

Conclusion:

Compared with TACE alone, combination therapy was safe enough and resulted in survival benefits. This is a promising treatment option for HCC patients with PVTT.
Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis
Authors: Reijnders-Boerboom Gabby T.J.A. , Albers Kim I. , Jacobs Lotte M.C. , Helden Esmee van , Rosman Camiel , Díaz-Cambronero Oscar , Mazzinari Guido , Scheffer Gert-Jan , Keijzer Christiaan , Warlé Michiel C.
Published: April 2023

Background:

Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group.

Materials and methods:

We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay.

Results:

Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien–Dindo grade 1–2) postoperative complications (RR=0.68, 95% CI: 0.53–0.86), lower pain scores (MD=−0.68, 95% CI: −0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51–0.88), and a reduced length of hospital stay (MD=−0.29, 95% CI: −0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77–1.73).

Conclusions:

Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.
Factors affecting the quality of laparoscopic D2 lymph node dissection for gastric cancer: a cohort study from two randomized controlled trials
Authors: Lu Jun , Huang Jiao-Bao , Wu Dong , Xie Jian-Wei , Wang Jia-Bin , Lin Jian-Xian , Zheng Chao-Hui , Huang Chang-Ming , Li Ping
Published: April 2023

Background:

Laparoscopic D2 lymph node dissection (LND) for gastric cancer has a wide range and high difficulty. In the past, the quality of surgery was often judged by the time of the operation or the amount of blood loss, but the analysis based on surgical video was rarely reported. The purpose of this study was to analyze the relationship between the quality of laparoscopic D2 LND for gastric cancer and postoperative complications.

Methods:

The surgical video and clinicopathological data of 610 patients in two randomized controlled trials in our center from 2013 to 2016 were retrospectively analyzed. Klass-02-QC LND scale and general error score tool were used to quantitatively evaluate the intraoperative performance of D2 LND. Logistic regression was used to analyze the influencing factors of postoperative complications.

Results:

The overall incidence of complications (CD classification≥2) was 20.6%; the incidence of surgical complications was 6.9%. According to whether the LND score reached 44, patients were divided into a qualified group (73%) and a not-qualified group (27%). Event score (ES) by quartile was divided into grade 1 (21.7%), grade 2 (26%), grade 3 (28%), and grade 4 (24.3%) from low to high. Univariate logistic regression analysis showed that ES greater than or equal to 3, tumor size greater than or equal to 35 mm, and cTNM >II were independent risk factors for not-qualified LND. Male,tumor size greater than or equal to 35 mm and cTNM >II were independent risk factors for grade 4 ES. Not-qualified LND (OR=1.62, 95% CI: 1.16–3.89, P=0.021), grade 4 ES (OR=3.21, 95% CI: 1.52–3.90, P=0.035), and cTNM >II (OR=1.74, 95% CI: 1.39–7.33, P=0.041) were independent risk factors for postoperative surgical complications.

Conclusions:

The qualification of LND and intraoperative events based on surgical video are the independent influencing factors of postoperative complications of laparoscopic gastric cancer surgery. Specialist training and teaching based on surgical video may help to improve the surgical skills of specialists and improve the postoperative outcome of patients.
Design of well-matched end-structure of anatomical proximal femoral locking plate based on computer-assisted imaging combined with 3D printing technology: a quality improvement study
Authors: Jia Xiaoyang , Zhang Kun , Qiang Minfei , Han Qinghui , Zhao Guojun , Wu Ying , Chen Yanxi
Published: April 2023

Background:

The extramedullary locking plate system was the common internal fixation method for hip fractures. However, common plates were poorly matched to femur, which was because they were designed based on anatomical parameters of the Western populations. Therefore, the aim was to design an end-structure of the anatomical proximal femoral locking plate that closely matched the anatomy of the Chinese population.

Materials and methods:

From January 2010 to December 2021, consecutive patients aged 18 years and older who underwent a full-length computed tomography scan of the femur were included. The end-structure (male and female model) of the anatomical proximal femoral locking plate was designed based on anatomical parameters of femurs that were measured in three-dimensional space using computer-assisted virtual technology. The match degree between the end-structure and femur were evaluated. Inter-observer and intra-observer agreement for the evaluation of match degree was assessed. The matching evaluation based on a three-dimensional printing model was regarded as the gold standard to assess the reliability.

Results:

A total of 1672 patients were included, with 701 men and 971 women. Significant differences were seen between male and female for all parameters of the proximal femur (all P<0.001). All match degree of end-structure was over 90%. Inter-observer and intra-observer agreement was almost perfect (all kappa value, >0.81). The sensitivity, specificity, and percentage of correct interpretation of matching evaluation in the computer-assisted virtual model was all greater than 95%. From femur reconstruction to completion of internal fixation matching, the process takes about 3 min. Moreover, reconstruction, measurement, and matching were all completed in one system.

Conclusions:

The results showed that based on the larger sample of femoral anatomical parameters, a highly matching end-structure of anatomical proximal femoral locking plate for Chinese population could be designed with use of computer-assisted imaging technology.
Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy
Authors: Ryder C. Yoonhee , Zacharek Mark A. , Welch Christopher M.
Published: April 2023

Objective

To compare the responses of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against interleukin-4 (IL-4), IL-5, or IL-13 signaling.

Study Design

Retrospective review.

Setting

Tertiary referral center.

Patients

Subjects with type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and otitis media who underwent treatment between 2005 and 2021.

Intervention

Treatment with targeted biologic therapy.

Main Outcome Measures

Pre- and posttreatment nasal endoscopy, ear examination, and audiologic evaluation.

Results

Four hundred seventy-seven subjects with type 2 CRSwNP were treated between 2005 and 2021. Sixty-two had otitis media with pre- and posttreatment evaluation. Retrospective chart review assessed pre- and posttreatment exam findings, nasal endoscopy, audiometry, and tympanometry. Nineteen subjects received a biologic therapy, whereas 43 did not. Exam, endoscopy, and tympanometry were graded for severity and compared pre- and posttreatment. Subjective ear exam and tympanometry were significantly improved with biologic therapy (control = 0.05, biologic = 0.84, p = 9.3 × 10−5; control = −0.1, biologic = 0.62, p = 0.0002). Conductive hearing loss as assessed by air–bone gaps did not change between groups (control = 1.2 dB better, biologic = 1.2 dB worse, p = 0.32). Nasal endoscopy findings improved with biologic therapy relative to the control group, although not statistically significant (control = 1.04, biologic = 1.36, p = 0.22).

Conclusions

Biologic therapies targeting interleukin-4 (IL-4), IL-5, and IL-13 signaling are potential new treatments for eosinophilic otitis media. This is the largest study demonstrating improvement in subjects with suspected eosinophilic otitis media in response to biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition.

Professional Practice Gap and Educational Need

Current treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment options.

Learning Objective

To determine if targeted biologic therapy, often used for eosinophilic asthma and type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent suspected eosinophilic otitis media.

Desired Result

Treatment of suspected eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared with current treatment options.

Level of Evidence

Level IV.

Indicate IRB or IACUC

Exempt. HUM00182703.
Unilateral biportal endoscopy versus microscopic decompression in the treatment of lumbar spinal stenosis: A meta-analysis
Authors: Zhou Huaqiang , Wang Xuhua , Chen Zhaoyuan , Liu Wuyang , Luo Jiaquan
Published: April 2023

Background:

The aim of this study was to evaluate whether there is a superior clinical effect of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis.

Methods:

We searched CNKI, WANFANG, CQVIP, CBM, PubMed, and Web of Science up to January 2022, and selected studies that met our inclusion criteria.

Results:

The results of this meta-analysis indicated that unilateral biportal endoscopy was demonstrated to be more beneficial for patients compared with microscopic decompression for the following outcomes: Operation time [standardized mean difference (SMD) = −0.943, 95% confidence interval (CI) (−1.856, −0.031), P = .043], hospital stays [SMD = −2.652, 95% CI (−4.390, −0.914), P = .003], EuroQol 5-Dimension questionnaire [SMD = 0.354, 95% CI (0.070, 0.638), P = .014], back pain visual analogue score [SMD = −0.506, 95% CI (−0.861, −0.151), P = .005], leg pain visual analogue score [SMD = −0.241, 95% CI (−0.371, −.0112), P = .000], the C-reactive protein level [SMD = −1.492,95% CI (−2.432, −0.552), P = .002]. Other outcomes demonstrated no significant differences between the 2 groups.

Conclusion:

For patients with lumbar spinal stenosis, unilateral biportal endoscopy was found to be more superior than microscopic decompression in terms of operation time, hospital stays, EuroQol 5-Dimension questionnaire, back visual analogue score, leg visual analogue score and the C-reactive protein level. There was no significant difference between the 2 groups in other outcome indicators.
Evaluation of risk factors, causative pathogens, and treatment in recurrent percutaneous nephrostomy catheter-related urinary tract infections in cancer patients
Authors: Mert Duygu , Iskender Gulsen , Kolgelier Servet , Ertek Mustafa
Published: April 2023

Introduction:

In cancer patients, percutaneous nephrostomy (PN) catheters can be used to relieve obstruction from chemotherapy, radiation therapy, or surgery, thereby improving kidney function and preventing further kidney damage. One of the complications of PN catheters is infections. Recurrent infections may delay chemotherapy, increase antimicrobial resistance with frequent antibiotic use, deteriorate the quality of life of patients, and increase costs. In this study, it was aimed to evaluate risk factors, causative pathogens, and treatment in recurrent PN catheter-related urinary tract infections in cancer patients.

Material and method:

Cancer patients with PN catheter-associated urinary tract infection who were followed-up in the Infectious Diseases and Clinical Microbiology Clinic between January 1, 2012 and December 31, 2021 were included in the study.

Results:

The total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were significantly higher in patients with recurrent infection when compared to the other group (P = .000, P = .000, P = .007, and P = .018, respectively). ESBL-positive Escherichia coli and ESBL-positive Klebsiella pneumoniae were most commonly isolated from the PN catheter urine cultures of patients with recurrent infections.

Discussion:

Long-term use of the PN catheter increases the risk of urinary tract infection and sepsis. In this study, the total catheterization time, and occurrence of preinfection catheter replacement, active chemotherapy, and kidney stones were found to be risk factors for the development of recurrent PN catheter-related urinary tract infection in cancer patients.

Conclusion:

It is important to know the risk factors in recurrent PN catheter-related urinary tract infections in cancer patients, take maximum protective measures, and follow-up. Knowing both the causative profile and the resistance rates will increase the chance of success in the treatment when empirical treatment is required. It should also be noted that these patients should be included in the group of patients who need prophylaxis for urinary tract infection.
Effects of aerobic exercise on metabolic indicators and physical performance in adult NAFLD patients: A systematic review and network meta-analysis
Authors: Liu Yangjun , Xie Wei , Li Juan , Ossowski Zbigniew
Published: April 2023

Background:

nonalcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of fat in the liver without alcoholism. We conducted a systematic review and meta-analysis to elucidate the efficacy of aerobic exercise on metabolic indicators and physical performance of adult patients with NAFLD.

Methods:

To conduct the systematic review and network meta-analysis, 2 researchers searched PubMed, EBSCO, and Web of science databases to identify randomized clinical trials of aerobic exercise interventions for adults with NAFLD published between inception and July 2022. We assessed the methodological quality of the included literature using the Cochrane Risk Assessment Scale and the PEDro Scale. Relevant data were extracted, variables were converted to the same units, and meta-analysis was performed using RevMan 5.4 software. We compared mean differences (MD) between experimental and control groups. For each outcome analyzed, we expressed data as MD with 95% CI to compare metabolic markers and exercise capacity between the experimental and control NAFLD patients.

Results:

Eleven randomized clinical trials with a total of 491 individuals with NAFLD were included in accordance with the criteria of this study. Types of aerobic exercise include moderate or high-intensity interval running, cycling, Nordic walking, equipment training, etc; Training duration 4 to 16 weeks, 30 to 60 minutes 3 or more times a week. Compared with the control group, aerobic exercise group had reduced weight of patients, (MD) 1.20 kg (95% CI: −1.38 to −1.01 kg, P < .00001). Seven studies confirmed that aerobic exercise significantly reduced triglycerides, (MD) 3.00 mg/dL (95% CI: −5.80 to −0.21 mg/dL, P = .04); increased high density lipoproteins (MD) 5.96 mg/dL (95% CI: 2.95 to 8.96 mg/dL, P = .0001) and reduced low-density lipoproteins (MD) 6.45 mg/dL (95% CI: −8.53 to −4.37 mg/dL, P < .00001); the study also showed that aerobic exercise reduced the liver enzymes aspartate aminotransferase and alanine aminotransferase to varying degrees. Aerobic exercise can improve physical performance and increase peak oxygen consumption of (MD) 6.29 mL/Kg*minutes, (95% CI: 3.05–9.53mL/Kg*minutes, P = .0001).

Conclusion:

Aerobic exercise significantly reduced weight and improved metabolic index and physical performance. Impacted by the limitations of various regimens, doses, duration, center settings, populations enrolled, the study had certain limitations. The randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of physical performance and metabolic capacity in this population.
Value of apparent diffusion coefficient on MRI for prediction of histopathological type in anal fistula cancer
Authors: Yamamoto Shinji , Yonezawa Keiji , Fukata Naoki , Takeshita Koji , Kodama Makoto , Yamana Tetsuro , Kiryu Shigeru , Okada Yukinori
Published: April 2023

The main histopathological types of anal fistula cancers are mucinous adenocarcinoma and tubular adenocarcinoma. The purpose of this study was to investigate the utility of the apparent diffusion coefficient (ADC) value in magnetic resonance imaging (MRI) to determine the histopathological type of an anal fistula cancer, and to investigate the relationship between ADC values and histopathological type (mucinous type or tubular carcinoma), clinical information, and surgical findings. We retrospectively identified 69 patients diagnosed with anal fistula cancer at our hospital from January 2013 to December 2021. Among them, we selected the patients diagnosed using the same 1.5-T MRI machine, underwent surgery, and a pathological sample was obtained during the operation. Finally, these 25 patients were selected for the analysis since they underwent the imaging scan using the same MRI machine. The ADC value was compared between mucinous and tubular adenocarcinomas, and between tumors at the Tis-T1-T2 and T3-T4 stages. Finally, 25 patients were selected. The mean age of the 25 patients included in the analysis was 60.8 ± 13.3 years and all were males. The median ADC of anal fistula cancers was 1.97 × 10–3 mm2/s for mucinous adenocarcinomas and 1.36 × 10–3 mm2/s for tubular adenocarcinomas; this difference was statistically significant (P < .01). Furthermore, the median ADC was 1.62 × 10–3 mm2/s for tumors in Tis-T1-T2 stages and 2.01 × 10–3 mm2/s for T3-T4 tumors (P = .02). The ADC value in MR images may predict the histopathological type and depth of anal fistula cancers. Also, the different ADC values between Tis-T1-T2 and T3-T4 tumors could help predict the classification of progression.
The prognostic effect of metastasis patterns on overall survival in organ metastatic lung adenocarcinoma
Authors: Tie Xiaowei , Wang Jin , Wang Yong , Fu Baobao , Wang Chenchen , Li Xiaomin , Jia Qianqian , Wang Fang , Chen Simeng , Zhang Yanshun
Published: April 2023

The effect of various metastases patterns on the prognosis of lung adenocarcinoma (AD) remains unknown. The purpose of our retrospective study is to determine whether various metastases patterns have a prognostic impact on patients with organ metastatic lung AD. Patient data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier method was chosen for the evaluation of overall survival (OS) rate. Univariable and multivariable Cox regression analyses were conducted to evaluate independent prognostic factors. In the SEER database, 12,228 patients with IV lung AD were retrieved in total. And 78.78% of those patients (9633/12,228) suffered from one of brain, lung, liver or bone metastasis due to disease progression. It was found that the most common site in patients with metastatic lung AD was brain (21.20%), and the least common site of metastasis was liver (3.50%). Patients who suffered single lung metastatic showed relatively good OS, and the median survival time was 11 months (95% CI 0.470–0.516). For those with 2 metastatic sites, data analysis suggested that the median survival times of patients with bone and lung metastasis (10 months; 95% CI 0.469–0.542) were better than others. For those with 3 metastatic sites, data analysis suggested that metastatic pattern had no effect on the OS. Brain is the most common single metastasis site of lung AD. Compared with the other 3 metastatic sites, patients with lung metastasis had better survival results. Deeper knowledge of metastatic patterns will help doctors to better understand the prognosis and formulate more appropriate treatment plans.
Degeneration of nigrostriatal pathway in patients with middle cerebral infarct: A diffusion tensor imaging study
Authors: Seo Jeong Pyo , Koo Dong Kyun
Published: April 2023

The nigrostriatal tract (NST) is a dopaminergic pathway that runs from the substantia nigra pars compacta in the midbrain to the dorsal striatum (caudate nucleus and putamen) and regulates voluntary movement via the basal ganglia motor loops. However, it is unclear whether the effects of ischemic stroke, such as middle cerebral artery (MCA) infarction, are associated with changes in the NST. Thirty MCA infarct patients and 40 healthy subjects with no history of psychiatric or neurological disorders were enrolled in the present study. Diffusion tensor tractography was used to investigate injury to the ipsilesional and contralesional NST in MCA infarct patients compared to the normal human brain. There was a significant difference in the mean fractional anisotropy and tract volume values of the NST between the patient and control groups (P < .05). post hoc analysis revealed that the mean fractional anisotropy and tract volume from the ipsilesional NST showed a significant difference compared with those of the contralesional NST and control groups (P < .05). MCA infarction can lead to damage to the ipsilesional NST, which can impair one’s ability to stop unwanted muscular contractions or voluntary movement.
Ischaemic colitis during pegylated interferon-alpha monotherapy for chronic hepatitis B: A case report
Authors: Liu Yu , Chen Hui , Xu Zhi-Ying
Published: April 2023

Rationale:

Pegylated interferon-alpha (PEG-IFN-α) is available for the treatment of hepatitis B virus infection, which is better than interferon-alpha (IFN-α) for the inhibition of hepatitis B virus replication. Ischemic colitis has been described from non-pegylated IFN-α, which occurs mainly in patients with hepatitis C virus infection. This is the first case of ischemic colitis during pegylated IFN-α monotherapy for chronic hepatitis B.

Patient concerns:

A 35-year-old Chinese man presented with complaints of acute lower abdominal pain and haematochezia, who was receiving PEG-IFN-α-2a monotherapy for chronic hepatitis B.

Diagnoses:

Colonoscopy revealed scattered ulcers and severe mucosal inflammation with edema in the left hemi colon and necrotizing changes in the descending portion. Biopsies revealed focal mucosal chronic inflammation and mucosal erosion. Therefore, the patient was diagnosed with ischemic colitis based on clinical and testing results.

Interventions:

PEG-IFN-α therapy was discontinued and switched to symptomatic management.

Outcomes:

The patient was discharged from the hospital after recovery. Follow-up colonoscopy revealed normal. The temporal association between the resolution of ischemic colitis and cessation of PEG-IFN-α treatment strongly favors the diagnosis of interferon-induced ischemic colitis.

Lessons:

Ischaemic colitis is a severe emergency complication of interferon therapy. Physicians should consider this complication in any patient taking PEG-IFN-α who develops abdominal discomfort and hematochezia.
Intranodal implantation of benign thyroid tissue as a late complication of ethanol ablation: A case report
Authors: Ahn Dongbin , Kawk Ji Hye , Cho Heungrae
Published: April 2023

Rationale:

Ethanol ablation (EA) is recommended as the primary treatment for benign thyroid cysts and its use is increasing. Although complications, such as pain, hoarseness, and hematoma, have been reported after EA, implantation of benign thyroid tissue has not been previously reported. Here, we present a case of intranodal implantation of benign thyroid tissue as a late complication of EA.

Patient concerns:

A 46-year-old man underwent EA for a benign cystic nodule in the left thyroid lobe and developed a thyroid abscess after several days. The patient was treated with incision and drainage and was discharged without complications. Two years later, the patient presented with multiple masses in both cervical regions. Ultrasound (US) and computed tomography indicated metastatic papillary thyroid carcinoma (PTC) at bilateral levels III, IV, and VI. The results of US-guided fine-needle aspiration cytology (FNAC) indicated benign lesions; however, thyroglobulin levels in the needle washout fluid were >250,000 ng/mL.

Diagnosis:

Total thyroidectomy with neck dissection was performed to remove the thyroid and lymph node masses and confirm the diagnosis. Histopathological findings revealed multiple areas of benign thyroid tissue in the bilateral cervical lymph nodes, with no indication of metastatic PTC, even after a BRAF gene mutation study and immunohistochemical staining for HBME-1 and galectin-3.

Outcomes:

No recurrence or complications were observed during the follow-up for 29 months.

Lessons:

Complicated EA may be associated with the dissemination of benign thyroid tissue into lymph nodes, with a confusing clinical presentation mimicking metastatic PTC. Radiologists and thyroid surgeons should consider the risk of intranodal implantation of benign thyroid tissue as a late complication of EA.
High FN1 expression is associated with poor survival in esophageal squamous cell carcinoma
Authors: Ma Junliang , Chen Shaolin , Su Min , Wang Wenxiang
Published: April 2023

Esophageal cancer (EC) is a serious threat to human health. The expression of fibronectin 1 (FN1) in esophageal squamous cell carcinoma (ESCC) remains controversial. The purpose of this study was to elucidate the expression of FN1 in ESCC and to assess the value of FN1 in the prognosis of ESCC patients. 100 ESCC patients from January 2015 to March 2016 were recruited in this study. qRT-PCR and immunohistochemistry (IHC) were used to detect FN1 mRNA and protein expression. The correlation between FN1 expression levels and prognosis of ESCC patients was analyzed. The qRT-PCR results showed that the expression of FN1 mRNA was significantly higher in ESCC tumor tissues than in adjacent esophageal tissues (P < .01). IHC results showed that FN1 protein was expressed in both tumor cells and stroma. High expression of FN1 mRNA and FN1 protein in ESCC tumor tissues was significantly correlated with the depth of tumor invasion, lymph node metastasis and clinical stage of the tumor (P < .05). Survival analysis revealed that patients with higher FN1 mRNA and protein expression had significantly lower survival rates than those with lower FN1 mRNA or protein expression (P < .01). Multivariate cox regression analysis showed that high FN1 protein expression in ESCC tumor tissues was an independent risk factor for low survival in ESCC patients (P < .05). High expression of FN1 protein in ESCC tumor tissue is an independent poor prognostic factor. FN1 protein could be a potential target for the treatment of ESCC.
Hybrid stent in management of malignant airway obstruction with carina esophageal fistula: A case report
Authors: Zhu Chenghua , Liu Jingning , Ke Mingyao , Yong Yazhi , Luo Bingqing , Feng Ganzhu
Published: April 2023

Rationale:

Airway stents have been developed rapidly to treat airway stenosis and fistula caused by various reasons. Malignant conditions that lead to central airway obstruction, especially the invasion of trachea carina and formation of esophageal fistula, are still a challenge for clinicians.

Patient concerns:

A 61-year-old man presented with malignant airway obstruction and fistula between trachea carina and esophagus accompanied by severe respiratory failure.

Diagnosis:

The patient was clinically diagnosed with esophageal squamous cell cancer of stage IV, carina esophageal fistula, severe pneumonia, hypoproteinemia.

Interventions:

Y-shaped covered metallic stent and Y-type silicone stent (hybrid stent) were placed in the airway to increase tracheal patency, block the fistula and perform carinal plasty.

Outcomes:

The clinical symptoms of the patient improved rapidly and the lung infection was controlled effectively. This patient was followed up for more than 2 month, and the quality of life was better than before.

Lessons:

Hybrid stent can be used as 1 of options for airway reconstruction and palliative treatment for patients with complex airway diseases caused by malignant tumors.
Primary cervical meningeal melanocytoma with a dumbbell shape: Case report and review of the literature
Authors: Hou Weina , Yu Jianmin , Gao Sumei , Chu Yujing
Published: April 2023

Rationale:

Meningeal melanocytoma is a rare benign pigmented tumor originat from leptomeningeal melanocytes. Here, we report the case of a female who presented with numbness and weakness of the limbs for approximately 6 months.

Patient concerns:

We report the case of a 60-year-old Chinese female who presented with numbness and weakness of the limbs for approximately 6 months. computed tomography (CT) and magnetic resonance imaging (MRI) revealed a dumbbell-shaped tumor inside and outside the cervical (C) spinal canal.

Diagnoses:

The patient was using CT and MRI. Subsequently, the patient underwent surgery, and low-grade melanocytoma was diagnosed pathologically.

Interventions:

Subsequently, the patient underwent a surgery, and the tumor was completely removed.

Outcomes:

The tumor did not recur after 6 months.

Conclusion:

This case suggested 2 “take-away” lessons: first, spinal meningeal melanocytomas may be dumbbell-shaped; and second, melanocytoma could appear as hyperintense, isointense, or hypointense on T2-weighted MRI.
Paradoxical massive pulmonary thromboembolism in a postpartum woman with factor VII deficiency with bleeding tendency: A case report
Authors: Kang Donghoon , Cha Hojeong , Park Sung Eun , Ahn Jong-Hwa , Park Ji Kwon , Kwon Iyun , Park Ji Eun
Published: April 2023

Rationale:

Factor VII (FVII) deficiency is an inherited bleeding disorder, and women with FVII deficiency are at risk of gynecological bleeding and postpartum hemorrhage. There have been no reports of pulmonary embolism in a postpartum woman with FVII deficiency as of yet. We report a case of postpartum massive pulmonary embolism with FVII deficiency.

Patient concerns:

A 32-year-old woman visited the hospital with premature rupture of membranes at 24 weeks and 4 days of gestation. She was diagnosed with FVII deficiency in an additional blood test after her laboratory results at admission included an increased prothrombin time and international normalized ratio abnormalities. After 12 days of pregnancy maintenance treatment, an emergency cesarean delivery was performed due to uncontrolled preterm labor. The day after the operation, she suffered a sudden loss of consciousness and cardiac arrest, and after she received 1 cycle of cardiopulmonary resuscitation, she was moved to the intensive care unit.

Diagnoses:

She was diagnosed with massive pulmonary thromboembolism with heart failure by chest enhanced computed tomography, C-echo, and angiography.

Interventions:

She was successfully treated with the early application of extracorporeal membrane oxygenation, catheter-guided thrombectomy, and anticoagulants.

Outcomes:

There were no major sequelae over 2 months of follow-up.

Lessons:

FVII deficiency does not protect against thrombosis. Due to the high thrombotic risk after childbirth, the risk of thrombosis should be recognized, and thromboprophylaxis should be considered if additional obstetric thrombotic risk factors are present.
PICU treatment of 3 cases of pediatric thyroid storm: Case series and literature review
Authors: Li Xinyao , Chen Jun , Li Zhuo
Published: April 2023

Rationale:

Thyroid storm (TS), also known as thyroid crisis, is a life-threatening condition that involves multiple organ dysfunction and high mortality due to uncontrolled hyperthyroidism. TS in children is extremely rare, early diagnosis and treatment can significantly improve the prognosis of the children.

Patient concerns:

Three female children who diagnosed as “thyroid storm” were admitted to Pediatric Intensive Care Unit (PICU). One of them had a family history of hyperthyroidism and others had infection factors induced TS. They presented with characteristic manifestations of TS and were evaluated with Burch-Wartofsky Point Scale (BWPS) hyperthyroidism score.

Diagnoses:

Three cases showed that free triiodothyronine 3 (FT3) and free triiodothyronine 4 (FT4) were increased and Thyroid-Stimulating-Hormone was significantly decreased, which were characteristic in hyperthyroidism. They presented with characteristic manifestations of TS and were evaluated with BWPS hyperthyroidism score.

Interventions:

All the cases were given antithyroid drugs (ATDs) for treatment. In addition, 1 of them underwent therapeutic plasma exchange (TPE) after transferring to PICU.

Outcomes:

One of the cases was declared dead and others were survived.

Lessons:

TS should be identified timely and treated early. Further studies are needed to determine the diagnostic criteria and scoring system for TS in pediatric.
Descending necrotizing mediastinitis caused by Streptococcus constellatus: A case report and review of the literature
Authors: Guo Jian , Lin Liheng , Zhou Haoge , Yang Wenfan , Shi Sen
Published: April 2023

Rationale:

Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here, we shared a successful diagnosis and treatment case of DNM that originates from oral to neck and mediastinum caused by Streptococcus constellatus (S constellatus). S constellatus is a clinically uncommon gram-positive coccus and is known for its ability to form abscesses. Timely surgical drainage and the correct use of antibiotics are key to successful treatment.

Patient concerns:

A 53-year-old male admitted to hospital with painful swelling of the right cheek, persistent oral pus and moderate fever lasting 1 week, followed by rapid development of a mediastinal abscess.

Diagnoses:

He was diagnosed with DNM caused by S constellatus.

Interventions:

On the evening of admission, an emergency tracheotomy and thoracoscopic exploration and drainage of the right mediastinum, floor of the mouth, parapharynx and neck abscess were performed. Antibiotics were administered immediately.

Outcomes:

At 28 days post-operatively, the abscess was absorbed, bilateral lung exudate decreased and the patient temperature, aspartate transaminase, alanine transaminase, bilirubin and platelets returned to normal. The patient was discharged after completing 4 weeks of antibiotic therapy. Follow-up at 3 months after discharge revealed no recurrence of the abscess.

Lessons:

Early surgical drainage and antibiotics treatment are important in mediastinal abscesses and infectious shock due to Streptococcus asteroids.