Perioperative risk factors for prognosis in patients undergoing radical esophagectomy: A retrospective study

BACKGROUND

Esophageal cancer constitutes one of the most aggressive malignant neoplasms associated with poor clinical outcomes. While surgical resection remains the cornerstone of curative intervention, optimization of perioperative care protocols has emerged as an essential strategy to reduce postoperative complications and potentially improve long-term survival rates in patients undergoing esophagectomy. However, substantial debate persists regarding the relative importance of various perioperative risk factors and their impact on post-resection outcomes.

AIM

To identify perioperative factors affecting prognosis after radical esophagectomy, aiming to improve patient outcomes through targeted interventions.

METHODS

A retrospective study analyzed 378 patients with esophageal cancer who underwent radical esophagectomy (McKeown, Sweet, or Ivor-Lewis procedures) from January 2022 through December 2023. All operations were performed by experienced surgeons following standardized perioperative protocols. The investigation gathered data on patient demographics, surgical parameters, tumor pathology (using the 8th edition American Joint Committee on Cancer staging system), and survival outcomes. Statistical analyses utilized Kaplan-Meier estimates and Cox proportional hazards modeling, with adjustment for confounding variables.

RESULTS

Multivariate Cox proportional hazards analysis identified three independent predictors of survival: Tumor-node-metastasis staging [Hazard ratio (HR) = 2.31, 95% confidence interval (CI): 1.72-3.10, P < 0.001], tumor differentiation (moderate: HR = 1.46, 95%CI: 1.02-2.09, P = 0.038; poor: HR = 2.15, 95%CI: 1.47-3.14, P < 0.001), and extended postoperative analgesic use (> 5 days) (HR = 1.43, 95%CI: 1.08-1.89, P = 0.012). Kaplan-Meier analysis demonstrated significantly lower overall survival rates in patients requiring analgesics for > 5 days compared to ≤ 5 days (P = 0.003), with consistent patterns observed for both opioid (P = 0.019) and nonsteroidal anti-inflammatory drug use (P = 0.028). The extended analgesic group exhibited a higher proportion of elderly patients (48.47% vs 35.57%, P = 0.015), while other baseline characteristics and tumor features remained comparable between groups.

CONCLUSION

Tumor-node-metastasis staging, tumor differentiation, and duration of postoperative analgesic use independently predict survival following radical esophagectomy, underscoring the significance of optimal pain management protocols.

Association of Clostridium difficile infection with clinical outcomes of patients with inflammatory bowel disease: A meta-analysis

BACKGROUND

Clostridium difficile infection (CDI) is common in patients with inflammatory bowel disease (IBD).

AIM

To assess the association of CDI with clinical outcomes of IBD.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched from inception to March 2024. Eligible articles included observational studies that reported on outcomes such as mortality, colectomy, hospitalization, intensive care unit (ICU) admission, complication rates, and length of hospital stay in IBD patients with and without CDI. Data were extracted, and a random-effects model was used to calculate pooled odds ratios (ORs) and mean differences (MDs).

RESULTS

As shown in the data from 21 studies with 1249158 participants, CDI significantly increased the risk of mortality in IBD patients [pooled OR = 4.569, 95% confidence intervals (95%CI): 2.584 to 8.079]. Although the pooled OR for colectomy was 1.409 (95%CI: 0.922 to 2.155), it was not statistically significant. Similarly, CDI did not impact hospitalization (pooled OR = 1.056, 95%CI: 0.512 to 2.179) and ICU admission outcomes (pooled OR = 1.970, 95%CI: 0.420 to 9.246) of patients with IBD. The rate of complications was comparable in the two groups (pooled OR = 0.658, 95%CI: 0.378 to 1.147). However, CDI was associated with a significantly more extended hospital stay (pooled MD = 0.349 days, 95%CI: 0.002 to 0.696).

CONCLUSION

CDI is linked to increased mortality and prolonged hospitalization in IBD patients. These results emphasize the need for early detection and appropriate management. Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.

Analysis of influencing factors on the nutritional status of non-dialysis elderly patients with chronic kidney disease and depression

BACKGROUND

The assessment of nutritional status in non-dialysis elderly patients with chronic kidney disease (CKD) and comorbid depression is clinically important. Determining key determinants of nutritional status in this population significantly improves nutritional management strategies and assists these patients overcome the disease.

AIM

To investigate the factors influencing the nutritional status of non-dialysis elderly patients with CKD and comorbid depression.

METHODS

This study retrospectively collected the clinical data of 182 non-dialysis elderly patients with CKD and comorbid depression admitted at Tangdu Hospital, Air Force Medical University, from January 2022 to June 2023. The participants were categorized based on the presence of malnutrition into the nutritionally normal group (n = 97) and the malnutrition group (n = 85). The clinical data of the two groups were subjected to unifactorial and multifactorial regression to analyze the factors influencing malnutrition among the participants. Data included sex, age, body mass index (BMI), percentage body fat, basal metabolic rate (BMR), blood urea nitrogen (BUN), creatinine (Cr), albumin (Alb), hemoglobin (Hb), pre-albumin (PA), patient-generated subjective global assessment, and Patient Health Questionnaire-9 (PHQ-9) score to identify depressive symptoms. After admitting the patients to the hospital, 5 mL of peripheral serum was withdrawn, the centrifuge was operated at 3500 rpm/minute with a centrifugal radius of 10 cm for 10 minutes, serum was collected, and serum Alb, Hb, PA, BUN, and Cr levels were detected using a fully automatic biochemical analyzer. The results were assessed using Statistical Package for the Social Sciences version 21.0 for conducting technical analyses. Metric data are presented as the mean ± standard error of the mean and replaced using the t-test. Count data are expressed as case counts and percentages and were replaced using the χ² test. Effective factors were modeled using logistic return modeling.

RESULTS

BMI, BMR, and serum Alb, Hb, PA, and Cr levels were lower in the nutritionally normal group than in the malnutrition group. Furthermore, BUN levels, PHQ-9 scores, and the percentage of anxiety symptoms were greater in the nutritionally normal group than in the normal nutrition group, with statistically significant differences (P < 0.05). Multiple factorial interpretations revealed anxiety and serum Alb, Hb, and PA levels as factors influencing the nutritional status of non-dialysis elderly patients with CKD and depression (P < 0.05).

CONCLUSION

Serum Alb, Hb, PA levels, and anxiety symptoms are all factors influencing malnutrition in non-dialysis elderly patients with CKD and depression; hence, clinical interventions can be targeted to patients with the above characteristics.

Potential clinical benefits of probiotics, prebiotics, synbiotics, and postbiotics for depression via the microbiota-gut-brain axis

BACKGROUND

Depression is a common mental-health disorder worldwide. Several studies have demonstrated the effects of gut microbiota-targeting interventions, such as probiotics, prebiotics, synbiotics, and postbiotics (PPSP), on depression.

AIM

To assess the potential benefits of PPSP on patients diagnosed with depressive disorder.

METHODS

A literature search of the PubMed, Web of Science, and Elsevier Science Direct databases for relevant studies published from database inception to March 2024 was performed. Studies that used a randomized controlled trial design and evaluated differences in depression between PPSP and placebo were included. Depressive symptoms were assessed using a validated scale. Analysis was performed using Review Manager version 5.4 (The Cochrane Collaboration, 2020).

RESULTS

Fourteen studies comprising 906 patients with depressive symptoms were included. PPSP improved depression compared with placebo [SMD: -0.39 (95%CI: -0.60 to -0.17); P < 0.001]. PPSP resulted in significant reductions in Hamilton Depression Rating Scale [MD: -1.72 (95%CI: -2.57 to -0.88); P < 0.001] and Beck Depression Inventory [MD: -2.69 (95%CI: -4.67 to -0.71); P < 0.001] scores. Sub-analysis confirmed the antidepressant effects of probiotics on depressive symptoms [SMD: -0.32 (95%CI: -0.48 to -0.16); P < 0.001], with prebiotics exerting no apparent effect [SMD: -0.08 (95%CI: -0.39 to -0.23); P = 0.62], and synbiotics exerting statistically significant benefits [SMD: -1.09 (95%CI: -1.45 to -0.73); P < 0.001].

CONCLUSION

PPSP effectively alleviates depressive symptoms, and subgroup analysis supports the benefits of probiotics and synbiotics. Nevertheless, evidence supporting the use of PPSP for the treatment of depression remains insufficient.

Volatilome and machine learning in ischemic heart disease: Current challenges and future perspectives

Integrating exhaled breath analysis into the diagnosis of cardiovascular diseases holds significant promise as a valuable tool for future clinical use, particularly for ischemic heart disease (IHD). However, current research on the volatilome (exhaled breath composition) in heart disease remains underexplored and lacks sufficient evidence to confirm its clinical validity. Key challenges hindering the application of breath analysis in diagnosing IHD include the scarcity of studies (only three published papers to date), substantial methodological bias in two of these studies, and the absence of standardized protocols for clinical implementation. Additionally, inconsistencies in methodologies-such as sample collection, analytical techniques, machine learning (ML) approaches, and result interpretation-vary widely across studies, further complicating their reproducibility and comparability. To address these gaps, there is an urgent need to establish unified guidelines that define best practices for breath sample collection, data analysis, ML integration, and biomarker annotation. Until these challenges are systematically resolved, the widespread adoption of exhaled breath analysis as a reliable diagnostic tool for IHD remains a distant goal rather than an imminent reality.

Nutritional status of elderly hypertensive patients and its relation to the occurrence of cognitive impairment

BACKGROUND

Hypertension is a common chronic disease in the elderly population, and its association with cognitive impairment has been increasingly recognized. Cognitive impairment, including mild cognitive impairment and dementia, can significantly affect the quality of life and independence of elderly individuals. Therefore, identifying risk factors for cognitive impairment in elderly hypertensive patients is crucial for developing effective interventions and improving health outcomes. Nutritional status is one of the potential factors that may influence cognitive function in elderly hypertensive patients. Malnutrition or inadequate nutrition can lead to various health problems, including weakened immune system, increased susceptibility to infections, and impaired physical and mental function. Furthermore, poor nutritional status has been linked to increased risk of cognitive decline and dementia in various populations. In this observational study, we aimed to investigate the nutritional status of elderly hypertensive patients and its relationship to the occurrence of cognitive impairment. By collecting baseline data on general information, body composition, and clinical indicators, we hope to identify risk factors for cognitive impairment in this patient population. The results of this study are expected to provide more scientific basis for the health management of elderly patients with hypertension, particularly in terms of maintaining good nutritional status and reducing the risk of cognitive impairment.

AIM

To explore the differences between clinical data and cognitive function of elderly hypertensive patients with different nutritional status, analyze the internal relationship between nutritional statuses and cognitive impairment, and build a nomogram model for predicting nutritional status in elderly hypertensive patients.

METHODS

The present study retrospectively analyzed 200 elderly patients admitted to our hospital for a hypertension during the period July 1, 2024 to September 30, 2024 as study subjects, and the 200 patients were divided into a modeling cohort (140 patients) and a validation cohort (60 patients) according to the ratio of 7:3. The modeling cohort were divided into a malnutrition group (26 cases), a malnutrition risk group (42 cases), and a normal nutritional status group (72 cases) according to the patients' Mini-Nutritional Assessment Scale (MNA) scores, and the modeling cohort was divided into a hypertension combined with cognitive impairment group (34 cases) and a hypertension cognitively normal group (106 cases) according to the Montreal Cognitive Assessment Scale (MoCA) scores, and the validation cohort was divided into a hypertension combined with cognitive impairment group (14 cases) and hypertension cognitively normal group (46 cases). The study outcome was the occurrence of cognitive impairment in elderly hypertensive patients. Univariate and multivariate logistic regression was used to explore the relationship between the general information of the elderly hypertensive patients and the influence indicators and the occurrence of cognitive impairment, the roadmap prediction model was established and validated, the patient work receiver operating characteristic curve was used to evaluate the predictive efficacy of the model, the calibration curve was used to assess the consistency between the predicted events and the actual events, and the decision curve analysis was used to evaluate the validity of the model. Pearson correlation analysis was used to explore the relationship between nutrition-related indicators and MoCA scores.

RESULTS

In this research, the modeling cohort comprised 140 cases, while the verification cohort consisted of 60 cases, with no notable discrepancy in the data between the two groups. In the modeling cohort, there were significant differences in body mass index (BMI), albumin (ALB), hemoglobin (Hb) and homocysteine levels among the malnourished group, the malnourished risk group and the normal nutritional status group. The results of univariate and multivariate analysis showed that BMI [odds ratio (OR) = 0.830, P = 0.014], ALB (OR = 0.860, P = 0.028), Hb (OR = 0.939, P = 0.035) and MNA score (OR = 0.640, P = 0.000) were independent protective factors for patients without cognitive impairment, and alkaline phosphatase (ALP) (OR = 1.074, P = 0.000) was an independent risk factor for patients with cognitive impairment. In this study, the prediction nomogram tailored for cognitive deterioration in elderly patients with hypertension demonstrated robust predictive power and a close correspondence between predicted and observed outcomes. This model offers significant potential as a means to forestall cognitive decline in hypertensive elderly patients. ALP was negatively correlated with MoCA score, while BMI, MNA score, Hb and ALB were positively correlated with MoCA score.

CONCLUSION

BMI, MNA score, Hb and ALB were independent protective factors for cognitive impairment in elderly hypertensive patients and were positively correlated with MoCA score. ALP was an independent risk factor for cognitive impairment in elderly hypertensive patients and was negatively correlated with the MoCA score. The column line graph model established in the study has a good predictive value.

Comprehensive bibliometric analysis of transcranial magnetic stimulation-based depression treatment from 2003 to 2022: Research hotspots and trends

BACKGROUND

Depression has become a global public health problem. In recent years, transcranial magnetic stimulation (TMS) has gained considerable attention as a non-invasive treatment for depression.

AIM

To investigate the research hotspots and trends in the field of TMS-based depression treatment from a bibliometric perspective.

METHODS

Using the Web of Science Core Collection, articles published between 2003 and 2022 on TMS-based depression treatment were retrieved from the science citation index expanded. The publication trends and research hotspots were analyzed using VOSviewer, CiteSpace, and the bibliometric online analysis platform. Regression analysis was performed using Microsoft Excel 2021 to predict publication growth trends.

RESULTS

We identified a total of 702 articles on TMS-based depression treatment with a predominance of clinical studies. Analysis of collaborative networks showed that the United States, the University of Toronto, and Daskalakis ZJ were identified as the most impactful country, institution, and researcher, respectively. In keyword burst analysis, it was found that theta burst stimulation (TBS), functional connectivity, and frequency were the most recent research hotspots.

CONCLUSION

TMS provides a novel therapeutic option for patients with treatment-resistant depression. Neuroimaging technology enables more precise TMS treatment, while the novel TMS modality, TBS, enhances both therapeutic efficacy and patient experience in TMS-based depression treatment. The integration of neuroimaging techniques with TBS represents a promising research direction for advancing TMS-based depression treatment. This study presents systematic information and recommendations to guide future research on TMS-based depression treatment.

Perceptions of sex education among college students: A case study of a medical school

BACKGROUND

Sex education was introduced early in foreign countries. For example, there is a more systematic sex education system abroad, which can better achieve the popularization of sex education. China's sex education started relatively late, yet there are many problems in the development of sex education in China; for example, college students lack knowledge of sexuality.

AIM

To explore the perception of sex education among medical college students.

METHODS

Students majoring in medicine in a medical school were selected as the survey subjects. Anonymous online questionnaires were used to conduct the survey, and the results were analyzed using GraphPad Prism, SPSS, Microsoft Excel, and other software. The questionnaire was administered to understand the source of sexual knowledge, sexual responsibility, mastery of sexual knowledge, and distress caused by sexual problems.

RESULTS

Most students majoring in medicine had no formal sex education, lacked sexual knowledge, or had a biased understanding of sexual responsibility. This study analyzed future research trends in sex education based on relevant achievements in the Chinese context and abroad to further realize the practical significance and value of sex education popularization in China and provide recommendations for parents and schools at different levels.

CONCLUSION

Sex education should be conducted among college students, and medical colleges and universities should strengthen scientific sex education.

Self-compassion, automatic thoughts, and mental pain in depression: Mediating effects and clinical implications

BACKGROUND

Depression is a leading global health concern with high suicide rates and recurrence. Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact. The hypothesis is that self-compassion will be negatively associated with mental pain, mediated by automatic thoughts.

AIM

To determine the mediating role of automatic thoughts in the relationship between self-compassion and mental pain in individuals with depression.

METHODS

This cross-sectional study included 389 inpatients with depression from Tianjin Anding Hospital. Participants completed the Self-Compassion Scale-Chinese Version (SCS-C), Automatic Thought Questionnaire (ATQ), and Orbach & Mikulincer Mental Pain Scale-Chinese Version (OMMP). Data were analyzed using Pearson correlations, multiple linear regressions, and mediation analysis.

RESULTS

The SCS-C total score was 68.95 ± 14.89, ATQ was 87.02 ± 28.91, and OMMP was 129.01 ± 36.74. Correlation analysis showed mental pain was positively associated with automatic thoughts (r = 0.802, P < 0.001) and negatively with self-compassion (r = -0.636, P < 0.001). Regression analysis indicated automatic thoughts (β = 0.623, P < 0.001) and self-compassion (β = -0.301, P < 0.001) significantly predicted mental pain. Mediation analysis confirmed automatic thoughts partially mediated the relationship between self-compassion and mental pain (ab = -0.269, 95%CI: -0.363 to -0.212).

CONCLUSION

Self-compassion is inversely related to mental pain in depression, with automatic thoughts playing a mediating role. These findings suggest potential therapeutic targets for alleviating mental pain in depressed patients.

Effects of cognitive combined with mindfulness-based stress reduction and sleep in patients with diabetes and endometrial cancer

BACKGROUND

Seek highly effective treatment measures for improving mood and sleep.

AIM

To explore the effects of mood and depression in patients with endometrial cancer after cognitive behavioral therapy (CBT) and mindfulness-based stress reduction.

METHODS

In a prospective study, 90 patients with diabetes, endometrial cancer, and depression were selected from January 2023 to January 2024 in our hospital. There were 45 patients in the control group and 45 patients in the observation group. In addition to the conventional treatment, the control group received cognitive behavioral treatment, and the observation group: Control group was given to compare changes in mood state and sleep quality before and after the intervention. Follow-up was performed3 months after treatment completion.

RESULTS

Before treatment, the mood and sleep quality scores between the two groups (P > 0.05); in the observation group, the 5 negative mood scores were lower and lower than the control group; the 2 positive mood scores were higher than in the control group, and the difference was statistically significant (P < 0.05); compared with before treatment, the 7 sleep quality scores and Pittsburgh sleep quality index scale total score in the observation group and lower in the control group (P < 0.05).

CONCLUSION

In patients with diabetes and endometrial cancer, mood state and sleep quality significantly improved after CBT and breathing relaxation. These findings provide new and effective treatment strategies in clinical practice.

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

BACKGROUND

Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.

AIM

To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.

METHODS

Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group (n = 50) and a control group (n = 50) according to the treatment regimen. The research group received radiofrequency ablation (RFA) in combination with sorafenib, and the control group only received RFA. The short-term efficacy of both the research and control groups was observed. Liver function and portal hypertension were compared before and after treatment. Alpha-fetoprotein (AFP), glypican-3 (GPC-3), and AFP-L3 levels were compared between the two groups prior to and after treatment. The occurrence of adverse reactions in both groups was observed. The 3-year survival rate was compared between the two groups. Basic data were compared between the survival and non-surviving groups. To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension, multivariate logistic regression analysis was employed.

RESULTS

When comparing the two groups, the research group's total effective rate (82.00%) was significantly greater than that of the control group (56.00%; P < 0.05). Following treatment, alanine aminotransferase and aspartate aminotransferase levels increased, and portal vein pressure decreased in both groups. The degree of improvement for every index was substantially greater in the research group than in the control group (P < 0.05). Following treatment, the AFP, GPC-3, and AFP-L3 levels in both groups decreased, with the research group having significantly lower levels than the control group (P < 0.05). The incidence of diarrhea, rash, nausea and vomiting, and fatigue in the research group was significantly greater than that in the control group (P < 0.05). The 1-, 2-, and 3-year survival rates of the research group (94.00%, 84.00%, and 72.00%, respectively) were significantly greater than those of the control group (80.00%, 64.00%, and 40.00%, respectively; P < 0.05). Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade, history of hepatitis, number of tumors, tumor size, use of sorafenib, stage of liver cancer, histological differentiation, history of splenectomy and other basic data (P < 0.05). Logistic regression analysis demonstrated that high Child-Pugh grade, tumor size (6-10 cm), history of hepatitis, no use of sorafenib, liver cancer stage IIIC, and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension (P < 0.05).

CONCLUSION

Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates. The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade, tumor size (6-10 cm), history of hepatitis, lack of sorafenib use, liver cancer at stage IIIC, and prior splenectomy.

Effects of salidroside on expression of ROCK in rats with liver fibrosis

AIM: To observe the effects of salidroside on the expression of ROCK in liver tissue of CCl₄-induced liver fibrosis in rats, and to explore its probable mechanism.

METHODS: Ninety healthy SD rats were randomly divided into 3 groups: control group (n = 10), salidroside group (n = 40) and liver fibrosis group (n = 40). Experimental liver fibrosis was induced by (with the concentration of 300 mL/L soluted in liquid paraffin) subcutaneous injection of CCl₄ (at the dosage of 3 mL/kg, twice per wk, 8 wks). The salidroside was injected into the peritoneal cavity at the dosage of 5 mg/kg, twice per week for 8 weeks. Liver tissues from each group were stained with Masson and HE staining to observe the collagen deposition. Expressions of ROCKⅠand ROCKⅡ in the liver tissue were detected with in situ hybridization (ISH) and immunohistochemistry (IH) respectively. All the figures were scanned with electronic computer, and the data were analyzed with Image-Plus software.

RESULTS: A significant collagen deposition and rearrangement of the parenchyma were noted in liver tissue of CCl₄-treated rats. There were lots of pseudolobule in liver tissue. The semiquantitative histological scores and average area of collagen were significantly increased when compared with control rats (2.1 ± 0.3 vs 3.6 ± 0.8, 74.82 ± 21.51 μm²vs 290.86 ± 89.37 μm², both P < 0.05). Compared with control group, the expressions of ROCKⅠ, ROCKⅡ and ROCKⅠmRNA, ROCKⅡmRNA were decreased significantly in salidroside group (0.203 ± 0.068 vs 0.357 ± 0.182, 0.237 ± 0.056 vs 0.394 ± 0.238; 0.197 ± 0.019 vs 0.394 ± 0.238, 0.185 ± 0.031 vs 0.279 ± 0.112, P < 0.05 or 0.01).

CONCLUSION: The expressions of ROCKⅠand ROCKⅡ in liver tissues are inhibited significantly with salidroside treatment. Salidroside could interfere with the signal transduction of Rho-ROCK pathway and then inhibit liver fibrosis in rats.

Inflammatory and immune changes and treatment in patients with fatty liver disease

Fatty liver disease (FLD) is a common chronic inflammatory and immune disease. Current research suggests that it is associated with a variety of clinical metabolic diseases, however, its etiology is very complex, and its exact mechanism is not fully clear. Enormous studies have found that inflammation and immunity play roles in the pathogenesis of FLD, via mechanisms involving inflammatory mediators or inflammatory factors, neutrophil infiltration, inflammasomes, peroxisome proliferator-activated receptors (PPARs), gut microbes-related inflammation, immune cells, Toll-like receptors (TLRs) and its downstream signal transduction pathways, gut microbe-related immune response, immunocytes, oxidative stress, other new markers of immune response and so on. In order to provide a reliable basis for accurate diagnosis and treatment of FLD, studies on the prevention, early diagnosis and prospective intervention of FLD should be strengthened. In addition, according to different pathogenesis, corresponding measures should be taken to reduce the risk of FLD and its related diseases.

Portal vein arterialization in 25 liver transplant recipients: A Latin American single-center experience

BACKGROUND

Portal vein arterialization (PVA) has been used in liver transplantation (LT) to maximize oxygen delivery when arterial circulation is compromised or has been used as an alternative reperfusion technique for complex portal vein thrombosis (PVT). The effect of PVA on portal perfusion and primary graft dysfunction (PGD) has not been assessed.

AIM

To examine the outcomes of patients who required PVA in correlation with their LT procedure.

METHODS

All patients receiving PVA and LT at the Fundacion Santa Fe de Bogota between 2011 and 2022 were analyzed. To account for the time-sensitive effects of graft perfusion, patients were classified into two groups: prereperfusion (pre-PVA), if the arterioportal anastomosis was performed before graft revascularization, and postreperfusion (post-PVA), if PVA was performed afterward. The pre-PVA rationale contemplated poor portal hemodynamics, severe vascular steal, or PVT. Post-PVA was considered if graft hypoperfusion became evident. Conservative interventions were attempted before PVA.

RESULTS

A total of 25 cases were identified: 15 before and 10 after graft reperfusion. Pre-PVA patients were more affected by diabetes, decompensated cirrhosis, impaired portal vein (PV) hemodynamics, and PVT. PGD was less common after pre-PVA (20.0% vs 60.0%) (P = 0.041). Those who developed PGD had a smaller increase in PV velocity (25.00 cm/s vs 73.42 cm/s) (P = 0.036) and flow (1.31 L/min vs 3.34 L/min) (P = 0.136) after arterialization. Nine patients required PVA closure (median time: 62 d). Pre-PVA and non-PGD cases had better survival rates than their counterparts (56.09 months vs 22.77 months and 54.15 months vs 31.91 months, respectively).

CONCLUSION

This is the largest report presenting PVA in LT. Results suggest that pre-PVA provides better graft perfusion than post-PVA. Graft hyperperfusion could play a protective role against PGD.

Role of the endocannabinoid system in the pathogenesis of cirrhosis

The endocannabinoid system is made up of endocannabinoid, cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2). Many studies have found that hepatic myofibroblasts and vascular endothelial cells express more CB1 and CB2 in the development of chronic liver disease. There is a close relationship between the endocannabinoid system and liver fibrosis and cirrhosis. This paper aims to review recent advances in understanding the role of the endocannabinoid system in the pathogenesis of fatty liver disease, liver fibrosis and cirrhosis complications.

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Hepatitis B virus PreS2 gene mutations in patients after hepatitis B vaccine immunization

AIM: To observe hepatitis B virus (HBV) PreS2 gene mutations in patients after hepatitis B vaccine immunization, and to discuss the relationship between hepatitis B vaccine immunization failure and PreS2 gene mutations.

METHODS: Forty-seven blood samples were collected from patients with chronic HBV infection after hepatitis B vaccine immunization who were treated at the Kunming Yan'an Hospital and the Third People's Hospital. HBV DNA was extracted from serum samples, and PreS2 gene fragments were amplified by PCR. The amplified gene fragments were analyzed by DNA sequencing. PCR products were obtained in 35 cases, and DNA sequencing was performed in 32 cases. There were 18 males and 14 females, and their age ranged from 19 to 56 years, with a mean value of 32.75 ± 10.22. The sequences of the amplifed PreS2 gene fragment sequences were analyzed with Chromas software and compared with sequenced deposited in Genbank with BLASTN. The results were analyzed using SPSS11.5 software.

RESULTS: The rate of PreS2 point mutations was 100% in the 32 specimens, including two (6.3%) cases of deletion mutations (6.3%), indicating that there may be deletion of amino acids such as Ile, Tyr, Phe, Gly, and Arg. Variation in the preS2 start codon (ATG) was not found in the 32 cases. There were a total of 517 point mutations, and preS2 base mutations had 11 types, namely, G-A, A-G, T-C, A-T, G-T, C-T, G-C, A-C, C-G, C-A, and T-A. The rate of different types of point mutations and the number of cases with different types of point mutations varied, with the rate of G-A mutation being highest and the greatest number of cases having the A-T mutation (P < 0.05). The rate of point mutations in different regions of the PreS2 gene also varied, with the middle region (nt 45-99) having a higher mutation rate and the upstream region having a lower mutation rate (P < 0.05).

CONCLUSION: There may be a correlation between PreS2 gene mutations and immunization failure, which will provide a theoretical basis for further study of the mechanism of hepatitis B vaccine immunization failure and guide the clinical practice. Gene therapy targeting these PreS2 gene mutations may become a new research direction of hepatitis B vaccine immunization.

Blood glucose and lipids levels in populations with workplace-eating habits

AIM: To explore the effect of dietary composition on the levels of blood glucose lipids as well as the health of individuals with workplace-eating habits.

METHODS: According to the results of questionnaires and medical examination, 100 adults were randomly recruited from a community of Beijing, in which annual medical examination was regularly performed in May. The related data were collected from 2000 to 2004.

RESULTS: The level of aspartate aminotransferase (AST) had a tendency to elevate year by year, and it was significantly different except that between the last two years. Meanwhile, the level of blood glucose tended to increase year by year, and it was markedly different except that between the third and second year as well as that between the last two years. Total cholesterol (TCH) level was enhanced year by year, and it was significant different except that between the second and first year, the fourth and third year as well as that between the fifth and fourth year. Triglycerides (TG) level also had the trend of being elevated year by year, but it had no significant difference except that between the fifth and first year.

CONCLUSION: There are some factors that contributes to the elevation of AST and blood glucose levels in the populations with workplace-eating habits, but their contributions for elevating blood lipid level are not obvious.

Heel pain caused by os subcalcis: A case report

BACKGROUND

The accessory bones are common bone variations around the feet and ankles, which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass, and most of them remain asymptomatic. Os subcalcis is an accessory bone at the plantar aspect of the calcaneus, which is located just posterior to the insertion of the plantar fascia. Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.

CASE SUMMARY

A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years. X-ray, computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus, located at the insertion of the plantar fascia. He underwent surgical excision of the lesion. Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.

CONCLUSION

This is a rare case with accessory os subcalcis leading to heel pain. It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.

Comparison of protective effects of compound ammonium glycyrrhetate and magnesium isoglycyrrhizinate on D-galactosamine- and carbon tetrachloride-injured human hepatocytes

AIM: To compare the protective effects of compound ammonium glycyrrhetate (CAG) and magnesium isoglycyrrhizinate (MI) on D-galactosamine (D-GalN)- and carbon tetrachloride (CCl₄)-injured human hepatocytes (L-02).

METHODS: After L-02 cells were treated with CAG and MI, respectively, they were incubated with CCl4 or D-GalN to induce cell injury. Cell growth was observed under an inverted microscope. The activity of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) and the content of glutathione (GSH) in culture supernatants were determined.

RESULTS: At a concentration of 1 g/L, both CAG and MI could improve the survival rate of cells, significantly inhibit D-GalN- and CCl₄-induced release of AST and LDH and intracellular GSH depletion, and increase D-GalN- and CCl₄-induced decrease in mitochondrial membrane potential. Both of the CAG and MI can inhibit D-GalN and CCl₄-induced release of AST and LDH and intracellular GSH depletion (CCl₄: 7.59 ± 1.27, 5.23 ± 0.70 vs 3.33 ± 0.40; D-GalN: 7.93 ± 0.36, 5.40 ± 0.52vs 3.77 ± 0.45, P < 0.01 or 0.05).

CONCLUSION: At a concentration of 1 g/L, both CAG and MI can exert protective effects on D-GalN and CCl4-injured human hepatocytes perhaps via a mechanism that is associated with improving intracellular GSH depletion. CAG is superior to MI in protecting injured L-02 hepatocytes.

Unlocking early detection: How screening can save lives from cervical cancer

Cervical cancer remains a significant public health challenge, particularly in low- and middle-income countries. Screening of cervical cancer is crucial because it can detect precancerous changes and early-stage cancer. Regard to the screening methods, combination of human papillomavirus (HPV) testing and cytological examination has superior sensitivity and specificity compared to cytology alone. Thus, recent guidelines recommend this combined approach instead of cytology alone to reduced cervical cancer incidence and mortality. By using this combination, HPV testing identifies high-risk strains associated with cervical cancer, while cytology helps detect abnormal cellular changes. This dual strategy enhances early detection rates, allowing for timely intervention and treatment. Moreover, recent studies demonstrated that this screening strategy also significantly reduced detection costs, indicating the potential for this screening strategy to be promoted, especially in economically constrained regions. Despite challenges in screening, such as accessibility, public awareness, and cultural attitudes, educating communities on the importance of HPV testing and cytology can improve participation rates. Overall, a combined HPV testing and cytology screening strategy represents a proactive approach to cervical cancer prevention, promising to save lives through early detection and treatment.

Ovarian growing teratoma syndrome with multiple metastases in the abdominal cavity and liver: A case report

BACKGROUND

Growing teratoma syndrome (GTS) is an unusual presentation of an amazing transformation of teratoma from malignant to benign on pathology during or after systemic or intraperitoneal chemotherapy. The definitive pathogenesis is still not fully understood due to the lack of large-sample studies.

CASE SUMMARY

A 53-year-old woman underwent radical surgery and postoperative intraperitoneal chemotherapy due to immature teratoma of the right ovary at the age of 28. She remained well during a 25-year follow-up period after surgery. Multiple asymptomatic solid masses were found in the liver on ultrasonography a month ago. Enhanced computed tomography (CT) of the abdomen revealed multiple masses in the abdominal cavity. The largest one was located in the posterior peritoneum next to the sixth segment of the right liver, about 7.9 cm × 7.5 cm in size. Three masses were present inside the liver, and one mass was in the right pelvic floor. Multiple lumps in the abdominal cavity were completely removed by surgery. During the operation, multiple space-occupying lesions were seen, ranging in size from 0.5 to 3 cm, and grayish white in color and hard in texture. Ovarian GTS was finally diagnosed based on postoperative pathology. After surgery, she recovered uneventfully. During a 3-year follow-up, the patient remained free of the disease without any recurrence on CT scan.

CONCLUSION

GTS is a rare phenomenon characterized by conversion of immature teratoma to mature one during or after chemotherapy and presents as growing and metastasizing masses. The pathogenesis of GTS is unclear, and the prognosis is good after surgical resection.

Portal vein pulsatility: An important sonographic tool assessment of systemic congestion for critical ill patients

In this editorial we comment on the article by Kuwahara et al, published in the recent issue of the World Journal of Cardiology. In this interesting paper, the authors showed a correlation between portal vein pulsatility ratio, examined by bedside ultrasonography, and prognosis of hospitalized patients with acute heart failure. Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination, biomarkers, central venous pressure estimation and X-rays. However, congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis. Doppler flow assessment of the abdominal veins is gaining popularity worldwide, as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.

Hematological abnormalities in liver cirrhosis

Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological mechanisms. Studies have documented a prevalence of thrombocytopenia, leukopenia, and anemia in patients with compensated cirrhosis of 77.9%, 23.5%, and 21.1%, respectively. These abnormalities carry significant clinical implications, including considerations for invasive procedures, infection risk, bleeding risk, and prognosis. Previously, cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagulation tests such as prothrombin time, partial thromboplastin time, international normalized ratio, and thrombocytopenia. However, this understanding has evolved, and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic events. Hemostasis in cirrhosis patients presents a complex phenotype, with procoagulant and anticoagulant abnormalities offsetting each other. This multifactorial phenomenon is inadequately reflected by routine laboratory tests. Thrombotic complications are more prevalent in decompensated cirrhosis and may correlate with disease severity. Bleeding is primarily associated with portal hypertension, endothelial dysfunction, mechanical vessel injury, disseminated intravascular coagulation, endotoxemia, and renal injury. This review comprehensively outlines hematologic index abnormalities, mechanisms of hemostasis, coagulation, and fibrinolysis abnormalities, limitations of laboratory testing, and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.