Combination of comprehensive thermal care and detail-oriented nursing care in the operating room for managing gestational diabetes mellitus

BACKGROUND

As the incidence of gestational diabetes mellitus (GDM) increases, its impact on cesarean sections has attracted widespread attention. Omni-directional, insulated care and detailed care are of great significance in this patient population, as they can effectively improve the quality of care in the operating room.

AIM

To explore the effect of the integrated use of comprehensive thermal insulation.

METHODS

Women with GDM who underwent cesarean sections at our hospital between April 2023 and February 2024 were included in this retrospective study. The participants were randomly allocated to two groups: The observation and control groups. An all-around thermal insulation nursing strategy, including preoperative, intraoperative, and postoperative temperature maintenance, was adopted. In addition, detailed nursing care measures, such as blood glucose monitoring, wound care, and psychological counseling, were implemented in the observation group.

RESULTS

Comparative observation revealed that all-around thermal insulation care can effectively prevent the incidence of maternal hypothermia caused by surgery, reduce the risk of infection, and promote blood circulation. The implementation of detailed care improved maternal satisfaction and reduced the incidence of complications via the appropriate management of fluctuations in the blood glucose levels and optimization of the nursing process before and after surgery according to the patient's characteristics.

CONCLUSION

The application of a combination of comprehensive thermal insulation and detailed nursing care improved the overall quality of perioperative care.

Causal associations between intermediate very-low-density lipoprotein cholesterol-to-total lipids ratio and peptic ulcer: A bidirectional Mendelian randomization study

BACKGROUND

Previous epidemiologic investigations have consistently demonstrated a strong association between the ratio of cholesterol to total lipids in medium very-low-density lipoprotein (VLDL) and the occurrence of peptic ulcers (PU). However, the precise causal relationship between these factors remains ambiguous. Consequently, this study aims to elucidate the potential correlation between the ratio of cholesterol to total lipids in medium VLDL and the incidence of peptic ulcer.

AIM

To investigate the ratio of cholesterol to total lipids in medium very-low-density lipoprotein (VLDL) association with PU via genetic methods, guiding future clinical research.

METHODS

Genome-wide association study (GWAS) datasets for the ratio of cholesterol to total lipids in intermediate VLDL and peptic ulcer were retrieved from the IEU OpenGWAS project (https://gwas.mrcieu.ac.uk). For the forward Mendelian randomization (MR) analysis, 72 single nucleotide polymorphisms (SNPs) were identified as instrumental variables. These SNPs were selected based on their association with the ratio of cholesterol to total lipids in intermediate VLDL, with peptic ulcer as the outcome variable. Conversely, for the inverse MR analysis, no SNPs were identified with peptic ulcer as the exposure variable and the ratio of cholesterol to total lipids in intermediate VLDL as the outcome. All MR analyses utilized inverse variance weighted (IVW) as the primary analytical method. Additionally, weighted median and MR-Egger methods were employed as supplementary analytical approaches to assess causal effects. Egger regression was used as a supplementary method to evaluate potential directional pleiotropy. Heterogeneity and multiplicity tests were conducted using the leave-one-out method to evaluate result stability and mitigate biases associated with multiple testing.

RESULTS

The genetically predicted ratio of cholesterol to total lipids in medium VLDL was significantly associated with an elevated risk of peptic ulcer (IVW: OR = 2.557, 95%CI = 1.274-5.132, P = 0.008). However, no causal association of peptic ulcer with the ratio of cholesterol to total lipids in medium VLDL was observed in the inverse Mendelian randomization analysis.

CONCLUSION

In conclusion, our study reveals a significant association between the ratio of cholesterol to total lipids in medium VLDL and an elevated risk of peptic ulcers. However, further validation through laboratory investigations and larger-scale studies is warranted to strengthen the evidence and confirm the causal relationship between these factors.

Clear cell sarcoma of the pancreas, an unusual cancer with unusual metastatic site or unusual primary site?

Clear cell sarcoma (CCS) is a type of malignant tumor that can arise from tendons and aponeuroses. This malignant proliferation of cells with melanocytic lineage normally occurs in young patients, and it is normally identified in extremities. However, different sites including gastrointestinal organs are also described. Due difficulties in the molecular and histopathology evaluation, the diagnosis is often confused with malignant melanoma. Most cases are treated with surgical resection, but overall, the prognosis is poor. In this editorial, we will discuss a very interesting case of CCS identified in the pancreas. We will discuss the literature and controversies in the management of this type of cancer. Furthermore, we will address molecular strategies to be incorporated in those cases to better understand the primary location of the tumor. Finally, future perspectives of the field and new strategies of treatment will be described.

Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging

BACKGROUND

Due to frequent and high-risk sports activities, the elbow joint is susceptible to injury, especially to cartilage tissue, which can cause pain, limited movement and even loss of joint function.

AIM

To evaluate magnetic resonance imaging (MRI) multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage injury.

METHODS

A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective study. We analyzed the accuracy of conventional MRI sequences (T1-weighted imaging, T2-weighted imaging, proton density weighted imaging, and T2 star weighted image) and Three-Dimensional Coronary Imaging by Spiral Scanning (3D-CISS) in the diagnosis of elbow cartilage injury. Arthroscopy was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with arthroscopy.

RESULTS

The diagnostic accuracy of 3D-CISS sequence was 89.34% ± 4.98%, the sensitivity was 90%, and the specificity was 88.33%, which showed the best performance among all sequences (P < 0.05). The combined application of the whole sequence had the highest accuracy in all sequence combinations, the accuracy of mild injury was 91.30%, the accuracy of moderate injury was 96.15%, and the accuracy of severe injury was 93.33% (P < 0.05). Compared with arthroscopy, the combination of all MRI sequences had the highest consistency of 91.67%, and the kappa value reached 0.890 (P < 0.001).

CONCLUSION

Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in adults. Multisequence MRI is recommended to ensure the best diagnosis and treatment.

Insights into complications after unicompartmental knee arthroplasty

Zhao's study, offers a comprehensive analysis of unicompartmental knee arthroplasty (UKA) revision indications. The study provides a detailed, case-by-case analysis of the factors leading to knee revision surgery in 13 patients. Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.

Returning from the afterlife? Sotorasib treatment for advanced KRAS mutant lung cancer: A case report

BACKGROUND

Lung cancer is increasing in incidence worldwide, and targeted therapies are developing at a rapid pace. Furthermore, the KRAS specific gene is strongly associated with non-small cell lung cancer (NSCLC). Adult patients with locally advanced or metastatic NSCLC who have tested positive for the KRAS G12C mutation and have progressed after at least one systemic treatment are treated with sotorasib.

CASE SUMMARY

In this study, we report on an advanced NSCLC with a KRAS G12C mutation. The histological diagnosis indicates stage IVB left lung adenocarcinoma with pelvic and bone metastases, identified as cT4N2bM1c. Using circulating tumor DNA analysis, it was possible to determine the mutation abundance of the KRAS gene exon 2, c.34G>Tp.G12C, which was 32.3%. The patient was advised to take sotorasib as part of their treatment. The imaging data were compared before and after treatment. Furthermore, clinical reassessments and regular serial blood testing were conducted. We found that the patient’s clinical symptoms significantly improved after receiving sotorasib medication, and there were no notable side effects, such as liver toxicity, during the treatment.

CONCLUSION

Sotorasib has shown promising clinical efficacy in patients with the KRAS G12c mutation and has no apparent toxic side effects.

IgG4-related sclerosing cholangitis associated with essential thrombocythemia: A case report

BACKGROUND

The complexity of immunoglobulin G4 (IgG4)-related diseases and their potential connection to hematologic malignancies remains unclear. This article provided a review of the diagnosis and treatment of a patient with IgG4-related sclerosing cholangitis (SC) and essential thrombocythemia (ET), along with an analysis of relevant literature to enhance comprehension of this disease.

CASE SUMMARY

A 56-year-old male was admitted to two hospitals with deteriorating jaundice and pruritus prior to hospitalization. Beyond our expectations, the patient was first diagnosed with IgG4-SC and ET with the Janus kinase 2 V617F mutation. Interestingly, the administration of acetate prednisone significantly resulted in improvements in both IgG4-SC and ET. Clinicians need to pay attention to immune disorders and inflammation as they contribute to the development of various disease phenotypes.

CONCLUSION

When IgG4-SC is suspected without histopathological evidence, diagnostic therapy and long-term regular follow-up can lead to positive treatment outcomes. Clinicians should be mindful of the potential presence of concurrent hematologic diseases in patients with immune disorders.

Information-motivation-behavioral guided nursing for stroke patients with pulmonary dysfunction: A randomized controlled trial

BACKGROUND

Patients with stroke frequently experience pulmonary dysfunction.

AIM

To explore the effects of information-motivation-behavioral (IMB) skills model-based nursing care on pulmonary function, blood gas indices, complication rates, and quality of life (QoL) in stroke patients with pulmonary dysfunction.

METHODS

We conducted a controlled study involving 120 stroke patients with pulmonary dysfunction. The control group received routine care, whereas the intervention group received IMB-model-based nursing care. Various parameters including pulmonary function, blood gas indices, complication rates, and QoL were assessed before and after the intervention.

RESULTS

Baseline data of the control and intervention groups were comparable. Post-intervention, the IMB model-based care group showed significant improvements in pulmonary function indicators, forced expiratory volume in 1 sec, forced vital capacity, and peak expiratory flow compared with the control group. Blood gas indices, such as arterial oxygen pressure and arterial oxygen saturation, increased significantly, and arterial carbon dioxide partial. pressure decreased significantly in the IMB model-based care group compared with the control group. The intervention group also had a lower complication rate (6.67% vs 23.33%) and higher QoL scores across all domains than the control group.

CONCLUSION

IMB model-based nursing care significantly enhanced pulmonary function, improved blood gas indices, reduced complication rates, and improved the QoL of stroke patients with pulmonary dysfunction. Further research is needed to validate these results and to assess the long-term efficacy and broader applicability of the model.

Endometrial carcinoma with cervical stromal invasion: Three case reports

BACKGROUND

Endometrial cancer is a kind of well-known tumors of female genitourinary system. Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer. There is still controversy regarding the use of magnetic resonance imaging (MRI) in the diagnosis of cervical stromal invasion of endometrial cancer. The diagnosis of cervical stromal invasion varies significantly between different observers and institutions. We present a limited case series of the particular pattern of endometrial cancer, which infiltrates the cervical stroma and is often overlooked.

CASE SUMMARY

We present three cases of endometrial carcinoma with cervical stromal invasion with cancer-free uterine cavity. One patient, a reproductive-aged woman, exhibited irregular menstruation and was diagnosed with endometrial polyps by hysteroscopy and segmental curettage. A MRI scan revealed polypoid nodules within the internal cervical orifice. The other two cases were postmenopausal women who presented with abnormal vaginal bleeding. Hysteroscopy and segmental curettage suggested atypical hyperplasia of the endometrium. MRI scans did not detect any malignant signs in the endometrium. In one case, a non-thickened endometrium was observed, while in another, hyperplasia of the endometrium was seen. Notably, none of these patients had malignant tumors identified in the uterine cavity via MRI scans. However, postoperative pathological results following hysterectomy consistently indicated cervical stromal invasion.

CONCLUSION

Cervical stromal invasion is easily missed if no cancer is found in the uterine body on MRI. Immunohistochemistry of endoscopic curettage specimens should be conducted to avoid underestimation of the disease.

Computed tomography-based radiomics predicts the fibroblast-related gene EZH2 expression level and survival of hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is the most common subtype of liver cancer. The primary treatment strategies for HCC currently include liver transplantation and surgical resection. However, these methods often yield unsatisfactory outcomes, leading to a poor prognosis for many patients. This underscores the urgent need to identify and evaluate novel therapeutic targets that can improve the prognosis and survival rate of HCC patients.

AIM

To construct a radiomics model that can accurately predict the EZH2 expression in HCC.

METHODS

Gene expression, clinical parameters, HCC-related radiomics, and fibroblast-related genes were acquired from public databases. A gene model was developed, and its clinical efficacy was assessed statistically. Drug sensitivity analysis was conducted with identified hub genes. Radiomics features were extracted and machine learning algorithms were employed to generate a radiomics model related to the hub genes. A nomogram was used to illustrate the prognostic significance of the computed Radscore and the hub genes in the context of HCC patient outcomes.

RESULTS

EZH2 and NRAS were independent predictors for prognosis of HCC and were utilized to construct a predictive gene model. This model demonstrated robust performance in diagnosing HCC and predicted an unfavorable prognosis. A negative correlation was observed between EZH2 expression and drug sensitivity. Elevated EZH2 expression was linked to poorer prognosis, and its diagnostic value in HCC surpassed that of the risk model. A radiomics model, developed using a logistic algorithm, also showed superior efficiency in predicting EZH2 expression. The Radscore was higher in the group with high EZH2 expression. A nomogram was constructed to visually demonstrate the significant roles of the radiomics model and EZH2 expression in predicting the overall survival of HCC patients.

CONCLUSION

EZH2 plays significant roles in diagnosing HCC and therapeutic efficacy. A radiomics model, developed using a logistic algorithm, efficiently predicted EZH2 expression and exhibited strong correlation with HCC prognosis.

Application of buried auricular point combined with Wenjing Sanhan prescription in arteriosclerosis obliterans patients with resting pain

BACKGROUND

Research on the combined use of ear acupoint embedding beans and warming meridians with cold-dispersing formulas for alleviating resting pain in patients with arteriosclerosis obliterans (ASO) remains limited.

AIM

To explore the therapeutic efficacy of auricular point embedding beans combined with Wenjing Sanhan prescription in alleviating resting pain in patients with lower-limb ASO.

METHODS

A total of 100 patients with ASO experiencing resting pain who were treated at our hospital from January 2022 to January 2023 were enrolled. They were randomly allocated into two groups using a double-blind approach. The control group was treated using a warming meridian with a cold-dispersing formula, while the study group received additional treatment with ear acupoint embedding beans. The clinical efficacy, ankle-brachial artery pressure ratio, hemorheological indicators, and traditional Chinese medicine symptom scores were compared between the two groups.

RESULTS

The clinical efficacy rate in the study group was significantly higher (94.00%) than that in the control group (72.00%, P < 0.05). Moreover, the ankle-brachial artery pressure ratio was significantly higher in the study group after treatment (P < 0.05). Hemorheological parameters, including whole blood viscosity, plasma viscosity (1.83 ± 0.11) mPa/s, fibrinogen levels (3.30 ± 0.21) g/L, platelet adhesion rate (49.87% ± 10.51%), and erythrocyte aggregation index (1.79 ± 0) were improved in the study group compared to the control group. In addition, the scores for decreased skin temperature (1.41 ± 0.26), intermittent claudication (1.30 ± 0.20), and resting pain (1.23 ± 0.31) were significantly lower in the study group than those in the control group (all P < 0.05). The level of oxidative stress in the study group also exhibited significant improvement (P < 0.05), and the levels of inflammatory factors were considerably lower than those in the control group.

CONCLUSION

The combination of ear point embedding beans and Wenjing Sanhan prescription demonstrates promising clinical efficacy in alleviating resting pain associated with ASO.

Effect of dietary with Zhibai dihuang pills and gonadotropin-releasing-hormone-analogue on girls with precocious and rapidly progressive puberty

BACKGROUND

At present, the clinical mechanisms underlying precocious puberty remain unclear, making effective intervention for children experiencing this condition and rapidly progressive puberty essential.

AIM

To explore the effects of Zhibai dihuang pills and gonadotropin-releasing hormone analogue (GnRHa) on growth and ovarian function in girls with precocious puberty.

METHODS

The clinical data of 84 adolescent girls with precocious puberty and rapidly progressive puberty from February 2017 to August 2023 were retrospectively analyzed. Girls were divided into a control group and an observation group, with 42 cases in each group. The control group received diet intervention combined with GnRHa treatment, while the observation group received diet intervention combined with Zhibai dihuang pills + GnRHa treatment. Outcomes such as clinical efficacy, growth indicators, ovarian function, and adverse reactions were compared between the two groups.

RESULTS

The observation group showed superior clinical efficacy compared to the control group (P < 0.05). Prior to the intervention, no significant differences were found in growth or ovarian function between the groups (P > 0.05). Post-intervention, the observation group exhibited significantly lower rates in growth, height, and bone age, along with reduced levels of progesterone, testosterone, estradiol, prolactin, luteinizing hormone, and follicle-stimulating hormone compared to the control group (P < 0.05). The incidence of adverse reactions was similar across both groups (P > 0.05).

CONCLUSION

Combining Zhibai dihuang pills with GnRHa and dietary intervention effectively improves growth, enhances ovarian function, and minimizes adverse reactions in adolescent girls with precocious and rapidly progressive puberty.

Are case reports valuable? Exploring their role in evidence based medicine and patient care

Case reports, often overlooked in evidence-based medicine (EBM), play a pivotal role in healthcare research. They provide unique insights into rare conditions, novel treatments, and adverse effects, serving as valuable educational tools and generating new hypothesis. Despite their limitations in generalizability, case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals. By acknowledging their limitations and adhering to reporting guidelines, case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM. This editorial explores the intrinsic value of case reports in EBM and patient care.

Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients

BACKGROUND

Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications. Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia.

AIM

To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma.

METHODS

This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023. Of these, 154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio. In the training set, 53 cases experienced intraoperative hypothermia and 101 did not. Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery. The area under the curve (AUC), sensitivity, and specificity were calculated.

RESULTS

Comparison of the hypothermia and non-hypothermia groups found significant differences in sex, age, baseline temperature, intraoperative temperature, duration of anesthesia, duration of surgery, intraoperative fluid infusion, crystalloid infusion, colloid infusion, and pneumoperitoneum volume (P < 0.05). Differences between other characteristics were not significant (P > 0.05). The results of the logistic regression analysis showed that age, baseline temperature, intraoperative temperature, duration of anesthesia, and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery (P < 0.05). Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence (P > 0.05). The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets, respectively.

CONCLUSION

Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery, which improved surgical safety and patient recovery.

Influence of humanistic care-based operating room nursing on safety, recovery, and satisfaction after radical surgery for colorectal carcinoma

BACKGROUND

Radical surgery is a preferred treatment for colorectal carcinoma, wherein nursing intervention is essential for postoperative recovery and prevention of complications. Recently, the application of humanistic care in medical care has attracted attention. Humanistic care emphasizes comprehensive care, with importance attached to patients’ physical needs as well as psychological and emotional support to provide more humane and personalized care services. However, no clinical reports have examined the use of humanistic care in patients undergoing radical surgery for colorectal carcinoma.

AIM

To investigate the influence of humanistic care-based operating room nursing on the safety, postoperative recovery, and nursing satisfaction of patients who have undergone radical surgery for colorectal carcinoma.

METHODS

In total, 120 patients with rectal cancer who underwent surgery in Zhongnan Hospital of Wuhan University between August 2023 and March 2024 were selected and grouped based on the nursing methods employed. Of these patients, 55 were treated with routine nursing intervention (control group) and 65 were provided humanistic care-based operating room nursing (research group). The patients’ vital signs were recorded, including systolic/diastolic blood pressure (SBP/DBP) and heart beats per minute (BPM), as well as serum stress indices, including norepinephrine (NE), adrenal hormone (AD), and cortisol (Cor). Postoperative recovery and complications were also recorded. Patients’ negative emotions, life hope, and nursing satisfaction were evaluated using the Self-rating Depression/Anxiety Scale (SDS/SAS), Herth Hope Index (HHI), and self-developed nursing satisfaction questionnaire, respectively.

RESULTS

During emergence from anesthesia, SBP, DBP, and BPM levels were found to be lower in the research group than those in the control group, also serum Cor, AD, and NE levels were lower. In addition, the research group had shorter operative, awakening, anal exhaust, first postoperative ambulation, drainage tube removal, intestinal recovery, and hospital times. The total complication rate and the SDS and SAS scores were lower in the research group than those in the control group. The HHI and nursing satisfaction scores were higher in the research group.

CONCLUSION

Humanistic care-based operating room nursing can mitigate physiological stress responses, reduce postoperative complications, promote postoperative recovery, relieve adverse psychological emotions, and enhance life hope and nursing satisfaction in patients undergoing radical surgery for colorectal carcinoma, which can be popularized in clinical practice.

Assessment of early factors for identification or prediction severe acute pancreatitis in pregnancy

BACKGROUND

Acute pancreatitis in pregnancy (APIP) is a rare and serious condition, and severe APIP (SAPIP) can lead to pancreatic necrosis, abscess, multiple organ dysfunction, and other adverse maternal and infant outcomes. Therefore, early identification or prediction of SAPIP is important.

AIM

To assess factors for early identification or prediction of SAPIP.

METHODS

The clinical data of patients with APIP were retrospectively analyzed. Patients were classified with mild acute pancreatitis or severe acute pancreatitis, and the clinical characteristics and laboratory biochemical indexes were compared between the two groups. Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.

RESULTS

A total of 45 APIP patients were enrolled. Compared with the mild acute pancreatitis group, the severe acute pancreatitis group had significantly increased (P < 0.01) heart rate (HR), hemoglobin, neutrophil ratio (NEUT%), and neutrophil–lymphocyte ratio (NLR), while lymphocytes were significantly decreased (P < 0.01). Logical regression analysis showed that HR, NEUT%, NLR, and lymphocyte count differed significantly (P < 0.01) between the groups. These may be factors for early identification or prediction of SAPIP. The area under the curve of HR, NEUT%, NLR, and lymphocyte count in the receiver operating characteristic curve analysis was 0.748, 0.732, 0.821, and 0.774, respectively. The combined analysis showed that the area under the curve, sensitivity, and specificity were 0.869, 90.5%, and 70.8%, respectively.

CONCLUSION

HR, NEUT%, NLR, and lymphocyte count can be used for early identification or prediction of SAPIP, and the combination of the four factors is expected to improve identification or prediction of SAPIP.

Are all primary omental infarcts truly idiopathic? Five case reports

BACKGROUND

Idiopathic omental infarction (IOI) is challenging to diagnose due to its low incidence and vague symptoms. Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies. Although hypercoagulability and thrombosis are among the causes of omental infarction, venous thromboembolism scanning is rarely performed as an etiological investigation.

CASE SUMMARY

The medical records of the 5 cases, who had the diagnosis of IOI by computed tomography, were examined. The majority of the patients were male (n = 4, 80%) and the mean age was 31 years (range: 21-38). The patients had no previous abdominal surgery or a history of any chronic disease. The main complaint of all patients was persistent abdominal pain. Omental infarction was detected in all patients with contrast-enhanced computed tomography. Conservative treatment was initially preferred in all patients, but it failed in 1 patient (20%). After discharge, all patients were referred to the hematology department for thrombophilia screening. Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase (A1298C mutation) and heterozygous for a factor V Leiden mutation.

CONCLUSION

IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain. Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.

Treatment of nasopharyngeal carcinoma and prevention of non-alcoholic Wernicke’s disease: A case report and review of literature

BACKGROUND

Wernicke encephalopathy is a neurological disorder caused by thiamine deficiency, commonly seen in alcoholic populations but also involving other circumstances that may lead to thiamine deficiency. The recognition of Wernicke encephalopathy often depends on clinicians’ keen ability to detect its typical triad of features; however, most cases do not present with the full constellation of signs, which complicates the timely identification of Wernicke encephalopathy.

CASE SUMMARY

This case report describes a patient with nasopharyngeal carcinoma who developed abnormal ocular function and ataxia following concurrent chemoradiotherapy, without a history of alcohol abuse. With the aid of radiological examinations, he received a timely diagnosis and treatment; however, his symptoms did not fully resolve during follow-up.

CONCLUSION

For patients with malignant tumors exhibiting neurological symptoms, clinicians should consider the possibility of Wernicke encephalopathy and provide prophylactic thiamine therapy.

Diagnostic challenges from conflicting results of tests and imaging

Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some cases. In rare instances, even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging, and has to wait until histological diagnosis or even autopsy results are available. The underlying reason of challenging diagnoses is mostly conflicting data from history, tests, and imaging that point to different diagnoses. In this issue of World Journal of Clinical Cases, Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni syndrome. The case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current technology. Clinicians should realize that in rare situations, agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.

Exploration of the complex origins of primary constipation

Constipation is a common gastrointestinal disorder characterized by infrequent bowel movements and difficulty in passing stools. It can significantly affect an individual's quality of life and overall well-being. Understanding the causes of constipation is important for its effective management and treatment. In this paper, we have reviewed the primary causes of constipation or functional constipation. Primary constipation is a bowel disorder associated with colonic or anorectal sensorimotor or neuromuscular dysfunction. As per the literature, it is multifactorial and involves factors such as decreased interstitial cells of Cajal, altered colonic motility, enteric nervous system dysfunction, intestinal flora disturbances, and psychological influences. Clinical symptoms include difficulty in defecation, decreased frequency of defecation, or a feeling of incomplete evacuation. A comprehensive evaluation and management of constipation require an interdisciplinary approach incorporating dietary modifications, lifestyle changes, pharmacotherapy, and psychological interventions. Further research is imperative to explain the intricate mechanisms underlying constipation and develop targeted therapies for improved patient outcomes.

“Keyboard sign” and “coffee bean sign” in the prenatal diagnosis of ileal atresia: A case report

BACKGROUND

Ileal atresia is a congenital abnormality where there is significant stenosis or complete absence of a portion of the ileum. The overall diagnostic accuracy of prenatal ultrasound in detecting jejunal and ileal atresia is low. We report a case of ileal atresia diagnosed prenatally by ultrasound examination with the “keyboard sign” and “coffee bean sign”.

CASE SUMMARY

We report a case of ileal atresia diagnosed in utero at 31 weeks' of gestation. Prenatal ultrasound examination revealed two rows of intestines arranged in an ‘S’ shape in the middle abdomen. The inner diameters were 1.7 cm and 1.6 cm, respectively. A typical “keyboard sign” was observed. The intestine canal behind the “keyboard sign” showed an irregular strong echo. There was no normal intestinal wall structure, showing a typical “coffee bean sign”. Termination of the pregnancy and autopsy findings confirmed the diagnosis.

CONCLUSION

The prenatal diagnosis of ileal atresia is difficult. The sonographic features of the “keyboard sign” and “coffee bean sign” are helpful in diagnosing the location of congenital jejunal and ileal atresia.

Seven-years post allogeneic hematopoietic stem cell transplantation pure red cell aplastic anemia cured with daratumumab: A case report and review of literature

BACKGROUND

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is currently the only viable method of curing patients with acute myeloid leukaemia. In 30% to 50% of patients, donors and recipients have some level of ABO blood group incompatibility. ABO blood group incompatibility can cause antibodies against the donor's red blood cells to persist in the recipient's body, resulting in a delay of several months in the recovery of red blood cells. A number of different treatments have been reported for post-transplant pure red cell aplastic anaemia (PRCA), such as plasmapheresis, donor lymphocyte infusions, anti-thymocyte globulin, rituximab and steroids.

CASE SUMMARY

A 41-year-old female diagnosed with acute myeloid leukaemia underwent peripheral blood allogeneic haematopoietic stem cell transplantation in November 2013 from an HLA matched unrelated donor. The donor was AB-positive and the recipient was O-positive. The patient was diagnosed with PRCA three months after receiving the donor stem cell transplant. After failing multiple lines of therapy, the patient applied for daratumumab. After receiving three doses of daratumumab, the patient developed a reticulocyte response and no longer required blood transfusions.

CONCLUSION

The use of daratumumab anti-CD38 for the remove of plasma cells is safe and effective and may be tried for refractory patients with PRCA after undergoing allo-HSCT for ABO incompatibility.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominal radiographs because it overlaps with the inferior vena cava on anteroposterior radiographs. Intensive observation by medical providers may be a cue for diagnosis. However, knowledge of catheter misplacement of the right ascending lumbar vein is also necessary, because misplacement cannot be suspected without that awareness.

Clinical efficacy, bone density, and follow-up in implant and orthodontic treatment for inclined adjacent teeth

BACKGROUND

Tooth defects can cause elongation of occlusal teeth, leading to insufficient repair space. The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant therapeutic effect.

AIM

To explore clinical efficacy, bone density, and follow-up of implant and orthodontic treatment for patients with inclined adjacent teeth.

METHODS

In total, 98 patients with oblique adjacent teeth were randomly assigned to implant restoration combined with orthodontic treatment (group A, n = 49) or to receive implant restoration alone (group B, n = 49). Changes in alveolar ridge bone density and apical bone density were observed before and after treatment in the two groups. Changes in chewing function and language function were compared between the two groups of patients. Follow-up lasted for 12 mo after repair to observe any adverse reactions in the oral cavity.

RESULTS

The clinical effective rates of group A and group B were 97.96% and 85.71%, respectively, with group A having a higher clinical effective rate than group B. After treatment, the bone density of the alveolar ridge and apical bone in both groups decreased compared to before treatment, while the chewing and language functions improved. The changes in various indicators in group A were more significant. After treatment, the satisfaction rate of group A (97.96%) was higher than that of group B (79.59%). The incidence of adverse reactions in group A (2.04%) was lower than that in group B (24.49%).

CONCLUSION

The amalgamation of implant restoration and orthodontic treatment for adjacent tilted teeth demonstrates notable clinical efficacy, diminishes alveolar bone resorption, and fosters patient functional rehabilitation while exhibiting negligible adverse reactions.

Navigating treatment resistance: Janus kinase inhibitors for ulcerative colitis

The management of refractory ulcerative colitis (UC) and acute severe UC (ASUC) is challenging due to the lack of standardized approaches in cases resistant to multiple treatments. In this editorial, I investigate the efficacy and safety of Janus kinase inhibitors, particularly upadacitinib and tofacitinib, in controlling severe and refractory disease. I highlight a notable case report by Xu et al, which explores the case of a patient with primary nonresponse to two classes of biologics and two fecal microbiota transplants who exhibited a remarkable response to upadacitinib. Furthermore, I discuss the use of tofacitinib in refractory UC and ASUC, either as monotherapy or in combination with biologics, which has shown promising response rates. Additionally, emerging evidence of upadacitinib efficacy in ASUC is presented. Overall, these cases emphasize the complex nature of managing refractory ASUC and the potential of small-molecule therapies to achieve remission. Further research is needed to refine treatment strategies for patients with treatment-resistant UC.