Rare giant intradural epidural hemolymphangioma: A case report

BACKGROUND

Hemolymphangioma is a rare, noninvasive benign tumor that originates from vascular and lymphatic malformations. It is usually congenital and can present with varying symptoms depending on its location and size. There are very few reports of hemolymphangiomas within the spinal canal, and giant lesions are exceptionally rare.

CASE SUMMARY

In July 2023, a 64-year-old male with a giant intravertebral epidural hemolymphangioma from thoracic 11 to lumbar 2 (T11-L2) was admitted to the Department of Spine Surgery at the People's Hospital of Binzhou City, China. The patient experienced progressive lumbar and left lower limb pain, numbness, weakness in both lower limbs, and difficulty with urination and defecation. Imaging studies revealed a large cystic mass in the spinal canal at T11-L2. Surgical decompression was performed, and the pathology confirmed hemolymphangioma.

CONCLUSION

Complete resection of hemolymphangiomas has the best prognosis, and final diagnosis relies on pathologic diagnosis. In this case, the mass was removed intact with a pedicle nail rod system, leading to adequate spinal decompression and restoration of spinal stability.

Analysis of long-term outcome of modified gastric bypass for type 2 diabetes mellitus in Chinese patients

BACKGROUND

Bariatric and metabolic surgery have been routinely performed following the rapid increase in obesity and metabolic diseases worldwide. Of all evolving procedures, Roux-en-Y gastric bypass (RYGB) is considered the gold standard for surgical treatment of patients with type 2 diabetes mellitus (T2DM) and obesity. RYGB was introduced in China nearly 20 years ago, but the number of RYGB surgeries only accounts for 3.1% of the total number of weight loss and metabolic surgeries in China, it’s effect on Chinese people still needs further study.

AIM

To investigate the effect and safety of a modified gastric bypass performed in Chinese patients with T2DM.

METHODS

Patients with obesity and T2DM who underwent modified gastric bypass, with > 5-year follow-up data, were analyzed.

RESULTS

All 37 patients underwent uneventful laparoscopic surgery, no patient was switched to laparotomy during the surgery, and no severe complications were reported. Average weight and body mass index of the patients reduced from 84.6 ± 17.3 (60.0–140.0) kg and 30.9 ± 5.0 (24.7–46.2) kg/m² to 67.1 ± 12.2 (24.7–46.2) kg and 24.6 ± 3.9 (17.7–36.5) kg/m², respectively, and fasting plasma glucose and glycated hemoglobin decreased from 7.4 ± 3.4 mmol/L and 8.2% ± 1.7% preoperatively to 6.5 ± 1.3 mmol/L and 6.5% ± 0.9% 5-years postoperatively, respectively. Only 29.7% (11/37) of the patients used hypoglycemic drugs 5-years postoperatively, and the complete remission rate of T2DM was 29.7% (11/37). Triglyceride level reduced significantly but high-density lipoprotein increased significantly (both P < 0.05) compared with those during the preoperative period. Liver and renal function improved significantly postoperatively, and binary logistic regression analysis revealed that the patients’ preoperative history of T2DM and fasting C-peptide were significant prognostic factors influencing complete T2DM remission after RYGB (P = 0.006 and 0.012, respectively).

CONCLUSION

The modified gastric bypass is a safe and feasible procedure for Chinese patients with obesity and T2DM, exhibiting satisfactory amelioration of weight problems, hyperglycemia, and combination disease.

Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma: A case report

BACKGROUND

Pancreatic trauma (PT) is rare among traumatic injuries and has a low incidence, but it can still lead to severe infectious complications, resulting in a high mortality rate. Acute pancreatitis (AP) is a common complication after PT, and when combined with organ dysfunction and sepsis, it will result in a poorer prognosis.

CASE SUMMARY

We report a 25-year-old patient with multiple organ injuries, including the pancreas, due to abdominal trauma, who developed necrotising pancreatitis secondary to emergency caesarean section, combined with intra-abdominal infection (IAI). The patient underwent performed percutaneous drainage, pancreatic necrotic tissue debridement, and abdominal infection foci debridement on the patient.

CONCLUSION

We report a case of severe AP and IAI secondary to trauma. This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery, and a better outcome was obtained.

Acute macular neuroretinopathy following COVID-19 infection: Three case reports

BACKGROUND

During the Coronavirus disease 2019 (COVID-19) pandemic, a notable increase in acute macular neuroretinopathy (AMN) cases was observed. This study aimed to investigate the potential association between AMN and COVID-19 by examining 3 cases in China.

CASE SUMMARY

The first case involved a 30-year-old man who presented with progressive vision loss following a COVID-19 infection. Optical coherence tomography (OCT) and near-infrared imaging identified hallmark AMN lesions, hyperreflective disruptions within the outer plexiform layer, and hyporeflective anomalies in the ellipsoid zone, leading to an AMN diagnosis. Despite partial visual recovery, OCT angiography (OCTA) revealed persistent microvascular changes, specifically a decreased vascular density in the deep capillary plexus. The second case was a 24-year-old woman who experienced blurred vision and exhibited bilateral cotton-wool spots on fundus examination post-COVID-19. Imaging confirmed the presence of AMN along with paracentral acute middle maculopathy (PAMM). Follow-up OCTA found a progressive reduction in vascular density, indicating ongoing microvascular compromise. The third case was a 28-year-old woman who reported sensations of occlusion in her right eye following a COVID-19 infection. Imaging confirmed both AMN and PAMM, revealing similar decreases of microvascular density on OCTA despite a significant improvement in visual acuity. We noted that all 3 patients had received the COVID-19 vaccine prior to the appearance of symptoms.

CONCLUSION

The findings highlight the diagnostic utility of advanced ocular imaging in detecting AMN in COVID-19 patients and the importance of comprehensive eye examinations.

Omadacycline in the treatment of scrub typhus: Three case reports

BACKGROUND

Scrub typhus is a naturally occurring acute infectious disease that is primarily transmitted through the bites of chiggers or larval mites infected by Orientia tsutsugamushi (O. tsutsugamushi). Omadacycline, a novel tetracycline, exhibits potent antibacterial efficacy against both typical bacteria and atypical pathogens. However, omadacycline application in the treatment of scrub typhus remains limited.

CASE SUMMARY

In the present work, we report several cases of scrub typhus, with the main clinical symptoms being fever, the formation of eschars or ulcers, local or systemic lymphadenopathy, headache, myalgia and rash. Blood samples were collected before omadacycline was administered, and O. tsutsugamushi infection was confirmed through targeted next-generation sequencing (tNGS). After two days of treatment, the patients’ symptoms, including fever, were alleviated, with no adverse drug reactions.

CONCLUSION

tNGS is an effective method for diagnosing scrub typhus. Omadacycline can be considered an alternative option for antiinfective therapy in patients with O. tsutsugamushi infections.

Shedding light on pancreatic metastasis of clear cell sarcoma: An exceptional journey

This editorial comments on the study by Liu et al investigating pancreatic metastasis of clear cell sarcoma (CCS) published in the World Journal of Clinical Cases. CCS is a rare and aggressive melanocytic tumor, that typically arises from tendons and aponeuroses of the limbs, and metastasizes to the lungs, bones, and brain. However, pancreatic metastasis has rarely been reported, presenting unique diagnostic and therapeutic challenges. Elucidating the clinical characteristics, imaging features, prognostic factors, and treatment outcomes of patients with pancreatic CCS metastasis is crucial. Surgery remains an effective management strategy for CCS. However, the high recurrence rate and low effectiveness of traditional adjuvant treatments necessitate a shift towards more personalized and targeted treatment plans. Research is needed to investigate and validate novel therapeutic approaches specifically tailored to the distinct genetic and molecular characteristics of rare malignancies like CCS. Additionally, the development of late metastases after a long disease-free interval is common in CCS patients. Therefore, routine postoperative surveillance for metastasis using computed tomography, magnetic resonance imaging, bone scans, and positron emission tomography scans is crucial. Moving forward, enhanced collaboration, investigation, and creative thinking among scientists, medical professionals, and legislators are essential to gain a deeper understanding of these rare presentations.

Analyze interleukin-1β, interleukin-6, and tumor necrosis factor-α levels in dry eye and the therapeutic effect of cyclosporine A

BACKGROUND

Dry eye is a common eye disease. Artificial tears supplements are widely used for the treatment of dry eyes. However, multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears, which may affect the therapeutic effect.

AIM

To analyze the characteristics of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.

METHODS

A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group, while 20 healthy individuals served as the control group during the same period. Levels of inflammatory markers, including IL-1β, IL-6, and TNF-α, were analyzed. The observation group was further divided into a study group and a control group, each consisting of 62 patients. The control group received artificial tears, whereas the study group received a combination of artificial tears and cyclosporine A. Inflammatory markers, Schirmer’s test (SIT), tear break-up time (TBUT), corneal fluorescein staining (CFS), National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) scores, and adverse events (AEs) were compared between the two groups.

RESULTS

The observation group exhibited significantly elevated serum levels of IL-1β, IL-6, and TNF-α in comparison to the healthy group. Following treatment, the study group demonstrated substantial reductions in IL-1β, IL-6, and TNF-α levels relative to the control group. Moreover, after treatment, the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group. Additionally, significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia, foreign body sensation, fatigue, red eye, and burning sensation within the study group. Furthermore, post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group (P < 0.05). It is noteworthy that significant AEs were reported in both groups throughout the treatment period.

CONCLUSION

Cyclosporine A combined with artificial tears is effective in treating dry eye, yielding enhanced outcomes by improving SIT and TBUT levels, reducing CFS scores, and ameliorating vision-related quality of life.

Enigmatic thymus: Variations in anatomical localisation of thymic tissue as an easily misdiagnosed congenital anomaly in surgical practice

We point out the issue of differential diagnosis regarding the finding of ectopically localised thymic tissue (a thymic cyst) in the neck. Thymic tissue can be found anywhere along its developmental tract of descent, from the angle of the mandible to the upper mediastinum. Disruption of the thymic descent can result in ectopically/abnormally localised islets of accessory thymic tissue, which may undergo cystic changes, as described in a case report by Sun et al. This anatomical variation of the thymus may be clinically misinterpreted as a neoplasm or other congenital anomalies as a branchial cyst, lymphatic malformation or cystic hygroma. The present editorial focuses on the challenge of establishing a diagnosis of ectopically localised tissue of thymus often presented as a lateral cervical mass, especially in the case of cystic variation/degeneration of this thymic tissue. We summarise hypotheses on the origin of such congenital cervical thymic cysts from the point of view of evolutionary history and embryology. We also discuss lesser-known facts about the anatomy, histopathology and developmental biology of the thymus as one of the most enigmatic organs in the human body.

Laparoscopy combined with hysteroscopy in the treatment of Robert’s uterus accompanied by adenomyosis: A case report

BACKGROUND

Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.

CASE SUMMARY

We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy. Unlike the existing cases reported in the literature, this patient had a late onset of Robert’s uterus symptoms. Due to right tubal ectopic pregnancy 3 years previously, the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain. She was examined and treated by laparoscopy and hysteroscopy, and is completely asymptomatic at 5-year follow-up.

CONCLUSION

The typical obstructive Mullerian abnormality requires further surgery. Combined laparoscopy and hysteroscopy is an effective, minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.

Analysis of causes for revision in unicompartmental knee arthroplasty

The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty (UKA) in their patients. These factors include substandard suturing of the wound, the presence of osteophytes and intra-articular loose bodies causing impingement, premature loosening of the tibial component, choosing unsuitable patients for the procedure, dislocation of the movable insert, and damage to the anterior cruciate ligament and medial collateral ligament. The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.

Enhanced recovery after surgery: Progress in adapted pathways for implementation in standard and emerging surgical settings

The concept of enhanced recovery after surgery (ERAS) has been practiced for decades and has been implemented in numerous surgical specialties. ERAS is a global surgical quality improvement initiative, and it is an element in the field of perioperative care. ERAS had shown significant clinical outcomes, patient-reported satisfaction, and improvements in medical service cost. ERAS has been developed for specific surgical procedures, but with the fast progress of newly introduced surgical procedures, the original ERAS have been developed and modified. Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status, including but not limited to pediatric surgery, laparoscopic and robotic assisted surgery, bariatric surgery, thoracic surgery, and renal transplantation. The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative, operative, and post-operative pathways. ERAS costs are higher than traditional care, but the patient’s clinical outcome and satisfaction are higher. ERAS is in progress in the fields of anesthetic tasks, pediatric surgery, and organ transplantation. Although ERAS has shown significant clinical outcomes, there are needs to modify the protocol for specific cases, hospital facilities, resources, and nurses training on elements of ERAS. Several challenges and limitations exist in the implementation of ERAS that deserve consideration, it includes: Frailty, maximizing nutrition, prehabilitation, treating preoperative anemia, and enhancing ERAS adoption globally are all included.

Prognostic significance of oligodendrocyte transcription factor 2 expression in glioma patients: A systematic review and meta-analysis

BACKGROUND

Gliomas are the most common primary central nervous system neoplasm. Despite recent advances in the diagnosis and treatment of gliomas, patient prognosis remains dismal. Therefore, it is imperative to identify novel diagnostic biomarkers and therapeutic targets of glioma to effectively improve treatment outcomes.

AIM

To investigate the association between oligodendrocyte transcription factor 2 (Olig2) expression and the outcomes of glioma patients.

METHODS

The PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure databases were searched for studies (published up to October 2023) that investigated the relationship between Olig2 expression and prognosis of glioma patients. The quality of the studies was assessed using the Newcastle Ottawa Scale. Data analyses were performed using Stata Version 12.0 software.

RESULTS

A total of 1205 glioma patients from six studies were included in the meta-analysis. High Olig2 expression was associated with better outcomes in glioma patients [hazard ratio (HR): 0.81; 95% (confidence interval) CI: 0.51-1.27; P = 0.000]. Furthermore, the results of subgroup meta-analysis showed that high expression of Olig2 was associated with poor overall survival in European patients (HR: 1.34; 95%CI: 0.79-2.27) and better prognosis in Asian patients (HR: 0.43; 95%CI: 0.22-0.84). The sensitivity analysis showed that no single study had a significant effect on pooled HR, and there was also no indication of publication bias according to the Egger’s and Begger’s P value test or funnel plot test.

CONCLUSION

High Olig2 expression may have a positive impact on the prognosis of glioma patients, and should be investigated further as a prognostic biomarker and therapeutic target for glioma.

Differential expression of plasma cytokines in sepsis patients and their clinical implications

BACKGROUND

Sepsis, which is characterized by acute systemic inflammation and is associated with high rates of morbidity and mortality, presents a significant challenge in health care. Some scholars have found that the sequential organ failure assessment (SOFA) and quick SOFA scores are not ideal for predicting severe sepsis and mortality. Microbial culture takes a long time (2-3 d) and provides no information for early diagnosis and treatment. Therefore, new diagnostic methods for sepsis need to be explored.

AIM

To assess cytokine levels in the plasma of sepsis patients and identify potential biomarkers for diagnosing sepsis.

METHODS

Ten sepsis patients admitted to the emergency department within 24 h of onset were enrolled as the observation group, whereas ten noninfected patients served as the control group. Of the 10 noninfected patients, 9 hypertension combined with cerebral infarction, 1 patients with vertiginous syndrome. Plasma Cytokines were measured using the Bio-Plex Pro™ Human Chemokine Panel 40-plex. Differentially expressed cytokines in plasma of sepsis and nonsepsis patients were analyzed using Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses.

RESULTS

Interleukin (IL)-16, granulocyte-macrophage granulocyte-macrophage colony-stimulating factor (GM-CSF), CX3CL1, CXCL9, CXCL16, CCL25, and CCL23 plasma levels were significantly increased in sepsis patients. GO analysis revealed that these cytokines were mainly associated with cellular structures such as intermediates, nuclear plaques, adhesion plaques, lateral plasma membranes, and cell matrix junctions. These genes were involved in various molecular functions, such as cytokine activity, receptor ligand activity, and signal receptor activator activity, contributing to various biological functions, such as leukocyte chemotaxis, migration, and chemotaxis. KEGG analysis indicated involvement in cytokine cytokine receptor interactions, chemokine signaling pathways, virus–protein interactions with cytokines and cytokine receptors, and the tumor necrosis factor signaling pathway.

CONCLUSION

Elevated serum levels of IL-16, GM-CSF, CX3CL1, CXCL9, CXCL16, CCL25, and CCL23 in sepsis patients suggest their potential as diagnostic biomarkers for sepsis.

Sinonasal teratocarcinosarcoma involving the nasal cavity, unilateral paranasal sinuses, and intracranial invasion: A case report

BACKGROUND

Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly invasive neoplasm originating from the nasal cavity and sinuses. Typically, it exhibits an invasive behavior towards adjacent structures; however, in exceptional instances, it may infiltrate the intracranial compartment. Due to the tumor's rarity and lack of distinctive features on computed tomography (CT) and magnetic resonance imaging (MRI) images, SNTCS is often misdiagnosed.

CASE SUMMARY

In this study, we present a case of SNTCS in a 56-year-old patient who exhibited unexplained cognitive impairment before admission. CT and MRI scans revealed the presence of a mass in the right nasal cavity, with lesions extending to the right ethmoid sinus and right frontal region. Subsequently, the patient underwent pathological examination for confirmation and received surgical intervention to excise the tumor. The future advancement in our understanding of this disease will significantly contribute to the precise diagnosis and treatment of SNTCS.

CONCLUSION

SNTCS is an exceptionally rare malignant tumor that originates from the nasal cavity and paranasal sinuses, presenting a diagnostic challenge due to its non-specific imaging findings. MRI accurately delineates the location, morphological characteristics, size, internal structure, extent of surrounding involvement, and metabolic information of the lesion. These aspects play a pivotal role in the precise localization and qualitative assessment of SNTCS. Nevertheless, a definitive diagnosis still requires a pathological biopsy.

Parathyroidectomy restored bone mineral density in a neglected femoral neck fracture with renal osteodystrophy: A case report

BACKGROUND

This case report contributes to the medical literature by highlighting the successful management of a neglected femoral neck fracture in a patient with renal osteodystrophy and secondary hyperparathyroidism (SHPTH) who was on dialysis due to end-stage renal disease (ESRD). It underscores the efficacy of parathyroidectomy (PTX) in restoring bone mineral density (BMD) and promoting fracture healing, addressing a significant complication in ESRD patients.

CASE SUMMARY

A 36-year-old female with renal osteodystrophy and on dialysis due to ESRD presented with a history of left patellar tendon rupture and later, a right achilles tendon avulsion fracture. Persistent right hip pain led to the discovery of a neglected right femoral neck fracture, which was initially overlooked due to the patient’s complex medical history. Two months post-achilles tendon repair, the patient underwent PTX to manage the refractory SHPTH. The postoperative course included rehabilitation and weight-bearing exercises. Remarkably, 2 years after osteosynthesis, radiographic assessments indicated a solid union of the periprothesis fracture and significant improvement in BMD, showcasing the efficacy of the treatment approach.

CONCLUSION

PTX, combined with appropriate rehabilitation, is crucial for improving BMD and fracture healing in ESRD patients with SHPTH.

Ventricular system-unrelated cerebellar ependymoma: A case report

BACKGROUND

An ependymoma is a glial tumor that usually occurs in or near the ventricle, close to the ependyma. It rarely occurs exclusively in the brain parenchyma without being associated with the ventricle.

CASE SUMMARY

Here, we report a rare case of a cerebellar ependymoma completely located in the brain parenchyma. A previously healthy 32-year-old female with a 1-month history of dizziness was admitted to our hospital. During hospitalization, magnetic resonance imaging of the brain revealed a space-occupying lesion measuring 57 mm × 41 mm × 51 mm in the right cerebellar hemisphere and inferior cerebellar vermis. The patient underwent surgical resection for the right cerebellar mass. Postoperative pathological examination revealed an ependymoma. At 1 year follow-up, the patient was doing well and showed no recurrence.

CONCLUSION

We conducted a literature review and summarized three theories regarding ependymomas located exclusively in the brain parenchyma, which are key to the diagnosis of intraparenchymal cerebellar ependymomas. Surgery and postoperative radiotherapy are the primary treatment options for ependymomas.

Application of sensory and motor training in AIDET communication mode in patients after knee arthroplasty

BACKGROUND

Patients with knee arthroplasty often have problems such as slow recovery of knee function, which may cause negative emotions and affect their postoperative rehabilitation. The application of sensory and motor training in the Acknowledge, Introduce, Duration, Evaluation, Thank You (AIDET) communication mode in patients after knee arthroplasty can provide reference for the selection of postoperative rehabilitation training measures.

AIM

To explore the sensory and motor training effects in AIDET communication mode on knee function recovery and resilience of patients after knee arthroplasty.

METHODS

One hundred patients who underwent knee arthroplasty at our hospital between January 2022 and January 2024 were randomly divided into two groups. The control group (n = 50) received routine rehabilitation training. In the observation group (n = 50), the AIDET communication mode was used to perform sensory and motor training, in addition to routine rehabilitation training. The rehabilitation training was administered for 8 weeks. After surgery, knee function, balance ability, walking ability, proprioception, and resilience were compared between the two groups.

RESULTS

The New York Hospital for Special Surgery knee scores of the observation group at the time of discharge and 8 weeks after intervention were (65.23 ± 6.84, 84.53 ± 5.27), which was higher than those of the control group (61.03 ± 7.15, 74.92 ± 6.52) (P < 0.05). The balance ability of the observation group at the time of discharge and 8 weeks after the intervention was higher than that of the control group, the time of time up to go test was shorter than that of the control group, and proprioceptive function was higher than that of the control group (P < 0.05). The resilience level in the observation group after the intervention was higher than that in the control group (P < 0.05).

CONCLUSION

Sensory and motor training in AIDET communication mode promotes knee function recovery of patients after knee arthroplasty, improves their limb walking ability and balance function, and increases their resilience level.

Sleep quality in middle-aged and elderly hemodialysis patients: Impact of a structured nursing intervention program

BACKGROUND

Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being. This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middle-aged and elderly hemodialysis patients.

AIM

To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.

METHODS

This cross-sectional study was conducted in a tertiary hospital, the First Affiliated Hospital of Nanchang University, in 2023. This study included 105 middle-aged and elderly hemodialysis patients aged ≥ 45 years who underwent maintenance hemodialysis for at least 3 mo, utilizing the Pittsburgh Sleep Quality Index (PSQI) to identify poor sleepers. Those identified underwent a 12-wk nursing intervention program focusing on education, relaxation techniques, and counseling. Post-intervention, sleep quality was reassessed using the PSQI.

RESULTS

The study found that 68.6% of hemodialysis patients were poor sleepers. Following the 12-wk nursing intervention program, there was a significant decrease in the mean global PSQI score from 8.9 ± 3.2 to 5.1 ± 2.7 (P < 0.001), indicating improved sleep quality. This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.

CONCLUSION

The structured nursing intervention program focusing on sleep hygiene education, relaxation techniques, and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients. The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population. These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.

Solitary fibrous tumor: A case report of this multifaceted tumor

BACKGROUND

Solitary fibrous tumor (SFT) is a remarkably uncommon mesenchymal tumor. STAT6 level and a combination of clinical, pathological, and molecular features are required to arrive at a proper diagnosis.

CASE SUMMARY

In this report, we present an intriguing case involving a 43-year-old woman who initially exhibited symptoms of a bleeding retroperitoneal tumor, initially resembling a gastrointestinal stromal tumor, but later confirmed as an SFT. However, a year later, what was initially believed to be a recurrence of her SFT was instead identified as a desmoid tumor.

CONCLUSION

Distinguishing SFT from other tumors was pivotal. Correcting misdiagnoses of tumor type initially and of recurrence later was necessary for appropriate treatment of the correct desmoid type.

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.

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.

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.