Physician-dependent diagnosis delay in Crohn's disease:A pseudoproposition or not?

The challenge of diagnosis delay in inflammatory bowel disease(IBD)has emerged as a significant concern for both patients and healthcare professionals.The widely accepted notion that there is an extended time frame from the onset of symptoms to the definitive diagnosis is often attributed to the heterogeneity of IBD and the non-specificity of clinical manifestations.Specific to patients with Crohn’s disease,the issue of delayed diagnosis appears to be more pronounced across different regions globally.The intricate interplay of real-world factors has led to debates regarding the primary contributors to these diagnostic delays.Drawing a comparison solely between patients and physicians and implicating the latter as the predominant influence factor may fall into a simplistic either-or logical trap that may obscure the truth.This letter,grounded in published evidence,explores areas for improvement in a forthcoming paper within the field,hoping to pinpoint the culprit behind the diagnosis delay issue for IBD patients rather than simply attributing it to so-called“physician-dependent factors”.Our objective is to motivate healthcare providers and policymakers in relevant fields to reflect on strategies for addressing this problem to reduce diagnostic delays and enhance patient outcomes.

Early diagnosis of esophageal cancer:How to put“early detection”into effect?

This editorial comments on the article by Qu et al in a recent edition of World Journal of Gastrointestinal Oncology,focusing on the importance of early diagnosis in managing esophageal cancer and strategies for achieving“early detection”.The five-year age-standardized net survival for esophageal cancer patients falls short of expectations.Early detection and accurate diagnosis are critical strategies for improving the treatment outcomes of esophageal cancer.While advancements in endoscopic technology have been significant,there seems to be an excessive emphasis on the latest high-end endoscopic devices and various endoscopic resection techniques.Therefore,it is imperative to redirect focus towards proactive early detection strategies for esophageal cancer,investigate the most cost-effective screening methods suitable for different regions,and persistently explore practical solutions to improve the five-year survival rate of patients with esophageal cancer.

Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Flexner's legacy and the future of medical education:Embracing challenge and opportunity

This editorial comments on the article by Alzerwi.We focus on the development course,present challenges,and future perspectives of medical education.Modern medical education is gradually undergoing significant and profound changes worldwide.The emergence of new ideas,methodologies,and techniques has created opportunities for medical education developments and brought new concerns and challenges,ultimately promoting virtuous progress in medical education reform.The sustainable development of medical education needs joint efforts and support from governments,medical colleges,hospitals,researchers,administrators,and educators.

Post competency training in standardized training of resident physicians and integrated postgraduates

We focus on the importance and necessity of post-competency-based training in medical education alongside its current challenges and opportunities.Integrating post competency training into standardized educational frameworks is increasingly recognized as a critical component of preparing residents and postgraduates for real-world clinical practice.Post competency training represents a commitment to excellence in medical education,striving to produce competent,skilled practitioners to meet the challenges of modern healthcare.

Optimal traditional Chinese medicine formulas in treating ulcerative colitis:Choose one or take it all?

Ulcerative colitis(UC)is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity,especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease.Traditional Chinese medicine(TCM)has emerged as a promising complementary therapy for UC.Based on the latest research,our editorial explored the current issues and potential essential research directions for TCM in treating UC.We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

Mindfulness and mindful parenting:Strategies for preschoolers with behavioral issues

The behavior issues of preschoolers are closely related to their parents'parenting styles.This editorial discusses the value and strategies for solving behavior issues in preschoolers from the perspectives of mindfulness and mindful parenting.We expect that upcoming studies will place greater emphasis on the behavioral concerns of preschoolers and the parenting practices that shape them,particularly focusing on proactive interventions for preschoolers'behavioral issues.

Multimodal emotion recognition in the metaverse era:New needs and transformation in mental health work

This editorial comments on an article recently published by López del Hoyo et al.The metaverse,hailed as"the successor to the mobile Internet",is undoubtedly one of the most fashionable terms in recent years.Although metaverse development is a complex and multifaceted evolutionary process influenced by many factors,it is almost certain that it will significantly impact our lives,including mental health services.Like any other technological advancements,the metaverse era presents a double-edged sword for mental health work,which must clearly understand the needs and transformations of its target audience.In this editorial,our primary focus is to contemplate potential new needs and transformation in mental health work during the metaverse era from the pers-pective of multimodal emotion recognition.

Safety and efficacy of modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension

BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas

BACKGROUND Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery.Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples.AIM To investigate the correlations among mindfulness,marital quality,anxiety,and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas.METHODS A cross-sectional study was conducted.The self-administered questionnaire was submitted online through smartphones.The levels of mindfulness,anxiety,depression,and marital quality were respectively investigated by the mindful attention awareness scale(MAAS),the self-rating anxiety scale(SAS),the selfrating depression scale(SDS),and the marriage perception scale(MPS)in these enrolled Han and Tujia primiparas.RESULTS No statistical significance was observed in the prevalence of postpartum anxiety and depression,nor scores of MAAS and MPS-Total in different regions or ethnicities(P>0.05).However,MPSMarital interaction(P<0.05),MPS-Family relationship(MPS-FR)(P<0.01),and MPS-Marital conflict(MPS-MC)(P<0.01)scores of urban primiparas were higher than those of rural primiparas.The MPS-MC score of Han primiparas was higher than that of Tujia primiparas(P<0.05).Negative correlations were observed between MAAS and SAS(r=-0.457,P<0.01),and MAAS and SDS(r=-0.439,P<0.01).SAS has revealed a highly positive correlation with SDS(r=0.720,P<0.01)and a weak negative correlation with MPS(r=-0.200,P<0.05).Besides,a weak negative correlation was observed between MAAS and MPS-MC(r=-0.184,P<0.05),and a weak positive correlation was noticed between SAS and MPS-MC(r=-0.225,P<0.01).Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety(P<0.05,95%CI:-0.384 to 0.033),MPS-MC and postpartum anxiety(P<0.01,95%CI:0.027-0.193),MPS-FR and postpartum depression(P<0.05,95%CI:-0.365 to 0.031),and MPS-MC and postpartum depression(P<0.01,95%CI:0.022-0.206).CONCLUSION Mindfulness demonstrates negative correlations with marital conflict,postpartum anxiety and depression,and it may have cross-ethnic and trans-regional characteristics.Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study,it demonstrates a full mediation effect on the relationships between family relationships,marital conflict,and postpartum anxiety and depression.

Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis:Progress and challenges

Infected necrotizing pancreatitis(INP)represents a severe condition in patients with acute pancreatitis.Invasive interventions are recommended in symptomatic INP.Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures.However,there is still no standardized protocol for endoscopic interventions.Recently,various studies have been published about the endoscopic management of INP.This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.

Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension:A case report

BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-butyl-2-cyanoacrylate(NBC)has been widely used in the endoscopic hemostasis of portal hypertension,but adverse events including renal or pulmonary thromboembolism,mucosal necrosis and gastrointestinal(GI)bleeding may occur after treatment.Herein,we report successfully managing gastric variceal(GV)hemorrhage secondary to LSPH using modified endoscopic ultrasound(EUS)-guided selective NBC injections.CASE SUMMARY A 35-year-old man was referred to our hospital due to an upper GI hemorrhage.Gastroscopy revealed GV hemorrhage and computed tomography venography(CTV)confirmed LSPH.The patient requested endoscopic procedures and rejected surgical therapies including splenectomy.EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose.The“sandwich”method using undiluted NBC and hypertonic glucose was applied.No complications occurred.The patient was followed up regularly after discharge.Three months later,the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH.No recurrent GI hemorrhage was reported during this follow-up period.CONCLUSION EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.

Endoscopic ultrasound-guided diagnosis and treatment of gastric varices

Gastric varices(GV)represent a common and severe complication in patients with portal hypertension,commonly seen in patients with cirrhosis and severe pancreatic disease.Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa,portal vein and its tributaries,and collateral circulations during direct endoscopic observation.Recently,various studies have been published about endoscopic ultrasound(EUS)-guided management of GV,mainly including diagnosis,treatment,and prognostic analysis.This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.

Simultaneous multiple primary malignancies diagnosed by endoscopic ultrasound-guided fine-needle aspiration:A case report

BACKGROUND Multiple primary malignancies(MPMs)refer to more than one primary malignancy in the same or separate organs of the same patient,and MPMs are considered when different histological characteristics are detected in epidemiological studies.Herein,we report a case presumed to be primary pancreatic cancer with multiple liver metastases by positron-emission tomography/computed tomography(PET/CT)and confirmed to be synchronous liver and pancreatic MPMs by endoscopic ultrasound-guided fine-needle aspiration(EUSFNA).CASE SUMMARY A 50-year-old man was referred to our hospital due to abdominal discomfort for 2 mo.Abdominal CT at a local hospital revealed a pancreatic mass with multiple liver nodules.After being transferred to our hospital,PET/CT confirmed all these lesions to have elevated metabolic activity,and therefore primary pancreatic cancer with multiple liver metastases was considered.EUS-guided liver aspiration unexpectedly found signet-ring cells with a high Ki-67 positive rate(20%),while EUS-guided pancreatic aspiration detected pancreatic neuroendocrine cells with a relatively low Ki-67 positive rate(1%).The final diagnosis from the multidisciplinary team was simultaneous liver and pancreatic MPMs.The patient returned to his local hospital for neoadjuvant chemotherapy and surgery,and he is still alive during the 6-mo postoperative follow-up.CONCLUSION Although rare,MPMs should be considered when treating pancreatic mass with suspected metastatic lesions,and EUS-FNA has proved minimally invasive and accurate.

The Effect of Blending Ratio on the Structure and Properties of the PPR/PS In situ Fiber Reinforced System Prepared by Multi-Flow Vibration Injection Molding

To enhance the mechanical properties of polypropylene random copolymer(PPR),polystyrene(PS)with four different contents were added to the PPR matrix through melt blending.Subsequently,using the Multi-Flow Vibration Injection Molding(MFVIM)technology,PPR/PS in situ microfiber composites(MFC)with different blending ratios were prepared.The results indicated that blending ratio had a great impact on the phase morphology and crystal structure of MFVIM samples,which was different from those of conventional injection molding(CIM)samples.PS ultrafine fibers could be formed under the shear field and could absorb the PPR molecular chains to form hybrid shish-kebab structures.Meanwhile,the PPR matrix could also form shish-kebab structures under the effect of strong shear.When the PS content reached 20%,under the combined action of PS in situ microfibers and highly oriented crystal structure,the tensile strength and Young’s modulus of the sample were obviously improved and the impact strength remained at a relatively high level.So a strong and tough balanced PPR based material was obtained.These results provide valuable insights for expanding the industrial and daily-life applications of PPR and show promising development prospects.