Pancreatic panniculitis as the first presentation of pancreatic ductaladenocarcinoma

To the Editor:Pancreatic panniculitis,also known as pancreatic fat necrosis or enzymatic panniculitis,is a rare type of panniculitis that occurs in 0.3%−3%of patients with pancreatic disease such as acute or chronic pancreatitis and pancreatic carcinoma,especially acinar cell carcinoma[1,2].The clinical manifestations are nonspecific erythema tender nodules.

Monkeypox presenting as a chancre-like rash:A case report

BACKGROUND Since May 2022,outbreaks of monkeypox have occurred in many countries around the world,and several cases have been reported in China.CASE SUMMARY A 38-year-old man presented with a small,painless,shallow ulcer on the coronary groove for 8 d.One day after the rash appeared,the patient developed inguinal lymphadenopathy with fever.The patient had a history of male-male sexual activity and denied a recent history of travel abroad.Monkeypox virus was detected by quantitative polymerase chain reaction from the rash site and throat swab.Based on the epidemiological history,clinical manifestations and nucleic acid test results,the patient was diagnosed with monkeypox.CONCLUSION Monkeypox is an emerging infectious disease in China.Monkeypox presenting as a chancre-like rash is easily misdiagnosed.Diagnosis can be made based on exposure history,clinical manifestations and nucleic acid test results.

Excisional hemorrhoidal surgery and its effect on anal continence

AIM:To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients.METHODS:Seventy-six consecutive patients(33 men and 43 women) with a mean age of 44 years were included.They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third-and fourth-degree hemorrhoids and failure in conservative treatment for years.Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work.The speed-constant rectal lavage apparatus was prepared in our laboratory.The device could output a pulsed and speed-constant saline stream with a high pressure,which is capable of overcoming any rectal resistance change.The patients were divided into three groups,group A(< 900 mL),group B(900-1200 mL) and group C(> 1200 mL) according to the results of the preoperative liquid continence test.RESULTS:All the patients completed the study.The average number of hemorrhoidal masses excised was 2.4.Most patients presented with hemorrhoidal symptoms for more than one year,including a mean duration of incontinence of 5.2 years.The most common symptoms before surgery were anal bleeding(n = 55),prolapsed lesion(n = 34),anal pain(n = 12) and constipation(n = 17).There were grade Ⅲ hemorrhoids in 39(51.3%) patients,and grade Ⅳ in 37(48.7%) patients according to Goligher classification.Five patients had experienced hemorrhoid surgery at least once.Compared with postoperative results,the retained volume in the preoperative liquid continence test was higher in 40 patients,lower in 27 patients,and similar in the other 9 patients.The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL,and postoperative volume was slightly decreased(991.27 ± 42.77 mL),but there was no significant difference(P = 0.057).Difference was significant in the test value before and after hemorrhoidectomy in group A(858.24 ± 32.01 mL vs 574.18 ± 60.28 mL,P = 0.011),but no obvious difference was noted in group B or group C.There was no significant difference in Wexner score before and after operation(1.68 ± 0.13 vs 2.10 ± 0.17,P = 0.064).By further stratified analysis,there was significant difference before and 2 months after operation in group A(2.71 ± 0.30 vs 3.58 ± 0.40,P = 0.003).In contrast,there were no significant differences in group B or group C(1.89 ± 0.15 vs 2.11 ± 0.19,P = 0.179;0.98 ± 0.11 vs 1.34 ± 0.19,P = 0.123).CONCLUSION:There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy.However,patients with preoperative compromised continence may have further deterioration of their continence,hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients.

RBBP4 promotes colon cancer malignant progression via regulating Wnt/β-catenin pathway

BACKGROUND Our previous study demonstrated that RBBP4 was upregulated in colon cancer and correlated with poor prognosis of colon cancer and hepatic metastasis.However,the potential biological function of RBBP4 in colon cancer is still unknown.AIM To investigate the biological role and the potential mechanisms of RBBP4 in colon cancer progression.METHODS Real-time polymerase chain reaction and western blot analysis were used to detect the expression of RBBP4 in colon cancer cell lines.The cell proliferation and viability of SW620 and HCT116 cells with RBBP4 knockdown was detected by Cell Counting Kit-8 and 5-ethynyl-2’-deoxyuridine staining.The transwell assay was used to detect the invasion and migration capabilities of colon cancer cells with RBBP4 knockdown.Flow cytometry apoptosis assay was used to detect the apoptosis of colon cancer cells.Western blotting analysis was used to detect the expression of epithelial-mesenchymal transition and apoptosis related markers in colon cancer.The nuclear translocation ofβ-catenin was examined by Western blotting analysis in colon cancer cells with RBBP4 knockdown.The TOPFlash luciferase assay was used to detect the effect of RBBP4 on Wnt/β-catenin activation.The rescue experiments were performed in colon cancer cells treated with Wnt/β-catenin activator LiCl and RBBP4 knockdown.RESULTS We found that RBBP4 was highly expressed in colon cancer cell lines.The 5-ethynyl-2’-deoxyuridine assay showed that knockdown of RBBP4 significantly inhibited cell proliferation.RBBP4 inhibition reduced cell invasion and migration via regulating proteins related to epithelial-mesenchymal transition.Knockdown of RBBP4 significantly inhibited survivin-mediated apoptosis.Mechanistically,the TOPFlash assay showed that RBBP4 knockdown increased activity of the Wnt/β-catenin pathway.Meanwhile,RBBP4 knockdown suppressed nuclear translocation ofβ-catenin.With Wnt/β-catenin activator,rescue experiments suggested that the role of RBBP4 in colon cancer progression was dependent on Wnt/β-catenin pathway.CONCLUSION RBBP4 promotes colon cancer development via increasing activity of the Wnt/β-catenin pathway.RBBP4 may serve as a novel therapeutic target in colon cancer.

Enterostomy can decrease the mortality of patients with Fournier gangrene

AIM:To determine the significance of enterostomy in the emergency management of Fournier gangrene.METHODS:The clinical data of 51 patients(49 men and 2 women)with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed.The patients were divided into two groups according the surgical technique performed:enterostomy combined with debridement(the enterostomy group,n=28)or debridement alone(the control group,n=23).Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery,as well as administration of broad-spectrum antibiotics.The clinical data and outcomes in both groups were analyzed.RESULTS:The surgical procedures were successful in both patient groups.In the enterostomy group,10 (35.8%)patients required skin grafting with a total of six debridement procedures.While in the control group,six(26.1%)patients required four debridement procedures.However,this difference was not statistically significant.Following surgery,the time to normal body temperature(6 d vs 8 d,P<0.05)and average length of hospital stay(14.3±7.8 d vs 20.1±8.9 d,P<0.05)were shorter in the enterostomy group.The case fatality rate was lower in the enterostomy group than that in the control group(3.6%vs 21.7%,P<0.05).CONCLUSION:Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.

Glucagonoma syndrome with necrolytic migratory erythema as initial manifestation

To the Editor:Necrolytic migratory erythema(NME)is a group of cutaneous lesions characterized by periodic episodes of annular or figurative dark red plaques,which are typically accompanied by blisters,erosions,and crusting.It is often associated with glucagonoma.Glucagonoma is an extremely rare neuroendocrine tumor that arises from pancreatic isletαcells and manifests as elevated glucagon,with an incidence of about 1 in 20 million per year[1,2].

Correlation between invasive microbiota in margin-surrounding mucosa and anastomotic healing in patients with colorectal cancer

BACKGROUND Impaired anastomotic healing is one of the major complications resulting from radical resection in colorectal cancer(CRC).Accumulating evidence suggests that intestinal microbiota is correlated with anastomotic healing.AIM To explore the microbiota structural shift in margin-surrounding mucosa and evaluate the predictive ability of selected bacterial taxa for impaired anastomotic healing.METHODS Margin-surrounding mucosa samples derived from 37 patients were collected to characterize the microbial community structure by 16 s r RNA gene sequencing.The patients were divided into two groups according to the healing status of anastomoses:well-healing group(n=30)and impaired-healing group(n=7).Statistic differences in bacteria taxa were compared by Wilcoxon test and chisquared test.The predictive ability of the selected bacterial taxa for the healing status of anastomoses was evaluated by the area under the receiver operator characteristic curve.RESULTS Community structure shifts were observed in the impaired-healing group andwell-healing group.Six bacterial species were found to be significantly correlated with anastomotic healing,and among these species,Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis were considered as the predictive factors.Taking the known risk factor age into consideration,Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis improved predictive ability for the healing status of anastomoses.CONCLUSION These data show that Alistipes shahii,Dialister pneumosintes,and Corynebacterium suicordis could be considered as supplementary factors in the prediction of anastomosis healing status in patients after CRC radical resection.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome(AIDS) complicated with drug-induced erythroderma.METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis(SCORTEN) scores, and disease outcome spectrums were analyzed.RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin(IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis

BACKGROUND: To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis(CRP) under direct vision of electronic colonoscope.METHODS: The clinical data of 13 CRP patients complicated with ≥ grade Ⅱ bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope,4% formaldehyde combined with 5-aminosalicylic acid(5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment,and the therapeutic effectiveness was observed and analyzed.RESULTS: The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1-and 2-month follow-up period.CONCLUSION: Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple,effective,affordable,and repeatable technique without obvious complications,which deserves further exploration and promotion.

Safety and efficacy of omalizumab for antihistamine-resistant chronic urticaria in children:a case series and literature review

Chronic urticaria(CU)is a common skin disease characterized by the occurrence of wheals,with or without angioedema,lasting more than 6 weeks.The prevalence of CU is about 0.7%[1],but higher in children,with an incidence of 1.38%[1].The occurrence of severe pruritus and unpredictable wheals may severely impact patients'quality of life,cause psychological problems,including sleep disorders and depression,and lead to economic burden due to limitation on daily life and work[2,3].