Family history influences the early onset of hepatocellular carcinoma

AIM: To evaluate the relationship between a positive family history of primary liver cancer and hepatocellular carcinoma (HCC) development in Korean HCC patients. METHODS: We studied a total of 2242 patients diagnosed with HCC between January 1990 and July 2008, whose family history of primary liver cancer was clearly described in the medical records.positive family history of HCC and 2077 (92.6%) did not. The male to female ratio was 3.6:1, and the major causes of HCC were chronic hepatitis B virus (HBV) infection in 75.1%, chronic hepatitis C virus infection in 13.2% and alcohol in 3.1%. The median ages at diag- nosis in the positiveand negative-history groups were 52 years (range: 29-79 years) and 57 years (range: 18-89 years), respectively (P < 0.0001). Furthermore, among 1713 HCC patients with HBV infection, the number of patients under 45 years of age out of 136 patients with positive family history was 26 (19.1%), whereas those out of 1577 patients with negative family history was 197 (12.5%), suggesting that a positive family history may be associated with earlier development of HCC in the Korean population (P = 0.0028). CONCLUSION: More intensive surveillance maybe recommended to those with a positive family history of HCC for earlier diagnosis and proper management especially when HBV infection is present.

Epidemiological and clinical characteristics of inflammatory bowel diseases in Cairo,Egypt

AIM: To study the natural history, patterns and clinical characteristics of inflammatory bowel diseases (IBD) in Egypt.

Autopsy results from a COVID-19 patient treated in a tropical area,and a review of the epidemiological history

Since the start of the COVID-19 pandemic,there has been an urgent need to produce accurate and sensitive tests.However,there have been instances where a positive nucleic acid test turns negative after treatment,and then positive again.This case report describes such an instance from the tropical region of Hainan,China.The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020.Symptoms appeared 9 d after arriving in Hainan,and it was confirmed that the nucleic acid test was positive after 4 repeats.Her condition declined rapidly,her heart stopped beating,and she was admitted in a coma to the ICU.After treatment,the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative,and tests on whole blood,anal swabs,and urine were also negative.Later,however,nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive.An autopsy examination was carried out 12h after her death,and multi-organ secretions were extracted for nucleic acid testing.The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus,which was confirmed by the visualization of the coronavirus by electron microscopy.Autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body.Epidemiology indicated that none of the people she came into contact with after arriving in Hainan,including close contacts,were infected.This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period.This case report indicates:(1)The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19,and(2)The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.

The natural history of flail chest injuries

Purpose： Flail chest （FC） injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre （MTC）. Methods： A retrospective cohort analysis has been conducted at an MTC with full trauma service. All patients （age 〉 16 years） sustaining FC were included. Patient demographics, injury characteristics and inpatient stay information were extracted. Results： Two hundred and ninety-three patients were identified, with a mean injury severity score （ISS） of 28.9 （range 9-75）, average age of 56.1 years （range of 16-100）, and a male predominance （78%）. Road traffic accidents accounted for 45% （n = 132） of injuries, whilst 44% were fall or jump from height （n = 129）. Associated lung contusion was present in 133 patients （45%） while 76% of patients were found to have 5 or more ribs involved in the flail segment （n = 223） with 96% （n = 281 ） having a unilateral FC. Inpatient treatment was required 19.9 days （range 0-150 days） with 59% of patients （n = 173） requiring intensive care unit （ICU） level care for 8.4 days （range 1-63） with 61.8% requiring mechanical ventilation （n = 107） for 10.5 days （range 1-54）, and Z8g underwent rib fixation with rib plates （n = 23）. The mortality rate was found to be 14% （n = 42）. A non-significant trend towards improved outcomes in the conservative group was found when compared with the fixation group; ventilation days （6.94 vs 10.06, p = 0.18） intensive treatment unit （ITU） length of stay （LOS） （12.56 vs 15.53, p = 0.28） and hospital LOS （32.62 vs 35.24, p = 0.69）. Conclusion： This study has successfully described the natural history of flail chest injuries, and has found a nonsignificant trend towards better outcomes with conservative management. With the cohort and management challenges now defined, work on outcome improvement can be targeted. In addition the comnarahility of results to other studies makes collaboration with other MTCs a realistic vrovosal.