Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Clinical application value of long non-coding RNAs signatures of genomic instability in predicting prognosis of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)presents challenges due to its high recurrence and metastasis rates and poor prognosis.While current clinical diagnostic and prognostic indicators exist,their accuracy remains imperfect due to their biol-ogical complexity.Therefore,there is a quest to identify improved biomarkers for HCC diagnosis and prognosis.By combining long non-coding RNA(lncRNA)expression and somatic mutations,Duan et al identified five representative lncRNAs from 88 lncRNAs related to genomic instability(GI),forming a GI-derived lncRNA signature(LncSig).This signature outperforms previously re-ported LncSig and TP53 mutations in predicting HCC prognosis.In this editorial,we comprehensively evaluate the clinical application value of such prognostic evaluation model based on sequencing technology in terms of cost,time,and practicability.Additionally,we provide an overview of various prognostic models for HCC,aiding in a comprehensive understanding of research progress in pro-gnostic evaluation methods.

Ganoderma lucidum:a comprehensive review of phytochemistry,efficacy,safety and clinical study

Ganoderma lucidum,one of the most well-known edible fungi,is believed to be very beneficial for longevity and vitality.A long usage history suggests that G.lucidum has various clinical therapeutic effects.And experimental studies have confirmed that G.lucidum has multiple pharmacological effects,including antitumor,anti-microbial,anti-HIV protease,and antidiabetic activity and so on.With the deepening of research,more than 300 compounds have been isolated from G.lucidum.There is an increasing population of G.lucidum-based products,and its international development is expanding.Currently,G.lucidum has drawn much attention to its chemical composition,therapeutic effect,clinical value,and safety.This paper provides a comprehensive review of these aspects to enhance the global promotion of G.lucidum.

Compare clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Meta-analysis

BACKGROUND To compare the efficacy and safety of total neoadjuvant therapy(TNT)and neoadjuvant chemoradiotherapy(nCRT)in the treatment of middle and low locally advanced rectal cancer.Our study will systematically collect and integrate studies to evaluate the ability of these two treatments to improve tumor shrinkage rates,surgical resection rates,tumor-free survival,and severe adverse events.AIM To provide clinicians and patients with more reliable treatment options to optimize treatment outcomes and quality of life for patients with locally advanced rectal cancer by comparing the advantages and disadvantages of the two treatment options.METHODS A full search of all clinical studies on the effectiveness and safety of TNT and nCRT for treating locally advanced rectal cancer identified in Chinese(CNKI,Wanfang,China Biomedical Literature Database)and English(PubMed,Embase)databases was performed.Two system assessors independently screened the studies according to the inclusion and exclusion criteria.Quality evaluation and RESULTS Finally,14 studies were included,six of which were randomized controlled studies.A total of 3797 patients were included,including 1865 in the TNT group and 1932 in the nCRT group.The two sets of baseline data were comparable.The results of the meta-analysis showed that the pCR rate[odds ratio(OR)=1.57,95%confidence interval(CI):1.30-1.90,P<0.00001],T stage degradation rate(OR=2.16,95%CI:1.63-2.57,P<0.00001),and R0 resection rate(OR=1.42,95%CI:1.09-1.85,P=0.009)were significantly greater in the nCRT group than in the nCRT group.There was no significant difference in the incidence of grade 3/4 acute toxicity or perioperative complications between the two groups.The 5-year OS[hazard ratio(HR)=0.84,95%CI:0.69-1.02,P=0.08]and DFS(HR=0.94,95%CI:0.03-1.39,P=0.74)of the TNT group were similar to those of the nCRT group.CONCLUSION TNT has greater clinical efficacy and safety than nCRT in the treatment of locally advanced rectal cancer.

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.

Exploration of Therapeutic Measures and Clinical Efficacy for Recurrent Respiratory Infections in Children

Objective:To explore the treatment strategies and clinical effects for recurrent respiratory infections in children.Methods:From May 2022 to May 2024,100 pediatric patients with recurrent respiratory infections were selected in this study and evenly divided into two groups.The control group(50 patients)was treated with conventional therapy supplemented with budesonide,while the observation group(50 patients)received pidotimod treatment in addition to the control group’s treatment.Subsequently,the duration of clinical symptom improvement,respiratory function enhancement,serological index changes,reinfection status,and parental satisfaction were compared between the two groups.Results:In terms of clinical symptoms,the observation group showed significantly shorter durations of fever reduction,cough relief,tonsil swelling reduction,and disappearance of fine wet rales compared to the control group(average reduction times were 1.6 days,2.3 days,2.1 days,and 1.9 days,respectively,P<0.05).Regarding respiratory function,the observation group experienced a 12%increase in peak expiratory flow rate variability,a 0.6-liter increase in lung capacity,a 0.7-liter increase in forced lung capacity,and a 0.5-liter increase in forced expiratory volume in the first second after treatment,all significantly higher than the control group(P<0.05).Serological testing revealed that interferon-γand interleukin-2 levels increased by 15%and 18%,respectively,while interferon-α,interleukin-5,and interleukin-4 levels decreased by 10%,12%,and 9%,respectively,in the observation group,showing significant differences compared to the control group(P<0.05).Additionally,the reinfection rate in the observation group(10%)was significantly lower than that in the control group(30%),with an average reduction of two reinfections within one year and a 3.2-day shorter infection control time(P<0.05).In terms of parental satisfaction,the observation group achieved 95%,significantly higher than the 70%in the control group(P<0.05).Conclusion:The addition of pidotimod to conventional therapy for pediatric patients with recurrent respiratory infections can significantly alleviate clinical symptoms,promote the recovery of respiratory function,regulate serological indicators,effectively reduce the risk of reinfection,and improve parental satisfaction.This method deserves widespread clinical application.

Clinical Efficacy of Metoprolol Succinate Extended-Release Tablets in the Treatment of Post-Myocardial Infarction Ventricular Arrhythmias

Objective:To investigate the clinical efficacy of metoprolol succinate extended-release tablets in the treatment of post-myocardial infarction ventricular arrhythmias.Methods:The clinical data of 84 patients with post-myocardial infarction ventricular arrhythmia included in the study were collected and they were divided into Groups A and B with 42 cases each using the randomization method.Group A was treated with oral glucosamine hydrochloride,while Group B was administered oral metoprolol succinate extended-release tablets.Combined indicators were used to evaluate the improvement of clinical indicators,therapeutic effects,and the incidence of adverse reactions in the two groups.Results:The baseline data of the two groups of patients were not statistically significant(Pall>0.05);after treatment,the QT dispersion,corrected QT dispersion,and heart rate of Group B were lower than that of Group A(Pall=0.000<0.001);the 2 total clinical effectiveness of Group B was 95.24%,which was significantly higher than 80.95%in Group A(χ=4.087,P=0.043<0.05);the total incidence of adverse reactions in Group B was 4.76%,which was significantly lower than 219.04%in Group A(χ=4.087,P=0.043<0.05).Conclusion:In the treatment of post-myocardial infarction ventricular arrhythmia,the use of metoprolol succinate extended-release tablets can effectively correct the QT dispersion of patients,improve their heart rate,increase clinical effectiveness,and reduce the incidence of adverse reactions.

Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

BACKGROUND Acute appendicitis(AA)is the most common cause of acute abdomen in children.Anesthesia significantly influences the surgical treatment of AA in children,making the scientific and effective selection of anesthetics crucial.AIM To assess the clinical effect of atropine(ATR)in combination with remifentanil(REMI)in children undergoing surgery for AA.METHODS In total,108 cases of pediatric AA treated between May 2020 and May 2023 were selected,58 of which received ATR+REMI[research group(RG)]and 50 who received REMI[control group(CG)].Comparative analyses were conducted on the time to loss of eyelash reflex,pain resolution time,recovery time from anesthesia,incidence of adverse events(AEs;respiratory depression,hypoxemia,bradycardia,nausea and vomiting,and hypotension),intraoperative responses(head shaking,limb activity,orientation recovery,safe departure time from the operating room),hemodynamic parameters[oxygen saturation(SPO2),mean arterial pressure,heart rate,and respiratory rate],postoperative sedation score(Ramsay score),and pain level[the Face,Legs,Activity,Cry,Consolability(FLACC)Behavioral Scale].RESULTS Compared with the CG,the RG showed significantly shorter time to loss of eyelash reflex,pain resolution,recovery from anesthesia,and safe departure from the operating room.Furthermore,the incidence rates of overall AEs(head shaking,limb activity,etc.)were lower,and influences on intraoperative hemodynamic parameters and stress response indexes were fewer.The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.CONCLUSION ATR+REMI is superior to REMI alone in children undergoing AA surgery,with a lower incidence of AEs,fewer influences on hemodynamics and stress responses,and better post-anesthesia recovery.

Analysis of the value and safety of thyroid-stimulating hormone in the clinical efficacy of patients with thyroid cancer

BACKGROUND Thyroid cancer(TC)is a common malignant tumor in the endocrine system.In recent years,the incidence and recurrence rates of TC have been raising due to increasing work pressure and irregular lifestyles.Thyroid-stimulating hormone(TSH)is a specific parameter for thyroid function screening.This study aims to explore the clinical value of TSH in regulating the progression of TC,so as to find a breakthrough for the early diagnosis and treatment of TC.AIM To explore the value and safety of TSH in the clinical efficacy of patients with TC.METHODS 75 patients with TC admitted to the Department of Thyroid and Breast Surgery of our hospital from September 2019 to September 2021 were selected as the observation group,and 50 healthy subjects were selected as the control group during the same period.The control group was treated with conventional thyroid replacement therapy,and the observation group was treated with TSH suppression therapy.The soluble interleukin(IL)-2 receptor(sIL-2R),IL-17,IL-35levels,free triiodothyronine(FT3),free tetraiodothyronine(FT4),CD3+,CD4+,CD8+,CD44V6,and tumor supplied group of factor(TSGF)levels were observed in the two groups.The occurrence of adverse reactions was compared between the two groups.RESULTS After treatment with different therapies,the levels of FT3,FT4,CD3+,and CD4+in the observation group and the control group were higher than those before treatment,while the levels of CD8+,CD44V6,and TSGF were lower than those before treatment,and the differences were statistically significant(P<0.05).More importantly,the levels of sIL-2R and IL-17 in the observation group were lower than those in the control group after 4 wk of treatment,while the levels of IL-35 were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of FT3,FT4,CD3+,and CD4+in the observation group were higher than those in the control group,and the levels of CD8+,CD44V6,and TSGF were lower than those in the control group.There was no significant difference in the overall incidence rate of adverse reactions between the two groups(P>0.05).CONCLUSION TSH suppression therapy can improve the immune function of patients with TC,lower the CD44V6 and TSGF levels,and improve serum FT3 and FT4 levels.It demonstrated excellent clinical efficacy and a good safety profile.

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra-and extrahepatic bile duct stones

BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Clinical Observation on the Treatment of Diabetic Kidney Disease with Damp-heat Stasis Syndrome in Clinical Proteinuria Stage by Kunkui Kidney Preserving Paste

[Objectives]To evaluate the clinical efficacy and safety of Kunkui Kidney Preserving Paste in the treatment of diabetic kidney disease(DKD)patients with damp-heat stasis syndrome in the clinical proteinuria stage.[Methods]Retrospective analysis was made on 30 patients with DKD who were diagnosed with damp-heat stasis syndrome in the clinical proteinuria stage from March 2021 to March 2023 in Jiangsu Province Hospital of Chinese Medicine,and who took Kunkui Kidney Preserving Paste continuously for six months.The urinary albumin/creatinine ratio(UACR),urinary complement C3,and urea nitrogen(BUN)of DKD patients before and after treatment were compared,and estimated glomerular filtration rate(eGFR),blood creatinine(Scr),and cystatin C(CysC)were estimated,and the therapeutic effects on renal function and urinary protein were evaluated.[Results]After treatment,UACR significantly decreased(P<0.01),and urinary complement C3 and Scr decreased(P<0.05),while other indicators showed no significant statistical difference(P>0.05).In terms of evaluating the efficacy of urinary protein therapy,8 cases showed recent relief;8 cases showed significant effect;9 cases were effective,and 5 cases were invalid after treatment,with a total effective rate of 83.33%.In terms of renal function efficacy evaluation,8 cases showed significant effect;4 cases were effective;11 cases were stable,and 7 cases were invalid,with a total effective rate of 76.67%.In the safety evaluation,there were no obvious adverse reactions.[Conclusions]The Kunkui Kidney Preserving Past has significant clinical efficacy and safety in treating DKD patients with damp-heat stasis syndrome in the clinical proteinuria period.It has significant advantages in reducing urinary protein and protecting renal function,which is worthy of clinical promotion.

Alzheimer's disease with depressive symptoms: Clinical effect of intermittent theta burst stimulation repetitive transcranial magnetic stimulation

BACKGROUND Alzheimer's disease(AD),characterized by the ongoing deterioration of neural function,often presents alongside depressive features and greatly affects the quality of life of individuals living with the condition.Although several treatment methods exist,their efficacy is limited.In recent years,repetitive transcranial magnetic stimulation(rTMS)utilizing the theta burst stimulation(TBS)mode,specifically the intermittent TBS(iTBS),has demonstrated promising therapeutic potential in the management of neuropsychiatric disorders.AIM To examine the therapeutic efficacy of iTBS mode of rTMS for treating depressive symptoms in patients with AD.METHODS This retrospective study enrolled 105 individuals diagnosed with AD with depressive symptoms at Huzhou Third Municipal Hospital,affiliated with Huzhou University,between January 2020 and December 2023.Participants received standard pharmacological interventions and were categorized into control(n=53)and observation(n=52)groups based on treatment protocols.The observation group received iTBS mode of rTMS,while the control group received pseudo-stimulation.A comparative analysis evaluated psychological well-being,adverse events,and therapeutic at initiation of hospitalization(T0)and 15 days post-treatment(T1).RESULTS At T1,both groups exhibited a marked reduction in self-rating depression scale and Hamilton depression scale scores compared to T0.Furthermore,the observa-tion group showed a more pronounced decrease than the control group.By T1,the Mini-mental state examination scores for both groups had increased markedly from their initial T0 assessments.Importantly,the increase was particularly more substantial in the observation group than in the control group.Fourteen patients in the control group had ineffective treatment effects,while five patients in the observation group experienced the same.Additionally,the observation group experienced a substantially reduced incidence of ineffective treatment as compared to the control group(both P<0.05);there were no recorded serious adverse events in either group.CONCLUSION The iTBS model of rTMS effectively treated AD with depression,improving depressive symptoms and cognitive function in patients without serious adverse reactions,warranting clinical consideration.

Clinical Observation of the Hot and Humid Compress Therapy of Traditional Chinese Medicine in the Treatment of Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation

Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.

Challenges related to clinical decision-making in hepatocellular carcinoma recurrence post-liver transplantation: Is there a hope?

Hepatocellular carcinoma(HCC)is a common liver malignancy and represents a serious cause of cancer-related mortality and morbidity.One of the favourable curative surgical therapeutic options for HCC is liver transplantation(LT)in selected patients fulfilling the known standard Milan/University of California San Francisco criteria which have shown better outcomes and longer-term survival.Despite careful adherence to the strict HCC selection criteria for LT in different transplant centres,the recurrence rate still occurs which could negatively affect HCC patients’survival.Hence HCC recurrence post-LT could predict patients’survival and prognosis,depending on the exact timing of recurrence after LT(early or late),and whether intra/extrahepatic HCC recurrence.Several factors may aid in such a complication,particularly tumour-related criteria including larger sizes,higher grades or poor tumour differentiation,microvascular invasion,and elevated serum alpha-fetoprotein.Therefore,managing such cases is challenging,different therapeutic options have been proposed,including curative surgical and ablative treatments that have shown better outcomes,compared to the palliative locoregional and systemic therapies,which may be helpful in those with unresectable tumour burden.To handle all these issues in our review.

Analysis of the Clinical Effect of Carisolv Minimally Invasive Gel in the Treatment of Pediatric Dental Caries

Objective:To study the clinical effect of Carisolv minimally invasive gel in the treatment of pediatric dental caries and its effect on pain.Methods:The research subjects of this paper were 113 cases of pediatric caries admitted to the hospital from April 2021 to April 2023,which were divided into two groups by the randomized table method.The control group(n=56)received the traditional dental drilling treatment method,and the observation group(n=57)applied Carisolv minimally invasive gel for treatment.The pain sensitivity and clinical efficacy as well as the emotions and adherence of the children were compared between the two groups.Results:The emotional score(ES)of children in the observation group was significantly lower than that of the control group,and the Frankl Adherence Scale score was significantly higher than that of the control group,P<0.05;the pain sensitivity of children in the observation group was better than that of the control group,and the total clinical efficacy rate of children in the observation group was significantly higher than that of the control group,P<0.05.Conclusion:Carisolv minimally invasive gel has considerable efficacy in the treatment of pediatric caries,and it can alleviate pain and improve children’s emotional state and adherence to the program.Thus,it is suitable for wide clinical applications.

Clinical Study on the Treatment of Low Anal Fistula in Infants and Young Children by Anal Gland Excision and Virtual Hanging Procedure

Objective:To compare the efficacy of anal adenectomy with virtual hanging wire and anal fistulotomy in the treatment of low anal fistula in infants and children.Methods:60 children with low anal fistula who were admitted to our hospital from October 2021 to March 2022 and met the inclusion criteria were randomly divided into two groups of 30 cases each;the treatment group was treated with anal adenectomy and virtual hanging wire surgery,and the control group was treated with anal fistula resection.The clinical efficacy after treatment was compared.Results:The total effective rate of both groups was 96.67%and the difference between the two groups was not statistically significant(P>0.05).The postoperative pain score of the treatment group was lower than that of the control group(P<0.05).The length of hospitalization and healing time of the treatment group was lower than that of the control group(P<0.05).The anal function of the patients in both groups was normal,and there was no adverse reaction.Conclusion:Anal gland excision and virtual hanging surgery for the treatment of low anal fistula in infants and children have the advantages of mild pain,reduced length of hospitalization,short healing time,and better patient experience as compared to anal fistula excision.

The Effect of the Direct Anti-Human Globulin Test on the Clinical Outcome of Patients Receiving Blood Transfusion

Objective:To study the effect of the direct anti-human globulin test on the clinical efficacy of blood transfusion patients.Methods:52 transfused patients were selected for this study,of which 26 cases with positive direct anti-human globulin tests were included in the positive group,and another 26 cases with negative direct anti-human globulin tests were included in the negative group.The apparent efficacy of the patients in the two groups after blood transfusion was compared.Results:After blood transfusion,the apparent efficacy of the negative group was significantly higher,P<0.05;in the positive group,the proportion of the predominantly multi-antibody group was the highest;after blood transfusion,the post-transfusion apparent efficacy of the simple IgG group was higher than that of the multi-antibody group,P<0.05;comparing the intensity of the different antibodies resulted in the 1+group,and the 3+to 4+groups were significantly lower after blood transfusion,P<0.05.Conclusion:The use of the direct antiglobulin test in transfused patients showed that patients with positive results would have better clinical efficacy.Direct anti-human globulin tests will have an impact on the clinical efficacy of blood transfusion in patients with positive results,so it is very important to carry out a direct anti-human globulin test on blood transfusion patients.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.