Extramammary Paget’s Disease Manifested by Intraepithelial Adenocarcinoma of the Vulva and Anus Combined with Invasive Adenocarcinoma of the Ampullary Part of the Rectum

The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.

Escherichia coli in chronic inflammatory bowel diseases: An update on adherent invasive Escherichia coli pathogenicity

Escherichia coli(E. coli), and particularly the adherent invasive E. coli(AIEC) pathotype, has been increasingly implicated in the ethiopathogenesis of Crohn's disease(CD). E. coli strains with similar pathogenic features to AIEC have been associated with other intestinal disorders such as ulcerative colitis, colorectal cancer, and coeliac disease, but AIEC prevalence in these diseases remains largely unexplored. Since AIEC was described one decade ago, substantial progress has been made in deciphering its mechanisms of pathogenicity. However, the molecular bases that characterize the phenotypic properties of this pathotype are still not well resolved. A review of studies focused on E. coli populations in inflammatory bowel disease(IBD) is presented here and we discuss about the putative role of this species on each IBD subtype. Given the relevance of AIEC in CD pathogenesis, we present the latest research findings concerning AIEC host-microbe interactions and pathogenicity. We also review the existing data regarding the prevalence and abundance of AIEC in CD and its association with other intestinal diseases from humans and animals, in order to discuss the AIEC disease- and hostspecificity. Finally, we highlight the fact that dietarycomponents frequently found in industrialized countries may enhance AIEC colonization in the gut, which merits further investigation and the implementation of preventative measures.

Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

Patients with inflammatory bowel disease(IBD)com-prise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions.Therefore surgical procedures need to aim at minimizing operative trauma with bestpostoperative recovery.Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease.However due to special disease related characteristics such as bowel stenosis,interen-teric fistula,abscesses,malnutrition,repetitive sur-geries,or immunosuppressive medications,patients with IBD represent a special cohort with specific needs for surgery.This review summarizes current evidence of minimally invasive surgery for patients with Crohn’s disease or ulcerative colitis and gives an outlook on the future perspective of technical advances in this highly moving field with its latest developments in single port surgery,robotics and trans-anal techniques.

Diagnostic Accuracy of Three-Dimensional Whole-Heart Magnetic Resonance Angiography to Detect Coronary Artery Disease with Invasive Coronary Angiography as a Reference:A Meta-Analysis

Objective:We aimed to evaluate the diagnostic performance of three-dimensional whole-heart magnetic resonance coronary angiography(MRCA)in detecting coronary artery disease(CAD)with invasive coronary angiography as the reference standard.Methods:We searched PubMed and Embase for studies evaluating the diagnostic performance of three-dimensional whole-heart MRCA for the diagnosis of CAD with invasive coronary angiography as the reference standard.The bivariate mixed-effects regression model was applied to synthesize available data.The clinical utility of whole-heart MRCA was calculated by the posttest probability based on Bayes’s theorem.Results:Eighteen studies were included,of which 16 provided data at the artery level.Patient-based analysis revealed a pooled sensitivity of 0.90(95%confi dence interval[CI]0.87–0.93)and specifi city of 0.79(95%CI 0.73–0.84),while the pooled estimates were 0.86(95%CI 0.82–0.89)and 0.89(95%CI 0.84–0.92),respectively,at the artery level.The areas under the summary receiver operating characteristic curve were 0.93(95%CI 0.90–0.95)and 0.92(95%CI 0.90–0.94)at the patient and artery levels,respectively.With a pretest probability of 50%,the patients’posttest probabilities of CAD were 81%for positive results and 11%for negative results.Conclusions:Whole-heart MRCA can be an alternative noninvasive method for diagnosis and assessment of CAD.

Recombinant human thrombopoietin treatment in patients with chronic liver disease-related thrombocytopenia undergoing invasive procedures:A retrospective study

BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic variceal ligation,and most of them have lower platelet counts,which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders.Unfortunately,there is no defined treatment modality for CLD-induced thrombocytopenia.Recombinant human thrombopoietin(rhTPO)is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy;however,there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLDassociated thrombocytopenia undergoing invasive procedures.METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021.Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia.Adverse events related to treatment,such as bleeding,thrombosis,and disseminated intravascular coagulation,were also investigated.RESULTS Among the enrolled patients,78(78%)showed a platelet count increase after rhTPO use,while 22(22%)showed no significant change in platelet count.The mean platelet count after rhTPO treatment in all patients was 101.53±81.81×10^(9)/L,which was significantly improved compared to that at baseline(42.88±16.72×10^(9)/L),and this difference was statistically significant(P<0.001).In addition,patients were further divided into three subgroups according to their baseline platelet counts(<30×10^(9)/L,30-50×10^(9)/L,>50×10^(9)/L).Subgroup analyses showed that the median platelet counts after treatment were significantly higher(P<0.001,all).Ninety(90%)patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO.No serious adverse events related to rhTPO treatment were observed.Overall,rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.CONCLUSION rhTPO can improve platelet count,reduce the risk of bleeding,and decrease the platelet transfusion rate,which may promote the safety of invasive procedures and improve overall survival of patients with CLD.

Laparoscopy for Crohn's disease:A comprehensive exploration of minimally invasive surgical techniques

BACKGROUND Along with the unceasing progress of medicine,Crohn's disease(CD),especially complex CD,is no longer a taboo for minimally invasive surgery.However,considering its special disease characteristics,more clinical trials are needed to confirm the safety and feasibility of laparoscopic surgery for CD.AIM To investigate the safety and feasibility of laparoscopic enterectomy for CD,assess the advantages of laparoscopy over laparotomy in patients with CD,and discuss comprehensive minimally invasive surgical techniques in complex CD.METHODS This study prospectively collected clinical data from patients with CD who underwent enterectomy from January 2017 to January 2020.It was registered in the Chinese clinical trial database with the registration number ChiCTR-INR-16009321.Patients were divided into a laparoscopy group and a traditional laparotomy group according to the surgical method.The baseline characteristics,operation time,intraoperative blood loss,temporary stoma,levels of abdominal adhesion,pathological characteristics,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,and hospitalization cost were compared between the two groups.RESULTS A total of 120 eligible patients were enrolled into the pre-standardized groups,including 100 in the laparoscopy group and 20 in the laparotomy group.Compared with the laparotomy group,the postoperative hospitalization time in the laparoscopy group was shorter(9.1±3.9 d vs 11.0±1.6 d,P<0.05),the days to flatus were fewer(2.8±0.8 d vs 3.5±0.7 d,P<0.05),the days to soft diet were fewer(4.2±2.4 d vs 6.2±2.0 d,P<0.05)and the intraoperative blood loss was less(103.3±80.42 mL vs 169.5±100.42 mL,P<0.05).There were no statistically significant differences between the two groups in preoperative clinical data,operation time(149.0±43.8 min vs 159.2±40.0 min),stoma rate,levels of abdominal adhesion,total cost of hospitalization,incidence of postoperative complications[8.0%(8/100)vs 15.0%(3/20)],or readmission rate within 30 days[1.0%(1/100)vs 0.00(0/20)].CONCLUSION Compared with laparotomy,laparoscopic enterectomy promotes the recovery of gastrointestinal function,shortens the postoperative hospitalization time,and does not increase the incidence of postoperative complications.Laparoscopic enterectomy combined with varieties of minimally invasive surgical techniques is a safe and acceptable therapeutic method for CD patients with enteric fistulas.

Minimally invasive surgery for inflammatory bowel disease: Current perspectives

The surgical management of complicated and recurrent inflammatory bowel disease(IBD),has remained a challenge.Minimally invasive surgery(MIS),in the form of laparoscopic resections,single port approach and robotic-assisted dissections in the management of IBD,have been examined in several prospective studies.All of them have shown advantages over open surgeryin terms of reduction of physical trauma of surgery,recovery time,better cosmetic outcomes and shorter hospitalization.However,it is important to appreciate that not all patients with IBD are suitable for MIS,so a combination of both open and MIS should be adopted to achieve optimum outcomes.A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice.

Role of adherent invasive Escherichia coli in pathogenesis of inflammatory bowel disease

Gut microbiota imbalances play an important role in inflammatory bowel disease(IBD),but no single pathogenic microorganism critical to IBD that is specific to the IBD terminal ileum mucosa or can invade intestinal epithelial cells has been found.Invasive Escherichia coli(E.coli)adhesion to macrophages is considered to be closely related to the pathogenesis of inflammatory bowel disease.Further study of the specific biological characteristics of adherent invasive E.coli(AIEC)may contribute to a further understanding of IBD pathogenesis.This review explores the relationship between AIEC and the intestinal immune system,discusses the prevalence and relevance of AIEC in Crohn's disease and ulcerative colitis patients,and describes the relationship between AIEC and the disease site,activity,and postoperative recurrence.Finally,we highlight potential therapeutic strategies to attenuate AIEC colonization in the intestinal mucosa,including the use of phage therapy,antibiotics,and anti-adhesion molecules.These strategies may open up new avenues for the prevention and treatment of IBD in the future.

Treatment of invasive fungal disease: A case report

BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.CASE SUMMARY A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo.Physical examination revealed multiple lymph nodes enlargement,especially those in the left neck and groin.CT scan showed multiple lymph nodes enlargement in the chest,especially left lung,abdominal cavity,and retroperitoneum.The first lymph node biopsy revealed granulomatous lesions of lymph nodes,so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given.Because fever and respiratory failure occurred 4 d after admission,mechanical ventilation was given,and Caspofungin and Voriconazole were used successively.However,the disease still could not be controlled.On the 11th day of admission,the body temperature reached 40° C.After mycosis of lymph nodes was confirmed by the second lymph node biopsy,Amphotericin B was given,and the patient recovered and was discharged from the hospital.CONCLUSION No fixed target organ was identified in this case,and only lymph node involvement was found.Caspofungin,a new antifungal drug,and the conventional first choice drug,Voriconazole,were ineffective,while Amphotericin B was effective.

A comparative study of the grafts patency rate between the minimally invasive direct and the standard off-pump coronary artery bypass grafting in triple-vessel disease

Objective This study aims to compare the grafts patency rate in triple-vessel disease between minimally invasive direct and the standard off-pump coronary artery bypass grafting.Methods Fifty patients who were hospitalized in Beijing ChaoYang Hospital during August 2013 to May 2015 were analyzed.MIDOPCABG group(n=25)underwent minimally invasive direct offpump coronary artery bypass grafting,and OPCABG group(n=25)underwent standard off-pump coronary artery bypass grafting group.

Minimally invasive nephrectomy for inflammatory renal disease

Objective:Once chronic inflammatory renal disease(IRD)develops,it creates a severe peri-fibrotic process,which makes it a relative contraindication for minimally invasive surgery(MIS).Our objective is to show that laparoscopic nephrectomy(LN)is a surgical option in IRD with fewer complications and better outcomes.Methods:Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed.Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition(xanthogranulomatous pyelonephritis,chronic nephritis,and renal tuberculosis).We describe intra-operative variables such as operative time,blood loss,conversion rate,postoperative complications and length of hospital stay.Results:There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD.We identified four(8%)major complications;three of them required transfusion and one conversion to open surgery.The mean operative time was 233108 min.Mean estimated blood loss was 206242 mL excluding the conversion cases and 281423 mL including them.The mean length of hospital stay was 3.02.0 days.Conclusion:Laparoscopic nephrectomy for IRD can safely be done.It is a reproducible technique with low risks and complication rates.Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.

Characteristics of Invasive Pneumococcal Disease in Young Children before the Introduction of PCV13 in Lombardy, Italy

An active surveillance system of invasive pneumococcal disease (IPD) started on September 2008 in Lombardy, Italy, among children aged less than 60 months and admitted for suspicion of IPD at emergency room of ten hospitals. This study examined the clinical characteristics of children enrolled up to December 2010, that is just before the introduction in this region of voluntary mass vaccination, free of charge, based on the 13-valent pneumococcal conjugate vaccine (PCV13). Two hundred fifty one children were suspected and 20 were confirmed as having IPD, based on isolation of Streptococcus pneumoniae from blood. Thirty-nine percent of children had received pneumococcal vaccination previously, and full vaccination with three doses of hepta-valent vaccine (PCV7) had been administered in 21.4%. Co-morbidity conditions were more frequent in children with confirmed than non-confirmed IPD (10.0% vs. 0.9%). The annual incidence rate of confirmed IPD was 28.6/100,000 (binomial 95% confidence interval, 18.6 to 44.1/100,000. Among confirmed IPD children, 11 exhibited pneumonia with bacteremia, 6 bacteremia without focus, 2 septicemia, 1 meningitis. Seventeen (85%) isolates were identified, and nine serotypes. The overall serotype coverage was 29.4% for PCV7 and 82.3% for PCV13. In non-vaccinated children, the coverage of PCV7 and PCV13 was 41.7% and 75.0%, respectively. Non-vaccine serotypes 12B, 15C, and 23B were identified. Antibiotic resistance was found in seven children, that is against penicillin (serotype 15C), erythromycin (14, 19A, 19F), tetracycline (15C, 19F), chloramphenicol (23F), and trimethoprim-sulfamethoxazole (23F). Two of these children had received antibiotic therapy (penicillin or azithromycin) during the week before hospital admission. The coverage vaccination rate in Lombardy was relatively low during the surveillance period and serotype distribution widespread. The introduction of PCV13 and a mass vaccination program in young children might impact positively on invasive pneumococcal disease in this surveilled population. Active long-term surveillance of non-vaccine serotypes is required wordwide.

Minimally invasive surgery for glycogen storage disease combined with inflammatory bowel disease:A case report

BACKGROUND Inflammatory bowel disease(IBD)is rare in patients with glycogen storage disease(GSD).In GSD patients,a decrease in the number of neutrophils leads to prolonged intestinal infection,leading to the formation of chronic inflammation and eventually the development of IBD.Minimally invasive surgery for patients with IBD has been proven to reduce inflammatory responses and postoperative risks and ultimately promote rapid recovery.Herein we discuss minimally invasive surgery and the perioperative management in a patient with GSD and IBD.CASE SUMMARY A 23-year-old male had GSD Ib associated with IBD-like disease for 10 years.Despite standard treatments,such as mesalazine,prednisone and adalimumab,the patient eventually developed colonic stenosis with incomplete ileus.After adequate assessment,the patient was treated with minimally invasive surgery and discharged in stable condition.CONCLUSION Minimally invasive surgery for patients with IBD and GSD is safe,feasible and effective.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stagesⅢb-Ⅴchronic kidney disease?

BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

lncRNACNN3-206 activates intestinal epithelial cell apoptosis and invasion by sponging miR-212, an implication for Crohn’s disease

BACKGROUND Statistics indicate that the incidence of Crohn’s disease(CD)is rising in many countries.The poor understanding on the pathological mechanism has limited the development of effective therapy against this disease.Previous studies showed that long noncoding RNAs(lncRNAs)could be involved in autoimmune diseases including CD,but the detailed molecular mechanisms remain unclear.AIM To identify the differentially expressed lncRNAs in the intestinal mucosa associated with CD,and to characterize their pathogenic role(s)and related mechanisms.METHODS The differential expression of lncRNAs was screened by high-throughput RNA sequencing,and the top candidate genes were validated in an expanded cohort by real-time PCR.The regulatory network was predicted by bioinformatic software and competitive endogenous RNA analysis,and was characterized in Caco-2 and HT-29 cell culture using methods of cell transfection,real-time PCR,Western blotting analysis,flow cytometry,and cell migration and invasion assays.Finally,these findings were confirmed in vivo using a CD animal model.RESULTS The 3'end of lncRNACNN3-206 and the 3’UTR of Caspase10 contain highaffinity miR212 binding sites.lncRNACNN3-206 expression was found to be significantly increased in intestinal lesions of CD patients.Activation of the lncRNACNN3-206-miR-212-Caspase10 regulatory network led to increased apoptosis,migration and invasion in intestinal epithelial cells.Knockdown of lncRNACNN3-206 expression alleviated intestinal mucosal inflammation and tissue damage in the CD mouse model.CONCLUSION lncRNACNN3-206 may play a key role in CD pathogenesis.lncRNACNN3-206 could be a therapeutic target for CD treatment.

Neurovascular unit permeability in neuroinflammatory diseases:a common pathologic and therapeutic target?

Deleterious inflammatory cell invasion has been implicated in neurological diseases,partly manifesting as a leaky blood-central nervous system ba rrier(BCNSB)(Huang et al.,2021).Uncovering the perturbations of the neurovascular unit(NVU)may reveal the role of detrimental proinflammatory cells and signaling molecules in disrupting the central nervous system immuneprivileged environment.

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

BACKGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.

Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

Gastroesophageal reflux disease affects 40% of the population in industrialized countries. GERD has a negative impact on the quality of life of affected patients. Although PPIs induce a good response in the control of symptoms, the need for prolonged use of the medication and the fact that more than a third of the patients have symptoms even after its correct use, make surgery, an alternative for the treatment of the disease. The aims of this study were to compare the quality of life related to GERD before and after MIS surgical treatment of GERD and/or hiatus hernia, and to analyze the results and complications of the MIS treatment of GERD. Methods: For retrospective analysis, the electronic database of patients with indications for surgical treatment due to GERD and/or patients with sliding or paraesophageal hernias was examined. The study included patients from Hospital Universitário Gaffrée e Guinle and the Postgraduate Course in General Surgery at PUC-Rio (Rio de Janeiro, Brazil) who underwent surgery using video laparoscopy or robotic surgery between January 2013 and March 2020. This is an observational, longitudinal, descriptive study with retrospective analysis of the data. Surgical treatment was indicated due to incomplete response to clinical treatment, young age with persistent symptoms, or complications of GERD. Patients with hiatus and/or paraesophageal hernia with indication for surgical treatment were included. Results: The study evaluated 160 patients who underwent anti-reflux surgery by laparoscopic or robotic surgery in the period from 2013 to 2020. A total of 88 women and 72 men were operated, mean 46.6 ± 13.7 years. An improvement in the preoperative QS-GERD scores compared to the postoperative scores was observed (27.56 ± 10.93 vs 1.4 ± 2.47, p < 0.01). Additionally, it was observed that there was no association between worse prognosis and failure rate with gender, sex, age, body mass index, surgical technique, or the number of sutures on the fundoplication valve. The length of hospital stay was 24 hours in 74.2% of patients, 48 hours in 19.3%, and 72 hours in 4.6%, with a global median of 24 hours and a mean of 28.7 hours. No patient required blood transfusion;none had early postoperative complications (seroma, wound infection, or eventration), or died. Conclusion: A significant drop in the QS-GERD score was found before and after the surgical treatment of GERD and or hiatus hernia. The MIS surgical treatment of GERD controlled the symptoms in most of the treated individuals, presenting a low rate of complications without mortality.

A narrative review of ocular surface disease considerations in the management of glaucoma

s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were excluded.Key Content and Findings:Topical glaucoma medications frequently cause adverse effects on the ocular surface,both through direct action of the medications themselves as well as through toxicity from their associated preservatives.Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma,such as trabeculectomy,can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications.Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates,while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability.The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden.It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity.However,more research is needed to directly assess the extent of improvement seen after MIGS.Conclusions:A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.