Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare occurrence alongside atrioventricular malformations. Exciting prospects include the use of autologous bone marrow transplant and the potential role of Connexin 43 protein treatment in the development of moyamoya disease.

Clinical Observation of the Therapeutic Effects of Wenzhong Hewei Formula in Treating Spleen and Stomach Qi Deficiency Syndrome in Internal Medicine Diseases

Objective:To observe the clinical efficacy and safety of Wenzhong Hewei Formula in treating spleen and stomach qi deficiency syndrome in internal medicine diseases.Methods:Sixty patients with spleen and stomach qi deficiency syndrome admitted to the hospital from April 2022 to June 2023 were randomly divided into observation and control groups,with 30 patients in each group.The control group received conventional internal medicine treatment,while the observation group was additionally treated with Wenzhong Hewei Formula on the basis of conventional treatment.Both groups were treated for 4 weeks.Results:The total effective rate of treatment in the observation group was higher than that of the control group(P<0.05).After treatment,the traditional Chinese medicine syndrome scores of both groups were significantly lower than before treatment,with the observation group showing a more pronounced reduction(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Wenzhong Hewei Formula can effectively improve clinical symptoms in patients with spleen and stomach qi deficiency syndrome,enhance clinical efficacy,and have a high level of safety,making it worthy of clinical promotion.

Etiology of inflammatory bowel disease:A unified hypothesis

Inflammatory bowel disease(IBD),including both ulcerative colitis(UC) and Crohn's disease(CD),emerged and dramatically increased for about a century.Despite extensive research,its cause remains regarded as unknown.About a decade ago,a series of findings made me suspect that saccharin may be a key causative factor for IBD,through its inhibition on gut bacteria and the resultant impaired inactivation of digestive proteases and over digestion of the mucus layer and gut barrier(the Bacteria-Protease-Mucus-Barrier hypothesis).It explained many puzzles in IBD such as its emergence and temporal changes in last century.Recently I further found evidence suggesting sucralose may be also linked to IBD through a similar mechanism as saccharin and have contributed to the recent worldwide increase of IBD.This new hypothesis suggests that UC and CD are just two symptoms of the same morbidity,rather than two different diseases.They are both caused by a weakening in gut barrier and only differ in that UC is mainly due to increased infiltration of gut bacteria and the resultant recruitment of neutrophils and formation of crypt abscess,while CD is mainly due to increased infiltration of antigens and particles from gut lumen and the resultant recruitment of macrophages and formation of granulomas.It explained the delayed appearance but accelerated increase of CD over UC and many other phenomena.This paper aims to provide a detailed description of a unified hypothesis regardingthe etiology of IBD,including the cause and mechanism of IBD,as well as the relationship between UC and CD.

Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children

Inflammatory bowel disease is a chronic,debilitating disorder of the gastrointestinal tract.The etiology of inflammatory bowel disease has not been elucidated,but is thought to be multifactorial with both environmental and genetic influences.A large body of research has been conducted to elucidate the etiology of inflammatory bowel disease.This article reviews this literature,emphasizing the studies of breastfeeding and the studies of genetic factors,particularly NOD2 polymorphisms.

Changes in the etiology of liver cirrhosis and the corresponding management strategies

We read with interest the article by Xing Wang,which was published in the recent issue of the World Journal of Hepatology 2023;15:1294-1306.This article focuses particularly on the prevalence and trends in the etiology of liver cirrhosis(LC),prognosis for patients suffering from cirrhosis-related complications and hepatocellular carcinoma(HCC),and management strategies.The etiology of cirrhosis varies according to geographical,economic,and population factors.Viral hepatitis is the dominant cause in China.Vaccination and effective treatment have reduced the number of people with viral hepatitis,but the overall number is still large.Patients with viral hepatitis who progress over time to LC and HCC remain an important population to manage.The increased incidence of metabolic syndrome and alcohol consumption is likely to lead to a potential exponential increase in metabolic dysfunction-associated steatotic liver disease(MASLD)-associated LC and alcoholic liver disease in the future.Investigating the evolution of the etiology of LC is important for guiding the direction of future research and policy development.These changing trends indicate a need for greater emphasis on tackling obesity and diabetes,and implementing more effective measures to regulate alcohol consumption in order to reduce the occurrence of MASLD.In an effort to help cope with these changing trends,the authors further proposed countermeasures for healthcare authorities doctors,and patients.

Etiology and Treatment Advances of Hematochezia in Infants Aged ≤3 Months

The incidence of hematochezia in infants aged three months or younger has shown an upward trend in recent years. This condition is characterized by visible bloody stools, which may appear bright red, dark red, jam-like, or mucus-purulent bloody stools, and is often accompanied by positive fecal occult blood tests, with or without additional systemic clinical symptoms. The etiology is multifactorial, potentially influenced by the maternal health status during pregnancy, neonatal diseases or treatments received in the NICU, and the methods used for establishing enteral and parenteral nutrition. Notably, allergic factors have gained prominence in recent years. This paper reviews recent studies to elucidate the incidence, primary causes, and current treatment approaches for early infant hematochezia, providing a reference for clinical practice.

The inherent high vulnerability of dopaminergic neurons toward mitochondrial toxins may contribute to the etiology of Parkinson＇s disease

Although the exact mechanism（s）of the degeneration of dopaminergic neurons in Parkinson’s disease（PD）is not well understood,mitochondrial dysfunction is proposed to play a central role.This proposal is strongly strengthened by the findings that compromised mitochondrial functions and/or exposure to mitochondrial toxins such as rotenone,paraquat,or MPTP causes degeneration of the midbrain dopaminergic.

The many faces of Crohn’s Disease: Latest concepts in etiology

The notion that Crohn’s Disease (CD) occurs as a result of an aberrant reaction to the commensal microbiota in genetically susceptible hosts is widely regarded by physicians and scientists as fact. Yet although it is undisputed that Crohn’s Disease is immune-mediated, an aberrant reaction to one’s own native flora is far from proven. The aim of the current review is to present a summary of the known infectious causes of Crohn’s Disease, whilst highlighting the limitations of using outdated methods to attempt to classify the disease as a single entity. We propose a re-classification of Crohn’s Disease, and suggest that the disease is best conceptualized as a syndrome, an “umbrella-like” term comprising a group of diseases with varying infective etiologies, which clinically, endoscopically and histologically are indistinguishable from CD.

A new exploration of spleen and stomach theory to guide children's massage treatment of pediatric diseases

Under the guidance of the theory of spleen and stomach,the author uses the rule of"holding the central,transporting the four sides,regulating emotions,taking spleen and stomach as the center,conditioning the five internal organs",applying pediatric massage to treat pediatric spleen and stomach diseases,various acute and chronic diseases and difficult diseases.In the process,the organs are treated,the symptoms are treated,and the curative effect is achieved.

The application of the “Treatment in Accordance with Three Categories of Etiologic Factors” theory in the prevention and treatment of epidemic diseases in traditional Chinese medicine since the Ming and Qing Dynasties

“Treatment in accordance with three categories of etiologic factors”(consideration of the climatic and seasonal conditions,environment and individual’s constitution in the treatment of diseases),that is,treatment following time,place and individual,is one of the basic principles followed by Chinese medicine in the clinical treatment of diseases.This paper analyzes the similarities and differences in traditional Chinese medicine treatment of patients with epidemic diseases in different regions and periods since the Ming(1368-1644 C.E.)and Qing(1636-1912 C.E.)Dynasties.In addition,the theory of epidemic disease prevention and control based on the application of“treatment in accordance with three categories of etiologic factors”was discussed to inspire and guide the prevention and treatment of COVID-19.

Development trends of etiological research contents and methods of noncommunicable diseases

1|BACKGROUND Noncommunicable diseases(NCDs)are a significant public concern,greatly impacting the economic and social development in China.In 2019,NCDs accounted for a staggering 88.5%of total deaths in China,with cardiovas-cular diseases,cancer,chronic respiratory diseases,and diabetes—the four major chronic diseases—contributing to a premature mortality rate of 16.5%[1].The complexity of NCDs arises from the involvement of multiple genetic and environmental factors that interact in intricate ways.The complexity is characterized by a multitude of interactions among genes,proteins,and metabolic path-ways throughout the various stages of life.

Analysis of the Spleen and Stomach Thoughts in Treating Eyelids Diseases in Essential Subtleties on the Silver Sea(《银海精微》)

Essential Subtleties on the Silver Sea(《银海精微》)is a well-known ophthalmology work of traditional Chinese medicine(TCM).There are many discourses on eyelids diseases.This paper analyzed the classification of related diseases and their treatment methods and intends to sort out the pathogenesis of eyelids diseases related to the spleen and stomach function in TCM,thus inspiring new treatment ideas and guiding clinical treatment.Through the sorting out,it is found that the eyelids diseases are closely related to the function of the spleen and stomach such as the Qi(气)and blood generation and transformation,the blood circulation,and the Yin(阴)-Yang(阳)harmony.The corresponding treatments are various,including expelling the pathogen,moving Qi(气)and invigorating blood,warming and activating the spleen Yang(阳).

Progress of gastric cancer etiology:N-nitrosamides in the 1990s

Stomach carcinoma is still the leading cause of cancer death in China and the second one in the world. Its possible causes include: A) chemical factors such as intragastric formation of N-nitroso compounds (NOC) and high salt intake; B ) biological factors such as infection of Helicobacter pylori and biotoxins intake; and C ) nutritional factors such as deficiency of vitamin C, selenium, and other antioxidants. Nitrogenous precursors of NOC, e.g., alkylamines, alkylureas, alkylguanidines, and alkylamides, occur widely in nature and potential nitrosating agents, e.g., nitrite (NO2-) and NOx (the gaseous oxides of nitrogen ) are similarly widespread. Relationship between exposure to NOC and causes of human cancer was investigated extensively ten years ago. Results indicated that the exposures of NOC might contribute to the occurrences of malignancy in the upper digestive tracts including stomachs. It was also observed that both high salt intake and deficiency of some micronutrients enhanced NOC-induced carcinogenicity. Recent studies show that infection of H. pylori can lead to atrophic gastritis and achlorhydria, and promote endogenous formation of NOC indirectly[1] . Much attention has been paid to stomach cancer and NOC regarding the characterization of natural N-nitrosamides in human environment in the 1990s.

Advances in nutritional therapy in inflammatory boweldiseases:Review

Inflammatory bowel diseases(IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.

Study of T-lymphocyte subsets,nitric oxide,hexosamine and Helicobacter pylori infection in patients with chronic gastric diseases

Chronic gastritis ( CG ) and peptic ulcer ( PU ) are frequently-occurring diseases. It is now well recognized that Helicobacter pylori (Hp) is a major factor that leads to CG and PU[1-8] In order to study the relationship among T lymphocyte subsets, NO, Hexosamine and Hp infection in patients with chronic gastric diseases, the levelsof blood T lymphocyte subsets, plasma NO and hexosamine in gastric mucosa were measured respectively in 30 patients with CG and 32 patients of PU + CG.

Transfusion transmitted virus infection in general populations and patients with various liver diseases in south China

INTRODUCTIONAlthough several specific detecting methods hadbeen applied to determine the hepatitis virus,therewas a lot of cryptogenic hepatitis without anyknown hepatitis infectious marker.Theprevalence of hepatitis G virus (HGV) (also knownas GB-C virus) infection has been reported to be 5%-13% in patients with non-A-E hepatitis andcirrhosis,however,there is little evidencesuggesting that HGV causes hepatitis in human.

Etiology and portal vein thrombosis in Budd-Chiari syndrome

AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS) patients prospectively. METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 2002 and July 2004 as having BCS were studied prospectively. Findings from on physical examination, ultrasonography, duplex ultrasonography and venography were analyzed. Hemogram and blood chemistry were studied at the time of diagnosis and on each hospital visit. Bone marrow examination and immune phenotyping were performed by a hematologist when necessary. Protein C, S, antithrombin Ⅲ, activated protein C resistance, and anticardiolipin antibodies, antinuclear antibodies, and anti ds-DNA were studied twice. The presence of ascite, esophageal varices, and portal thrombosis were evaluated at admission and on every visit. RESULTS: At least one etiological factor was determined in 54 (72%) of the patients. The etiology could not be defined in 21 (28%) patients. One etiological factor was found in 39, 2 factors in 14 and 3 factors in 1 patient. The most common cause was the web (16%), the second was Hydatid disease (11%), the third was Behcet’s disease (9%). Portal vein thrombosis was present in 11 patients and at least one etiology was identified in 9 of them (82%). CONCLUSION: Behcet’s disease and hydatid disease are more prominent etiological factors in Turkey than in other countries. Patients with web have an excellent response to treatment without signs of portal veinthrombosis while patients having thrombofilic factors more than one are prone to develop portal vein thrombosis with worse clinical outcome.

Etiology,diagnosis, management and outcomes of epiphora referrals to an oculoplastic practice

AIM： To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice.METHODS： Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed.RESULTS： There were 237 subjects with a primary complaint of epiphora. They included 130 （55%） females and 107 （45%） males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction （46%）; followed by multifactorial epiphora （22%）, reflex tearing （22%） and eyelid malposition （11%）. Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 （77%） patients who returned for follow up, 41 （23%） reported a complete resolution and 102 （56%） reported a significant improvement in their symptoms.CONCLUSION： Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.

ERCP and CT diagnosis of pancreas divisum and its relation to etiology of chronic pancreatitis

AIM To inquire into the ERCP and CT features of pancreas divisum (PD) and its role in the etiology of chronic pancreatitis. METHODS Fourteen patients with PD were analyzed in regard to the findings in ERCP and CT, the activities of serum amylase and the incidence of pancreatitis. Dorsal ductography via minor papilla cannulation was performed in six of them. RESULTS The length of dorsal and ventral pancreatic duct was 16 56cm±2 52cm and 5 55cm±1 46cm. Most of the patients had dilatation of dorsal (10/14) and ventral (8/14) duct and the stenosis of dorsal duct terminal (10/14). Delayed clearance of contrast in dorsal duct was found in 8 patients. The size and contour of the pancreas were normal in all the patients at conventional CT. Pancreatitis was identified in 13 patients. CONCLUSION Dorsal ductography was necessary in the diagnosis of PD. Conventional CT play little role in the diagnosis of PD. Patients with PD run a higher risk of pancreatitis due to the stenosis of the minor papilla.