Bilateral Cervical Ribs Fusing or Naffziger Syndrome: About an Observation in Guinea and Literature Review

Thoraco-brachial outlet syndrome (TDSD) or cervical rib brings together all the clinical symptoms (arterial, neurological and/or venous) due to extrinsic, intermittent or permanent compression of the vascular-nervous elements of the root of the upper limb during cervico-thoraco-brachial crossing syndrome. This pathology is relatively common but often overlooked;it affects women more often (between 4/1 and 2/1) and is rare in children. We report the case of a 59-year-old female patient seen in the department for paresthesia and muscular weakness of the upper limbs rated 3/5 on the right and 4/5 on the left progressively evolving over 39 years, electromyography (EMG) showed indicated compression of the brachial plexus and the CT scan confirmed the presence of bilateral cervical ribs fused with the first on the left. She benefited from physiotherapy while awaiting her surgery, and unfortunately, she died of a stroke in the traumatology department. This pathology is the first in our department to be supported by a review of the literature.

Restless head syndrome:A retrospective study

BACKGROUND Restless legs syndrome(RLS)is characterized by an urge to move with an unpleasant sensation in the lower limbs.RLS typically affects the legs.However,it can also affect several other body regions,such as the arms,abdomen,face,neck,head,and genital area.There are only a few reports of the RLS variant affecting the head.AIM To assess the epidemiological,clinical,and other aspects of the RLS variant affecting the head.METHODS We conducted a retrospective study of 17 adult patients(>18 years)who met the RLS criteria and simultaneously experienced RLS-like symptoms in the head.RESULTS The median age at which symptoms appeared was 41.6 years.Males and females were equally affected(1.1:1).All 17 patients had uncomfortable sensations in the lower legs.Insomnia or disturbed sleep was the most common comorbidity(n=16,88.2%).However,headache was the most common presenting or primary symptom(n=10,70.5%).Dizziness or an abnormal sensation in the head was the second most common presenting symptom(5 patients,29.4%).Other presenting features were leg pain,backache,and generalized body pain.All patients responded favorably to dopaminergic medications.CONCLUSION If RLS-related unpleasant sensations and pain are felt in the head,they may be misinterpreted as headache,dizziness,or psychosomatic symptoms.RLS and headaches in a subset of patients may be two phenotypic manifestations of the same disorder.

Magnetic resonance imaging evaluation and nuclear receptor binding SET domain protein 1 mutation in the Sotos syndrome with attention-deficit/hyperactivity disorder

Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.

Corticosteroids in posterior reversible encephalopathy syndrome:Friend or foe?A systematic review

BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is a complex neurological disorder characterized by symptoms such as headaches,seizures,confusion,and visual disturbances.The pathophysiology of PRES involves endothelial dysfunction,disrupted cerebral autoregulation,and resulting vasogenic edema.Hypertension and other factors that alter cerebral autoregulation are critical in its development.Corticosteroids,widely used for their anti-inflammatory and immunosuppressive properties,play a controversial role in PRES.AIM To elucidate the dual role of corticosteroids in the context of PRES by critically evaluating the existing literature.Specifically,it seeks to assess the results of PRES induced by corticosteroid therapy and the efficacy and safety of corticosteroids in the treatment of PRES.By synthesizing case reports and series,this review aims to provide a comprehensive understanding of the mechanisms,clinical presentations,and management strategies associated with corticosteroid-related PRES.METHODS The review was carried out according to the PRISMA guidelines.The databases searched included Science Direct,PubMed,and Hinari.The search strategy encompassed terms related to corticosteroids and PRES.Studies were included if they were peer-reviewed articles examining corticosteroids in PRES,excluding non-English publications,reviews,and editorials.Data on patient demographics,clinical characteristics,imaging findings,corticosteroid regimens,and outcomes were extracted.The risk of bias was evaluated using the Joanna Briggs Institute tool for case reports.RESULTS A total of 56 cases of PRES(66.1%women,33.9%men)potentially induced by corticosteroids and 14 cases in which corticosteroids were used to treat PRES were identified.Cases of PRES reportedly caused by corticosteroids showed a mean age of approximately 25.2 years,with seizures,headaches,hypertension,and visual disturbances being common clinical sequelae.Magnetic resonance findings typically revealed vasogenic edema in the bilateral parieto-occipital lobes.High-dose or prolonged corticosteroid therapy was a significant risk factor.On the contrary,in the treatment cases,corticosteroids were associated with positive outcomes,including resolution of vasogenic edema and stabilization of symptoms,particularly in patients with underlying inflammatory or autoimmune diseases.CONCLUSION Corticosteroids have a dual role in PRES,capable of both inducing and treating the condition.The current body of literature suggests that corticosteroids may play a greater role as a precipitating agent of PRES rather than treating.Corticosteroids may induce PRES through hypertension and subsequent increased cerebral blood flow and loss of autoregulation.Corticosteroids may aid in the management of PRES:(1)Enhancing endothelial stability;(2)Antiinflammatory properties;and(3)Improving blood-brain barrier integrity.Mechanisms which may reduce or mitigate vasogenic edema formation.

Diagnosis and treatment of bipolar disorder in Phelan-McDermid syndrome:A case report and review of literature

BACKGROUND Phelan-McDermid syndrome(PMS)is a rare genetic disorder characterized by intellectual disability,delayed language development,autism spectrum disorders,motor tone abnormalities,and a high risk of psychiatric symptoms,including bipolar disorder.CASE SUMMARY This report presented an 18-year clinical history of a 36-year-old woman with PMS,marked by intellectual disabilities,social withdrawal,and stereotyped behaviors.Diagnosed with bipolar disorder at the age of 18 years old,she encountered significant treatment challenges,including severe adverse reactions to antipsychotic medications in 2022,which led to speech and functional regression.Through rehabilitation and comprehensive therapy,her condition gradually improved.In 2024,after further treatment,her symptoms stabilized,highlighting the complexities and successes of long-term management.CONCLUSION Effective management of PMS requires a thorough clinical history,genetic testing,and long-term supportive care.

Evaluation of the prevalence and risk factors of burnout syndrome among healthcare workers:A cross-sectional study

BACKGROUND Burnout syndrome is a significant issue among healthcare professionals worldwide,marked by depersonalization,emotional exhaustion,and a reduced sense of personal achievement.This psychological and physical burden profoundly affects healthcare professionals'quality of care and overall well-being.In Somalia,where the healthcare system faces numerous challenges,the escalating demand for medical services and inadequate resources,coupled with overwhelming workloads,long hours,and high-stress levels,make healthcare providers particularly vulnerable to burnout syndrome.This,in turn,affects both the mental health of healthcare personnel and the quality of care they provide.AIM To examine the prevalence and determinants of burnout syndrome among healthcare practitioners in Mogadishu,Somalia.METHODS This cross-sectional prospective study was performed among 246 healthcare providers employed at a tertiary care hospital in Mogadishu,Somalia,who were recruited via random sampling.Data were collected using questionnaires that covered sociodemographic,psychological,work-related characteristics,and burnout syndrome.Bivariate and multivariate logistic regression analyses were performed to identify the variables that correlated with burnout syndrome.The results were presented using adjusted odds ratios(AORs),95%CIs,and P values,with a cutoff of 0.05 for identifying significant associations.RESULTS Among the participants,24%(95%CI:18.8%–29.8%)exhibited symptoms of burnout syndrome.Factors associated with burnout included female gender(AOR=6.60;95%CI:2.29-19.04),being married(AOR=3.07;95%CI:1.14-8.28),being divorced or widowed(AOR=5.84;95%CI:1.35-25.35),working more than 7 night shifts(AOR=3.19;95%CI:1.30–7.82),having less than 5 years of job experience(AOR=5.28;95%CI:1.29-21.65),experiencing poor sleep quality(AOR=5.29;95%CI:1.88-14.89),and exhibiting depressive(AOR=4.46;95%CI:1.59-12.53)and anxiety symptoms(AOR=7.34;95%CI:2.49-21.60).CONCLUSION This study found that nearly one in four healthcare professionals suffers from burnout syndrome.Improving sleep quality,monitoring,and providing mental health support could enhance their well-being and patient care.

Current understanding of adult nephrotic syndrome:Minimal change disease

The underlying molecular changes that result in minimal change disease(ne-phrotic syndrome)require an in-depth analysis.Current molecular studies have shown the involvement of zinc fingers and homeobox transcriptional factors in its pathogenesis.The application of therapeutic drugs relies on understanding the cascade of molecular events to determine their efficacy in managing the clinical condition.

Hepatorenal syndrome:Paving a pathway from a fatal condition to an opportunity to preserve kidney function

In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was later termed hepatorenal syndrome(HRS).HRS primarily affects cirrhotic patients with ascites and often follows severe infections,digestive hemorrhages,or high-volume paracentesis.Pathophysiologically,HRS involves low glomerular filtration rate,hypotension,renin-angiotensin axis activation,water clearance,hyponatremia,and minimal urinary sodium excretion.These conditions mimic those seen in decreased effective circulatory volume(ECV)scenarios such as septic shock or heart failure.HRS represents a specific form of prerenal acute kidney injury(AKI)in patients with baseline renal ischemia,where the kidney attempts to correct decreased ECV by retaining sodium and water.Intense renal vasoconstriction,passive hyperemia from ascites,and acute tubular necrosis(ATN)with specific urinary sediment changes are observed.Persistent oliguria may transition HRS to ATN,although this shift is less straightforward than in other prerenal AKI contexts.Notably,liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions.Experimental studies,such as those by Duailibe et al,using omega-3 fatty acids in cirrhotic rat models,have shown promising results in reducing oxidative stress and improving kidney function.These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments.Future research should address the impact of omega-3 on survival and secondary outcomes,as well as consider the balance of therapeutic risks and benefits in severe liver disease.

Bivalirudin for anticoagulation in elderly acute coronary syndrome:Effects on myocardial microcirculation and adverse events

The management of acute coronary syndrome(ACS)in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes.Bivalirudin,a direct inhibitor of thrombin,serves as an alternative to traditional therapies.This drug is particularly effective in enhancing myocardial microcircu-lation and reducing adverse events after clinical interventions.The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS.Compared with unfractionated heparin,bivalirudin markedly reduced the emergency response time and improved cardiac function indicators.It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions.These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications,thus serving as a safe,effective anticoagulation agent for older patients with ACS.Nonetheless,further large-scale,high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes.Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care,balancing efficacy and safety.Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.

Percheron syndrome with memory impairment as chief manifestation:A case report

BACKGROUND Percheron acute artery occlusion is a rare type of acute cerebral infarction.CASE SUMMARY An elderly male presented with sudden-onset near-memory and sensory impairments for 5 days.Upon admission,based on symptoms,signs,magnetic resonance imaging,and computed tomography findings,a diagnosis of Percheron syndrome was made.Subsequently,anti-platelet therapy,lipid-lowering treat-ment,cerebral circulation enhancement(such as the administration of calcium channel blockers to improve cerebral blood flow),and neurotrophic support(such as the use of drugs like citicoline to protect nerve cells)were immediately implemented,along with additional symptomatic treatments.The patient’s symptoms were alleviated,following which he was discharged.CONCLUSION The diagnosis of acute occlusion of the Percheron artery requires rich clinical expertise and accurate imaging tools.Timely intervention and effective follow-up hold significant implications for optimizing patient recovery.

Cholecystogastric fistula presenting as pyloric obstruction - a Bouveret’s syndrome: A case report

BACKGROUND Bouveret’s syndrome is a rare(1%-4%)form of cholelithiasis characterized by gastric outlet obstruction.It presents mainly in elderly women with nausea,vomiting,and abdominal pain.On physical examination,common findings include dehydration signs such as tachycardia,decreased urine output,abdo-minal discomfort,and distention.Diagnosis relies on computed tomography(CT)and magnetic resonance imaging,with Rigler's triad(pneumobilia,ectopic gall-stone,gastric distension)being highly specific.This report aims to improve under-standing of Bouveret’s syndrome and inform better management and treatment strategies.CASE SUMMARY A 60-year-old male patient presented with a three-day history of nausea,vomiting,upper abdominal pain,and loss of appetite.An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts.Endos-copy revealed a brown and black stone measuring approximately 3030 mm in dia-meter in the gastric pylorus,incompletely obstructing the gastric outlet.The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan.Endoscopic removal of the stone was successful,owing to the stone being fragmented and extracted in pieces using a crushing basket.Three weeks later,laparoscopy was attempted but failed because of severe tissue adhesions.Conse-quently,the procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.He returned to the outpatient clinic for follow-up,and no further concerns were noted.Core Tip:Bouveret’s syndrome is a rare form of cholelithiasis leading to gastric outlet obstruction.Diagnosis is confirmed through imaging,particularly abdominal computed tomography,with Rigler's triad serving as a key diagnostic indicator.Endoscopic removal of the gallstone is the first-line treatment,but surgery is required if endoscopic methods fail,especially in cases with severe adhesions.In this case,a 60-year-old male had successful endoscopic stone removal.Laparotomy was later performed for fistula repair and cholecystectomy after laparoscopy failed.This case highlights the importance of early diagnosis and flexible treatment,combining endoscopy and surgery for the best outcomes.TREATMENT Endoscopic removal of the stone was successful.The stone was fragmented and removed piecemeal using a crushing basket.Laparoscopy was attempted three weeks later;however,severe tissue adhesions were present.The procedure was converted to a laparotomy,and fistula repair and cholecystectomy were performed.During the surgery,we encountered several challenges.First,the presence of a biliary-enteric fistula complicated the procedure,as inflammation and chronic fistulous communication had altered its anatomy.To address this,we carefully repaired the fistula,ensuring minimal disruption to surrounding structures to avoid additional complications.Additionally,the patient had significant adhesions due to chronic biliary disease,which made dissection challenging.These adhesions involved the gallbladder,bile ducts,and intestines,requiring meticulous separation to prevent injury to critical structures.In areas with severe adhesions,we employed careful dissection techniques and,when necessary,adjusted our surgical strategy to minimize trauma and ensure safe removal of the gallstone and restoration of normal anatomy.

Evaluation of surgical strategy for low anterior resection syndrome using preoperative low anterior resection syndrome score in China

BACKGROUND Despite improved survival rates in rectal cancer treatment,many patients experience low anterior resection syndrome(LARS).The preoperative LARS score(POLARS)aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning.AIM To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS.METHODS This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors.Patients were categorized into three groups according to their POLARS score:no LARS(score 0-20),minor LARS(score 21-29),and major LARS(score 30-42).The QLQ-C30/CR29 scores were compared among these groups,and the agreement between POLARS predictions and the actual LARS scores was analyzed.RESULTS The study population was divided into three groups:major LARS(n=51,27.42%),minor LARS(n=109,58.6%),and no LARS(n=26,13.98%).Significant differences in the QLQ-C30 scales of social function,diarrhea,and financial impact were detected between the no LARS and major LARS groups(P<0.05)and between the minor LARS and major LARS groups(P<0.05).Similarly,significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool,fecal incontinence,and stool frequency between the no LARS and minor LARS groups(P<0.05),as well as between the minor LARS and major LARS groups(P<0.05).The predictive precision for major LARS using the POLARS score was 82.35%(42/51),with a recall of 35.89%(42/117).The mean absolute error(MAE)between the POLARS score and the actual LARS score was 8.92±5.47.In contrast,the XGBoost(extreme gradient boosting)model achieved a lower MAE of 6.29±4.77,with a precision of 84.39%and a recall of 74.05%for predicting major LARS.CONCLUSION The POLARS score demonstrated effectiveness and precision in predicting major LARS,thereby providing valuable insights into postoperative symptoms and patient quality of life.However,the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.

Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome as a cause of pneumothorax: A case report

BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome,a rare inflammatory disease,was described in 1987 by Chamot et al,who identified its common characteristics and transitional forms through case reports.The inci-dence rate is now 1 in 10000 among Caucasians and 0.00144 in 10000 among Japanese.Pneumothorax occurs when gas enters the pleural cavity,typically due to lung disease or chest trauma,and is characterized as either spontaneous or traumatic.Spontaneous pneumothorax is commonly linked to congenital lung tissue abnormalities or lung conditions,such as ruptured pulmonary bullae,emphysema,and bronchial asthma.Respiratory involvement in SAPHO syn-drome has historically been noted.CASE SUMMARY We present the case of a 44-year-old male patient who had previously been diagnosed with SAPHO syndrome.Following a two-year cessation of methotrexate therapy,he experienced recurrent anterior chest wall and joint pain accompanied by dyspnea.We conducted a comprehensive examination for the patient,which included physical examination,laboratory tests,and imaging studies.The clinical presentation and treatment outcomes suggest that his pneumothorax was related to an episode of SAPHO syndrome.We performed closed thoracic drainage surgery for the patient and treated his symptoms with etoricoxib(60 mg daily).Upon discharge,methotrexate was prescribed again.In subsequent follow-ups,there was no recurrence of joint and respiratory symptoms observed in the patient.CONCLUSION SAPHO syndrome has been proposed as a transitional stage between ankylosing spondylitis and psoriatic arthritis.One study reported a 0.29%incidence of spontaneous pneumothorax in patients with ankylosing spondylitis,higher than in the general population.Additionally,30%of patients with SAPHO syndrome test positive for HLA-B27,an antigen linked to ankylosing spondylitis.Symptomatically,some patients with SAPHO syndrome meet diagnostic criteria for ankylosing spondylitis,with sternoclavicular joint involvement and paravertebral ossific-ations resembling syndesmophytes in ankylosing spondylitis.These features suggest a possible linked between SAPHO syndrome and ankylosing spondylitis.

Microvesicles derived from mesenchymal stem cells: A promising therapeutic strategy for acute respiratory distress syndrome-related pulmonary fibrosis?

Pulmonary fibrosis significantly contributes to the pathogenesis of acute respiratory distress syndrome(ARDS),markedly increasing patient mortality.Despite the established anti-fibrotic effects of mesenchymal stem cells(MSCs),numerous challenges hinder their clinical application.A recent study demon-strated that microvesicles(MVs)from MSCs(MSC-MVs)could attenuate ARDS-related pulmonary fibrosis and enhance lung function via hepatocyte growth factor mRNA transcription.This discovery presents a promising strategy for managing ARDS-associated pulmonary fibrosis.This article initially examines the safety and efficacy of MSCs from both basic science and clinical perspectives,subsequently exploring the potential and obstacles of employing MSC-MVs as a novel therapeutic approach.Additionally,it provides perspectives on future research into the application of MSC-MVs in ARDS-associated pulmonary fi-brosis.

IBS-D内脏高敏感小鼠模型的建立与评价

目的 建立并评价腹泻型肠易激综合征(irritable bowel syndrome with diarrhea, IBS-D)内脏高敏感小鼠模型。方法 采用不同剂量的鼠类柠檬酸杆菌(Citrobacter rodentium,CR)灌胃联合慢性避水应激(water avoidance stress, WAS)制备IBS-D内脏高敏感小鼠模型。将60只C57BL/6J小鼠随机分为正常对照组(NC组)和模型组。模型组按不同CR剂量(0.12、0.15、0.18、0.21、0.30ml)联合WAS建立。造模后,比较小鼠粪便性状评分、粪便含水量、全肠道转运时间、结肠转运时间、腹部撤退反射(abdominal withdrawal reflex, AWR)评分,观察结肠组织病理改变。结果 与NC组比较,模型组小鼠粪便稀溏质软、粪便含水量升高、全肠道转运时间减少(P<0.05)、结肠转运时间明显减少(P<0.005)、AWR评分3分阈值注水量减少。且CR剂量0.21ml和0.30ml模型组小鼠粪便边缘模糊不清呈糊状、AWR评分3分阈值注水量明显减少(P<0.01)、结肠组织细胞排列紊乱、炎性细胞浸润、隐窝增生、皱襞变短。结论 采用CR灌胃联合WAS能够成功建立IBS-D内脏高敏感小鼠模型。结合模型各项评价结果,推荐使用0.21ml CR剂量灌胃造模。

Hepatocardiorenal syndrome in liver cirrhosis:Recognition of a new entity?

Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.

基于TLR4/NF-κB通路研究白术-白芍药对对IBS-D模型大鼠的治疗作用

目的研究白术-白芍药对对腹泻型肠易激综合征(Diarrhea-predominant irritable bowel syndrome,IBS-D)模型大鼠TLR4/NF-κB信号通路相关靶标的影响,旨在阐述其治疗低度炎性反应的潜在机制。方法以番泻叶灌胃+慢性不可预知刺激建立IBS-D模型大鼠,并随机分为模型组、药对组、白芍组、白术组、西药组,每组6只。另取6只不造模大鼠,设为空白组。各药物组大鼠灌胃相应药液,连续治疗14 d。通过体重、大便含水量、AWR评分评价白术-白芍药对对模型大鼠症状的干预效果;各组大鼠腹主动脉取血,剖取回肠末端组织,通过qRT-PCR法、HE染色、Elisa、Westernblot法检测白术-白芍药对对IBS-D大鼠炎症以及TLR4/NF-κB信号通路相关靶标的调控。结果与模型组对比,药对能改善体重、降低大便含水量(P<0.01)、糖水偏好率(P<0.01),在40 mmHg、60 mmHg压力下降低AWR评分(P<0.01),改善回肠末端组织炎症病理状态,下调TLR4、NF-κB、IL-1βmRNA表达(P<0.01),下调血清TLR4、NF-κB、MyD88表达,上调血清IL-10表达,下调MyD88、p-NF-κB p65、IL-6蛋白表达(P<0.01)。结论白术-白芍药对改善IBS-D大鼠腹泻症状和内脏高敏感性,可能与抑制TLR4/NF-κB信号通路相关靶标,调控炎性反应细胞因子的表达水平有关。

The Role of Lactic Acid Bacteria in the Pathophysiology and Treatment of Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a multifactorial chronic disorder characterized by various abdominal complaints and a worldwide prevalence of 10% - 20%. Although its etiology and pathophysiology are complex and still not completely understood, aberrations along the microbe-gut-brain axis are known to play a central role. IBS is characterized by interrelated alterations in intestinal barrier function, gut microbe composition, immune activation, afferent sensory signaling and brain activity. Pharmaceutical treatment is generally ineffective and, hence, most therapeutic strategies are based on non-drug approaches. A promising option is the administration of probiotics, in which lactic acid bacteria strains are considered specifically beneficial. This review aims to provide a concise, although comprehensive, overview of the role of lactic acid bacteria in the pathophysiology and treatment of IBS.

Tricuspid mass-curious case of Li-Fraumeni syndrome: A case report

BACKGROUND Li-Fraumeni syndrome(LFS)is a rare autosomal dominant cancer-predisposing syndrome,which can manifest as a polymorphic spectrum of malignancies.LFS is associated with an early onset in life,with the majority of cases occurring prior to the age of 46.Notwithstanding the infrequency of primary cardiac tumors,it behooves clinicians to remain vigilant in considering the differential diagnosis of such tumors in LFS patients who present with a cardiac mass.This is due to the markedly elevated risk for malignancy in this particular population,far surpassing that of the general populace.CASE SUMMARY Herein,we present a case of a 30-year-old female with LFS who was found to have a tricuspid valve leaflet mass.CONCLUSION This case exemplifies valuable learning points in the diagnostic approach for this exceptionally rare patient population.

The Common Causes of Irritable Bowel Syndrome (IBS) in Northern Saudi Arabia

Background: Several psychological factors have been linked to the etiology of irritable bowel syndrome (IBS). The aim of the present study was to assess the burden of psychological factors (anxiety, depression, and working status) in the etiology of IBS in Northern Saudi Arabia. Methodology: Data regarding IBS were attained from 930 Saudi volunteers existing in the city of Hail, Northern Saudi Arabia. A purposeful questionnaire was developed and used to obtain the required data. Each questionnaire was completed by a medical student in the course of the interview. Results: IBS symptoms were recognized in 46% of the study population of whom 38% were males and 62% were females. The risk of anxiety as a risk for IBS was statistically significant. The relative risk and 95% confidence interval (95% CI) = RR (95% CI) = 1.4801 (1.2608 to 1.7376), P Conclusion: IBS and IBS related symptoms are prevalent in Northern Saudi Arabia. IBS symptoms are significantly associated with anxiety, depression and to a lesser extent may be linked to occupation and daily working hours.