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.

Saccharomyces boulardii as a single trigger of food protein-induced enterocolitis syndrome: Seven case reports

BACKGROUND Food protein-induced enterocolitis syndrome(FPIES)is the most serious type of non-immunoglobulin E(IgE)-mediated food allergic reaction manifesting as sepsis-like symptom,which can lead to shock.Saccharomyces boulardii(S.boulardii),a probiotic prescribed frequently in clinical settings,has been reported to trigger FPIES in an infant with soy-triggered FPIES.In this report,we describe a new clinical FPIES in which S.boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.CASE SUMMARY Seven FPIES cases triggered by only S.boulardii were gathered from 2011 to the present.None of the patients had previously experienced any allergic reaction to cow’s milk,soy,or complementary food.The age of the patients was 4-10-months old,and the symptoms of FPIES developed after ingestion of S.boulardii,which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea.All patients experienced severe repetitive vomiting 1-3 hours after S.boulardii ingestion.Extreme lethargy,marked pallor,and cyanosis were also observed.No IgE-mediated hypersensitivity developed in any patient.Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S.boulardii ingestion,and only one case showed bloody,purulent,and foul-smelling diarrhea.The patients stabilized quickly,mostly within 6 hours.Symptoms got all improved within 24 hours after discontinuation of S.boulardii.CONCLUSION S.boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.

Unusual ovarian hyperstimulation syndrome presentation:Pleural effusion without ascites.A case report

BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.

Health anxiety and work loss in patients diagnosed with serrated polyposis syndrome:A cross sectional study

BACKGROUND Serrated polyposis syndrome(SPS)is a polyposis condition with neoplastic potential,but its psychological impact is not well understood.AIM To assess health anxiety prevalence in a regional Australian cohort of SPS patients and explore factors influencing it,including workforce impacts of regular surveillance.METHODS This cross-sectional study screened patients aged 18-65 undergoing colonoscopy in a regional gastroenterology practice between January 2015 and June 2022.Eligible SPS patients were invited to participate.Data included the Short Health Anxiety Inventory,employment status,and previous demographic and medical findings.RESULTS Health anxiety was found in 21.57%of SPS patients,with anxious patients being significantly more concerned about surveillance(OR=7.70).Patients lost an average of 11.04 work hours per colonoscopy.CONCLUSION Health anxiety in SPS patients aligns with rates in other gastroenterology populations.Identifying it may improve management,though further research is needed to better understand prevalence and care improvements.

Anlotinib-induced sick sinus syndrome:Two case reports

BACKGROUND This manuscript describes the first known cases of sick sinus syndrome(SSS)associated with the use of anlotinib in non-small cell lung cancer patients,highlighting the need for increased vigilance and cardiac monitoring.CASE SUMMARY Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment,respectively,presenting with syncope and palpit-ations.Electrocardiogram confirmed SSS,and different treatment approaches were taken for each patient.One patient received a dual-chamber permanent pacemaker,while the other discontinued the medication and experienced symptom resolution.CONCLUSION Anlotinib can induce SSS,suggesting that cardiac monitoring is crucial during anlotinib treatment.Individualized management strategies are necessary for affected individuals.

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.

Cauda equina syndrome with urinary retention as a postoperative complication of lumbar spine surgery:A case report

BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.

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.

Literature study on traditional Chinese medicine syndromes after renal transplantation

BACKGROUND Kidney transplantation is the most effective means to treat patients with renal failure,but its postoperative problems such as rejection reactions,immunosuppressant poisoning,chronic transplant kidney nephropathy,etc.still have not been effectively solved.This study searched for literature on traditional Chinese medicine(TCM)syndromes after kidney transplantation in China,conducted statistical analysis of the results,and sought to identify the underlying patterns.AIM To understand the TCM syndromes after renal transplantation and associated rules and provide a theoretical basis for further clinical research.METHODS The literature pertaining to TCM syndromes in renal transplantation,published in the China National Knowledge Infrastructure,Wanfang database,and WIP database from 1970 to 2021,was meticulously searched and comprehensively and statistically analyzed.RESULTS Following the established inclusion and exclusion criteria,13 studies were selected for analysis.Post-renal transplantation,no significant discrepancy was noted among the groups based on the location of TCM viscera.However,when categorized according to TCM pathogenic factors,the groups with spleen and kidney yang deficiency,as well as liver and kidney yin deficiency,exhibited a statistically significant difference in the frequency.CONCLUSION Currently,the research on TCM syndromes pertaining to renal transplantation is in its nascent phase.It is imperative to conduct a multicentric,large-scale survey of TCM syndromes subsequent to renal transplantation in the ensuing years.

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.

Pembrolizumab-induced Guillain-Barrésyndrome in triple-negative breast cancer:A case report

BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis.We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.CASE SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting pain.Symptoms progressed to global weakness,ascending paralysis,and double vision.Neurological examination revealed significant lower extremity weakness and sensory deficits.Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS.Initial treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose glucocorticoids.The patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation facility.CONCLUSION Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.

Cardiovascular involvement in multisystem inflammatory syndrome in children and midterm follow-up from a pediatric tertiary center in India

BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.

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.