Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

Metabolic disorders and hepatitis: Insights from a Mendelian randomization study

BACKGROUND Hepatitis is a systemic disease that often results in various comorbidities.Meta-bolic disorders,the most common comorbidities in clinical practice,were selected for this study.AIM To investigate the causal relationship between comorbidities and hepatitis trea-tment outcomes.METHODS A total of 23583378 single nucleotide polymorphisms from 1248743 cases and related summaries of genome-wide association studies were obtained from online public databases.A two-sample Mendelian randomization(MR)was performed to investigate causality between exposure[type 2 diabetes mellitus(T2D),hyperlipidemia,and hypertension]and outcome(chronic hepatitis B or C in-fections).RESULTS The data supported the causal relationship between comorbidities and hepatitis infections,which will affect the severity of hepatitis progression and will also provide a reference for clinical researchers.All three exposures showed a link with progression of both hepatitis B(T2D,P=0.851;hyperlipidemia,P=0.596;and hypertension,P=0.346)and hepatitis C(T2D,P=0.298;hyperlipidemia,P=0.141;and hypertension,P=0.035).CONCLUSION The results of MR support a possible causal relationship between different ex-posures(T2D,hyperlipidemia,and hypertension)and chronic hepatitis progression;however,the potential mechanisms still need to be elucidated.

Diamond-Like Carbon Depositing on the Surface of Polylactide Membrane for Prevention of Adhesion Formation During Tendon Repair

Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats.The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane,with histological score decreasing from 3.12±0.27 to 2.20±0.22 and anti-adhesion effectiveness increasing from 21.61%to 44.72%.Mechanistically,the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively;thus,the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited.Consequently,excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)is largely reduced.For biocompatibility evaluation,PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes.Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds,which further delays the fibrosis process.It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.

Correlation between diabetic retinopathy and Helicobacter pylori infection: a cross-sectional retrospective study

AIM:To explore the correlation between diabetic retinopathy(DR)and Helicobacter pylori(Hp)infection,based on data from a physical examination population.METHODS:This cross-sectional retrospective analysis included data of 73824 health examination participants from December 2018 to December 2019.Participants were divided into the diabetic group and non-diabetic group,nondiabetic retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)group,proliferative diabetic retinopathy(PDR)group,and Hp infection group.Gender,age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and Hp data were recorded to compare the degree of DR lesions and Hp infection.Logistic regression analysis was used to evaluate the correlation between DR and Hp infection.RESULTS:There was a statistically significant difference between the diabetic and non-diabetic group(χ2=94.17,P<0.0001).Logistic regression analysis showed that male sex,age,BMI,SBP,TG,LDL-C,and Hp infection were independent risk factors for DR.There was no correlation between the degree of DR lesions and Hp infection(ρ=-0.00339,P=0.7753).Age[odds ratio(OR)=1.035,95%CI:1.024,1.046,P<0.0001]and SBP(OR=1.009,95%CI:1.004,1.015,P=0.0013)were independent risk factors for the degree of DR.CONCLUSION:There is a significant correlation between DR and Hp infection in the physical examination population.Hp infection is a risk factor for DR,and there is no significant difference between Hp infection and DR of different pathological degrees.Actively eradicating Hp may be of help to prevent DR.

Mutation-associated transcripts reconstruct the prognostic features of oral tongue squamous cell carcinoma

Tongue squamous cell carcinoma is highly malignant and has a poor prognosis.In this study,we aimed to combine whole-genome sequencing,whole-genome methylation,and whole-transcriptome analyses to understand the molecular mechanisms of tongue squamous cell carcinoma better.Oral tongue squamous cell carcinoma and adjacent normal tissues from five patients with tongue squamous cell carcinoma were included as five paired samples.After multi-omics sequencing,differentially methylated intervals,methylated loop sites,methylated promoters,and transcripts were screened for variation in all paired samples.Correlations were analyzed to determine biological processes in tongue squamous cell carcinoma.We found five mutated methylation promoters that were significantly associated with mRNA and lncRNA expression levels.Functional annotation of these transcripts revealed their involvement in triggering the mitogen-activated protein kinase cascade,which is associated with cancer progression and the development of drug resistance during treatment.The prognostic signature models constructed based on WDR81 and HNRNPH1 and combined clinical phenotype-gene prognostic signature models showed high predictive efficacy and can be applied to predict patient prognostic risk in clinical settings.We identified biological processes in tongue squamous cell carcinoma that are initiated by mutations in the methylation promoter and are associated with the expression levels of specific mRNAs and lncRNAs.Collectively,changes in transcript levels affect the prognosis of tongue squamous cell carcinoma patients.

Unusual breast metastasis of gastrointestinal stromal tumor:A case report and literature review

BACKGROUND Gastrointestinal stromal tumors(GISTs)are the most frequent mesenchymal tumors of gastrointestinal tract.The most common sites of metastases are the liver and the peritoneum,whereas breast metastases from GIST are extremely rare.We present a second case of GIST breast metastasis.CASE SUMMARY We found a case of breast metastasis from rectum GIST.A 55-year-old female patient presented with rectum tumor with multiply liver lesions and metastasis in the right breast.Abdominal-perineal extirpation of rectum was performed,histology and immunohistochemistry study showed GIST,mixed type with CD117 and DOG-1 positive staining.The patient was taking imatinib 400 mg for 22 mo with stable disease.Because of growth of the breast metastasis the treatment was changed twice:The dose of imatinib was doubled with further progression in the breast lesion and then the patient was receiving sunitinib for 26 mo with partial response in the right breast and stable disease in the liver lesions.The breast lesion increased and right breast resection was done–surgery on local progression,the liver metastases were stable.Histology and immunohistochemistry studies revealed GIST metastasis,CD 117 and DOG 1 positive with KIT exon 11 mutation.After surgery the patient resumed imatinib.Until now the patient has been taking imatinib 400 mg for 19 mo without progression,last follow up was in November 2022.CONCLUSION GISTs breast metastases are extremely rare,we described the second case.At the same time second primary tumors have been reported frequently in patients diagnosed with GISTs and breast cancer is one of the most common second primary tumors in patients with GISTs.That is why it is very important to distinguish primary from metastatic breast lesions.Surgery on local progression made it possible to resume less toxic treatment.

Chemical composition of natural waters at Broknes Peninsula, Larsemann Hills, Antarctica

The article contributes to the study of the content of major and trace elements in various types of natural waters of the Broknes Peninsula,Larsemann Hills,Antarctica collected in January–February 2014 and 2020 during the 7th and 12th Belarusian Antarctic Expeditions.Samples of old(13 samples)and newly fallen snow(5),lakes(23)and groundwater(8)were analyzed.The content of 25 major and trace elements was determined using ICP-MS method,main anions was determined by titrimetric and turbidimetric methods.Good similarity chemical composition of snow,groundwater and lake waters in spite of differences in the content of major ions and trace elements has been obtained.The influence of marine salts on natural waters are analyzed,and their accumulation in lake waters especially in the endorheic small and shallow lakes in spite of ultra-oligotrophic atmospheric precipitates are shown.The spatial heterogeneity of groundwater and temporal and spatial heterogeneity of lake waters have been demonstrated.The results are important for understanding the variabilities of major and trace elements content in snow,groundwater and lake waters,and their relationship,as well as for identifying trends in their change,taking into account anthropogenic loads in the region and climate change.

Occurrence of Boerhaave's syndrome after diagnostic colonoscopy:what else can emergency physicians do?

Dear editor,Boerhaave’s syndrome is a barogenic tear of the esophagus,typically at the gastroesophageal junction,caused by a sudden increase in intraluminal pressure in the distal esophagus.[1]In recent years,the number of Boerhaave’s syndrome cases has increased,and a growing proportion of clinicians have recognized this rare but life-threatening disease.

Single Lung Acute Respiratory Distress Syndrome

Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lungs are the second most commonly affected organ after the liver. Intrathoracic and extrapulmonary hydatid disease can affect the pleura, mediastinum, heart, diaphragm, and chest wall. The unusual location or complications of thoracic hydatid disease can present both a diagnostic problem and a therapeutic and surgical problem. We present results of a case of multilocular thoracic hydatid disease complicated by aortic wall erosion and cystic fistula in a 23-year-old patient who developed acute respiratory distress syndrome (ARDS) on the 4th day after emergency pneumonectomy. The surgery was carried out under the conditions of the auxiliary artificial circulation. This case represented a serious clinical situation with the highest risk to life. The need for immediate respiratory support was due to the development of severe respiratory failure, and the presence of direct and indirect harmful factors of ARDS. The correct choice of modes and techniques of mechanical ventilation resulted in significant and sustained improvement in gas exchange parameters without hemodynamic disorders with a further favorable outcome.

Clinical and genetic diagnosis of autosomal dominant osteopetrosis typeⅡin a Chinese family:A case report

BACKGROUND Osteopetrosis is a rare genetic disorder characterized by increased bone density due to defective bone resorption of osteoclasts.Approximately,80%of autosomal dominant osteopetrosis type II(ADO-II)patients were usually affected by heterozygous dominant mutations in the chloride voltage-gated channel 7(ClCN7)gene and present early-onset osteoarthritis or recurrent fractures.In this study,we report a case of persistent joint pain without bone injury or underlying history.CASE SUMMARY We report a 53-year-old female with joint pain who was accidentally diagnosed with ADO-II.The clinical diagnosis was based on increased bone density and typical radiographic features.Two heterozygous mutations in the ClCN7 and Tcell immune regulator 1(TCIRG1)genes by whole exome sequencing were identified in the patient and her daughter.The missense mutation(c.857G>A)occurred in the CLCN7 gene p.R286Q,which is highly conserved across species.The TCIRG1 gene point mutation(c.714-20G>A)in intron 7(near the splicing site of exon 7)had no effect on subsequent transcription.CONCLUSION This ADO-II case had a pathogenic CLCN7 mutation and late onset without the usual clinical symptoms.For the diagnosis and assessment of the prognosis for osteopetrosis,genetic analysis is advised.

Diagnostic and classification value of immune-related lncRNAs in dilated cardiomyopathy

Background:Various physiological mechanisms are linked to dilated cardiomyopathy(DCM)development,including oxidative stress,immune irregularities,inflammation,fibrosis,and genetic changes.However,precise molecular drivers of DCM,especially regarding abnormal immune responses,remain unclear.This study investigates immune-related long non-coding RNAs(lncRNAs)in DCM’s diagnostic and therapeutic potential.Methods:GSE141910,GSE135055,and GSE165303 datasets were acquired from the GEO database.LASSO,SVM-RFE,and random forest algorithms identified DCM-associated immune-related lncRNAs.Diagnostic capabilities were assessed by Nomogram and receiver operating characteristic(ROC)curves.Multivariate linear regression explored lncRNA correlations with ejection fraction.Single-sample gene set enrichment analysis(ssGSEA)gauged immune cell infiltration/functions.Functional enrichment analyses were performed using Gene set variation analysis(GSVA),gene ontology(GO),and the Kyoto Encyclopedia of Genes and Genomes(KEGG).Consensus clustering categorized DCM cases.Results:Ten immune-related lncRNAs emerged:C10orf71-AS1,FHAD1-AS1,SCIRT,FNDC1-AS1,MELTFAS1,LOC101928834,GDNF-AS1,DCXR-DT,C3orf36,and LOC107985323.These lncRNAs,tied to immunomodulation,showed promising DCM diagnostic accuracy.Adjusted for confounders,they independently correlated with ejection fraction.Using lncRNA expression,DCM patients were grouped into subtypes.Subtype C1 displayed a higher level of immune cell infiltration and immune checkpoint expression compared to subtype C2,emphasizing the variations in the immune microenvironment.Conclusion:This study identifies ten immune-related lncRNAs for further exploration in DCM diagnosis and subtyping.Based on expression patterns,we propose two potential DCM subtypes.Notably,findings are preliminary and hypothesis-generating,demanding validation and further investigation.This research provides insights into DCM diagnosis and classification.

Association between the Lung Immune Prognostic Index and mortality in patients with idiopathic inflammatory myopathy-associated interstitial lung disease

Objective:To explore the association between the Lung Immune Prognostic Index(LIPI)and 1-year all-cause mortality in patients with idiopathic inflammatory myopathy related interstitial lung disease(IIM-ILD).Methods:Patients who were diagnosed with IIM-ILD at West China Hospital,Sichuan University from January 2008 to December 2021 were retrospectively included and categorized into three groups based on LIPI.Univariable and multivariable Cox proportional hazards models were conducted to explore potential association between the LIPI and patients'mortality.Results:A total of 1116 patients were screened,and 830 were included in this study.The multivariable Cox analysis showed that,compared with patients with poor LIPI,the hazard ratio(HR)for all-cause 1-year mortality was 0.22(95%CI 0.05-0.93,P=0.04)for patients in the good LIPI group(LDH<250 IU/L and dNLR<3).After excluding patients lost to follow-up within one year,a similar result was found for LIPI(HR 0.20,95%CI 0.05-0.86;P=0.03).Conclusions:Good LIPI was independently associated with decreased risk of all-cause 1-year mortality in patients with IIM-ILD.This easy-to-obtain index might be served as a potential marker for assessing the prognosis of IIM-ILD.

中医药临床随机对照试验报告规范(征求意见稿)

1 制订中医药临床随机对照试验报告规范（CONSORT for TCM）的必要性中医对疾病及其治疗的认识有别于西医,尤其中医“辨证论治”和“临证察机”的治疗原则比西医分型分类更加复杂，其临床研究因而有不同于西医的特点。但无论多么复杂，随机对照试验（RCT）仍是目前公认的中医药防治性研究偏倚可能性最小的设计方案。由于中医药临床试验采用RCT方案仅约30年，试验设计还需要深人探索，试验结果报告还不规范。2005年，中国循证医学中心对中医药临床“随机对照试验”的主要研究者进行电话采访，调查随机方法正确性。

中国循证医学中心促进中医药现代化的策略

1对中医药现代化的基本认识 1．1中医药现代化的必要性 “中医药现代化”的必要性归根结底有两个：（1）保护中华民族积数千年智慧形成的知识产权，特别是中药知识产权；（2）让人类共享中华民族的智慧结晶。

实施临床试验报告规范,提高临床试验透明度

临床试验是指以人为对象的前瞻性研究,预先将受试者或受试人群分配至接受一种或多种医疗干预,以评价医疗干预对健康结局的影响。其中“医疗干预”包括但不仅限于药物，也包括细胞及其他生物制品、外科治疗、放射治疗、医疗器械、行为疗法、治疗过程的改变和预防保健等。

中医药临床随机对照试验报告规范(征求意见稿)(英文)

1 Necessity for the extension of CONSORTfor TCMThe way for traditional Chinese medicine (TCM) to interpret both diseases and therapies differs

Expression of COX-2, PCNA, Ki-67 and p53 in gastrointestinal stromal tumors and its relationship with histopathological parameters

AIM: To investigate the expression of Cyclooxygenase-2 (COX-2), proliferating cell nuclear antigen (PCNA), Ki-67 and p53 in gastrointestinal stromal tumors (GISTs) and its relationship with histopathological parameters. METHODS: Twenty-five GISTs were examined by light microscopy and immunohistochemistry. c-kit, CD34, SMA, S-100 protein, COX-2, PCNA, Ki-67 and p53 were detected immunohistochemically and the relationship was evaluated among histopathologic parameters such as mitotic index (MI), tumor grade, tumor size, COX-2, PCNA, Ki-67 and p53. RESULTS: COX-2 protein expression was found in 19 of 25 (76%) of the tumors, and expression was noted in the cytoplasm of the tumor cells. p53 was significantly related to MI and tumor grade but no relationship was found between COX-2, proliferation markers and MI, tumor grade and tumor size. CONCLUSION: COX-2 is expressed in most GISTs and it may play an important role in the proliferation and progression of these tumors or a useful marker to identify GIST. Although immunohistochemical assessment of p53 can be used for distinguishing the risk groups of GISTs, tumor size and mitotic rate should be considered at the same time.

On the Capitalization of Land Resources in Rural Areas in China

The capitalization of land resources in rural areas is good for the transforming of agricultural management method,carrying out the process of urbanization,alleviating lack of funds for construction in rural areas and further guarantee farmers’rights.However,in the process of capitalization of land resources in rural areas in China,problems such as ambiguity of land property right,inaccuracy of the appraisal of the investment in land,imperfectness of the related supporting system and non-fluency of land resources circulation in rural areas and so on still exist,which need the support from governments of all levels to actively explore and survey,taking such actions as carrying out land registration,establishing a scientific and normative price appraisal system for land resources,improving the system of registration as a legal person,increasing subsidies,improving taxation reducing policy,forming the diversified rural financial system,setting up and improving the land resources circulation market in rural areas and so on.

Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

Sediment record of environmental change at Lake Lop Nur (Xinjiang, NW China) from 13.0 to 5.6 cal ka BP

Lake Lop Nur is located in the eastern part of the Tarim Basin in Xinjiang,northwestern China.A 220-cm-long sediment core was collected from the center of the ear-shaped depression forming the basin and dated with AMS^(14)C.Grain size,total organic matter(TOC),total nitrogen(TN),and TOC/TN(C/N)analyses were used to reconstruct climatic conditions from 13.0 to 5.6 cal ka BP.The results showed fi ve main climatic stages.Zone I(13.0–11.3 cal ka BP)was a wet–dry environment,whereas Zone II(11.3–8.9 cal ka BP)consisted of a primarily wet environment.Zone III(8.9–7.7 cal ka BP)was subdivided into Zone IIIa(8.9–8.2 cal ka BP)that indicated lake constriction and dry climate,and Zone IIIb(8.2–7.7 cal ka BP)in which the proxies indicated wet conditions.In Zone IV(7.7–6.6 cal ka BP),the climate presented a bit wet conditions.In Zone V(6.6–5.6 cal ka BP),abundant glauberite is present in the sediment and silt dominates the lithology;these results indicate the lake shrank and the overall climate was dry.Abrupt environmental events were also identifi ed,including six dry events at 11.0,10.5,9.3,8.6,8.2,and 7.6 cal ka BP and one fl ood event from 7.8 to 7.7 cal ka BP in the Early–Middle Holocene.