Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report

BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.

A meta-analysis on the clinical efficacy of fire dragon cupping in the treatment of lumbar disc herniation

Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.

Network-pharmacology-based research on protective effects and underlying mechanism of Shuxin decoction against myocardial ischemia/reperfusion injury with diabetes

BACKGROUND Patients with diabetes mellitus are at higher risk of myocardial ischemia/reperfusion injury(MI/RI).Shuxin decoction(SXT)is a proven recipe modification from the classic herbal formula"Wu-tou-chi-shi-zhi-wan"according to the traditional Chinese medicine theory.It has been successfully used to alleviate secondary MI/RI in patients with diabetes mellitus in the clinical setting.However,the underlying mechanism is still unclear.AIM To further determine the mechanism of SXT in attenuating MI/RI associated with diabetes.METHODS This paper presents an ensemble model combining network pharmacology and biology.The Traditional Chinese Medicine System Pharmacology Database was accessed to select key components and potential targets of the SXT.In parallel,therapeutic targets associated with MI/RI in patients with diabetes were screened from various databases including Gene Expression Omnibus,DisGeNet,Genecards,Drugbank,OMIM,and PharmGKB.The potential targets of SXT and the therapeutic targets related to MI/RI in patients with diabetes were intersected and subjected to bioinformatics analysis using the Database for Annotation,Visualization and Integrated Discovery.The major results of bioinformatics analysis were subsequently validated by animal experiments.RESULTS According to the hypothesis derived from bioinformatics analysis,SXT could possibly ameliorate lipid metabolism disorders and exert anti-apoptotic effects in MI/RI associated with diabetes by reducing oxidized low density lipoprotein(LDL)and inhibiting the advanced glycation end products(AGE)-receptor for AGE(RAGE)signaling pathway.Subsequent animal experiments confirmed the hypothesis.The treatment with a dose of SXT(2.8 g/kg/d)resulted in a reduction in oxidized LDL,AGEs,and RAGE,and regulated the level of blood lipids.Besides,the expression of apoptosis-related proteins such as Bax and cleaved caspase 3 was down-regulated,whereas Bcl-2 expression was up-regulated.The findings indicated that SXT could inhibit myocardial apoptosis and improve cardiac function in MI/RI in diabetic rats.CONCLUSION This study indicated the active components and underlying molecular therapeutic mechanisms of SXT in MI/RI with diabetes.Moreover,animal experiments verified that SXT could regulate the level of blood lipids,alleviate cardiomyocyte apoptosis,and improve cardiac function through the AGE-RAGE signaling pathway.

老年患者出院后跌倒发生率及影响因素的调查研究

目的了解老年人出院后1年内累积跌倒发生率及其影响因素。方法2019年5月至2020年8月,对重庆市一所三级甲等医院的出院老年患者进行前瞻性调查研究。采用中文版跌倒风险自评量表、衰弱评估量表(FRAIL scale)和9项患者健康问卷(Patient Health Questionnaire-9,PHQ-9)、Barthel指数评定量表(Bar-thel index,BI)调查出院老年人跌倒风险、衰弱、抑郁、自理能力状况并在其出院后电话追踪1年。应用累积发生率函数估计老年人出院后1年内跌倒的累积发生率,利用竞争风险模型中部分分布风险函数探讨跌倒的危险因素。结果共有1077例老年患者参与此研究,出院后1、6、12个月跌倒累计发生率分别为4.45%、9.03%和10.80%。出院时伴有抑郁和衰弱的老年人在出院后1、6、12个月的跌倒累计发生率分别26.19%、49.93%、58.53%和21.59%、41.67%、48.73%,远高于没有抑郁和衰弱的老年人(P<0.05)。出院时伴有抑郁、衰弱、Barthel指数得分61~80分、住院时间>20 d、随访时间内再次入院、由他人照料和跌倒风险是影响老人出院后1年内跌倒的因素。结论住院老年人出院后1年内跌倒发生率随出院时间的延长具有累积效应,且受多种因素影响,未来构建预出院老年人跌倒预防策略时应关注这些影响因素,并重点关注老年人抑郁和衰弱。

Tumour mutational burden is overestimated by target cancer gene panels

Background:Tumour mutational burden(TMB)has emerged as a predictive marker for responsiveness to immune checkpoint inhibitors(ICI)in multiple tumour types.It can be calculated from somatic mutations detected from whole exome or targeted panel sequencing data.As mutations are unevenly distributed across the cancer genome,the clinical implications from TMB calculated using different genomic regions are not clear.Methods:Pan-cancer data of 10,179 samples were collected from The Cancer Genome Atlas cohort and 6,831 cancer patients with either ICI or non-ICI treatment outcomes were derived from published papers.TMB was calculated as the count of non-synonymous mutations and normalised by the size of genomic regions.Dirichlet method,linear regression and Poisson calibration models are used to unify TMB from different gene panels.Results:We found that panels based on cancer genes usually overestimate TMB compared to whole exome,potentially leading to misclassification of patients to receive ICI.The overestimation is caused by positive selection for mutations in cancer genes and cannot be completely addressed by the removal of mutational hotspots.We compared different approaches to address this discrepancy and developed a generalised statistical model capable of interconverting TMB derived from whole exome and different panel sequencing data,enabling TMB correction for patient stratification for ICI treatment.We show that in a cohort of lung cancer patients treated with ICI,when using a TMB cutoffof 10 mut/Mb,our corrected TMB outperforms the original panel-based TMB.Conclusion:Cancer gene-based panels usually overestimate TMB,and these findings will be valuable for unifying TMB calculations across cancer gene panels in clinical practice.

Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester

Objective This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging(CDFI)technology and the high-definition flow imaging(HDFI)technique in detecting fetal pulmonary veins(PVs)in the first trimester(11–13^(+6)weeks).Methods From December 2018 to October 2019,328 pregnant women with 328 normal singleton fetuses(crown-rump length:45–84 mm)who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study.The cases were divided into three groups according to the gestational age:group A,11^(+0)−11^(+6)weeks;group B,12^(+0)−12^(+6)weeks;and group C,13^(+0)−13^(+6)weeks.Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly.The abilities of CDFI and HDFI to display PVs were compared.Results Successful PV display rates via CDFI and HDFI were 2.3%and 68.2%(P<0.01),22.4%and 82.4%(P<0.01),41.5%and 91.2%(P<0.01)for group A,group B,and group C,respectively.The total successful display rates for the two methods were 28.9%(CDFI)and 84.8%(HDFI)(P<0.01).Conclusions The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy(11–13^(+6)weeks).HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization

Catheters navigating through complex vessels,such as sharp turns or multiple U-turns,remain challenging for vascular embolization.Here,we propose a novel multistage vascular embolization strategy for hard-to-reach vessels that releases untethered swimming shape-memory magnetic microrobots(SMMs)from the prior catheter to the vessel bifurcation.SMMs,made of organo-gel with magnetic particles,ensure biocompatibility,radiopacity,thrombosis,and fast thermal and magnetic responses.An SMM is initially a linear shape with a 0.5-mm diameter at 20°C inserted in a catheter.It transforms into a predetermined helix within 2 s at 38°C blood temperature after being pushed out of the catheter into the blood.SMMs enable agile swimming in confined and tortuous vessels and can swim upstream using helical propulsion with rotating magnetic fields.Moreover,we validated this multistage vascular embolization in living rabbits,completing 100-cm travel and renal artery embolization in 2 min.After 4 weeks,the SMMs maintained the embolic position,and the kidney volume decreased by 36%.

The status quo and future prospects of digital twins for healthcare

Digital twin technology plays a pivotal role in driving the digital transformation of healthcare services.This review provides a comprehensive overview of the applications of digital twins in the healthcare sector.We elucidate the concept and classification of digital twins for healthcare and provide a detailed account of their current applications in clinical diagnosis,treatment,and hospital operational management.Taking the cardiac digital twin as an example,this review showcases the typical use of digital twins in clinical practice and scientific research.Additionally,the challenges faced by digital twin technology in data collection,model construction,ethics,and regulations were analyzed.Finally,the broad prospects of digital twins in promoting precision and personalization in healthcare are envisioned.

Opportunities and challenges of digital twin technology in healthcare

To the Editor:The classic case considered to be the primary application of the digital twin approach is the Apollo 13 mission in 1970.In 2003,the concept of the digital twin was presented by Prof.Michael Grieves at the University of Michigan.However,the widespread dissemination of the digital twin concept is attributed to the National Aeronautics and Space Administration’s application of digital twin for aerospace vehicle health maintenance and assurance in 2011.[1]The improvement of new-generation information technology has led to a wider range of applications for digital twin technology,including healthcare.

Antibody response and cross-neutralization after Omicron BA.2 infection

Dear Editor,The Omicron(B.1.1.529)variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was first identified in November 2021,in South Africa and Botswana.The first Omicron sub-lineage that emerged was BA.1,which was supplanted by BA.2 in many countries.One of the most notable features of the Omicron variant is its ability to evade neutralizing antibodies(nAbs)targeting the original virus lineages.

G protein-coupled receptors in neurodegenerative diseases and psychiatric disorders

Neuropsychiatric disorders are multifactorial disorders with diverse aetiological factors.Identifying treatment targets is challenging because the diseases are resulting from heterogeneous biological,genetic,and environmental factors.Nevertheless,the increasing understanding of G protein-coupled receptor(GPCR)opens a new possibility in drug discovery.Harnessing our knowledge of molecular mechanisms and structural information of GPCRs will be advantageous for developing effective drugs.This review provides an overview of the role of GPCRs in various neurodegenerative and psychiatric diseases.Besides,we highlight the emerging opportunities of novel GPCR targets and address recent progress in GPCR drug development.

Advances in 3D bioprinting technology for cardiac tissue engineering and regeneration

Cardiovascular disease is still one of the leading causes of death in the world,and heart transplantation is the current major treatment for end-stage cardiovascular diseases.However,because of the shortage of heart donors,new sources of cardiac regenerative medicine are greatly needed.The prominent development of tissue engineering using bioactive materials has creatively laid a direct promising foundation.Whereas,how to precisely pattern a cardiac structure with complete biological function still requires technological breakthroughs.Recently,the emerging three-dimensional(3D)bioprinting technology for tissue engineering has shown great advantages in generating micro-scale cardiac tissues,which has established its impressive potential as a novel foundation for cardiovascular regeneration.Whether 3D bioprinted hearts can replace traditional heart transplantation as a novel strategy for treating cardiovascular diseases in the future is a frontier issue.In this review article,we emphasize the current knowledge and future perspectives regarding available bioinks,bioprinting strategies and the latest outcome progress in cardiac 3D bioprinting to move this promising medical approach towards potential clinical implementation.

Gingerol improves cardiac function in rats with cardiorenal syndrome via inhibiting fibrosis

Background Cardiorenal syndrome(CRS)is a clinical syndrome with a complex mechanism,and there is currently no specific treatment.Gingerol was confirmed to possess anti-inflammatory,antioxidant and cardiotonic properties as cardiovascular pharmacological effects.However,in vivo studies have yet to prove that it can improve cardiac function and inhibit fibrosis in rats with cardiorenal syndrome.Methods In this study,34 male Sprague-Dawley(SD)rats were randomly divided into control(n=9),model(n=12)and gingerol groups(n=13).The model and the gingerol groups underwent ligation of the left anterior descending coronary artery and 5/6 subtotal nephrectomy to construct a type 2 cardiorenal syndrome rat model.The rats in gingerol group were injected intraperitoneally with 50 mg/kg gingerol.The same amount of saline was administered to both the control and the model groups.Following 4 weeks of treatment,the rat cardiac function and myocardial fibrosis were evaluated by cardiac ultrasound and blood biochemistry.Results Biochemical results showed that the brain natriuretic peptide(BNP)levels of gingerol group decreased(P<0.05).Cardiac ultrasound revealed that gingerol improved cardiac systolic function and ventricular remodeling(P<0.05).The systolic function of the model group was significantly decreased compared with the control group.Masson staining confirmed that the fibrosis area in the model group was significantly augmented than that in the control group,while the area of fibrosis in the gingerol group was diminished compared to the model group(P<0.01).Moreover,immunofluorescence showed that compared with the control group,the expression of collagen 1,TGF-β1 andα-SMA was significantly increased in the model group,and both collagen deposition and the expression of collagen I,TGF-β1 andα-SMA decreased in gingerol group.Immunohistochemistry revealed that the expression of collagen 1 andα-SMA was significantly increased in the model group compared with the control group,while it was decreased in gingerol group(P<0.05).Conclusions Gingerol can improve the cardiac function and cardiac fibrosis in rats with cardiorenal syndrome.

Effects of sugar addition on adipolysis and volatile profiles of dry cured sausage

As sugar play a primary role in food flavor and biochemical reaction during the industrial manufacture of dry cured meat products,we aim to evaluate the function of sugar and how the quality changed with the addition of sugar on dry cured sausage after three months of preservation,and the corresponding effect on acidity value and the total acid value.The roles of sugars’effects on FA hydrolysis and flavor formation are required to be assessed.We selected the addition of sugar with the gradient contents from 3%to 15%,we found that the total acid,acidity value,peroxide value,FA and organic acid were significantly affected.Mono unsaturated fatty acids(MUFA)was the main content of FAs,following by saturated FA and polyunsaturated FA.C18:1n9c was the major FA,following by C16:0 and C18:0.Six kinds of organic acids in dry-cured sausages containing different concentrations of sugar were analyzed by HPLC and the total organic acid reached a maximum of 12.15%by after adding 6%sugar.Acetic acid was 8.06%and lactic acid was 2.56%.This study concludes that sugar is the main factor in flavor formation of dry cured sausage and affects the sausage quality for three months in storage.