Journal of International Medical Research最新文献

Cribriform morular thyroid carcinoma is a rare thyroid malignancy with uncertain histogenesis. It predominantly affects young women and is strongly associated with familial adenomatous polyposis. This paper reports a rare case of sporadic cribriform morular thyroid carcinoma in a female patient in her early 50s, with somatic genetic testing revealing a KMT2C mutation. She presented with a solitary lesion confined to the right thyroid lobe and had no family history of familial adenomatous polyposis. Colonoscopy and germline genetic testing revealed no abnormalities. This finding suggests a potential link between KMT2C mutations and sporadic cribriform morular thyroid carcinoma. The clinical and imaging manifestations of this malignancy lack specificity, and the final diagnosis depends on routine pathological examination and immunohistochemical analysis. This report indicates the need for the clinical investigation of family history and genetic testing, thus contributing to the clinical realization of standardized follow-up monitoring and management.

BackgroundProne ventilation improves lung function in patients with acute respiratory distress syndrome by enhancing oxygenation; however, managing enteral nutrition during prone ventilation is challenging due to body position changes.ObjectiveThe objective of the study was to assess the safety and efficacy of enteral nutrition during prone ventilation. A meta-analysis was conducted to evaluate the efficacy and safety of enteral nutrition in the prone position in critically ill ventilated patients.MethodsBy searching databases such as PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and WanFang Data, the relevant literature was retrieved from their inception to 24 December 2024. The Newcastle-Ottawa Scale was used to evaluate article quality. Egger's test was used to check for publication bias, and Review Manager 5.4 was used to conduct the analyses.ResultsAmong 81 publications, five studies with a total sample size of 319 were included in this study. Enteral nutrition in the prone position, compared with that in the supine position, was associated with a lower energy achievement rate (mean difference: -0.88; 95% confidence interval: -1.83 to 0.06; P < 0.00001), no significant difference in mortality (odds ratio: 1.11; 95% confidence interval: 0.65 to 1.88; P = 0.7), a greater incidence of ventilator-associated pneumonia (odds ratio: 2.11; 95% confidence interval: 1.12 to 3.96; P = 0.02), more frequent vomiting (odds ratio: 2.38; 95% confidence interval: 1.61 to 3.50; P < 0.0001), a greater gastric residual volume (odds ratio: 2.72; 95% confidence interval: 1.47 to 5.03; P = 0.001), and increased interruptions in enteral nutrition (odds ratio: 4.75; 95% confidence interval: 2.22 to 10.17; P < 0.0001). The Egger's test suggested no significant publication bias in the meta-analysis of mortality, gastric residual volume, adequate enteral nutrition achievement, and ventilator-associated pneumonia.ConclusionA greater gastric residual volume, more frequent vomiting, and greater incidences of ventilator-associated pneumonia and enteral feeding interruptions are linked to enteral nutrition during prone ventilation. There was no statistically significant difference in mortality between the prone and supine positions. However, the prone position showed a slight trend toward reducing energy achievement rates, although this difference was not statistically significant.Trial registration number: PROSPERO CRD: 42023441409.

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic illustrated the relationship between cardiac arrhythmias and pro-inflammatory states. Pro-inflammatory cytokines, including interleukin-6 (IL-6), have significant effects on cardiac conduction. Atrial or ventricular arrhythmias occurring while infected results in a doubling of mortality. Tocilizumab, a monoclonal antibody that blocks the IL-6 receptor, is associated with improved mortality and is believed to be related to immune modulation of the COVID-19-related hyperinflammatory state.MethodsA single-center retrospective review of all patients with severe COVID-19, defined as admission to an intensive care unit or requirement of respiratory or circulatory support, from March 2020 through March 2022, was conducted. Patients who received or did not receive tocilizumab were grouped into the treatment and control groups, respectively.ResultsFour hundred seventy-three patients were reviewed and 400 met the criteria for inclusion in our study. There were 305 patients (age, 63 ± 13 years, 58% male) in the control group and 95 (age, 57 ± 15 years, 51% male) in the treatment group. In-hospital mortality was greatly reduced with tocilizumab compared with controls (44.2% vs 85.9%, p < 0.001) and new-onset atrial fibrillation (AF) showed a statistically significant reduction (17.8% vs 29.5%, p = 0.019). New-onset wall motion abnormalities, potentially related to myocarditis or acute coronary syndrome, also trended toward significance with tocilizumab (7.7% vs 15.7%, p = 0.10). Deep vein thrombosis, pulmonary embolism, stroke, and sustained ventricular arrhythmias did not meet statistical significance.ConclusionAs expected, tocilizumab did show significant improvement in mortality. Tocilizumab also showed a significant reduction of new-onset AF. Other cardiac structural endpoints did not reach statistical significance.Abstract PresentationsA preliminary version of this research was presented during a regional conference at the Mid-Atlantic Capital Cardiology Symposium (MACCS) on 19 November 2023.

Systemic sclerosis is a rare autoimmune disorder that affects multiple organ systems, including the lungs, kidneys, and liver, and often leads to fatal complications. Adrenocortical adenoma, a benign tumor, can secrete hormones such as cortisol, resulting in symptoms including hypertension, diabetes, and obesity, although it can also be asymptomatic. This article presents a case of a patient with systemic sclerosis and adrenocortical adenoma, detailing the diagnostic and therapeutic journey before and after laparoscopic adrenal tumor resection. It offers insights into the clinical management of such cases and analyzes how surgical removal of the adenoma affects the treatment and prognosis of systemic sclerosis. This study aimed to provide valuable knowledge to healthcare professionals managing patients with this dual diagnosis, further contributing to the medical understanding of treatment outcomes in such cases.

Left ventricular pseudoaneurysm (LVP), a rare but life-threatening complication following acute myocardial infarction (AMI), has an incidence of approximately 0.5% and a high mortality rate due to its significant risk of rupture. Early detection and timely surgical intervention are crucial. The diagnosis of LVP can be effectively achieved through various imaging modalities, including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography angiography, and left ventriculography. However, determining the optimal therapeutic strategy requires a comprehensive multidisciplinary discussion approach and individualized consideration. This report presents a challenging case of a patient who experienced recurrent AMI 25 years after the initial event, with an incidental discovery of a calcified LVP. The distinctive features of this case include the long-term presence of a calcified pseudoaneurysm without rupture and the successful management strategy employed following the recurrent AMI.

ObjectiveThis retrospective study aimed to investigate the correlation between the cardiopulmonary exercise test (CPET) and the severity of coronary stenosis (SYNTAX score) in patients with stable coronary artery disease (SCAD), thereby assessing CPET's diagnostic value.MethodsWe classified 220 patients who underwent coronary angiography into coronary heart disease (CHD) and non-CHD groups based on stenosis severity. Patients with SCAD were categorized into mild, moderate, and severe groups by the SYNTAX score. CPET was performed, and data on the general information, serological indicators, and echocardiographic parameters were collected. CPET parameters included oxygen uptake related to the work rate (△VO₂/△WR), peak metabolic equivalent (Peak Mets), anaerobic threshold (AT), peak oxygen consumption per kilogram (PVO₂/kg), and metabolic equivalent at anaerobic threshold (Met@AT).ResultsPatients without SCAD demonstrated significantly higher CPET parameters than those with SCAD. The CPET parameters varied significantly across severity groups in the SCAD group, with the mild group exhibiting higher values than the moderate and severe groups. No significant differences were observed in the baseline data between the groups or among patients with varying numbers of lesion branches.ConclusionCPET parameters demonstrated a significant negative correlation with the SYNTAX score in patients with SCAD, indicating its potential clinical value in assessing the severity of coronary stenosis and diagnosing SCAD.

Plasma cell leukemia is a rare and aggressive malignancy characterized by monoclonal gammopathy and the presence of circulating plasma cells in the peripheral blood. Therapeutic strategies for plasma cell leukemia remain undefined, with treatments primarily borrowed from those used in multiple myeloma. The first-line treatment typically involves a combination of a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators within an intensive chemotherapy regimen. Following this, consolidation with autologous hematopoietic stem cell transplantation is offered to eligible patients, followed by maintenance therapy. For patients ineligible for autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation is considered a viable alternative. Given the challenges in securing a fully human leukocyte antigen-matched donor, haploidentical hematopoietic stem cell transplantation serves as a potential salvage therapy, as demonstrated in the clinical case presented. This article presents the case of a female patient in her 50s diagnosed with plasma cell leukemia who, following unsuccessful autologous hematopoietic stem cell mobilization, underwent haploidentical hematopoietic stem cell transplantation from her son, resulting in complete donor chimerism and a favorable response.

This study investigated the occurrence of left ventricular thrombus formation and subsequent embolic stroke in patients with Takotsubo syndrome. Through the case analysis of an 80-year-old Chinese elderly female patient, it was found that although Takotsubo syndrome is generally considered a self-limiting disease, it can lead to severe complications such as left ventricular thrombus and cerebral stroke. The patient experienced a cardioembolic stroke during hospitalization, and magnetic resonance imaging revealed acute cerebral vascular occlusion. This case highlights the importance of anticoagulation therapy, especially in the prevention of thromboembolic events in patients with Takotsubo syndrome complicated with intracardiac thrombosis.

Left ventricular thrombus is one of the major complications of dilated cardiomyopathy. Although the presence of a cardiac thrombus is a major risk factor for embolization, several probable conditions, the connection of which is not thoroughly studied, such as gout disease and methamphetamine abuse, are also possible causes. We present the case report of a male in his early 40s with a history of alcohol and methamphetamine abuse, gout, and dilated cardiomyopathy, experiencing multiple ischemic attacks, including acute limb ischemia, dysarthria, and renal infarct. Echocardiography revealed a large clot in the left ventricle. The patient received heparin at a rate of 1000 units/hour, followed by warfarin at 10 mg/day, and probenecid at 500 mg/day. The thrombus resolved upon anticoagulant therapy, with improvement in the patient's symptoms. Left ventricular thrombus formation in dilated cardiomyopathy is influenced by many factors, including drug toxicity (for instance, methamphetamine), uric acid levels, and N-terminal precursor B-type natriuretic peptide. The thrombus can cause cardioembolic attacks in multiple sites, and the choice for emergent therapy is an oral anticoagulant, which may improve the ejection fraction. However, certain aspects related to cardiac thrombosis and embolization risk still warrant more comprehensive studies.

ObjectivesAcute leukemia often leads to severe complications such as febrile neutropenia. Mortality rates remain high, underscoring the need for novel prognostic markers. Regulatory T cells (Tregs) have not been extensively studied in this context.MethodsThis prospective observational, single-center study included 114 patients diagnosed with acute leukemia. Tregs percentages were measured using flow cytometry. Statistical analyses involved logistic regression to identify factors significantly associated with survival.ResultsOf the 114 patients, 78 recovered, while 36 died. The median Treg percentages were 5.9% in patients under 65 years and 5.38% in those 65 and older. A lower percentage of Tregs was associated with higher mortality in the older group (p = 0.04). Multivariate analysis highlighted the presence of comorbidities, documented infections, and day seven C-reactive protein levels as significant predictors of survival.ConclusionThis study supports the importance of monitoring chronic diseases and infection foci alongside traditional markers like C-reactive protein. Future research should explore the mechanistic roles of Tregs in immunosuppression and survival in this vulnerable population.