World Journal of Clinical Cases最新文献

Myeloid sarcoma (MS) is a rare neoplasm characterized by the proliferation of immature myeloid precursor cells outside the bone marrow. The pathogenesis of MS is complex and not completely understood. Moreover, it develops in any extramedullary site of the body. In this editorial, we discuss the article published by Li et al, which presents a clinical case involving a 32-year-old man who exhibited gingival inflammation in the maxillary region. It was initially diagnosed as periodontal disease. However, clinical evaluation revealed a firm, grayish-white mass which underscored the need for comprehensive diagnostics to distinguish MS from other oral conditions. This article emphasizes the different clinical presentations of similar case studies in the literature, and highlights the difficulty in diagnosing oral MS due to its rarity and variability in clinical manifestation. The treatment of MS depends on the clinical presentation, tumor location, and the patient's response to conventional therapies. The various therapeutic options currently available are analyzed and discussed. Early intervention and multidisciplinary management are crucial for improving treatment outcomes. Increased awareness and education about the various clinical presentations of MS lead to earlier diagnosis and timely treatment, thereby enhancing patients' survival and quality of life. Continued research is essential for optimizing therapeutic strategies and addressing the challenges presented by this rare neoplasm.

In this editorial, we comment on a recent article which addressed the therapeutic effect of aspirin plus edaravone in patients with cerebral infarction (CI). Herein, we outline the progress in therapy of CI. Apart from thrombolysis, aspirin is the most effective treatment for CI. Edaravone, a free radical scavenger, reduces endothelial cell damage and delays neuronal cell death. Aspirin plus edaravone mitigates damage to brain tissue by different mechanisms, thereby expediting the reinstation of neurological function. However, the nephrotoxic effect of edaravone, along with gastrointestinal bleeding associated with aspirin, may restrict this combination therapy. Although clinical studies have demonstrated the efficacy of thrombolytic therapy and mechanical thrombectomy, patients receiving these treatments experience modest efficacy and many adverse events. Moreover, interest in exploring natural medicines for CI is increasing, and they appear to have a high potential to protect against CI. The evolution of therapeutic strategies is expected to improve clinical outcomes of patients with CI.

Gastroduodenal tuberculosis (GD-TB) is exceptionally rare. The clinical manifestations of gastrointestinal TB are diverse and non-specific, which makes diagnosis difficult, leading to delayed diagnosis and high mortality. As a peer-reviewer of World Journal of Clinical Cases, I would like to share my opinion on the article published by this journal. The patient had no family history of TB or contact with people with TB. Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient. The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.

Meta-learning of dental X-rays is a machine learning technique that can be used to train models to perform new tasks quickly and with minimal input. Instead of just memorizing a task, this is accomplished through teaching a model how to learn. Algorithms for meta-learning are typically trained on a collection of training problems, each of which has a limited number of labelled instances. Multiple X-ray classification tasks, including the detection of pneumonia, coronavirus disease 2019, and other disorders, have demonstrated the effectiveness of meta-learning. Meta-learning has the benefit of allowing models to be trained on dental X-ray datasets that are too few for more conventional machine learning methods. Due to the high cost and lengthy collection process associated with dental imaging datasets, this is significant for dental X-ray classification jobs. The ability to train models that are more resistant to fresh input is another benefit of meta-learning.

In this editorial, we comment on the article by Lei et al, with a specific focus on the timing of the initiation of the antifibrotic agent pirfenidone (PFD) in the management of idiopathic pulmonary fibrosis (IPF) and its impact on lung function of IPF patients. PFD is an antifibrotic agent that is widely used in the management of IPF in both early and advanced stages. It inhibits various pathways and has antifibrotic, anti-inflammatory, and antioxidant properties. Despite dosage lowering, PFD slowed IPF progression and maintained functional capacity. The 6-min walk distance test indicated that patients tolerated adverse events well, and PFD significantly reduced the incidence of progression episodes and death. Even when a single disease-progression event occurred, continuing PFD treatment had benefits.

In this editorial we comment on the article by Ji et al. We focus specifically on the EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment and the development of drug resistance to EGFR-TKIs.

The authors have conducted a comprehensive investigation into the safety and effectiveness of butorphanol for epidural analgesia during labor. Their critical analysis of the paper and discussion of the technique's advantages and disadvantages provide a thorough understanding of the topic.

The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.

Background: Immunoglobulin G4-related disease (IgG4-RD) is a complex immune-mediated condition that causes fibrotic inflammation in several organs. A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis, which manifests as inflammation of the dura mater in intracranial or spinal regions. Although IgG4-RD can affect multiple areas, the spine is a relatively rare site compared to the more frequent involvement of intracranial structures.

Case summary: A 70-year-old male presented to our hospital with a two-day history of fever, altered mental status, and generalized weakness. The initial brain magnetic resonance imaging (MRI) revealed multiple small infarcts across various cerebral regions. On the second day after admission, a physical examination revealed motor weakness in both lower extremities and diminished sensation in the right lower extremity. Electromyographic evaluation revealed findings consistent with acute motor sensory neuropathy. Despite initial management with intravenous immunoglobulin for presumed Guillain-Barré syndrome, the patient exhibited progressive worsening of motor deficits. On the 45^th day of hospitalization, an enhanced MRI of the entire spine, focusing specifically on the thoracic 9 to lumbar 1 vertebral level, raised the suspicion of IgG4-related spinal pachymeningitis. Subsequently, the patient was administered oral prednisolone and participated in a comprehensive rehabilitation program that included gait training and lower extremity strengthening exercises.

Conclusion: IgG4-related spinal pachymeningitis, diagnosed on MRI, was treated with corticosteroids and a structured rehabilitation regimen, leading to significant improvement.

After perusing the paper by Kim et al, I discovered that this is an interesting manuscript and a successful study. Virtual reality (VR) is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade. In the era of big data, VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment. As a novel scientific and technological tool, VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment. VR can simulate the real clinical situation, stimulate the enthusiasm of young doctors and nurses for clinical study, and simultaneously safeguard and promote medical safety and doctor-patient harmony. Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities. While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching, the risks resulting from improper clinical diagnosis and treatment have been circumvented. All of this is evident and comprehensible.