Medicine international最新文献

The post-coronavirus disease 2019 (COVID-19) era calls for a comprehensive analysis of the recent COVID-19 pandemic to extract important lessons for the international scientific community for the improvement of its readiness towards future pandemic threats and challenges. The present review article presents key aspects of the COVID-19 pandemic, with the main topics covered being the following: i) The recent advances in intensive care, focusing particularly on high flow nasal oxygen therapy; ii) COVID-19 and politics; and iii) COVID-19 and science communication. Both medical aspects of the COVID-19 pandemic as well as non-medical issues, including politics and science communication, should be further evaluated and be definitely included in future medical educational programs, worldwide.

Gastric cancer (GC) is classified into four molecular subtypes according to the Epstein-Barr virus-positive status, microsatellite instability, genomic stability and chromosomal instability (CIN). The CIN subtype is characterized by a high frequency of gene amplifications in receptor tyrosine kinases (RTKs) and a poor prognosis. In addition, the CIN subtype often exhibits intratumoral heterogeneity and indicates insensitivity to targeted drugs. Elucidating the molecular mechanisms of CIN in GC is therapeutically crucial; however, the molecular mechanisms involved are not yet fully understood. The kinetochore-associated 1 (KNTC1) gene encodes kinetochore-associated protein 1 (KNTC1), a major component of the outer kinetochore. The downregulation of KNTC1 causes a high frequency of lagging chromosomes and consequent aneuploidy and CIN in Drosophila and Caenorhabditis elegans. However, the association between KNTC1 and CIN in GC has not yet been clarified. Therefore, the present study investigated the role of KNTC1 in GC CIN. It was found that GC cell lines with a high frequency of lagging chromosomes had a low KNTC1 mRNA expression. Notably, KNTC1 knockdown increased the frequency of lagging chromosomes in GC cell lines. In particular, GC cell lines with the amplification of RTK genes exhibited a significant increase in the frequency of lagging chromosomes. On the whole, the findings of the present study suggest that the suppression of KNTC1 expression may contribute to CIN in GC and may be involved in the generation of intratumoral genetic heterogeneity in GC.

Surgical adhesions in the pelvis are a well-known complication following cesarean sections. The present study describes a unique case involving acute intra-abdominal inflammation due to ischemic necrosis of the fallopian tube with a hydatid of Morgagni, resulting from entrapment in post-operative adhesions and leading to preterm labor. The patient described herein, a woman in her 36th week of pregnancy with a history of two prior lower-segment cesarean sections, presented with diffuse abdominal pain escalating in intensity and intermittent vomiting. A diagnosis of preterm labor was established, prompting a decision to proceed with cesarean section. The procedure was uneventful, revealing numerous post-operative pelvic adhesions intraoperatively. Further examination revealed ischemic necrosis of the left fallopian tube with a small hydatid of Morgagni, attributed to entrapment due to an adhesion, with no involvement of the left ovary. Upon dissecting the adhesion, tubal perfusion was promptly restored. A decision was made to preserve the affected fallopian tube and perform surgical drainage of the hydatid of Morgagni. Both the mother and newborn were discharged in excellent condition from the clinic on the 4th post-operative day. The case descrbied herein underscores the rarity of preterm labor resulting from ischemic tubal necrosis with a hydatid of Morgagni, secondary to post-cesarean section adhesions. It emphasizes the importance of an intraoperative examination for tubal and ovarian conditions to detect surgical adhesions and underscores the value of preoperative diagnosis and the prevention of post-operative adhesions in pregnant women undergoing cesarean section.

Fibroepithelial stromal polyps of the vulva are rare clinical entities, typically appearing as isolated polypoid stromal lesions, covered by squamous epithelium. The presence of non-traumatic ulcerative lesions on the tumor surface, particularly when the tumor is relatively small, necessitates the differentiation from malignant lesions of the vulva. The present study describes the case of a 44-year-old patient who presented to an outpatient gynecological clinic, reporting as her sole symptom the presence of a mass in the vulval region, which had been increasing in size over the past 12 months. Upon examination and palpation of the external genitalia, a painless pedunculated tumor measuring ~5 cm, originating from the upper third of the right labium majus, covered with normal skin, but bearing ulcerative lesions, was found. An ulcerative fibroepithelial polyp of the vulva was suspected, and surgical treatment with wide excision of the lesion was decided upon. A histological examination of the surgical specimen confirmed the diagnosis. The immunohistochemical analysis of the tumor ruled out malignancy. Following an uneventful post-operative course, the patient was discharged from the clinic the following day. At 6 months post-operatively, no recurrence of the fibroepithelial polyp was found at the site of pedicle resection. The present study, also provides a brief literature review of this rare disease entity following the case presentation, highlighting the necessity of wide surgical excision of vulvar fibroepithelial polyps and their differentiation from vulvar malignancies.

The maternal antenatal attachment scale (MAAS), the pregnancy outcome questionnaire (POQ) and the Centre for Epidemiologic Studies Depression Scale (CESD), among other approaches, have been developed to address pregnancy-related psychological issues. However, the need to develop and validate effective scales to screen the complex experiences of pregnant women continues to be extensively discussed in the literature. The aim of the present study was to build and validate fuzzy models that represent the necessary and sufficient causal combinations that lead to higher levels of anxiety regarding pregnancy outcomes, maternal prenatal attachment to the unborn child and depressive symptoms, respectively. For this purpose, measurements from the MAAS, POQ and CESD scales, along with demographic data, were collected from 135 pregnant women, including cases of natural conception (NC) and assisted reproduction (ART) births. Fuzzy-set qualitative comparative analysis (FSQCA) was employed to produce sets of causal combinations, which were validated against their consistency and coverage. These combinations were then used to develop and validate fuzzy cognitive maps (FCMs) to model the fluctuations in the status of pregnant women. To the best of our knowledge, the present study is the first to utilize FSQCA or FCM to address this issue. The results indicated that the POQ was the distinguishing factor between NC and ART that led to higher MAAS levels. Marital status (MS) and state anxiety were found to lead to higher POQ levels for pregnancies derived from NC. For pregnancies following ART, the factors to consider include income, week of pregnancy, MS, MAAS intensity and trait anxiety. POQ was found to lead to higher levels of CESD for ART pregnancies, while NC, MS and state anxiety are also prerequisites. On the whole, the present study demonstrates that the proposed FSQCA- and FCM-based approach enables obstetricians and midwives to incorporate their expertise in evaluating cases on an individual basis, while also providing a framework for creating intelligent systems to support healthcare policy decisions.

The aim of the present study was to identify the frequency of vasovagal reactions (VVRs) and the factors influencing their occurrence. For this purpose, a total of 742 donors who applied for whole blood donation at a blood center were included in the study. The frequency of VVR and its association with donor-related factors were assessed. The results revealed that the median age of the donors was 36 years, with 9.8% female and 90.2% male donors. VVRs were observed in 4.9% of the donors. The median age of the donors who experienced VVRs was found to be lower than that of those who did not experience VVRs. The incidence of VVRs was higher in first-time donors. The median blood donation rate for donors who experienced VVRs was 2, compared to 4 for those who did not, and the difference was statistically significant. On the whole, the present study demonstrates that the frequency of VVRs is higher in first-time blood donors, and that the blood donation rate is lower for those who experience VVRs. Preventive measures for VVRs, particularly for first-time donors, could increase the rate of blood donation.

Hypokalemic periodic paralysis (HPP) is a rare disease. Due to channelopathy caused by mutations in skeletal muscle ion channels, episodes of sudden flaccid muscle weakness and hypokalemia develop as a result of various trigger factors. The present study reports the case of a 25-year-old male patient with HPP admitted with acute onset numbness and paralysis in the extremities accompanying hypokalemia (2.66 mEq/l). The patient became asymptomatic following treatment with a potassium (K) supplement and was diagnosed with HPP. The present study describes this case of HPP in an aim to remind colleagues of the possibility of HPP in hypokalemic patients with muscle weakness and flaccid paralysis.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by enhancing the ability of the immune system to combat malignancies. Nivolumab and cemiplimab, monoclonal antibodies targeting programmed cell death protein 1, have exhibited notable therapeutic efficacy; however, they are associated with immune-related adverse events (irAEs). The present study describes the cases of 2 patients, a 71-year-old male with metastatic esophageal adenocarcinoma and a 66-year-old female with metastatic squamous cell carcinoma who developed acute/subacute onset rapidly progressive myositis/myasthenia gravis (MG) following treatment with nivolumab and cemiplimab. Both patients had negative MG antibody panels and the first had uninformative electrodiagnostic testing, rendering the diagnosis challenging. Additionally, 1 patient had myocarditis and the other had hepatitis. The mechanisms of ICI-induced myositis/MG remain unclear. Early recognition and intervention are vital for the prevention of severe morbidity and mortality. Treatment strategies, including the termination of the offending ICI medication, steroids, intravenous immunoglobulin (IVIG) and plasma exchange, should be tailored based on individual patient responses, and physicians should not hesitate to commence IVIG or plasma exchange once the diagnosis is established.. These cases underscore the importance of vigilance for myositis/MG in patients treated with ICIs, even with uninformative serological and electrodiagnostic testing, and the need for collaboration between multiple disciplines in managing complex irAEs including the associated myocarditis and hepatitis.

Hiatal Hernia (HH) and gastroesophageal reflux disease (GERD) have been found to be associated with respiratory conditions, such as pulmonary fibrosis. However, their association with asthma remains ambiguous. Thus, the present cross-sectional, retrospective, monocentric study aimed to investigate the prevalence of asthma among patients with HH, evaluate its severity in these patients, and screen for associated respiratory symptoms. Additionally, the present study explored the association between the prevalence of asthma and various parameters, including sex, GERD medications and symptoms. For this purpose, a retrospective study, conducted at one central university medical center from January, 2020 to May, 2023, included patients with HH identified on a computed tomography scan. Patients were contacted and evaluated using structured questionnaires. Asthma-free patients underwent assessment for respiratory symptoms indicative of asthma using a validated questionnaire from the European Community Respiratory Health Survey. In patients with asthma, disease severity was assessed using the Global Initiative for Asthma symptom control criteria. The results revealed that out of 17,374 scans, 1,308 (7.53%) were positive for HH. Among the 453 cases eligible for analysis in the present study, 67 (14.79%) were diagnosed with asthma, of which 28 (41.79%) were diagnosed with uncontrolled asthma. Among the asthma-free patients, 136 (35.23%) reported at least one unspecified respiratory symptom. In the patients with HH, sex and GERD exhibited showed no association with asthma (P=0.07 and P=0.11, respectively). However, patients taking GERD medications exhibited a higher prevalence of asthma (P=0.03). On the whole, the present study demonstrates that the prevalence of asthma in patients with HH appears to be elevated. Hence, an ambivalence arises as regards the presence of a HH potentially associated with poorly controlled asthma and GERD medication potentially exacerbating asthma.

Recurrence following the surgical evacuation of a chronic subdural hematoma (CSDH) occurs in up to 33% of cases. Several clinical and radiologic factors have been identified that are associated with the recurrence of hematoma. However, the optimal treatment for recurrent CSDH has not yet been determined. The present study, based on a case report, reviews the predictors and treatment options for refractory CSDHs. An 85-year-old male patient presented with a symptomatic bilateral CSDH. The hematoma was initially removed through a burr hole and closed drainage system, resulting in clinical improvement and in the radiographic resolution of the hematoma. At the first recurrence, steroids were administered and the hematoma was re-evacuated. After 1 month, the patient returned comatose due to a massive right subdural hematoma and was treated with an ipsilateral craniotomy and a membranectomy. After 2 days, the patient succumbed due to massive intraparenchymal bleeding. The treatment of refractory CSDHs is challenging. The failure of brain re-expansion and senile atrophy appear to be the key predictors of recurrence. Patients who are at high-risk need to be identified promptly and treated with a multidisciplinary approach that considers adjuvant medications, middle meningeal artery embolization and repeat hematoma evacuation, probably with a membranectomy and an endoscope.