Annals of Medicine and Surgery最新文献

Introduction: Arterial ischemic stroke (AIS) caused by occlusion of large vessels in childhood is a devastating rare condition that can contribute to long-term disabilities. Childhood leukemia is identified as a recognized risk factor for ischemic strokes. Mechanical thrombectomy is the standard of care for large vessel occlusions in adults. However, there are still no definite recommendations regarding the application and outcomes of endovascular thrombectomy and the devices used for pediatric patients with arterial ischemic stroke.

Case presentation: The authors report a 13-year-old female with acute lymphoblastic leukemia who developed AIS due to thrombosis in the left internal carotid and proximal middle cerebral artery in the induction phase of treatment. The patient underwent successful mechanical thrombectomy via Solumbra by using "Embolus Retriever with Interlinked Cages (ERIC)" stent retriever and Sofia plus catheter, which resulted in successful recanalization of ICA and MCA.

Discussion: Selected pediatric patients with AIS due to large vessel occlusions can benefit from mechanical thrombectomy. Although the recently published literature demonstrated the efficacy and safety of MT in children, strong guideline recommendations are still absent. At present, the last AHA/ASA guidelines for early management of AIS recommends intravenous thrombolysis and endovascular therapy in adults, whereas controversy still exists in children. An urgent approach within the defined therapeutic time frame and a multidisciplinary team specialized in pediatric stroke with professionally trained interventional neuroradiologist is essential for achieving optimal results.

Conclusion: Mechanical thrombectomy provides promising results with high rates of arterial recanalization and favorable outcomes in pediatric patients with AIS.

Helicobacter pylori is a microaerophilic gram-negative bacterium infecting around half of the world's population. Despite its well-known role in gastric malignancies, its impact on esophageal cancer comes with a complex paradox. Several mechanisms have been proposed to explain its observed lack of carcinogenic activity in the esophagus, including the trigger of anti-inflammatory pathways, promoting atrophic gastritis, and esophageal microbiome modulation. However, recent studies have highlighted a significantly more complicated interplay, where H. pylori, typically considered a pathogen, may even deliver a protective effect against esophageal carcinogenesis. This paper aims to evaluate the prevalence of H. pylori infection among patients with esophageal carcinoma, discussing the underlying mechanisms of the paradoxical effects of H. pylori on esophageal cancer.

Objective: In recent years, lung cancer-prediction models have become popular. However, few bibliometric analyses have been performed in this field.

Methods: This study aimed to reveal the scientific output and trends in lung cancer-prediction models from a global perspective. In this study, publications were retrieved and extracted from the Web of Science Core Collection (WoSCC) database. CiteSpace 6.1.R3 and VOSviewer 1.6.18 were used to analyze hotspots and theme trends.

Results: A marked increase in the number of publications related to lung cancer-prediction models was observed. A total of 2711 institutions from in 64 countries/regions published 2139 documents in 566 academic journals. China and the United States were the leading country in the field of lung cancer-prediction models. The institutions represented by Fudan University had significant academic influence in the field. Analysis of keywords revealed that lncRNA, tumor microenvironment, immune, cancer statistics, The Cancer Genome Atlas, nomogram, and machine learning were the current focus of research in lung cancer-prediction models.

Conclusions: Over the last two decades, research on risk-prediction models for lung cancer has attracted increasing attention. Prognosis, machine learning, and multi-omics technologies are both current hotspots and future trends in this field. In the future, in-depth explorations using different omics should increase the sensitivity and accuracy of lung cancer-prediction models and reduce the global burden of lung cancer.

Introduction and importance: Gastric glomus tumors (GGT) are rare soft tissue tumors of the gastrointestinal tracts (GIT). It is somewhat challenging to establish the diagnosis of GGT and differentiate it from the more common submucosal neoplasms.

Case presentation: A 34-year-old female patient presented with upper gastrointestinal bleeding. Extensive workup including endoscopic ultrasonography (EUS) revealed a well-circumscribed isoechoic mass arising from the muscularis propria. Based on fine needle biopsy (FNB) findings, with H&E stains performed only initially, the mass was considered a neuroendocrine tumor (NET). Antrectomy with Billroth II anastomosis was performed. A microscopic and immunohistochemical studies of the resected specimen showed the cells to be positive for smooth muscle actin (SMA) making GGT the final diagnosis.

Clinical discussion: Of the 116 patients included in our analysis, 56.9% (n=66) were females and age group was between 41 and 64 years old in 63.8% (n=74) of the patients. About 55 cases (47.4%) had abdominal or epigastric pain or discomfort, which was the most frequent clinical symptom. In immunohistochemistry, SMA staining is present in 68.1% of the cases, underscoring its diagnostic significance. Laparotomy with wedge or partial gastrectomy was employed in 46.1% of the recorded cases. Due to malignant potential, long-term follow-up and monitoring are usually recommended.

Conclusion: Despite the rarity of GGT, they should be included in the differential diagnosis of gastric submucosal tumors, with immunohistochemistry studies playing a major role in the diagnosis. Furthermore, a comprehensive evaluation of the literature in the past 8 years was presented in a table.

Background: Arm morbidity and postoperative complications following sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) are common problems in patients with breast cancer. The de-escalating axillary surgery is increasing; however, there is a lack of patients with suspicious nodes. This study aimed to reduce the need for SLNB in suspicious lymph node cases.

Methods: A prospective cohort study of women with invasive breast cancer who underwent surgery between January 2021 and December 2022. The study included two cohorts: Cohort A comprised patients with stage cT1-2N0-1M0 cancer who planned upfront surgery, while Cohort B included patients with stages cT1-4N2M0, cT3-4N1M0, or cT1-2N0-1M0 who received neoadjuvant systemic treatment. During the study, a clip was inserted into the suspicious lymph node on imaging to determine whether it could serve as a sentinel node and potentially replace SLNB or reduce the need for axillary surgery.

Result: In cohort A, 22 surgeries were performed, while in cohort B, seven surgeries were performed. The median follow-up time was 15 months. In cohort A, 71% of the patients had cN0 disease, while 28% had cN1 disease. A suspicious node correlated to a sentinel node was noted in 66.67% of cohort A. The false-negative rate (FNR) was 14.28%. However, when the clip node removal procedure was performed instead of the sentinel node procedure, the FNR was 10%.

Conclusion: In early breast cancer, suspicious nodes in imaging studies could not currently represent sentinel lymph nodes, and the FNR was still high. Nevertheless, more studies with larger populations will provide a better understanding due to the limited number of patients.

Introduction: Olanzapine, an atypical antipsychotic, is widely used for treating psychiatric conditions such as schizophrenia and bipolar disorder. Accidental overdose in children is rare but can lead to severe clinical effects. This case report discusses the management of a 5-year-old male who accidently ingested 180 mg of olanzapine, the highest reported dose in a child around 5 year.

Case presentation: A 5-year-old boy accidentally ingested 180 mg of Olanzapine, resulting in loss of consciousness and central nervous system depression. He exhibited hyperglycemia, elevated lactate, and prolonged prothrombin time, but no significant cardiovascular issues. Following intubation and supportive care, including intravenous medications and mechanical ventilation, the child gradually improved. He was discharged in stable condition with follow-up instructions.

Discussion: Olanzapine toxicity in children presents with a variety of symptoms, including somnolence, hypotension, and neurological impairments, which are dose-dependent. Even in case of an exceptionally high overdose, the absence of cardiovascular toxicity supports safety profile of olanzapine. Common laboratory findings include hyperglycemia, elevated liver enzymes, and metabolic disturbances. Management involves airway protection, supportive care, and monitoring, as no specific antidote exists. Prompt and appropriate care, even in severe cases under limited resource settings, can lead to favorable outcomes.

Conclusion: In cases of high-dose accidental olanzapine poisoning in children, it is essential to begin quick intervention and comprehensive supportive care to achieve successful outcomes and can be managed even in limited resource settings. Preventive measures are crucial to avoid such incidents, and careful monitoring is essential in managing pediatric olanzapine overdose.

Background: Nonalcoholic fatty liver disease (NAFLD) is increasingly concerning due to its rising prevalence. It encompasses conditions from simple steatosis to severe nonalcoholic steatohepatitis (NASH), posing risks such as fibrosis, cirrhosis, or hepatocellular carcinoma if untreated. This systematic review and meta-analysis aims to assess aldafermin, an FGF19 analog, for efficacy and safety in NASH patients.

Methods: Eligible studies were identified by searching PubMed, Cochrane Library, and Google Scholar, resulting in 1115 studies. Three RCTs were included. The risk of bias was assessed using the Cochrane Risk of Bias tool, and data synthesis utilized Review Manager software. The certainty of evidence was evaluated with the GRADE approach.

Results: In the 3 mg dose group, aldafermin significantly improved various parameters. The ELF score decreased notably (pooled MD: -0.46, 95% CI: -0.64 to -0.28; P<0.00001). Additionally, fibrosis improvement without NASH worsening showed a pooled MD of 8.15 (95% CI: -3.62 to 19.93; P<0.17), and fibrosis improvement with NASH resolution displayed a pooled MD of 10.16 (95% CI: 1.68-18.64; P=0.02). Furthermore, significant reductions were noted in absolute AST levels (pooled MD: -13.40, 95% CI: -18.66 to -8.14; P<0.00001) and absolute ALT levels (pooled MD: -19.92, 95% CI: -27.08 to -12.75; P<0.00001), suggesting improved liver function.

Conclusion: The meta-analysis indicates that aldafermin, particularly, the 3 mg dose, shows significant efficacy in improving liver histology and biochemical markers in NASH patients compared to placebo, along with a satisfactory safety profile.

Background/aim: B19 virus (B19V) is a single-strand DNA virus that has specific tropism to erythroid progenitor cells (EPCs). The virus enters the cells via P antigen and coreceptors and induces infection and cell apoptosis. GATA1 has a high expression in EPC and is a critical transcription factor for the cells development and differentiation. As human EPCs are the main target of the virus infection that have high expression of GATA-1 as the critical transcription factor, the aim of this study was to investigate the effect of GATA1 cotransfection with B19V genome on the expression of the viral mRNAs in HEK293 as nonpermissive cell line to the virus that had no mRNA expression of GATA-1.

Methods: HEK293 cells were transfected with pHI0 plasmid containing the B19V genome and the plasmid of the GATA1 genome. The quantity of B19V mRNAs (NS1, 7.5 kDa, and 11 kDa) expression was evaluated after 24 h of transfection.

Results: The results showed a statistically significant increase in fold change expression of (NS1 ∽12.3, VP1 ∽27.6, 11kb protein ∽38) in cotransfected cells with GATA1 and B19 plasmids compare to control group (P<0.05).

Conclusion: This research showed transfected cells with GATA1 had elevation in the expression of the B19V genes mRNAs in a nonpermissive cell. This result may show the role of GATA1 as a critical transcription factor in support of the virus infection in EPCs. This suggests that GATA1 may potentially sport B19V replication or gene expression.