Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in ...Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in non-anaemic individuals with CKD and ID,focusing on safety,efficacy,and emerging therapeutic implications.Current diagnostic markers,including serum ferritin,transferrin saturation,and reticulocyte haemoglobin content,are reviewed alongside their limitations in the context of inflammation and variability.The pathophysiology of ID in CKD is explored,highlighting the roles of hepcidin,hypoxia-inducible factor pathways,and uraemic toxins.Comparative studies reveal that IV iron offers a more rapid correction of iron stores,improved com-pliance,and fewer gastrointestinal side effects compared to oral iron.Evidence from trials such as“iron and heart”and“iron and muscle”suggests potential benefits of IV iron on functional capacity and fatigue,though findings were sta-tistically non-significant.Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations,with newer formulations like ferric derisomaltose demonstrating favourable safety profiles.This review underscores the need for standardized screening protocols for ID in CKD,even in the absence of anaemia,to facilitate earlier intervention.Future research should prioritise robust outcome measures,larger sample sizes,and person-specific treatment strategies to optimise dosing and administration frequency.Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes,quality of life,and long-term health in people with CKD.展开更多
BACKGROUND: The exact mechanism by which cyclooxy- genase-2 (COX-2) promotes inflammation in pancreatitis in obscure. This study was undertaken to investigate the role of COX-2 inhibition in an animal model of pancrea...BACKGROUND: The exact mechanism by which cyclooxy- genase-2 (COX-2) promotes inflammation in pancreatitis in obscure. This study was undertaken to investigate the role of COX-2 inhibition in an animal model of pancreati- tis , a disease process characterized by a systemic inflamma- tory response and ensuing neutrophil-mediated lung injury. METHODS: Pancreatitis was induced in 24 Sprague-Daw- ley rats by intraperitoneal injection of 20% L-arginine (500 mg/100 g body weight). The animals were randomized into 3 groups (8 rats in each group); controls and rats with pancreatitis intravenously resuscitated with either normal saline (0.9% NaCl 3 ml/kg) at 24 and 48 hours or COX-2 inhibitor (parecoxib 1 mg/kg). Pancreatic and lung inju- ries were assessed histologically. Lung injury was assessed utilizing wet;dry ratio and myeloperoxidase activity to in- dicate pulmonary neutrophil infiltration. A Western blot was used to determine COX-2 protein expression in pancrea- tic tissue. RESULTS: The animals treated with COX-2 inhibitors dis- played significantly less pancreatic and lung injuries than their normal saline counterparts. Histological pancreatic and lung injury scores were significantly reduced (P <0.05) in the COX-2 treated group. Lung wet: dry ratios were sig- nificantly improved and pulmonary neutrophil infiltration was attenuated in the COX-2 group (P<0.05). Western blot analysis confirmed attenuated COX-2 protein expression. CONCLUSION: This study shows, for the first time in a rat model, that adjuvant COX-2 inhibition significandy attenu- ates the severity of both pancreatitis and its associated sys- temic inflammatory response and end-organ injury.展开更多
Liposarcomas are rare soft tissue tumors, commonly affecting the lower limbs and less commonly the retroperitoneum. Although other organs can be affected,the pancreas is one of the rarest, and metastasis at presentati...Liposarcomas are rare soft tissue tumors, commonly affecting the lower limbs and less commonly the retroperitoneum. Although other organs can be affected,the pancreas is one of the rarest, and metastasis at presentation has never been reported. We describe the case of a 76-year-old gentleman presenting with abdominal pain and an abdominal mass. Imaging confirmed a primary tumor in the body and tail of the pancreas, with a metastatic deposit in the mesentery adjacent to the second part of the duodenum. Biopsy confirmed a liposarcoma, and subsequently a complete surgical excision was achieved. He then received adjuvant radiotherapy and has remained disease free for the next 26 mo.展开更多
Cholangiocarcinoma(CCA)is an aggressive malignancy arising from the biliary epithelium.It may occur at any location along the biliary tree with the perihilar area being the most common.Prognosis is poor with 5-year ov...Cholangiocarcinoma(CCA)is an aggressive malignancy arising from the biliary epithelium.It may occur at any location along the biliary tree with the perihilar area being the most common.Prognosis is poor with 5-year overall survival at less than 10%,typically due to unresectable disease at presentation.Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours,but is frequently not possible due to locally advanced disease.On the other hand,orthotopic liver transplantation(LT)allows for a radical and potentially curative resection for these patients,but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes.In patients with perihilar CCA,within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT,excellent results have been achieved in the last decades,resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience.However,in intrahepatic CCA,the role of LT remains controversial and owing to dismal previous results it is not an accepted indication.Nevertheless,more recent studies have demonstrated favourable results with LT in early intrahepatic CCA,indicating that,under defined criteria,its role may increase in the future.This review highlights the history and contemporary advances of LT in CCA,with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.展开更多
BACKGROUND The global incidence of intrahepatic cholangiocarcinoma(ICCA)is soaring.Due to often delayed presentation,only a narrow spectrum of the disease is usually surgically resectable.To more accurately stage the ...BACKGROUND The global incidence of intrahepatic cholangiocarcinoma(ICCA)is soaring.Due to often delayed presentation,only a narrow spectrum of the disease is usually surgically resectable.To more accurately stage the disease,reduce recurrence,and improve overall survival,surgical teams are increasingly performing intraoperative lymph node dissection(LND)as well.This procedure has its associated morbidity,while there is no consensus or formal guidelines on its role in this setting.Hence,there is a need to better delineate the evidence for performing LND alongside surgical resection of the ICCA.AIM To perform a systematic review and meta-analysis on the role of LND in improving prognostication and survival post-resection of ICCA.METHODS We performed a systematic literature search using Pubmed,Medline,Embase,and the Cochrane Library,for all studies involving LND,ICCA,and surgical resection using several keywords,Medical Subject Headings(MeSH)tags,and appropriate synonyms.All clinical studies comparing curative intent resection of ICCA with LND vs resection without LND were included,while single-arm case series,studies with insufficient data,and duplicates were excluded.We included all English-language studies from the different academic databases up till early December 2022.The primary outcome measures were set for overall survival(OS)and disease-free survival(DFS).RESULTS This systematic review and meta-analysis included 15 studies that fulfilled the selection criteria comprising 11413 patients with surgically-resectable ICCA,of whom 6424(56.3%)underwent hepatectomy with LND while the remainder underwent hepatectomy only.In patients who underwent LND,on average,27.7%of the resected lymph nodes were positive for metastatic disease.Overall,the results showed that performing LND did not significantly improve OS or DFS.However,the effect of LND on OS showed a degree of variability by geographical region,in Eastern and Western countries.As LND is increasingly being performed,further time-based analysis was undertaken to identify time-dependent changes in the role of LND.An increasing adoption of LND was not associated with improved OS.Furthermore,no roles were identified for neoadjuvant/adjuvant chemotherapy or increasing lymph node retrieval in improving OS either.CONCLUSION LND might aid in staging,prognosticating,and deciding further management of resected ICCA,but does not improve OS and DFS and is unsuitable for high-risk patients unlikely to benefit from further treatments.展开更多
The incidence of sepsis is increasing over time, along with an increased risk of dying from the condition. Sepsis care costs billions annually in the United States. Death from sepsis is understood to be a complex proc...The incidence of sepsis is increasing over time, along with an increased risk of dying from the condition. Sepsis care costs billions annually in the United States. Death from sepsis is understood to be a complex process, driven by a lack of normal immune homeostatic functions and excessive production of proinflammatory cytokines, which leads to multi-organ failure. The Toll-like receptor(TLR) family, one of whose members was initially discovered in Drosophila, performs an important role in the recognition of microbial pathogens. These pattern recognition receptors(PRRs), upon sensing invading microorganisms, activate intracellular signal transduction pathways. NOD signaling is also involved in the recognition of bacteria and acts synergistically with the TLR family in initiating an efficient immune response for the eradication of invading microbial pathogens. TLRs and NOD1/NOD2 respond to different pathogenassociated molecular patterns(PAMPs). Modulation of both TLR and NOD signaling is an area of research that has prompted much excitement and debate as a therapeutic strategy in the management of sepsis. Molecules targeting TLR and NOD signaling pathways exist but regrettably thus far none have proven efficacy from clinical trials.展开更多
AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009...AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease(NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.RESULTS A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers(n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC(37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLDHCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015(4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3%(P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups(6.6 ng/m L vs 26 ng/m L; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.CONCLUSION The growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.展开更多
Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of wor...Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of world population lives in slums yet there is no information regarding their health status in context to asthma and COPD. Aims: We investigated the prevalence of asthma and chronic-bronchitis symptoms and associated risk-factors in slum habitats of Pune city. Methodology: 7062 adult slum-dwellers living in 12 slums of Pune city were cross-sectionally interviewed by local healthcare workers with respiratory health questionnaire which was designed using respiratory symptoms of validated European Community Respiratory Health Survey (ECRHS II) questionnaire and International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire. Results: The overall prevalence of selfreported asthma symptoms was 10% (18 - 40 years: 6.5%;>40 years: 13.5%). The overall prevalence of chronic bronchitis was 8.5% [18 - 40 years: 7% (males: 7%, females: 7%);>40 years: 10% (males: 10%, females: 10%)]. Increasing age (p = 0.00), female gender (p = 0.001), unemployment (0.00) current smoking (p = 0.00) and ex-smoking (p = 0.004) emerged as significant risk factor for asthma. While, ex-smoking (p = 0.004) and low-education status (p = 0.00) emerged as significant risk factors for chronic bronchitis. Conclusion: In slums reporting of asthma and chronic-bronchitis symptoms was much higher than what has been reported earlier from India. Asthma was commonly seen in females, old age, unemployed and ever-smokers. While chronic bronchitis was commonly seen in ex-smokers and illiterate subjects. Chronic bronchitis was equally distributed amongst male and females, despite 0% prevalence of smoking in females.展开更多
Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was p...Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.展开更多
China's food security mainly depends on the core areas of food production.Under the dual constraints of resource scarcity and environmental degradation,improving the grain production efficiency of the main grain-p...China's food security mainly depends on the core areas of food production.Under the dual constraints of resource scarcity and environmental degradation,improving the grain production efficiency of the main grain-producing areas has become the fundamental way to strengthen the grain production capacity and improve the national food security capability,and to improve the efficiency of grain production in major grain-producing areas requires empirical support.This paper used the Super SBM model and the Malmquist index to measure the grain production efficiency of the main grain-producing areas from 2001 to 2020 from both static and dynamic perspectives,and compared the differences in grain production efficiency among different soil types and different provinces(autonomous regions)in the main grain-producing areas.The results showed that from 2001 to 2020,the grain production in the main grain-producing areas was in a relatively ineffective state,and the differences in grain production efficiency among different soil types and different provinces(autonomous regions)in the main grain-producing areas were obvious.The order of grain production efficiency in different soil types was black soil region>red-yellow soil region>paddy soil region>fluvo-aquic soil region,and the order of grain production efficiency of the provinces(autonomous regions)in the main grain-producing areas was Jilin>Heilongjiang>Inner Mongolia>Jiangxi>Hunan>Sichuan>Hubei>Jiangsu>Liaoning>Henan>Anhui>Shandong>Hebei.From 2001 to 2020,the total factor productivity of grain in the main grain-producing areas increased,but due to the trade-off between the technological progress and the growth of technical efficiency,the increase in the total factor productivity of grain in the main grain-producing areas was small,and the growth mainly came from the increase of input factors in this period.The total factor productivity of grain in Hebei,Heilongjiang,Liaoning,Jilin,Inner Mongolia,Shandong,Jiangsu,Henan and Anhui increased,but the increase was small,while the total factor productivity of grain in Jiangxi,Sichuan,Hunan and Hubei provinces declined.展开更多
This paper focuses on analysis of salinity distribution along Red River and its main branches to determine and limit effects of salinity intrusion under variable scenarios for outlet discharge from upstream reservoirs...This paper focuses on analysis of salinity distribution along Red River and its main branches to determine and limit effects of salinity intrusion under variable scenarios for outlet discharge from upstream reservoirs and the tidal magnitude under global climate change effects. The effect of outlet discharge from upstream reservoirs, which generates flow in droughty months, is considered as upstream input condition for salinity intrusion. The sea level rising phenomenon is represented by scenarios according to prediction of the Intergovernmental Panel on Climate Change （IPCC）. The lateral flow and the rainfall in dry season are neglected in the process of simulation. MIKE 11, ID river model software by DHI （Danish Hydraulic Institute）, is used to simulate the processes of salt water intrusion from the river mouths to the upstream of the river in consideration the effect of the Sea Level Rise phenomenon and the operation of existing reservoirs and those under construction. The results indicate that salinity intrusion length from river mouth depends on the estuary characteristics, discharges from upper reservoirs and tidal phases （low and high tides）. With the safe salinity concentration for agriculture and livestock is 4 psu, the study shows that the length of intruded salt in Red River is about 40km from the river mouth, in otherwise, the effect of salinity intrusion in Thai Binh river is negligible. The Sea Level Rise phenomenon has inconsiderable affects on salinity intrusion processes in Red River System. The influence of outlet discharges from upstream reservoirs has also negligible affects on prevent salinity intrusion from the sea. According to the results of the study, reasonable water resources utilization and appropriate reservoir operation approaches in the drought will be studied to protect the crop and aquaculture from salinity intrusion.展开更多
With the development of the knowledge economy, social professional quality of talent has an increasingly demanding. Medical students is China＇ s medical and health undertakings reserve personnel, it plays an importan...With the development of the knowledge economy, social professional quality of talent has an increasingly demanding. Medical students is China＇ s medical and health undertakings reserve personnel, it plays an important role for better protection of people＇ s health by strengthening vocational personality training medical students and improving professional quality. Therefore, we must pay attention to the medical student＇ s career awareness, ethics, professionalism, career aspirations and career interests of education on medical students to develop a healthy personality of the medical profession, and lay the foundation for the sustainable development of medical and health services.展开更多
World Health Organization(WHO)reported that the integration of some traditional medicine practices with national main stream health system was started since the 1970s[1].WHO developed and published two strategies rega...World Health Organization(WHO)reported that the integration of some traditional medicine practices with national main stream health system was started since the 1970s[1].WHO developed and published two strategies regarding traditional and complementary medicine,which were WHO strategy for traditional medicine 2002–2005 and WHO strategy for traditional medicine 2014–2023[2,3].展开更多
Background: There is great interest in developing blood-based biomarkers for Alzheimer’s disease (AD);however, there is no consensus as to what blood fraction is most appropriate for analyzing particular markers. The...Background: There is great interest in developing blood-based biomarkers for Alzheimer’s disease (AD);however, there is no consensus as to what blood fraction is most appropriate for analyzing particular markers. The current study provides empirical evidence regarding how blood-based proteins vary depending on whether they are assayed in serum or plasma. Methods: Weanalyzed concentrations of 100 proteins in matched samples of serum and plasma from 39 Caucasian AD participants from the Texas Alzheimer’s Research and Care Consortium bymultiplex immunoassay. Results: Concentrations of 40 proteins were highly correlated (r2≥ 0.75) between plasma and serum while the remaining proteins were moderately to weakly correlated (r2< 0.75). Discussion: Whether plasma vs. serum is assayed can have a large impact on the observed concentration of some proteins, including several proteins that are of great interest to AD pathophysiology. The current findings may explain the significant discrepancies often times reported in the AD biomarker field.展开更多
Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing ...Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.展开更多
Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of ps...Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of psychological vulnerability,aging attitudes,and life meaning in elderly patients with comorbidities.Methods:A total of 685 elderly inpatients and outpatients at Renmin Hospital of Wuhan University between July and December 2022 were selected using the simple random sampling method.Social demographic data were collected,and the Attitudes to aging Questionnaire(AAQ),the Chinese Life Meaning Questionnaire(C-MLQ),and the Psychological Vulnerability Scale(C-PVS)were used for the analysis.A total of 685 questionnaires were received,and 602 valid questionnaires were collected,with an effective rate of 87.88%.Data analysis was performed using SPSS V25.0 and AMOS V24.0.Results:The total scores of psychological vulnerability,aging attitudes,and life meaning were 69.4±12.8,80.2±13.5 and 39.2±8.3,respectively.The psychological vulnerability was significantly negatively correlated with life meaning and aging attitudes(r=-0.351,-0.264;p<0.01).There was a significant positive correlation between aging attitudes and life meaning(r=0.515;p<0.01).Life meaning played a partial mediating role between psychological vulnerability and aging attitudes(β=3.070,p<0.05).Conclusion:This study found that the psychological vulnerability in elderly patients with comorbidities was at the lower level,which was related to the elderly patients’aging attitudes and their current status of life meaning.The level of psychological vulnerability in elderly patients with senile-related comorbidities needs to be further improved.Medical workers should pay attention to the psychological vulnerability of elderly patients and improve the identification of psychological crises of such patients.展开更多
Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralis...Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.展开更多
Introduction:Cupping therapy is an integrative and complementary medicine therapy that practiced worldwide by several civilizations for thousands of years.Cupping therapy is reported to be a relatively safe practice e...Introduction:Cupping therapy is an integrative and complementary medicine therapy that practiced worldwide by several civilizations for thousands of years.Cupping therapy is reported to be a relatively safe practice especially if performed by qualified therapists.Subconjunctival hemorrhage(SCH)is a common cause of eye redness and can be classified into traumatic and spontaneous.Case presentation:This case report discussed an adverse event related to wet cupping therapy.The patient developed SCH one day after performing cupping therapy.He was completely recovered after 2 weeks.This case report should increase the knowledge of cupping therapists regarding increasing safety of patient when performing wet cupping therapy on specific body parts especially,head,neck and cervical areas.Furthermore,it highlighted the importance of conducting research regarding the mechanical and physiological effects of cupping therapy.Conclusion:Adverse events related to cupping therapy should be reported with every patient.Cupping therapists should be aware of this possible mild adverse event.To the best of our knowledge,this is the first published adult case of SCH related to wet cupping therapy session.More studies are critically needed for evaluation of cupping therapy effects and adverse events especially when performed on head and neck.展开更多
Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Panc...Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Pancreatoduodenectomy and distal pancreatectomy are the standard resections for tumors located in the pancreatic head-neck or body-tail,respectively,and not uncommonly sacrifice a significant amount of healthy pancreatic parenchyma.Central pancreatectomy(CP)is a parenchyma-sparing procedure,initially performed by Dagradi and Serio in 1982,in a patient with pancreatic neck insulinoma.Since then,an increasing number of cases are being performed worldwide,either via open or minimally invasive surgical access.Additionally,pancreatic enucleation is reserved for tumors<3 cm,without involvement of the main pancreatic duct.CP remains an alternative approach in selected cases,albeit in the presence of some controversies,such as its use in early pancreatic ductal adenocarcinoma or metastatic deposits to the central aspect of the pancreas from other malignancies.In recent years,clarity is lacking as regards indications for CP,and despite accumulating evidence in favor of limited resections for suitable pancreatic tumors,no evidence-based consensus guidelines are yet available.Nevertheless,it appears that appropriate patient selection is of paramount importance to maximize the advantages of preservation of endocrine and exocrine pancreatic functions as well as to mitigate the risks of higher complication rates.In this comprehensive review,we explore the role of CP in the treatment of lesions located in the neck and proximal body of the pancreas.展开更多
文摘Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in non-anaemic individuals with CKD and ID,focusing on safety,efficacy,and emerging therapeutic implications.Current diagnostic markers,including serum ferritin,transferrin saturation,and reticulocyte haemoglobin content,are reviewed alongside their limitations in the context of inflammation and variability.The pathophysiology of ID in CKD is explored,highlighting the roles of hepcidin,hypoxia-inducible factor pathways,and uraemic toxins.Comparative studies reveal that IV iron offers a more rapid correction of iron stores,improved com-pliance,and fewer gastrointestinal side effects compared to oral iron.Evidence from trials such as“iron and heart”and“iron and muscle”suggests potential benefits of IV iron on functional capacity and fatigue,though findings were sta-tistically non-significant.Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations,with newer formulations like ferric derisomaltose demonstrating favourable safety profiles.This review underscores the need for standardized screening protocols for ID in CKD,even in the absence of anaemia,to facilitate earlier intervention.Future research should prioritise robust outcome measures,larger sample sizes,and person-specific treatment strategies to optimise dosing and administration frequency.Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes,quality of life,and long-term health in people with CKD.
文摘BACKGROUND: The exact mechanism by which cyclooxy- genase-2 (COX-2) promotes inflammation in pancreatitis in obscure. This study was undertaken to investigate the role of COX-2 inhibition in an animal model of pancreati- tis , a disease process characterized by a systemic inflamma- tory response and ensuing neutrophil-mediated lung injury. METHODS: Pancreatitis was induced in 24 Sprague-Daw- ley rats by intraperitoneal injection of 20% L-arginine (500 mg/100 g body weight). The animals were randomized into 3 groups (8 rats in each group); controls and rats with pancreatitis intravenously resuscitated with either normal saline (0.9% NaCl 3 ml/kg) at 24 and 48 hours or COX-2 inhibitor (parecoxib 1 mg/kg). Pancreatic and lung inju- ries were assessed histologically. Lung injury was assessed utilizing wet;dry ratio and myeloperoxidase activity to in- dicate pulmonary neutrophil infiltration. A Western blot was used to determine COX-2 protein expression in pancrea- tic tissue. RESULTS: The animals treated with COX-2 inhibitors dis- played significantly less pancreatic and lung injuries than their normal saline counterparts. Histological pancreatic and lung injury scores were significantly reduced (P <0.05) in the COX-2 treated group. Lung wet: dry ratios were sig- nificantly improved and pulmonary neutrophil infiltration was attenuated in the COX-2 group (P<0.05). Western blot analysis confirmed attenuated COX-2 protein expression. CONCLUSION: This study shows, for the first time in a rat model, that adjuvant COX-2 inhibition significandy attenu- ates the severity of both pancreatitis and its associated sys- temic inflammatory response and end-organ injury.
文摘Liposarcomas are rare soft tissue tumors, commonly affecting the lower limbs and less commonly the retroperitoneum. Although other organs can be affected,the pancreas is one of the rarest, and metastasis at presentation has never been reported. We describe the case of a 76-year-old gentleman presenting with abdominal pain and an abdominal mass. Imaging confirmed a primary tumor in the body and tail of the pancreas, with a metastatic deposit in the mesentery adjacent to the second part of the duodenum. Biopsy confirmed a liposarcoma, and subsequently a complete surgical excision was achieved. He then received adjuvant radiotherapy and has remained disease free for the next 26 mo.
文摘Cholangiocarcinoma(CCA)is an aggressive malignancy arising from the biliary epithelium.It may occur at any location along the biliary tree with the perihilar area being the most common.Prognosis is poor with 5-year overall survival at less than 10%,typically due to unresectable disease at presentation.Radical surgical resection with clear margins offers a chance of cure in patients with resectable tumours,but is frequently not possible due to locally advanced disease.On the other hand,orthotopic liver transplantation(LT)allows for a radical and potentially curative resection for these patients,but has been historically controversial due to the limited supply of donor grafts and previously poor outcomes.In patients with perihilar CCA,within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT,excellent results have been achieved in the last decades,resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant experience.However,in intrahepatic CCA,the role of LT remains controversial and owing to dismal previous results it is not an accepted indication.Nevertheless,more recent studies have demonstrated favourable results with LT in early intrahepatic CCA,indicating that,under defined criteria,its role may increase in the future.This review highlights the history and contemporary advances of LT in CCA,with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.
文摘BACKGROUND The global incidence of intrahepatic cholangiocarcinoma(ICCA)is soaring.Due to often delayed presentation,only a narrow spectrum of the disease is usually surgically resectable.To more accurately stage the disease,reduce recurrence,and improve overall survival,surgical teams are increasingly performing intraoperative lymph node dissection(LND)as well.This procedure has its associated morbidity,while there is no consensus or formal guidelines on its role in this setting.Hence,there is a need to better delineate the evidence for performing LND alongside surgical resection of the ICCA.AIM To perform a systematic review and meta-analysis on the role of LND in improving prognostication and survival post-resection of ICCA.METHODS We performed a systematic literature search using Pubmed,Medline,Embase,and the Cochrane Library,for all studies involving LND,ICCA,and surgical resection using several keywords,Medical Subject Headings(MeSH)tags,and appropriate synonyms.All clinical studies comparing curative intent resection of ICCA with LND vs resection without LND were included,while single-arm case series,studies with insufficient data,and duplicates were excluded.We included all English-language studies from the different academic databases up till early December 2022.The primary outcome measures were set for overall survival(OS)and disease-free survival(DFS).RESULTS This systematic review and meta-analysis included 15 studies that fulfilled the selection criteria comprising 11413 patients with surgically-resectable ICCA,of whom 6424(56.3%)underwent hepatectomy with LND while the remainder underwent hepatectomy only.In patients who underwent LND,on average,27.7%of the resected lymph nodes were positive for metastatic disease.Overall,the results showed that performing LND did not significantly improve OS or DFS.However,the effect of LND on OS showed a degree of variability by geographical region,in Eastern and Western countries.As LND is increasingly being performed,further time-based analysis was undertaken to identify time-dependent changes in the role of LND.An increasing adoption of LND was not associated with improved OS.Furthermore,no roles were identified for neoadjuvant/adjuvant chemotherapy or increasing lymph node retrieval in improving OS either.CONCLUSION LND might aid in staging,prognosticating,and deciding further management of resected ICCA,but does not improve OS and DFS and is unsuitable for high-risk patients unlikely to benefit from further treatments.
基金supported by the National Natural Science Foundation of China (Grant 81420108022)Jiangsu Province Program of Innovative and Entrepreneurial Talents (2011 – 2014)
文摘The incidence of sepsis is increasing over time, along with an increased risk of dying from the condition. Sepsis care costs billions annually in the United States. Death from sepsis is understood to be a complex process, driven by a lack of normal immune homeostatic functions and excessive production of proinflammatory cytokines, which leads to multi-organ failure. The Toll-like receptor(TLR) family, one of whose members was initially discovered in Drosophila, performs an important role in the recognition of microbial pathogens. These pattern recognition receptors(PRRs), upon sensing invading microorganisms, activate intracellular signal transduction pathways. NOD signaling is also involved in the recognition of bacteria and acts synergistically with the TLR family in initiating an efficient immune response for the eradication of invading microbial pathogens. TLRs and NOD1/NOD2 respond to different pathogenassociated molecular patterns(PAMPs). Modulation of both TLR and NOD signaling is an area of research that has prompted much excitement and debate as a therapeutic strategy in the management of sepsis. Molecules targeting TLR and NOD signaling pathways exist but regrettably thus far none have proven efficacy from clinical trials.
文摘AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease(NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.RESULTS A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers(n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC(37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLDHCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015(4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3%(P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups(6.6 ng/m L vs 26 ng/m L; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.CONCLUSION The growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.
文摘Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of world population lives in slums yet there is no information regarding their health status in context to asthma and COPD. Aims: We investigated the prevalence of asthma and chronic-bronchitis symptoms and associated risk-factors in slum habitats of Pune city. Methodology: 7062 adult slum-dwellers living in 12 slums of Pune city were cross-sectionally interviewed by local healthcare workers with respiratory health questionnaire which was designed using respiratory symptoms of validated European Community Respiratory Health Survey (ECRHS II) questionnaire and International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire. Results: The overall prevalence of selfreported asthma symptoms was 10% (18 - 40 years: 6.5%;>40 years: 13.5%). The overall prevalence of chronic bronchitis was 8.5% [18 - 40 years: 7% (males: 7%, females: 7%);>40 years: 10% (males: 10%, females: 10%)]. Increasing age (p = 0.00), female gender (p = 0.001), unemployment (0.00) current smoking (p = 0.00) and ex-smoking (p = 0.004) emerged as significant risk factor for asthma. While, ex-smoking (p = 0.004) and low-education status (p = 0.00) emerged as significant risk factors for chronic bronchitis. Conclusion: In slums reporting of asthma and chronic-bronchitis symptoms was much higher than what has been reported earlier from India. Asthma was commonly seen in females, old age, unemployed and ever-smokers. While chronic bronchitis was commonly seen in ex-smokers and illiterate subjects. Chronic bronchitis was equally distributed amongst male and females, despite 0% prevalence of smoking in females.
基金supported by grants from the Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (ZYYCXTD-C-202003)the China Academy of Chinese Medical Sciences Evidence-based Capacity Improvement Project (ZZ13-024-7)
文摘Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.
基金Supported by Science of China University Journals(CUJS2021-027)China Agricultural Journals Website 2021(CAJW2021-033)。
文摘China's food security mainly depends on the core areas of food production.Under the dual constraints of resource scarcity and environmental degradation,improving the grain production efficiency of the main grain-producing areas has become the fundamental way to strengthen the grain production capacity and improve the national food security capability,and to improve the efficiency of grain production in major grain-producing areas requires empirical support.This paper used the Super SBM model and the Malmquist index to measure the grain production efficiency of the main grain-producing areas from 2001 to 2020 from both static and dynamic perspectives,and compared the differences in grain production efficiency among different soil types and different provinces(autonomous regions)in the main grain-producing areas.The results showed that from 2001 to 2020,the grain production in the main grain-producing areas was in a relatively ineffective state,and the differences in grain production efficiency among different soil types and different provinces(autonomous regions)in the main grain-producing areas were obvious.The order of grain production efficiency in different soil types was black soil region>red-yellow soil region>paddy soil region>fluvo-aquic soil region,and the order of grain production efficiency of the provinces(autonomous regions)in the main grain-producing areas was Jilin>Heilongjiang>Inner Mongolia>Jiangxi>Hunan>Sichuan>Hubei>Jiangsu>Liaoning>Henan>Anhui>Shandong>Hebei.From 2001 to 2020,the total factor productivity of grain in the main grain-producing areas increased,but due to the trade-off between the technological progress and the growth of technical efficiency,the increase in the total factor productivity of grain in the main grain-producing areas was small,and the growth mainly came from the increase of input factors in this period.The total factor productivity of grain in Hebei,Heilongjiang,Liaoning,Jilin,Inner Mongolia,Shandong,Jiangsu,Henan and Anhui increased,but the increase was small,while the total factor productivity of grain in Jiangxi,Sichuan,Hunan and Hubei provinces declined.
文摘This paper focuses on analysis of salinity distribution along Red River and its main branches to determine and limit effects of salinity intrusion under variable scenarios for outlet discharge from upstream reservoirs and the tidal magnitude under global climate change effects. The effect of outlet discharge from upstream reservoirs, which generates flow in droughty months, is considered as upstream input condition for salinity intrusion. The sea level rising phenomenon is represented by scenarios according to prediction of the Intergovernmental Panel on Climate Change （IPCC）. The lateral flow and the rainfall in dry season are neglected in the process of simulation. MIKE 11, ID river model software by DHI （Danish Hydraulic Institute）, is used to simulate the processes of salt water intrusion from the river mouths to the upstream of the river in consideration the effect of the Sea Level Rise phenomenon and the operation of existing reservoirs and those under construction. The results indicate that salinity intrusion length from river mouth depends on the estuary characteristics, discharges from upper reservoirs and tidal phases （low and high tides）. With the safe salinity concentration for agriculture and livestock is 4 psu, the study shows that the length of intruded salt in Red River is about 40km from the river mouth, in otherwise, the effect of salinity intrusion in Thai Binh river is negligible. The Sea Level Rise phenomenon has inconsiderable affects on salinity intrusion processes in Red River System. The influence of outlet discharges from upstream reservoirs has also negligible affects on prevent salinity intrusion from the sea. According to the results of the study, reasonable water resources utilization and appropriate reservoir operation approaches in the drought will be studied to protect the crop and aquaculture from salinity intrusion.
文摘With the development of the knowledge economy, social professional quality of talent has an increasingly demanding. Medical students is China＇ s medical and health undertakings reserve personnel, it plays an important role for better protection of people＇ s health by strengthening vocational personality training medical students and improving professional quality. Therefore, we must pay attention to the medical student＇ s career awareness, ethics, professionalism, career aspirations and career interests of education on medical students to develop a healthy personality of the medical profession, and lay the foundation for the sustainable development of medical and health services.
文摘World Health Organization(WHO)reported that the integration of some traditional medicine practices with national main stream health system was started since the 1970s[1].WHO developed and published two strategies regarding traditional and complementary medicine,which were WHO strategy for traditional medicine 2002–2005 and WHO strategy for traditional medicine 2014–2023[2,3].
文摘Background: There is great interest in developing blood-based biomarkers for Alzheimer’s disease (AD);however, there is no consensus as to what blood fraction is most appropriate for analyzing particular markers. The current study provides empirical evidence regarding how blood-based proteins vary depending on whether they are assayed in serum or plasma. Methods: Weanalyzed concentrations of 100 proteins in matched samples of serum and plasma from 39 Caucasian AD participants from the Texas Alzheimer’s Research and Care Consortium bymultiplex immunoassay. Results: Concentrations of 40 proteins were highly correlated (r2≥ 0.75) between plasma and serum while the remaining proteins were moderately to weakly correlated (r2< 0.75). Discussion: Whether plasma vs. serum is assayed can have a large impact on the observed concentration of some proteins, including several proteins that are of great interest to AD pathophysiology. The current findings may explain the significant discrepancies often times reported in the AD biomarker field.
基金supported by grants from the National Natural Science Foundation of China(81730057,82130062)the Key Project of Military Medical Innovation Program of Chinese PLA(18CXZ026)+1 种基金the Guangdong Clinical Research Center for Critical Care Medicine(2020B1111170005)the Sun Yat?sen University Clinical Research Program 5010(2019002)。
文摘Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.
基金2023 Hubei Provincial Key Laboratory Open Project-Nursing Special Project:2023KFH017Current Status Survey and Interventional Research on Alexithymia in Elderly Cancer Patients(Chaired by Lili Zhang)+3 种基金Wuhan University Clinical Nursing Special Research Cultivation Fund Project:LCHL202307Constructing a Long-Term Care Model Based on Narrative Transport Model to Identify and Reduce the Vulnerability of Psychological Crises in Elderly Patients with Comorbidities(Chaired by Lili Zhang)2022 Hubei Provincial Key Laboratory Open Project-Nursing Special Project:2022KFH030Empirical Study on the Construction and Application of a Frailty Risk Warning Model for Hospitalized Elderly Patients(Chaired by Jiaojiao Wu).
文摘Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of psychological vulnerability,aging attitudes,and life meaning in elderly patients with comorbidities.Methods:A total of 685 elderly inpatients and outpatients at Renmin Hospital of Wuhan University between July and December 2022 were selected using the simple random sampling method.Social demographic data were collected,and the Attitudes to aging Questionnaire(AAQ),the Chinese Life Meaning Questionnaire(C-MLQ),and the Psychological Vulnerability Scale(C-PVS)were used for the analysis.A total of 685 questionnaires were received,and 602 valid questionnaires were collected,with an effective rate of 87.88%.Data analysis was performed using SPSS V25.0 and AMOS V24.0.Results:The total scores of psychological vulnerability,aging attitudes,and life meaning were 69.4±12.8,80.2±13.5 and 39.2±8.3,respectively.The psychological vulnerability was significantly negatively correlated with life meaning and aging attitudes(r=-0.351,-0.264;p<0.01).There was a significant positive correlation between aging attitudes and life meaning(r=0.515;p<0.01).Life meaning played a partial mediating role between psychological vulnerability and aging attitudes(β=3.070,p<0.05).Conclusion:This study found that the psychological vulnerability in elderly patients with comorbidities was at the lower level,which was related to the elderly patients’aging attitudes and their current status of life meaning.The level of psychological vulnerability in elderly patients with senile-related comorbidities needs to be further improved.Medical workers should pay attention to the psychological vulnerability of elderly patients and improve the identification of psychological crises of such patients.
文摘Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.
文摘Introduction:Cupping therapy is an integrative and complementary medicine therapy that practiced worldwide by several civilizations for thousands of years.Cupping therapy is reported to be a relatively safe practice especially if performed by qualified therapists.Subconjunctival hemorrhage(SCH)is a common cause of eye redness and can be classified into traumatic and spontaneous.Case presentation:This case report discussed an adverse event related to wet cupping therapy.The patient developed SCH one day after performing cupping therapy.He was completely recovered after 2 weeks.This case report should increase the knowledge of cupping therapists regarding increasing safety of patient when performing wet cupping therapy on specific body parts especially,head,neck and cervical areas.Furthermore,it highlighted the importance of conducting research regarding the mechanical and physiological effects of cupping therapy.Conclusion:Adverse events related to cupping therapy should be reported with every patient.Cupping therapists should be aware of this possible mild adverse event.To the best of our knowledge,this is the first published adult case of SCH related to wet cupping therapy session.More studies are critically needed for evaluation of cupping therapy effects and adverse events especially when performed on head and neck.
文摘Benign,premalignant or low-grade malignant pancreatic tumors are increasingly diagnosed owing to the widespread uptake of cross-sectional imaging.Surgical excision is a potential treatment option for these tumors.Pancreatoduodenectomy and distal pancreatectomy are the standard resections for tumors located in the pancreatic head-neck or body-tail,respectively,and not uncommonly sacrifice a significant amount of healthy pancreatic parenchyma.Central pancreatectomy(CP)is a parenchyma-sparing procedure,initially performed by Dagradi and Serio in 1982,in a patient with pancreatic neck insulinoma.Since then,an increasing number of cases are being performed worldwide,either via open or minimally invasive surgical access.Additionally,pancreatic enucleation is reserved for tumors<3 cm,without involvement of the main pancreatic duct.CP remains an alternative approach in selected cases,albeit in the presence of some controversies,such as its use in early pancreatic ductal adenocarcinoma or metastatic deposits to the central aspect of the pancreas from other malignancies.In recent years,clarity is lacking as regards indications for CP,and despite accumulating evidence in favor of limited resections for suitable pancreatic tumors,no evidence-based consensus guidelines are yet available.Nevertheless,it appears that appropriate patient selection is of paramount importance to maximize the advantages of preservation of endocrine and exocrine pancreatic functions as well as to mitigate the risks of higher complication rates.In this comprehensive review,we explore the role of CP in the treatment of lesions located in the neck and proximal body of the pancreas.
