A Surgeon's Challenge: Diagnosing and Managing Hidden Bile Duct Stones Post-cholecystectomy.

This case report details the diagnostic and management challenges encountered with hidden bile duct stones post-cholecystectomy in a 58-year-old female patient. Despite a successful laparoscopic cholecystectomy, the patient developed sudden upper abdominal pain and jaundice, leading to the discovery of an impacted bile duct stone. The case underscores the limitations of conventional preoperative diagnostics and highlights the importance of advanced imaging techniques and a multidisciplinary approach for optimal outcomes. The successful extraction of the stone via endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy demonstrates the efficacy of this therapeutic strategy. This report emphasizes the need for heightened vigilance and comprehensive evaluation in the postoperative management of gallstone disease, contributing valuable insights into the complexities of choledocholithiasis post-cholecystectomy.

Paper-based ratiometric fluorescent sensing platform based on mixed quantum dots for the detection of glucose in urine.

A paper-based ratiometric fluorescent sensing platform has been developed for glucose detection based on a dual-emission fluorescent probe consisting of carbon quantum dots (C QDs) and CdTe QDs. When the two kinds of QDs are mixed, the fluorescence of C QDs is reversibly quenched by CdTe QDs. However, in the presence of glucose, the fluorescence of CdTe QDs is quenched by H2O2 catalyzed by glucose oxidase (GOx), which restores the fluorescence of C QDs. The proposed paper-based ratiometric fluorescent sensing platform exhibited good sensitivity and selectivity towards glucose. The working linear range was 0.1 mM to 50 mM with a limit of detection (LOD) of 0.026 mM. Additionally, the proposed paper-based sensor possesses viability for the determination of glucose in actual urine samples.

Does every Staphylococcus aureus infection require anti-MRSA drugs? Three case reports of a Staphylococcus aureus infection.

Staphylococcus aureus is a common clinical pathogen. Does every S. aureus infection require anti-MRSA drugs? Reported here are three cases of a community-acquired infection with S. aureus. The first case involveds a 45-year-old male who was admitted due to right ankle pain for 1 month; he was diagnosed with chronic suppurative osteomyelitis and an acute soft tissue infection of the ankle. S.aureus was cultured from the pus and was resistant to penicillin and sensitive to oxacillin and vancomycin. After receiving oxacillin, he was cured and discharged 45 days after admission. The second case involved a 44-year-old male who was admitted due to lumbar pain with right lower limb numbness for more than 1 month and fever for 1 day. S. aureus was cultured from blood specimens and was resistant to penicillin and sensitive to oxacillin and vancomycin. After receiving oxacillin, he as cured. The third case involved a 7-day-old newborn who was admitted due to skin jaundice for 6 days. S. aureus was cultured from skin secretions specimens and was resistant to penicillin and sensitive to oxacillin, erythromycin, and vancomycin. The newborn was treated with oxacillin for 4 days, and she was cured and discharged. Not all cases a suspected S. aureus infection require anti-MRSA drugs; instead, previous S. aureus susceptibility results in the area and hospital, as well as the patient's clinical profile, need to be taken into account.

Attention should be paid to acute hepatitis of unknown etiology in children.

Since April 5, 2022, an increase in cases of severe acute hepatitis of unknown etiology among children with no underlying conditions was first reported in the United Kingdom (UK). Testing excluded viral hepatitis types A, B, C, D, and E and other known common and uncommon infectious and non-infectious causes of acute hepatitis. As of May 26, 2022, 650 cases of acute hepatitis of unknown etiology in children have been reported in at least 33 countries worldwide, with 99 additional cases pending classification. Here, the current prevalence of this condition around the world, a hazard analysis, possible causes, the risk of an outbreak in China, and advice on prevention have been briefly reviewed.

Biological functions, mechanisms, and clinical significance of circular RNA in pancreatic cancer: a promising rising star.

Pancreatic cancer (PC) is a highly malignant solid tumor with insidious onset and easy early metastasis. Despite tremendous efforts devoted to research in this field, the mechanisms underlying PC tumorigenesis and progression remain unclear. Additionally, robust biomarkers and satisfactory therapeutic strategies for clinical use in PC patients are still lacking. Circular RNAs (circRNAs) are a new type of non-coding RNA originating from precursor messenger RNAs, with a covalent continuous closed-loop structure, strong stability and high specificity. Accumulating evidence suggests that circRNAs may participate in PC development and progression. Abnormal expression of circRNAs in PC is considered a vital factor that affects tumor cell proliferation, migration, invasion, apoptosis, angiogenesis and drug resistance. In this review of relevant articles published in recent years, we describe the basic knowledge concerning circRNAs, including their classification, biogenesis, functions and research approaches. Moreover, the biological roles and clinical significance of circRNAs related to PC are discussed. Finally, we note the questions remaining from recent studies and anticipate that further investigations will address these gaps in knowledge in this field. In conclusion, we expect to provide insights into circRNAs as potential targets for specific PC diagnosis and treatment in the future.

Brain abscess due to Aggregatibacter aphrophilus in association with atrial septal defect：Case report and literature review.

BACKGROUND: Aggregatibacter aphrophilus（A. aphrophilus）is one of the organisms of the HACEK group. Previously reported cases of brain abscesses caused by A. aphrophilus infection have occurred in children with a basis for congenital heart disease, or in adults with a basis for dental disease. Rare cases of brain abscess caused by A. aphrophilus have been reported in adults with congenital heart disease or in patients without dental disease history. Herein we present a rare case of brain abscess caused by A. aphrophilus, who was in association with atrial septal defect for more than 20 years, and had no dental disease and did not develop infective endocarditis. CASE PRESENTATION: A 51-year-old female was admitted due to progressively worsening headache and left limb weakness for more than 10 days. She denied the history of chronic diseases such as hypertension and diabetes, and no periodontal disease. While she had a history of atrial septal defect, a form of congenital heart disease with severe pulmonary hypertension for more than 20 years. After admission, echocardiographic illustrated congenital heart disease with severe pulmonary hypertension. CT and MRI showed brain abscess. Cerebrospinal fluid (CSF) results also confirmed the presence of intracranial infection. Empirical therapy with vancomycin 1.0 g i.v q12h and meropenem 2.0 g i.v q8h was initiated from the day of admission. On the fourth day after admission, brain abscess resection and decompressive craniectomy were performed, and the pus drained on operation were cultured and Gram-negative bacilli grew, which was identified as A.aphrophilus. Vancomycin was discontinued and meropenem was continued（2.0 g i.v q8h）for 5 weeks, followed by oral levofloxacin 0.5 qd for 4 weeks of out-patient antibiotics. The patient recovered fully within 9 weeks of treatment. CONCLUSIONS: This is the first case of A. aphrophilus to cause brain abscess in adult with a history of congenital heart disease for more than 20 years, who had no dental disease and did not develop infective endocarditis. We also highlight the value of bacterial 16 S rDNA PCR amplification and sequencing in identifying bacteria in abscesses which are culture-negative, and prompt surgical treatment，choosing effective antibiotics and appropriate course of treatment will get better clinical effect.

Non-tuberculosis extensive abdominal lymph node calcification leading to portal hypertension with esophageal and gastric variceal bleeding: a rare case report.

BACKGROUND: Calcification of abdominal lymph node is a common clinical phenomenon, but it is extremely rare to cause serious adverse clinical outcomes. In the present case, the ruptured hemorrhage of the oesophagogastric fundic varices occurred as a result of portal hypertension due to compression of the portal vein by calcified lymph nodes. The patient was treated with medication, interventional therapy, endoscopic therapy, and surgery, respectively and the four different treatment options for the bleeding are worth summarizing. The etiology of this case is extremely rare and is the first to be reported in the world. CASE PRESENTATION: A 32-year-old male patient with no apparent causes of sudden onset of vomiting of blood, the patient underwent four different treatment methods to stop the hemorrhage. The combined diagnosis of whole abdomen enhanced CT and angiography was calcified abdominal lymph nodes compressing the portal vein, leading to portal hypertension and resulting in esophageal and gastric variceal bleeding. Postoperatively, a biopsy of the caseous tubercular tissue of the abdominal wall observed intraoperatively was performed and the biopsy did not show a tubercular component. Therefore, the extensive intra-abdominal lymph node calcification was not associated with tuberculosis. The patient's bleeding ceased after surgery. CONCLUSION: This case has improved the clinician's understanding of the etiology of non-cirrhotic portal hypertension. Based on this, and with this case, the differences between various hemostatic measures were studied in depth.

Oral high-dose acetylcysteine: Effective against the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a high rate of transmission and it exhibits immune escape characteristics. N-acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH), which can enter cells to play an antioxidant role, so it is better than glutathione. Patients tolerate NAC well, and adverse reactions are rare and mild, so this type of drug with multiple actions is considered to be a mucolytic agent as well as a drug for the prevention/treatment of various diseases, including COVID-19. Previous studies indicated that the clinical effectiveness of NAC is dose-dependent. Low-dose NAC (0.2 g tid for adults) is a mucolytic expectorant, high-dose NAC (0.6 g bid or tid) has expectorant action as well as antioxidant action, and extreme-dose NAC (300 mg/kg.d) is used for detoxification in cases of an acetaminophen overdose. Presumably, orally administered high-dose NAC (0.6 g tid for adults and 10 mg/kg tid for children) could be used as an adjuvant to treat an Omicron infection. It should reduce the time to negative conversion and prevent severe COVID-19, reducing the duration of hospitalization and increasing the bed turnover rate.

The value of dynamic contrast-enhanced magnetic resonance imaging combined with apparent diffusion coefficient in the differentiation of benign and malignant diseases of the breast.

BACKGROUND: The value of combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) histogram analysis for the diagnosis of breast cancer has not been evaluated in previous studies. PURPOSE: To investigate the diagnostic value of DCE-MRI combined with ADC in benign and malignant breast lesions. MATERIAL AND METHODS: The clinicopathological imaging data included 168 patients (177 lesions) with breast lesions who underwent convention breast MRI, DCE-MRI, and diffusion-weighted imaging (DWI); they were divided into the benign lesion group (n = 39) and malignant lesion group (n = 129) based on pathology. RESULTS: Using the type III outflow curve as a diagnostic criterion for malignant breast lesions, the diagnostic sensitivity was 76.9%, the specificity was 80%, the correct rate was 72.2%, and its area under the curve (AUC) was 0.823. Using an enhancement ratio > 100% as a diagnostic criterion for malignant breast lesions, the sensitivity was 61.5%, specificity was 80%, and AUC was 0.723. Using > 3 ipsilateral vessels as a diagnostic criterion for malignant lesions in the breast resulted in a diagnostic sensitivity of 81.6%, a specificity of 80.8%, and an AUC of 0.805. CONCLUSION: The type of time intensity curve DCE-MRI, the early enhancement rate in the first phase, the number of ipsilateral vessels, and the ADC full volume histogram of the blood supply score and DWI are valuable in the diagnosis of benign and malignant breast lesions.

Selective use of pancreatic duct occlusion during pancreaticoduodenectomy in patients with a small-size duct and atrophic parenchyma in the distal pancreas: A retrospective study.

Background: Despite the advancements in surgical techniques, postoperative pancreatic fistula (POPF) remains a potentially life-threatening complication of pancreaticoduodenectomy (PD). Pancreatic duct occlusion (PDO) without anastomosis has also been proposed to alleviate the clinical consequences of POPF in selected patients after PD. Objectives: To assess the safety and effectiveness of PDO with mechanical closure after PD in patients with an atrophic pancreatic body-tail and a small pancreatic duct. Methods: We retrospectively identified two female and two male patients from April 2019 to October 2020 through preoperative computed tomography of the abdomen. Among them, three patients underwent PDO with mechanical closure after PD, and one underwent PDO after pylorus-preserving PD. In addition, patients' medical records and medium-and long-term follow-up data were analyzed. Results: Postoperative histological examination revealed a solid pseudopapillary tumor in two patients, pancreatic ductal adenocarcinoma in one patient, and chronic pancreatitis with pancreatic duct stones in one patient. However, none of the patients developed biochemical or clinically relevant POPF, with no postpancreatectomy hemorrhage, biliary leakage, delayed gastric emptying, intra-abdominal abscess, or chyle leakage. Among the four patients, three developed new-onset diabetes mellitus, and one had impaired glucose tolerance. Furthermore, three patients received pancreatic enzyme supplementation at a dose of 90,000 Ph. Eur. units/d, and one was prescribed a higher dose of 120,000 Ph. Eur. units/d. Conclusions: PDO with mechanical closure is an alternative approach for patients with an atrophic pancreatic body-tail and a small pancreatic duct after PD. Therefore, further evidence should evaluate the potential benefits of selective PDO in these patients.

Nuclear-targeted p53 and DOX co-delivery of chitosan derivatives for cancer therapy in vitro and in vivo.

The nucleus is one of the most important cellular organelles. Chitosan-grafted poly-(N-3-carbobenzyloxy-lysine) (CCL) decorated with human immunodeficiency virus-1 transactivator of transcription (TAT) can co-deliver p53 and doxorubicin into the nucleus simultaneously, such that their antitumor functions are exerted. However, TAT-CCL has been shown to have an anti-tumor effect only in vitro; the effect in vivo was unsatisfactory. Here, a unique nucleus-targeted delivery system based on amidized TAT (aTAT)-CCL with aTAT functional on the surface was designed to achieve a highly efficient nucleus-targeting gene and drug delivery system for effective cancer cell elimination in vitro and in vivo. In this delivery system, TAT is amidized to inhibit its nonspecific interactions. Confocal laser scanning microscopy observations revealed that if aTAT-CCL was incubated in pH 5.0 acetate buffer solution for 24 h before use (named aTAT-CCL-HB), more aTAT-CCL-HB entered the nucleus compared with aTAT-CCL or CCL. aTAT-CCL-HB can also achieve high gene transfection and drug delivery efficiencies and low viability in HepG2 cells. However, only aTAT-CCL achieved extensive circulation in the blood compartment and high antitumor activity in vivo. Amidization of TAT in vectors may become a promising strategy for nucleus-targeted delivery systems, especially in in vivo applications.

Hypoxia-inducible factor-1α rs11549465 C>T and rs11549467 G>A gene polymorphisms are associated with an increased risk of digestive cancers in Asians.

OBJECTIVE: We used a meta-analysis framework to examine the correlation between HIF-1α gene polymorphisms and the susceptibility to digestive cancers. METHODS: Cochrane Library Database, EMBASE, MEDLINE, Pubmed, CINAHL, Chinese Biomedical Database and Web of Science were searched without language restrictions to identify relevant case-control studies reporting data on HIF-1α gene polymorphisms in digestive cancers. Data was extracted from the selected studies and meta-analysis was carried out using STATA 12.0 and Comprehensive Meta-analysis 2.0 softwares. Relative risk (RR) and its 95% confidence interval (95%CI) were calculated. A total of 8 eligible case-control studies were included. These 8 studies contained a combined total of 1,276 patients diagnosed with various digestive cancers and 3,392 healthy controls. Two functional HIF-1α polymorphisms (rs11549465 C>T and rs11549467 G>A) were examined in these 8 studies. RESULTS: Our findings demonstrated that both rs11549465 C>T and rs11549467 G>A HIF-1α polymorphisms conferred significantly increased risk of digestive cancers. However, ethnicity-stratified analysis revealed that HIF-1α rs11549465 C>T and rs11549467 G>A polymorphisms were associated with an elevated risk of digestive cancer in Asians, but not in Caucasians. These two polymorphisms also conferred different degrees of susceptibility to various digestive cancer types. CONCLUSION: Our meta-analysis suggests that HIF-1α rs11549465 C>T and rs11549467 G>A polymorphisms influence the pathogenesis of digestive cancers in Asians.

WDR26/MIP2 interacts with VDAC1 and regulates VDAC1 expression levels in H9c2 cells.

MIP2, one of WDR26 isoforms, encodes a 498 amino acid protein with an amino-terminal CTLH domain and five carboxyl-terminal WD40 motifs. MIP2 is localized to the mitochondria and protects cardiomyocytes against oxidative stress; however, nothing is known about how MIP2 confers its cytoprotection. Using co-immunoprecipitation (co-IP) method to isolate MIP2-protein complex from Sprague -Dawley rat heart, followed by mass spectrometry analysis, we have identified VDAC1, a protein located at mitochondria, as a novel MIP2-interacting protein in the myocardium of rat hearts as well as H9c2 cells. This interaction was further confirmed by co-IP assays in the myocardial tissues and H9c2 cardiomyocytes, and by protein overlay assay (POA) in vitro. It was shown that MIP2 overexpression alleviated the H2O2-induced increase of VDAC1 and cell damage, and MIP2 deficiency aggravated the increase of VDAC1 and cell damage in H2O2 -treated H9c2 cells. Our research suggests that the protective effect of MIP2 on the cardiomyocytes against oxidative stress is partly associated with its interaction with VDAC1 and thus inhibiting its expression.

Self-Assembled Modified Soy Protein/Dextran Nanogel Induced by Ultrasonication as a Delivery Vehicle for Riboflavin.

A simple and green approach was developed to produce a novel nanogel via self-assembly of modified soy protein and dextran, to efficiently deliver riboflavin. First, modified soy protein was prepared by heating denaturation at 60 °C for 30 min or Alcalase hydrolysis for 40 min. Second, modified soy protein was mixed with dextran and ultrasonicated for 70 min so as to assemble nanogels. The modified soy protein-dextran nanogels were characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) and ζ-potential studies to confirm the formation of NGs. Transmission electron microscopy (TEM) revealed the NGs to be spherical with core-shell structures, in the range of 32-40 nm size. The nanogels were stable against various environmental conditions. Furthermore, the particle size of the nanogels hardly changed with the incorporation of riboflavin. The encapsulation efficiency of nanogels was found to be up to 65.9% at a riboflavin concentration of 250 µg/mL. The nanogels exhibited a faster release in simulated intestine fluid (SIF) compared with simulated gastric fluid (SGF). From the results obtained it can be concluded that modified soy protein-dextran nanogels can be considered a promising carrier for drugs and other bioactive molecule delivery purposes.

Association between the CYP1A1 A2455G polymorphism and risk of cancer: evidence from 272 case-control studies.

A2455G is a common polymorphism in CYP1A1, showing differences in its biological functions. Case-control studies have been performed to elucidate the role of A2455G in cancer; however, the results are conflicting and heterogeneous. Hence, we performed a meta-analysis to investigate the association between cancer susceptibility and A2455G (64,593 cases and 91,056 controls from 272 studies) polymorphism in different inheritance models. We used odds ratios with 95% confidence intervals to assess the strength of the association. Overall, significantly increased cancer risk was observed in any genetic model (dominant model, odds ration [OR] = 1.19, 95% confidence interval [CI] = 1.13-1.25; recessive model: OR = 1.41, 95% CI = 1.29-1.54; additive model: OR = 1.49, 95% CI = 1.35-1.65) when all eligible studies were pooled into the meta-analysis. In further stratified and sensitivity analyses, the elevated risk remained for subgroups of breast cancer, colorectal cancer, esophageal cancer, hepatocellular cancer, head and neck cancer, leukemia, lung cancer, and prostate cancer, but these associations vary in different ethnic populations. In summary, this meta-analysis suggests the participation of A2455G in the susceptibility for some cancers, such as breast cancer, colorectal cancer, lung cancer, and so on. Moreover, ethnicity, histological type of cancer, and smokers seem to contribute to varying expressions of the A2455G on some cancers risk. In addition, our work also points out the importance of new studies for A2455G polymorphism in some cancer types, such as gallbladder cancer, Indians of breast cancer, and Caucasians of ovarians, because these cancer types had high heterogeneity in this meta-analysis (I(2) > 75%).