The field of vascular medicine has undergone a profound transformation in the 21^st century, transforming our approach to assessment and treatment. Atherosclerosis, a complex inflammatory disease that affects medium and large arteries, presents a major challenge for researchers and healthcare professionals. This condition, characterized by arterial plaque formation and narrowing, poses substantial challenges to vascular health at individual, national, and global scales. Its repercussions are far-reaching, with clinical outcomes including ischemic heart disease, ischemic stroke, and peripheral arterial disease—conditions with escalating global prevalence. Early detection of vascular changes caused by atherosclerosis is crucial in preventing these conditions, reducing morbidity, and averting mortality. This article underscored the imperative of adopting a holistic approach to grappling with the intricacies, trajectories, and ramifications of atherosclerosis. It stresses the need for a thorough evaluation of the vasculature and the implementation of a multidisciplinary treatment approach. By considering the entire vascular system, healthcare providers can explore avenues for prevention, early detection, and effective management of this condition, ultimately leading to improved patient outcomes. We discussed current practices and proposed new directions made possible by emerging diagnostic modalities and treatment strategies. Additionally, we considered healthcare expenditure, resource allocation, and the transformative potential of new innovative treatments and technologies.

• Vascular medicine
• Vasculature assessment
• Holistic approach
• Prevention avenues
• Healthcare transformation

This editorial commentary critically examines the systematic review by Miotti et al, which discusses the evolving trends in upper lid blepharoplasty towards a conservative, volume-preserving approach. The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity, paralleling broader trends in panfacial rejuvenation. Miotti et al delve into the nuances of fat pad management, advocating for conservation over reduction to sustain natural contours and improve long-term aesthetic outcomes. This perspective is supported by comparative studies and empirical data, such as those from Massry and Alghoul et al, highlighting the benefits of conservative approaches in terms of patient satisfaction and aesthetic longevity. The review also stresses the importance of surgeon discretion in adapting procedures to diverse patient demographics, particularly in addressing distinct features such as the Asian upper eyelid. However, it identifies a significant gap in long-term comparative research, underscoring the need for future studies to substantiate the safety and efficacy of these minimalist techniques. Overall, Miotti et al.'s work contributes profoundly to the discourse on personalized, conservative cosmetic surgery, urging ongoing research to refine and validate surgical best practices in upper eyelid blepharoplasty.

• Upper lid blepharoplasty
• Volume preservation
• Panfacial rejuvenation
• Aesthetic longevity, Blepharoplasty

Oral candidiasis (OC) is an oral health disease that could influence patients’ oral health quality of life.

To estimate prevalence of OC among disabled and non-disabled individuals and its potential risk factors in the Al-Baha region, Saudi Arabia.

An observational cross-sectional study was carried out among 148 disabled and non-disabled participants. The technique of concentrated oral rinse employing the Sabouraud Dextrose Agar medium accompanied with 0.05% chloramphenicol was conducted to assess and isolate candida. Oral examination using the World Health Organization guidelines was conducted to examine participants’ oral health status. A pre-designed questionnaire was also used to evaluate sociodemographic, medical history, and oral hygiene habits of the studied population.

Out of 148 participants (n = 57, 38%) had colonized candida. None of the studied population had visible Candida lesions. However, Candida was found in the oral rinses without the subject presenting any lesions or issues caused by Candida (asymptomatic colonization). The most common prevalent OC among participants were Candida albicans,Candida glabrata, Candida dubliniensis, Candida krusei, Candida tropicalis, and Candida parapsilosis (n = 35, 61%; n = 8, 14%; n = 6, 10%; n = 5, 9%; n = 2, 4%; and n = 1, 2%) respectively. Diabetes, smoking, poor plaque, and gingival status were key potential risk factors that significantly associated with candida’s density and presence (P = 0.001, P = 0.001, P = 0.01, and P = 0.01) respectively. Disability status had no statistically significant effect on presence and density of Candida.

The prevalence of OC is almost third of the studied population; thus, may provoke a need to develop preventive strategies to reduce the OC rate and establish solid treatment plans.

• Oral health
• Candida
• Oral candidiasis
• Dental public health
• Disabled
• Disability
• Risk factors
• Epidemiology

Iron is a double-edged sword! Despite being essential for numerous physiological processes of the body, a dysregulated iron metabolism can result in tissue damage, exaggerated inflammatory response, and increased susceptibility to infection with certain pathogens that thrive in iron-rich environment. During sepsis, there is an alteration of iron metabolism, leading to increased transport and uptake into cells. This increase in labile iron may cause oxidative damage and cellular injury (ferroptosis) which progresses as the disease worsens. Critically ill patients are often complicated with systemic inflammation which may contribute to multiple organ dysfunction syndrome or sepsis, a common cause of mortality in intensive care unit. Originally, ferritin was known to play an important role in the hematopoietic system for its iron storage capacity. Recently, its role has emerged as a predictor of poor prognosis in chronic inflammation and critical illnesses. Apart from predicting the disease outcome, serum ferritin can potentially reflect disease activity as well.

• Critical illness
• Ferritin
• Inflammation
• Iron
• Mortality
• Sepsis

In this editorial, we comment on an article published in a recent issue of the World Journal of Clinical Cases. There is a pressing need for reliable tools for diagnosing tuberculosis (TB) of the gastrointestinal tract. Despite advancements in the diagnosis and treatment, TB remains a global health challenge. Ali et al demonstrated that TB may mimic gastrointestinal conditions, such as gastric outlet obstruction, causing a delay in the diagnosis. Furthermore, the latter complication is frequently observed during infections, including Helicobacter pylori, and rarely is related to TB, as in the presented case. In line with this, we think that laboratory tests based on interferon-gamma release assays can be a helpful tool for diagnosing latent TB paced in the gastrointestinal tract. Innovative strategies and approaches for diagnosing latent/active extra pulmonary TB are crucial for establishing the diagnosis early and enhancing treatment strategies to mitigate the global burden of TB.

• Tuberculosis
• Gastrointestinal tuberculosis
• Interferon-gamma release assay
• IGRA
• Primary gastroduodenal tuberculosis
• Gastric outlet obstruction
• Case report

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a complex disorder characterized by symptoms resulting from intermittent hypoxia and hypopnea, with research indicating a crucial role of immune system dysregulation and genetic variations in its pathogenesis. A recent Zhao et al study utilizes Mendelian randomization analysis to explore the causal relationship between immune cell characteristics and OSAHS. The study identifies specific lymphocyte subsets associated with OSAHS, providing valuable insights into the disease's pathophysiology and potential targets for therapeutic intervention. The findings underscore the significance of genetic and immunological factors in sleep disorders, offering a fresh perspective on OSAHS's complexities. Compared to existing literature, Zhao et al's study stands out for its focus on genetic markers and specific immune responses associated with OSAHS, expanding upon previous research primarily centered on systemic inflammation. In conclusion, the study represents a significant advancement in the field, shedding light on the causal role of immune cells in OSAHS and paving the way for future research and targeted treatments.

• Obstructive sleep apnea
• Mendelian randomization
• Lymphocyte characteristics
• Immunology
• Obstructive sleep apnea-hypopnea syndrome

Globally, prostate cancer has become a major threat to men's health, with an increasing incidence and causes serious effects on the quality and length of life of patients. Despite the rapid development of medical technology, which provides treatments, including surgery, radiotherapy, and endocrine therapy, the treatment of patients with prostate cancer, especially with endocrine therapy, has become a major challenge in clinical treatment owing to the lengthy course of treatment, side effects of drugs, and impact of the disease on the psychological and physiological functioning of the patient, producing poor treatment adherence and a decline in quality of life.

To explore effects of nursing intervention prioritizing patient safety and case management in patients with prostate cancer undergoing endocrine therapy.

Eighty patients with prostate cancer who received endocrine therapy at our hospital between January 2022 and January 2024 were divided into observation and control groups with 40 cases per group. The control group was treated using a routine nursing workflow while the observation group received case management nursing guidance prioritizing patient safety. Scores for anxiety and depression, prostate cancer symptoms, and quality of life and patient compliance and satisfaction were compared between the groups after three months of intervention.

After the nursing intervention, the anxiety and depression scores of the observation group were significantly lower than those of the control group (P < 0.05). The quality of life score, sexual function, and hormone function were significantly higher than those in the control group (P < 0.05).

Case management guidance based on patient safety effectively reduced anxiety and depression in patients undergoing endocrine therapy for prostate cancer and improved their quality of life, treatment compliance, and satisfaction.

• Prostate cancer
• Case management
• Endocrine therapy
• Quality of life
• Patient safety

HDR syndrome is a rare genetic disease caused by variants in the GATA3 gene and is phenotypically defined by the triad of hypoparathyroidism (H), deafness (D), and renal disease (R). Renal disorders of HDR are mainly developmental abnormalities, although renal functional abnormalities can also be observed. Nephrotic syndrome or nephrotic-level proteinuria is rare in HDR syndrome. Here, we report a Chinese infant with HDR syndrome who presented with early-onset nephrotic syndrome. We suggest that variants in the GATA3 gene might be associated with nephrotic syndrome.

A 9-month-old boy was hospitalized with a complaint of diarrhea. Proteinuria was detected in the patient by routine testing for 3 days. No edema, oliguria, fever or abnormal urine color were observed. Routine urinary tests at a local hospital revealed proteinuria (protein 3 +) and microscopic hematuria (red blood cells 5-10/HP). The patient was born by cesarean delivery due to placental abruption at 35 weeks + 4 days of gestation. Intrauterine growth retardation was detected beginning at 6 months of gestation. His birth weight was 1.47 kg (< P3^th), length was 39 cm (< P3^th), and head circumference was 28 cm (< P3^th). His motor developmental milestones were obviously delayed. Clinical data were analyzed, and genetic analysis for hereditary nephrotic syndrome was performed by next-generation sequencing. The clinical data showed that the boy exhibited growth retardation, early-onset nephrotic syndrome, microscopic hematuria, sensorineural deafness, T-cell immunodeficiency and congenital heart disease. Genetic tests revealed that the boy carried a de novo hemizygous variant, c.704C>T (p.Pro235 Leu), in exon 3 of the GATA3 gene.

We report an infant with HDR syndrome who presented with early-onset nephrotic syndrome in China. We suggest that variants in the GATA3 gene might be associated with infant-onset nephrotic syndrome.

• HDR syndrome
• Sensorineural deafness
• Nephrotic syndrome
• China
• Case report

The coexistence of esophageal variceal bleeding and superficial esophageal cancer (SEC) is relatively rare in clinical practice. Moreover, there have been few reports of SEC overlying esophageal varices (EVs). Herein, we report our successful use of endoscopic submucosal dissection (ESD), esophageal solitary venous dilatation (ESVD), and endoscopic injection sclerotherapy (EIS) to treat a 75-year-old man who was diagnosed with SEC coexisting with esophageal variceal bleeding.

A 75-year-old man was admitted to the hospital due to black stool for 4 days. The patient had a history of liver cancer, cirrhosis, and portal hypertension. Endoscopic examination revealed esophageal and gastric varicose veins, as well as esophageal carcinoma in situ. We first treated esophageal variceal bleeding by ESVD and EIS. One week later, ESD treatment was done, and the complete resection of early esophageal cancer was successfully completed via endoscopy. There were no postoperative complications, such as bleeding, infection, or perforation.

The sequential treatment of ESVD, EIS, and ESD is an effective method for treating EVs with early esophageal cancer.

• Endoscopic selective varices devascularization
• Endoscopic injection sclerotherapy
• Endoscopic submucosal dissection
• Esophageal variceal bleeding, Superficial esophageal cancer
• Case report

Upper gastrointestinal bleeding (UGIB) can be attributed to either non-variceal or variceal causes. The latter is more aggressive with hemodynamic instability secondary to decompensated cirrhosis and portal hypertension. Non-variceal UGIB (NVUGIB) occurs due to impaired gastroprotective mechanisms attributed to several drugs such as anticoagulants and nonsteroidal anti-inflammatory drugs. Helicobacter pylori infection contributes to the development of peptic ulcer bleeding as well. NVUGIB presentation can be either hemodynamically stable or unstable. During the initial assessment a scoring system including patient-related factors (current cardiac, renal, and liver diseases and hemodynamic and laboratory parameters) is used to determine the patient’s prognosis. The Glasgow Blatchford score has been shown to be the most useful and precise. Those with high-risk NVUGIB require urgent assessment and upper endoscopy to achieve better short-term and long-term outcomes such as less hospitalization, blood transfusion, and surgery.

• Gastric
• Peptic
• Non-steroidal anti-inflammatory drugs
• Anticoagulants
• Melena

Liver failure (LF) is prevalent in China and is characterized by complex pathogenesis, challenging clinical management, poor prognosis, and rising incidence and mortality rates. The immune status is an important factor affecting LF prognosis. Interleukins (Ils) are a type of cytokine that act and interact with multiple cells, including immune cells. These signaling molecules play important roles in intercellular information transmission, including the regulation of immune cells; mediation of the activation, proliferation, and differentiation of T and B cells; and orchestration of the inflammatory response. To date, many studies have explored the correlation between IL expression and liver disease prognosis, but few studies have evaluated Ils as the prognostic biomarkers of LF. This article reviews the potential use of Ils as the prognostic biomarkers of LF. Particularly, it evaluates the predictive values of IL-21, IL-22, and IL-31, the three often overlooked yet promising prognostic biomarkers, in predicting susceptibility to LF. Harnessing biomarkers for early prognostic insights can facilitate tailored treatment strategies and enhance patient survival. Thus, this article focuses on the identification of IL-21, IL-22, and IL-33 as biomarkers in preclinical and clinical studies on LF and reviews their role as biomarkers in the pathogenesis and diagnosis of LF.

• Interleukin-21
• Interleukin-22
• Interleukin-31
• Liver failure
• Biological markers
• Potential value

Cataracts are a common ophthalmic disease and postoperative vision recovery is crucial to patient quality of life. Rational and efficient care models play an important role in promoting vision recovery.

To evaluate the clinical effectiveness of procedural nursing care combined with communication intervention in vision recovery after cataract ultrasound emulsification.

A randomized controlled study was conducted on 100 patients with cataracts who underwent ultrasound emulsification surgery. They were randomly assigned to an experimental group or a control group. The experimental group received procedural nursing combined with Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication intervention, whereas the control group received conventional nursing. The effectiveness of the nursing model was assessed by comparing differences in vision recovery, pain scores, and mental health status between the two groups.

It was found that over time the visual acuity of patients in both groups gradually recovered and patients in the experimental group had lower pain scores and superior mental health status than the control group (P < 0.05).

Procedural nursing combined with CICARE communication intervention has positive effects on vision recovery in patients after cataract ultrasound emulsification.

• Sequential nursing
• Communication intervention
• CICARE
• Cataract ultrasound emulsification
• Vision restoration

Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offer the potential for long-term survival in peritoneal carcinomatosis, outcomes following CRS/HIPEC vary significantly.

To identify the clinical factors associated with progression-free survival (PFS) after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal, ovarian, and gastric cancers.

We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival (OS) in patients recruited between 2015 and 2020. Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year. Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.

Of the 80 enrolled patients, 39 had an unfavorable PFS (< 1 year) and 41 had a favorable PFS (≥ 1 year). Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0 (CC-0) or length of CRS ≤ 6 h had a favorable PFS [odds ratio (OR) = 0.141, P = 0.004; and OR = 0.361, P = 0.027, respectively]. In multiple logistic regression, achieving CC-0 was the strongest prognostic factor for a favorable PFS (OR = 0.131, P = 0.005). A peritoneal cancer index score > 12 was associated with a lower rate of achieving CC-0 (P = 0.027). The favorable PFS group had a significantly longer OS (median 81.7 mo vs 17.0 mo, P < 0.001).

Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival. This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.

• Peritoneal metastasis
• Cytoreductive surgery
• Hyperthermic intraperitoneal chemotherapy
• Predictor
• Recurrence

Tuberculous peritonitis (TBP) is a chronic, diffuse inflammation of the peritoneum caused by Mycobacterium tuberculosis. The route of infection can be by direct spread of intraperitoneal tuberculosis (TB) or by hematogenous dissemination. The former is more common, such as intestinal TB, mesenteric lymphatic TB, fallopian tube TB, etc., and can be the direct primary lesion of the disease.

We present an older male patient with TBP complicated by an abdominal mass. The patient's preoperative symptoms, signs and imaging data suggested a possible abdominal tumor. After surgical treatment, the patient's primary diagnosis of TBP complicating an intraperitoneal tuberculous abscess was established by combining past medical history, postoperative pathology, and positive results of TB-related laboratory tests. The patient's symptoms were significantly reduced after surgical treatment, and he was discharged from the hospital with instructions to continue treatment at a TB specialist hospital and to undergo anti-TB treatment if necessary.

This case report analyses the management of TBP complicated by intraperitoneal tuberculous abscess and highlights the importance of early definitive diagnosis in the hope of improving the clinical management of this type of disease.

• Abdominal mass
• Tuberculous peritonitis
• Intraperitoneal tuberculous abscess
• Surgical treatment
• Case report

This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual. The report highlights challenges in diagnosing appendiceal intussusception, emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies. The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is underscored, prompting consideration of malignancy in appendiceal intussusception cases. Additionally, the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends. The awareness of potential misinterpretations and the imperative for further investigation into this rare condition are emphasized.

• Appendiceal intussusception
• Colorectal cancer
• Early-onset colorectal cancer
• Digestive endoscopy
• Abdominal pain
• Bloody stools
• Diarrhea

In this editorial, we discuss the clinical implications of the article “Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography” published by Li et al. Pulmonary lymphatic disorders involve abnormalities in the lymphatic tissues within the thoracic cavity. Specifically, pulmonary lymphatic perfusion syndrome describes a condition where the flow of lymphatic fluid in the lungs is redirected towards abnormally widened lymphatic vessels. Clinically, individuals with this syndrome may experience symptoms such as chyloptysis, plastic bronchitis (PB), chylothorax, chylopericardium, and interstitial lung disease. These disorders can be caused by various factors, including PB, chylothorax, and complex lymphatic malformations. Advancements in lymphatic imaging techniques, such as intranodal lymphangiography, computed tomography lymphangiography, and dynamic contrast-enhanced magnetic resonance lymphangiography, have enabled the detection of abnormal lymphatic flow. This has enhanced our understanding of the pathophysiology of these conditions. Additionally, innovative minimally invasive treatments, such as thoracic duct embolization, selective embolization of lymphatic channels, and surgical procedures aim to improve clinical condition of patients and address their dietary needs.

• Chylothorax
• Dynamic contrast-enhanced magnetic resonance lymphangiography
• Plastic bronchitis
• Pulmonary lymphatic disorder
• Pulmonary lymphatic perfusion syndrome

Prostate cancer (PCa) has high morbidity and mortality rates in elderly men. With a history of thousands of years, traditional Chinese medicine derived from insects could be an important source for developing cancer-targeted drugs to prevent tumorigenesis, enhance therapeutic effects, and reduce the risk of recurrence and metastasis. Multiple studies have shown that Coridius chinensis (Cc) has anticancer effects.

To elucidate the mechanism of action of Cc against PCa via network pharmacology and molecular docking.

Potential targets for Cc and PCa were predicted using ChemDraw 19.0 software, the PharmMapper database and the GeneCards database. Then, the STRING database was used to construct the protein–protein interaction network. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment and molecular docking analyses were subsequently conducted to identify the key targets, active ingredients and pathways involved.

GO and KEGG analyses indicated that the PI3K-Akt signalling pathway was the critical pathway (P value < 1.0 × 10^-8). Multiple targeting ingredients that can affect multiple pathways in PCa have been identified in Cc. Seven active compounds (asponguanosines A, asponguanine B, asponguanine C, aspongpyrazine A, N-acetyldopamine, aspongadenine B and aspongpyrazine B) were selected for molecular docking with 9 potential targets, and the results revealed that aspongpyrazine A and asponguanosine A are the main components by which Cc affects PCa (affinity<-5 kcal/mol, hydrogen bonding), but more studies are needed.

We used network pharmacology to predict the bioactive components and important targets of Cc for the treatment of PCa, supporting the development of Cc as a natural anticancer agent.

• Coridius chinensis
• Molecular docking
• Network pharmacology
• Prostate cancer
• Traditional Chinese medicine

Alzheimer’s disease (AD) is a grave illness that results in cognitive and social issues. A recent study examined the association between neuroimaging results, cognitive dysfunction, atypical cellular immune function, and poor prognostic factors in AD patients who demonstrated poor prognosis. Poor prognosis was associated with abnormal cellular immune function, extrapyramidal symptoms, altered consciousness, abnormal electroencephalogram, modified Rankin scale, increased neutrophil lymphocyte ratio, and severe pneumonia. The impaired cellular immune function characterized by a reduction in the blood T lymphocytes’ proportion predicted poor prognosis as an independent risk factor in AD. Early initiation and maintenance of AD medications is associated with better outcomes.

• Amyloid beta peptide
• Alzheimer's disease
• Dementia
• Cellular immunity
• Prognosis
• T lymphocytes
• Magnetic resonance spectroscopy

Gastrointestinal tract metastasis from lung cancer is rare and compared to small cell lung cancer (SCLC), non-SCLC (NSCLC) is even less likely to metastasize in this manner. Additionally, small intestinal tumors can also present with diverse complications, some of which require urgent intervention.

In this report, we detail a unique case of stage IV lung cancer, where the presence of small intestine tumors led to intussusception. Subsequent to a small intestine resection, pathology confirmed that all three tumors within the small intestine were metastases from adenocarcinoma of the lung. The postoperative follow-up period extended beyond 14 mo.

In patients with stage IV NSCLC, local tumor control can be achieved with various treatments. However, if small intestinal metastasis occurs, surgical intervention remains necessary, as it may improve survival.

• Non-small cell lung cancer
• Brain metastases ablation
• Small bowel metastases
• Small bowel resection
• Case report

In this editorial, we commented on the article by Akers et al published in the recent issue of the World Journal of Clinical Cases. We focused specifically on the role of the transcription factor paired box protein 8 (PAX8) belonging to the family PAX in the carcinogenesis of a gynecologic tumor, endocervical adenocarcinoma, arising from the tissue of mesonephric origin, and the potential diagnostic value for the same type of neoplasms. The global vaccination program of human papillomavirus (HPV) has dramatically reduced the incidence of cervical cancer, including cases of adenocarcinoma. The type of adenoid epithelial origin has a lower frequency of HPV detection but tends to be more aggressive and fatal. Cases of endocervical adenocarcinoma occurring in females of menopause age have been described in the 2023 volume of the World Journal of Clinical Cases and in our study recently published in Oncol Lett. The histopathological findings and immunohistochemical assays showed that the lesions had glandular morphology, and the specimens in these two reports were immunohistochemically positive for the transcription factor PAX8, albeit that they had opposing expression profiles of tumor suppressor p16 and estrogen receptor and the presence of the HPV genome. The presence of a mucin protein, MUC 5AC, as revealed in both studies suggested target molecules for the diagnosis of mucinous adenoid type of uterine tumor and other histological origins. The clinical outcome was unfavorable due to metastasis and recurrence. This prompted the improvement of the antitumor modality, with the introduction of precise targeting therapy. Mucin has now been reported to be the therapeutic target for adenocarcinomas.

• Cervical adenocarcinoma
• Diagnostic biomarker
• Paired box protein 8
• Embryogenesis
• Transcription factor

Extragastrointestinal stromal tumors (EGIST) and gastrointestinal stromal tumors are of similar pathological type and form. Here we report a rare case of EGIST diffusely distributed in membranous tissue in abdominal cavity, the feature of which included diffuse tumors at membranous tissue in entire abdominal cavity and spontaneous bleeding of the tumors.

The patient was a 71-year man and hospitalized due to continuous pain at lower abdomen for more than 10 days. Upon physical examination, the patient had flat and tough abdomen with mild pressing pain at lower abdomen, no obvious abdominal mass was touchable, and shifting dullness was positive. Positron emission tomography-computed tomography (CT) showed that in his peritoneal cavity, there were multiple nodules of various sizes, seroperitoneum, multiple enlarged lymph nodes in abdominal/pelvic cavity and right external ilium as well as pulmonary nodules. Plain CT scanning at epigastrium/hypogastrium/pelvic cavity + enhanced three-dimensional reconstruction revealed multiple soft tissue nodules in abdominal/pelvic cavity, peritoneum and right groin. Tumor marker of carbohydrate antigen 125 was 808 U/mL, diffuse tuberous tumor was seen in abdominal/pelvic cavity during operation with hematocelia, and postoperative pathological examination confirmed EGIST. Imatinib was administered with better therapeutic effect.

Gene testing showed breast cancer susceptibility gene 1 interacting protein C-terminal helicase 1 and KIT genovariation, and the patient was treated with imatinib follow-up visit found that his clinical symptoms disappeared and the tumor load alleviated obviously via imageological examination.

• Diffuse tumor in abdominal cavity
• Extragastrointestinal stromal tumors
• Gastrointestinal stromal tumors
• Malignant extragastrointestinal stromal tumors
• Diffusely membranous metastasis

We report a case of uterine artery pseudoaneurysm (UAP) occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization (UAE).

A 48-year-old primigravid, primiparous patient was incidentally found to have an endometrial polyp during a health checkup, and underwent a hysteroscopic polypectomy at another hospital. Her cervix was dilated with a Laminken-R^® device. After the Laminken-R^® was withdrawn, a large amount of genital bleeding was observed. This bleeding persisted after the hysteroscopic polypectomy, and, as hemostasis became impossible, the patient was transferred to our hospital by ambulance. On arrival, transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus, and color Doppler ultrasonography showed feeder vessels penetrating the mass. Pelvic contrast-enhanced computed tomography (CT) confirmed the presence of a mass at this site, and vascular proliferation was observed within the uterine cavity. Consequently, UAP was diagnosed, and UAE was performed. The patient’s postoperative course was uneventful, and 6 mo post-UAE, no recurrence of blood flow to the UAP was observed.

When abnormal genital bleeding occurs during hysteroscopic surgery, ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.

• Cervical dilation
• Hysteroscopic surgery
• Uterine artery pseudoaneurysm
• Uterine artery embolization
• Case report

Real-time shear wave elastography (SWE) is a non-invasive imaging technique used to measure tissue stiffness by generating and tracking shear waves in real time. This advanced ultrasound-based method provides quantitative information regarding tissue elasticity, offering valuable insights into the mechanical properties of biological tissues. However, the application of real-time SWE in the musculoskeletal system and sports medicine has not been extensively studied.

To explore the practical value of real-time SWE for assessing Achilles tendon hardness in older adults.

A total of 60 participants were enrolled in the present study, and differences in the elastic moduli of the bilateral Achilles tendons were compared among the following categories: (1) Age: 55-60, 60-65, and 65-70-years-old; (2) Sex: Male and female; (3) Laterality: Left and right sides; (4) Tendon state: Relaxed and tense state; and (5) Tendon segment: Proximal, middle, and distal.

There were no significant differences in the elastic moduli of the bilateral Achilles tendons when comparing by age or sex (P > 0.05). There were, however, significant differences when comparing by tendon side, state, or segment (P < 0.05).

Real-time SWE plays a significant role compared to other examination methods in the evaluation of Achilles tendon hardness in older adults.

• Aged Achilles tendon
• Real-time
• Shear wave elastography
• Young’s modulus
• Muscle stiffness

Although there is currently a wealth of evidence to indicate that maternal educational attainment is associated with gestational diabetes mellitus (GDM), the specific modifiable risk factors that mediate the causal relationship between these two variables have yet to be identified.

To identify the specific modifiable risk factors that mediate the causal relationship between the level of maternal education and GDM.

Mendelian randomization (MR) was conducted using data from genome-wide association studies of European populations. We initially performed a two-sample MR analysis using data on genetic variants associated with the duration of education as instruments, and subsequently adopted a two-step MR approach using metabolic and lifestyle factors as mediators to examine the mechanisms underlying the relationship between the level of maternal education and risk of developing GDM. In addition, we calculated the proportions of total causal effects mediated by identified metabolic and lifestyle factors.

A genetically predicted higher educational attainment was found to be associated with a lower risk of developing GDM (OR: 0.71, 95%CI: 0.60-0.84). Among the metabolic factors assessed, four emerged as potential mediators of the education-GDM association, which, ranked by mediated proportions, were as follows: Waist-to-hip-ratio (31.56%, 95%CI: 12.38%-50.70%), body mass index (19.20%, 95%CI: 12.03%-26.42%), high-density lipoprotein cholesterol (12.81%, 95%CI: 8.65%-17.05%), and apolipoprotein A-1 (7.70%, 95%CI: 4.32%-11.05%). These findings proved to be robust to sensitivity analyses.

Our findings indicate a causal relationship between lower levels of maternal education and the risk of developing GDM can be partly explained by adverse metabolic profiles.

• Educational status
• Gestational diabetes mellitus
• Metabolism
• Lifestyle factors
• Mendelian randomization analysis

This editorial aimed to consolidate the current evidence in literature on the association between myasthenia gravis (MG) and cardiac involvement, focusing on the impact of thymoma, antistriational antibodies, and late-onset MG. Additionally, the study aimed to explore the influence of genetic differences among populations on the association with cardiac disease. We conducted a review of existing literature in PubMed and Google Scholar to find relevant studies on cardiac involvement in MG. We created search criteria using a combination of free text words, including MG, antistriational antibodies, thymectomy, cardiomyopathy, myocarditis, arrhythmias, autonomic dysfunction. Relevant articles published in English language were analyzed and incorporated. The findings indicate a strong association between thymoma, myasthenic crisis, antistriational antibodies, and late-onset MG with cardiac involvement. The study also revealed that genetic differences among populations influence the risk of cardiac disease and electrocardiography (ECG) abnormalities in MG patients. Autonomic dysfunctions altered cardiac autonomic response and increased susceptibility to arrhythmias and sudden cardiac death in MG patients. The study supports the significance of thymoma, antistriational antibodies, and late-onset MG as key factors associated with cardiac involvement in MG patients. It emphasizes the importance of ECG as the initial test in managing MG patients, particularly in the perioperative period, to identify and genetic testing if needed to address their cardiac risk effectively.

• Myasthenia gravis
• Antistriational antibodies
• Thymectomy
• Cardiomyopathy
• Myocarditis
• Arrhythmias
• Autonomic dysfunction