Medicine
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Ovarian tumor torsion is a critical gynecological emergency, predominantly affecting women of reproductive age, with benign teratomas being the most common culprits. In contrast, malignant ovarian tumors, such as mucinous cystadenocarcinoma, infrequently present with torsion due to their invasive and angiogenic characteristics. The occurrence of torsion in malignant tumors complicates diagnosis and management, particularly when associated with complications like congestion, infarction, and internal bleeding. This report details a rare case of primary ovarian mucinous cystadenocarcinoma presenting with acute torsion and significant internal bleeding. Our study highlights the diagnostic challenges and the urgent need for clear treatment guidelines, addressing an important gap in the existing literature regarding the management of torsion malignant ovarian tumors. By documenting this case, we aim to contribute to the understanding of this rare condition and provide insights that may help clinicians in similar scenarios. ⋯ Currently, there are no effective preoperative diagnostic and treatment guidelines for ruptured malignant ovarian tumors with torsion. The possibility of malignancy should be considered, and frozen section biopsy should be considered during surgery. Full detorsion before tumor resection to avoid incomplete pedicle coagulation and bleeding. Specimen removal by in-bag morcellation in minimally invasive surgery to prevent complications related to residual fragments of the specimen or dissemination of an occult malignancy.
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While recent studies suggested a potential causal link between type 1 diabetes mellitus (T1DM) but not type 2 diabetes mellitus (T2DM) and idiopathic pulmonary fibrosis (IPF), the involved mechanism remains unclear. Here, using a Mendelian randomization (MR) approach, we verified the causal relationship between the two types of diabetes mellitus and IPF and investigated the possible role of inflammation in the association between diabetes mellitus and IPF. Based on genome-wide association study (GWAS) summary data of T1DM, T2DM, and IPF, the univariable MR, multivariable MR (MVMR), and mediation MR were successively used to analyze the causal relationship. ⋯ In conclusion, T1DM is related to an increased risk of IPF. Notably, the causal effect was partially mediated by CXCL10 and IL-12B. Hence, monitoring T1DM patients may help in the early detection and prevention of IPF.
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Parkinson's disease is a progressive neurodegenerative disease and the care burden in informal caregivers is huge. Summarizing factors associated with the informal caregivers burden can improve our understanding of providing proactive support to informal caregivers caring for patients with Parkinson's disease (PwP) at risk, and provides evidence for clinical practice. ⋯ Targeted interventions addressing those modifiable factors should be developed and investigated to lighten the care burden of informal caregivers for PwP.
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In patients with advanced hepatocellular carcinoma (HCC) following sorafenib failure, regorafenib has been used as an initial second-line drug. It is unclear the real efficacy and safety of sorafenib-regorafenib sequential therapy compared to placebo or other treatment (cabozantinib or nivolumab or placebo) in advanced HCC. ⋯ Compared with other treatment (cabozantinib or nivolumab or placebo), regorafenib seemed to be more effective for patients with HCC who have not responded to initial sorafenib treatment.
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Comparative Study Observational Study
Effects of abdominal, vaginal, and laparoscopic hysterectomies on total oxidant/antioxidant levels: A prospective observational study.
This prospective observational study aimed to compare abdominal hysterectomy (AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) in terms of oxidative stress (OS) by measuring serum levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Of the 3 groups, namely, AH, VH, and TLH, 22 patients were enrolled in each to investigate the aim of the study mentioned above. Patient demographics, clinical and surgical characteristics, and preoperative and postoperative (0th and 24th hours) serum TAS, TOS, and OSI levels were investigated. ⋯ Serum TOS and OSI levels increased dramatically over time in the AH and TLH groups (P < .05), but not in the VH group (P > .05). post hoc analysis showed that the changes in serum TOS and OSI values in the AH and TLH groups were between the preoperative and postoperative 0th hour levels (P < .001). Our results indicated that the total antioxidant capacity was preserved in all 3 techniques. However, VH causes less OS than the other hysterectomy techniques.