Case report: Aortoesophageal fistula-an extremely rare but life-threatening cardiovascular cause of hematemesis.

Aortoesophageal fistula (AEF) is an extremely rare cardiovascular etiology of hematemesis and upper gastrointestinal bleeding. As such, its recognition and diagnosis are challenging and may be delayed when such patients present to the emergency department (ED). Without timely surgical intervention, AEF is almost always fatal. Awareness of AEF as a possible diagnosis and consequently early identification of these patients presenting to the ED are therefore crucial in optimizing clinical outcomes. We report a 45-year-old male presenting to the ED with the classical triad of an AEF (Chiari's triad)-midthoracic pain or dysphagia, a sentinel episode of minor hematemesis, then massive hematemesis with risk of exsanguination. The case report highlights the importance of considering the differential diagnosis of AEF when evaluating patients presenting to the ED with hematemesis, especially if they have predisposing risk factors such as prior aortic or esophageal surgeries, aortic aneurysms, or thoracic malignancies. Patients suspected of having AEF should be prioritized for early computed tomography angiography to expedite diagnosis and treatment.

Thoughts of treatment of tumor diseases based on toxic pathogen theory / 中国中药杂志

The toxic pathogen theory, an important part of the theories of traditional Chinese medicine(TCM), began in the Qin and Han dynasties, formed in the Jin, Sui, Tang, and Song dynasties, developed rapidly in the Ming and Qing dynasties, and conti-nued to develop in contemporary times based on the achievements of its predecessors. The continuous exploration, practice, and inheri-tance of many medical practitioners over the generations have facilitated the enrichment of its connotation. The toxic pathogen is violent, fierce, dangerous, prolonged, rapid in transmission, easy to hurt the internal organs, hidden, and latent, with many changes, and it is closely related to the development of tumor diseases. TCM has a history of thousands of years in the prevention and treatment of tumor diseases. It is gradually realized that the etiology of tumor is mainly attributed to the deficiency of healthy Qi and excess of to-xic pathogen, and the struggle between healthy Qi and toxic pathogen runs through the whole course of tumor, with the deficiency of healthy Qi as the prerequisite and the invasion of toxic pathogen as the root of the occurrence. The toxic pathogen has a strong carcinogenic effect and is involved in the whole process of tumor development, which is closely related to the malignant behaviors of tumors, including proliferation, invasion, and metastasis. This study discussed the historical origin and modern interpretation of the toxic pathogen theory in the prevention and treatment of tumors, with aims of sorting out the theoretical system based on the toxic pathogen theory in the treatment of tumor diseases, and illustrating the importance of the toxic pathogen theory in the treatment of tumors in the context of modern research on pharmacological mechanisms and the development and marketing of relevant anti-tumor Chinese medicinal preparations.

Broadening Our Horizons: Increasing Diversity of Scientific Publications From Taiwan Emergency Physicians, 2012-2017.

BACKGROUND: Scientific publications and academic research are objective indicators that provide dynamic views of the evolution of emergency medicine (EM). This study is aimed to evaluate the academic contribution of Taiwan emergency departments (EDs) by analyzing scientific publications. METHODS: This is an observational study and all publications between 2012 and 2017 were retrieved from the Scopus database. The EM journals were adopted from the 2016 Journal Citation Reports (JCR) category of EM. Three groups of publications were enrolled: (1) publications with first authors affiliated with Taiwan EDs in EM journals; (2) publications with first authors affiliated with Taiwan EDs in non-EM journals; (3) publications with first authors affiliated with Taiwan other than EDs in EM journals. Data regarding the name and category of the publishing journal, the publication year, the publication type, and the number of citations were collected for further analysis. The publication and category numbers were also merged with previous study to obtain a longer trend analysis from 1992. RESULTS: A total of 291 publications affiliated with Taiwan EDs were published in EM journals and 697 publications in 275 non-EM journals. A total of 286 publications in EM journals affiliated with Taiwan but other than ED. The trend of publication numbers in all three groups and category numbers since 1992 were increasing (all p < 0.001). Publication numbers in non-EM journals increased the most and obtained the highest cited times. The 275 non-EM journals were classified into 69 categories. The leading five categories were Medicine, General & Internal, Multidisciplinary Sciences, Surgery, Infectious Diseases, Geriatrics & Gerontology. CONCLUSIONS: The importance of researches originating from Taiwan EDs has been increasingly recognized by both the global EM community and by other medical specialties during the past 25 years. The advancement of academic contribution by Taiwan EDs is evident from the perspectives of quantity and breadth.

Euglycemic diabetic ketoacidosis caused by dapagliflozin: A case report.

RATIONALE: Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Euglycemic diabetic ketoacidosis (eDKA) is however challenging to identify in the emergency department (ED) due to absence of marked hyperglycemia, often leading to delayed diagnosis and treatment. eDKA has been recently found to be associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, one of the newest classes of antidiabetics, though there are very limited reports implicating dapagliflozin as the offending agent in ED patients. Here we report a type 2 diabetic patient who presented to the ED with eDKA secondary to dapagliflozin administration. PATIENT CONCERNS: A 61-year-old Asian female with underlying type 2 DM presented to our ED with body weakness, dyspnea, nausea, vomiting, and mild abdominal pain for the past 2 days. These symptoms were preceded by poor oral intake for 1 week due to severe toothache. Dapagliflozin was recently added to her antidiabetic drug regimen of metformin and glibenclamide 2 weeks ago. DIAGNOSES: Arterial blood gases showed a picture of severe metabolic acidosis with an elevated anion gap, while ketones were elevated in blood and positive in urine. Blood glucose was mildly elevated at 180 mg/dL. Serum lactate levels were normal. Our patient was thus diagnosed with eDKA. INTERVENTION: Our patient was promptly admitted to the intensive care unit and treated for eDKA through intravenous rehydration therapy with insulin infusion. OUTCOMES: Serial blood gas analyses showed gradual resolution of the patient's ketoacidosis with normalized anion gap and clearance of serum ketones. She was discharged uneventfully on day 4, with permanent cessation of dapagliflozin administration. LESSONS: Life-threatening eDKA as a complication of dapagliflozin is a challenging and easilymissed diagnosis in the ED. Such an ED presentation is very rare, nevertheless emergency physicians are reminded to consider the diagnosis of eDKA in a patient whose drug regimen includes any SGLT2 inhibitor, especially if the patient presents with nausea, vomiting, abdominal pain, dyspnea, lethargy, and is clinically dehydrated. These patients should then be investigated with ketone studies and blood gas analyses regardless of blood glucose levels for prompt diagnosis and treatment.

Exploration of prognostic factors of castration-resistant prostate cancer patients / 中草药

Objective To investigate the prognostic factors of castrated resistant prostate cancer (CRPC). Methods From December 1, 2015 to November 30, 2017, CRPC patients who met the inclusion criteria were collected from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tumor Hospital of Tianjin Medical University, and General Hospital of Tianjin Medical University. The reliability and validity of 18 included factors were analyzed. The Kaplan-Meier method was used to screen the prognostic factors of CRPC and draw the survival curve.The significant fators from single factor analysis were included in COX proportional risk model for multiple-factor analysis to determine the independent prognostic factors. Results Hematuria, osteodynia, HGB 5.18 mmol/L, TPSA > 10 ng/mL, f/tPSA > 0.19, deficiency of both qi and blood, and no treatment of combination of traditional Chinese medicine were the risk factors for overall survival (OS) in CRPC patients; CHO > 5.18 mmol/L was the only risk factor for OS in CRPC patients, which was established as risk factors. CHO > 5.18 mmol/L, HGB 5.18 mmol/L is an independent risk factor for OS in CRPC patients.

Laboratory techniques for the diagnosis of prostate cancer: An update / 中华男科学杂志

The prevalence of prostate cancer is increasing, which is one of the leading causes of malignancy-associated deaths of males. Because the early symptoms of prostate cancer are not obvious, 20% of the patients have metastasis at the time of initial diagnosis. The low rate of early diagnosis of prostate cancer has contributed to a higher mortality rate in China than in Europe and the United States. Highly specific and sensitive diagnostic markers exist in the blood, urine and semen of prostate cancer patients. Combined laboratory techniques can improve the rate of the early diagnosis of prostate cancer, help early treatment, and prolong the survival of the patients.

ICA of full complex-valued fMRI data using phase information of spatial maps.

BACKGROUND: ICA of complex-valued fMRI data is challenging because of the ambiguous and noisy nature of the phase. A typical solution is to remove noisy regions from fMRI data prior to ICA. However, it may be more optimal to carry out ICA of full complex-valued fMRI data, since any filtering or voxel-based processing may disrupt information that can be useful to ICA. NEW METHOD: We enable ICA of the full complex-valued fMRI data by utilizing phase information of estimated spatial maps (SMs). The SM phases are first adjusted to properly represent spatial phase changes of all voxels based on estimated time courses (TCs), and then these are used to segment the voxels into BOLD-related and unwanted voxels based on a criterion of TC real-part power maximization. Single-subject and group phase masks are finally constructed to remove the unwanted voxels from the individual and group SM estimates. RESULTS: Our method efficiently estimated not only the task-related component but also the non-task-related component DMN. COMPARISON WITH EXISTING METHOD(S): Our method extracted 139-331% more contiguous and reasonable activations than magnitude-only infomax for the task-related component and DMN at |Z|>2.5, and detected more BOLD-related voxels, but eliminated more unwanted voxels than ICA of complex-valued fMRI data with pre-ICA de-noising. Our TC-based phase de-ambiguity exhibited higher accuracy and robustness than the SM-based method. CONCLUSIONS: The TC-based phase de-ambiguity is essential to prepare the SM phases. The SM phases provide a new post-ICA index for reliably identifying and suppressing the unwanted voxels.

The safety and long-term survival after laparoscopic surgery versus open surgery for colon cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the short-term outcomes and 5-year recurrence, overall survival, and disease-free survival of laparoscopic assisted surgery for colon cancer.</p><p><b>METHODS</b>The clinical and pathologic data were compared between the patients who underwent colectomy during March 2003 to July 2008 and assigned in laparoscopic group (n = 92) and open group (n = 285) according the surgical approach. The 5-year overall survival, disease-free survival, and recurrence rate were analyzed for all patients who were followed-up for more than 36 months in either of the groups.</p><p><b>RESULTS</b>The laparoscopic colectomy was associated with manifested less blood loss (50(50) ml) (Z = -8.292, P < 0.01), early return of bowel function (the evacuation time was (3.0 ± 1.0) days, and the meal time after operation was (4.0 ± 1.3) days) (t = -6.475 and -4.871, P < 0.01), and longer length (cm) of distal resection margin ((10 ± 4) cm vs. (9 ± 4) cm, t = 3.527, P = 0.000). The 5-year overall survival of the laparoscopic group and the open group were 63.6% and 61.8% respectively. The 5-year disease-free survival of the I-III stage patients in the laparoscopic group and the open group were 69.5% and 65.5% respectively, and the local recurrence were 8.7% and 13.6% (all P > 0.05).</p><p><b>CONCLUSION</b>The laparoscopic colectomy for colon cancer is safe in short-term clinical results and non-inferior to the open colectomy in long-term oncological outcomes.</p>

Quality control of laparoscopic surgery for gastric cancer / 中华胃肠外科杂志

As the improvement of technique and accumulation of experience in the past decade, the development of laparoscopic surgery has been in the advanced phase for the minimally invasive surgery for the management of gastric cancer. Even laparoscopic surgery has severaladvantages such as faster recovery courses and improved quality of life, however, surgical quality control for oncology must always be the most important consideration. The quality control system consists of accurate clinical staging, patient selection, intraoperative standard operating procedure, proper education and training course, data management for clinicopathologic information, and evidence-based studies.

Risk factors associated with postoperative complications of D2 radical resection for local advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the risk factors of postoperative complications following D2 radical resection for advanced gastric cancer.</p><p><b>METHODS</b>From June 2004 to May 2011, 483 patients with local advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection were enrolled in the study, including 132 patients of LAG (27.3%) and 351 patients of open procedure (72.7%). Clinicopathological data and postoperative complications were reviewed retrospectively. Postoperative complications were classified into overall and severe complications according to Clavien-Dindo Classification. Multivariate logistic model was used to identify risk factors of postoperative complications.</p><p><b>RESULTS</b>The overall incidence of postoperative overall and severe complications and mortality were 12.4% (60/483), 2.5% (12/483) and 0.2% (1/483), respectively. Univariate analysis showed that no significant differences were found in overall and severe complications between the two surgical approaches (13.6% vs. 12.0%, P=0.620; 3.0% vs. 2.3%, P=0.743). Furthermore, multivariate analysis showed that age ≥60 years, preoperative comorbidity and intraoperative blood loss >300 ml were independent risk factors associated with overall postoperative complications. Remarkably, intraoperative blood loss >300 ml was also an independent risk factor for severe postoperative complications.</p><p><b>CONCLUSIONS</b>LAG with D2 lymph node dissection for local advanced gastric cancer is technically feasible and safe. However, the elderly, preoperative comorbidity and increased intraoperative blood loss are associated with elevated risk of complications. Decreased intraoperative bleeding may reduce the potential postoperative complications.</p>