Baotou Central Hospital

This paper reports a case of an 82-year-old male with a giant peritoneal loose body (GPLB) complicated by pancreatic head cancer. The patient was admitted for upper abdominal pain and jaundice. CT revealed a 5.5 × 5.6 cm oval low-density mass on the right side of the pelvis with a central high-density calcified focus, initially diagnosed as a gastrointestinal stromal tumor. During surgery, a yellow free mass measuring 6 × 6 × 5 cm was found in the pelvic cavity; pathology confirmed that it was a peritoneal loose body. Grossly, it was yellow and ovoid, with central calcification on the cut surface; microscopically, necrotic adipose tissue and hyalinized collagen fibers were visible. Meanwhile, we comprehensively reviewed and analyzed 32 previously reported cases of GPLB, summarizing the disease characteristics, clinical manifestations, formation mechanisms, diagnostic approaches, and treatment strategies. We propose a hypothesis-generating observation that abnormal liver and kidney function may accelerate the growth rate of giant peritoneal loose bodies. We also recommend that surgical removal be performed regardless of whether symptoms are present, with laparoscopy as the preferred procedure. This study aims to improve clinicians’ understanding of this disease and reduce misdiagnosis.

Patients with moderate-to-severe allergic rhinitis (AR) often experience a heavy clinical burden and require more medications to alleviate nasal symptoms. The aim of this study was to evaluate the efficacy and safety of GSP301, a fixed-dose combination nasal spray containing olopatadine hydrochloride and mometasone furoate, in patients with seasonal AR (SAR). In this multicenter, randomized, double-blind, parallel-group study, moderate-to-severe SAR patients were assigned at a 1:1:1 ratio to receive intranasal GSP301, olopatadine hydrochloride (OLO), or mometasone furoate (MF) for 14 days. The primary endpoint was the change from baseline in the average A.M. and P.M. 12-hour reflective total nasal symptom score (rTNSS). Secondary endpoints included changes in the instantaneous TNSS (iTNSS), individual nasal symptoms, reflective total ocular symptom score (rTOSS), instantaneous total ocular symptom score (iTOSS), individual ocular symptoms, and rhinoconjunctivitis quality-of-life questionnaire (RQLQ). Exploratory endpoints and adverse events were also analyzed. Among the 534 subjects, the GSP301 group demonstrated statistically significant improvements in the average rTNSS compared with the OLO group [posterior least square mean difference (LSMD) = -0.56; P < 0.0001] and the MF group (posterior LSMD = -0.43; P < 0.0001). Consistent benefits were observed across secondary endpoints, including iTNSS, rTOSS, RQLQ, and individual nasal and ocular symptoms (all P < 0.05). Additionally, GSP301 reduced the levels of interleukin (IL)-5 and eosinophilic cationic protein (ECP) in nasal secretions. Treatment-emergent adverse events (TEAEs) occurred in 11.2%, 13.5%, and 11.3% of patients in the GSP301, OLO, and MF groups, respectively. Compared with OLO and MF, GSP301 demonstrated superior efficacy, safety, and potential advantages in alleviating local inflammation in patients with moderate-to-severe SAR.

The HSK16149-201/301 trial demonstrated short-term efficacy of the GABA analog crisugabalin for diabetic neuropathic pain. In the current study, patients in both the crisugabalin and placebo control groups of the HSK16149-201/301 trial were invited to receive 80 mg/day crisugabalin for an additional 52 weeks. The primary end point was safety. The secondary end point was pain control as measured using the Short-Form McGill Pain Questionnaire (SF-MPQ). A total of 301 patients (mean age 59.7 years and males 58.1%) were enrolled. The rate of treatment-related adverse events (TRAEs) was 38.9% (117/301). The most frequent TRAEs were dizziness (27.2%), somnolence (8.3%), and peripheral edema (3.0%). The rate of Grade 3 or higher TRAEs was 1.7%. TRAEs led to dose reduction in 41 patients (13.6%), treatment interruption and discontinuation each in three patients (1.0%). At week 52, the mean difference in SF-MPQ pain rating index (PRI) and visual analog scale pain score from baseline was -2.5 (95% CI -2.9 to -2.0; paired t-test p < 0.0001) and -23.4 (95% CI -25.6 to -21.2; paired t-test p < 0.0001), respectively. The proportion of patients with SF-MPQ PPI score ≤ 1 increased by 19.0% over baseline (p < 0.0001). In summary, crisugabalin at 80 mg/day was well tolerated and demonstrated sustained analgesic activities. ClinicalTrials.gov identifier: NCT05890053.

Rationale:Systemic vasculitis is one of the most challenging, complex and difficult diseases in the field of rheumatic diseases and even in the field of internal medicine, which can involve multiple systems of the whole body. Owing to their rich vascular beds, the lungs and kidneys are among the most commonly affected organs in systemic vasculitis. Lung involvement can manifest as interstitial lung disease, diffuse alveolar hemorrhage, pulmonary nodules, pulmonary arterial hypertension, pulmonary aneurysms, pulmonary arteriovenous thrombosis, etc, which are easily confused with infections, tumors, and other diseases. Renal involvement in systemic vasculitis presents with a diverse spectrum of clinical manifestations. Given its high prevalence, complex clinical presentation, significant diagnostic challenges, and generally poor prognosis, achieving a thorough understanding of its various phenotypes, establishing an early diagnosis, and initiating prompt and aggressive treatment are crucial for substantially improving patient outcomes.Patient concerns:A 68-year-old man presented with a cough. His condition deteriorated despite antibiotic treatment for suspected pneumonia, followed by the development of worsening renal function evidenced by progressively elevated serum creatinine and proteinuria. Subsequent serological testing was positive for antineutrophil cytoplasmic antibody antibodies.Diagnoses:Laboratory tests and pulmonary computed tomography scan.Interventions:The patient was started on a regimen of oral cyclophosphamide and high-dose glucocorticoids.Outcomes:The patient’s renal function has deteriorated and requires maintenance hemodialysis.Lessons:This case emphasizes the necessity of maintaining vigilance when distinguishing ANCA-associated vasculitis lung damage from lung infection in patients.

Introduction: Cardiometabolic risk factors remain the leading cause of cardiovascular disease (CVD) and death in the US. US women veterans (WV) are a growing, high-risk population with higher rates of chronic conditions and increasing engagement with veteran affair (VA) healthcare yet remain understudied. Objectives: This study aimed to investigate the potential ethnic/racial and age group differences in the life-long prevalence of traditional cardiometabolic risk factors among US WV from 2000-2019. Methods: The national VA electronic health records (her) were used to assess the prevalence of diabetes, hypertension, hyperlipidemia, smoking, and neuroendocrine disorders among US WV who visited a VA facility from 1/1/2000 to 12/31/2019. Diagnoses were based on international classification of disease (ICD)-9 and -10 codes. Participants were stratified by races/ethnicities (non-Hispanic White, Black, Asian, American Indian/Pacific Islander, and Hispanic/Latino) and age group (18-39, 40-59, 60+). Age-standardized lifelong prevalence of CVD risk factors was assessed overall, by races/ethnicities, and by age groups. Age-standardized lifelong prevalence represents the sum of raw age-specific risk factor rates multiplying the standard age-specific proportion in the 2000 U.S. census reference population Results: The WV cohort expanded from 80,707 in 2000 to 739,309 in 2019. Significant racial/ethnic disparities emerged. Blacks demonstrated the highest prevalence of diabetes (from 13.5% to 19.2%) and hypertension (38.2% to 43.9%). Notably, American Islanders showed the most rapid escalation in diabetes (1.9-fold increase). Whites maintained the highest prevalence of smoking, hyperlipidemia, and neuroendocrine disorders. Asians experienced a 9.6-fold surge in smoking (3.8% to 36.5%), while Black saw a 3.1-fold rise in hyperlipidemia (11.5% to 35.8%) and a 3.1-fold rise in neuroendocrine disorders. The remaining subgroups exhibited absolute prevalence increases of approximately 40% for smoking and 20% for hyperlipidemia. Marked age-related patterns also emerged. The 60+ age group had the highest prevalence of risk factors from 2000-2019, except smoking. This group also exhibited the greatest fold increases in every category except hypertension. Conclusion: The cardiometabolic risk burden among U.S. women veterans has reached critical levels, with pronounced racial/ethnic and age group disparities, necessitating immediate targeted public health interventions.