bluuebunny/crossref_metadata_2025 huggingface dataset:
The key security management scheme of cloud storage based on blockchain and digital twins
Authors: Huang Jie , Yi Jiangyi
Published: January 2024

As a secure distributed ledger technology, blockchain has attracted widespread attention from academia and industry for its decentralization, immutability, and traceability characteristics. This paper proposes a cloud storage key security management scheme based on blockchain. To resist brute-force attacks launched by adversaries on ciphertexts, the scheme uses an oblivious pseudo-random function (OPRF) to generate randomized convergent keys and improve data confidentiality. Second, the scheme enhances the reliability of concurrent key management through a secret sharing mechanism, where convergent keys are split into key fragments and distributed on blockchain for storage. Even if a certain number of key fragments are lost or damaged, users can still recover complete key information through block transaction records. In addition, the scheme effectively supports file-level and block-level data security deduplication. Security analysis and experimental performance evaluation indicate that this scheme can ensure the security of keys and the confidentiality of data, and it has a low computational overhead for generating file-level encryption keys under this scheme. Even for a 100 MB file, the computational overhead required for generating encryption keys is less than 2 s, which improves computational efficiency.
No significant differences in 60‐day postoperative complication rates between conventional and shortened stems
Authors: Girardot Guillaume , Guy Sylvain ,   ReSurg, Bonin Nicolas
Published: January 2024

Purpose

To compare 60‐day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study.

Methods

The authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery.

Results

Compared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60‐day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109).

Conclusions

There were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS.

Level of Evidence

Level IV, Retrospective comparative cohort study
The role of arthroscopy in the management of adult elbow trauma
Authors: Valencia Maria , Foruria AM.
Published: January 2024

Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26–7.5%.

The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published.

The main indications for fracture arthroscopic‐assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non‐comminute fractures that can be fixed percutaneously.

In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.
Using a literary and arts magazine to promote mental health and wellness among trainee healthcare professionals: lessons from a Canadian student-led project
Authors: Zhou Carl , Pasumarthi Keerthana , Liang Isabella , Xie Jim , Olagunju Andrew Toyin
Published: January 2024

Breathe is a student-led literary and arts magazine whose goal is to provide a platform for creative expression about mental health issues and promote mental wellness among trainee healthcare professionals using student-submitted art and written pieces. Select pieces were published to improve readers’ understanding of and self-reflection on mental health. Common themes among the submissions include life outside of healthcare, imposter syndrome and coping with stress. This novel project had high satisfaction reported by 87.5% of surveyed readers. We advocate for improved mental health awareness and increased use of artistic expression as a coping strategy against stressors in healthcare education worldwide.
De-Escalation of Therapy for Prostate Cancer
Authors: Esen Tarik , Esen Baris , Yamaoh Kosj , Selek Ugur , Tilki Derya
Published: January 2024

Prostate cancer (PCa) is the second most commonly diagnosed cancer in men with around 1.4 million new cases every year. In patients with localized disease, management options include active surveillance (AS), radical prostatectomy (RP; with or without pelvic lymph node dissection), or radiotherapy to the prostate (with or without pelvic irradiation) with or without hormonotherapy. In advanced disease, treatment options include systemic treatment(s) and/or treatment to primary tumour and/or metastasis-directed therapies (MDTs). Specifically, in advanced stage, the current trend is earlier intensification of treatment such as dual or triple combination systemic treatments or adding treatment to primary and MDT to systemic treatment. However, earlier treatment intensification comes with the cost of increased morbidity and mortality resulting from drug-/treatment-related side effects. The main goal is and should be to provide the best possible care and oncologic outcomes with minimum possible side effects. This chapter will explore emerging possibilities to de-escalate treatment in PCa driven by enhanced insights into disease biology and the natural course of PCa such as AS in intermediate-risk disease or salvage versus adjuvant radiotherapy in post-RP patients. Considerations arising from advancements in PCa imaging and technological advancements in surgical and radiation therapy techniques including omitting pelvic lymph node dissection in the era of prostate-specific membrane antigen positron emitting tomography, the potential of MDT to delay/omit systemic treatment in metachronous oligorecurrence, and the efficacy of hypofractionation schemes compared with conventional fractionated radiotherapy will be discussed.
Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource–Stratified Guideline Q and A
Authors: Al Sukhun Sana , Koczwara Bogda , Temin Sarah , Arun Banu K.
Published: January 2024

The Systemic Treatment of Patients with Metastatic Breast Cancer: @ASCO Resource-Stratified Guideline Q and A presents takeways, rationale, and key recommendations based on #JCOGO full guideline for patients by menopausal and marker status.
vs.
as a probe of a scalar mediator dark-matter scenario
Authors: Berezhnoy Alexander , Melikhov Dmitri
Published: January 2024

Recently, Belle II reported the observation of the decay

, where M

X
is the missing mass, with the branching ratio much exceeding

which is the only Standard Model (SM) process contributing to this reaction. If confirmed, this might be an indication of new non-SM particles produced in this decay. One of the possible explanations of the observed effect could be light dark-matter (DM) particles produced via a scalar mediator field. We give simple arguments, that a combined analysis of the

and

reactions would be a clean probe of the scalar mediator scenario: i) making use of an observed value

and ii) assuming that the effect is due to the light dark-matter coupling to the top quark via a scalar mediator field, one finds an upper limit

. Within the discussed scenario, this upper limit does not depend on the mass of the scalar mediator nor on the specific details of the unobserved dark-matter particles in the final state.
Quantitative MRI Biomarkers Measure Changes in Targeted Brain Areas in Patients With Obesity
Authors: Baynat Louise , Yamamoto Takayuki , Tourdias Thomas , Zhang Bei , Prevost Valentin , Infante Asael , Klein Achille , Caid Julien , Cadart Olivier , Dousset Vincent , Gatta Cherifi Blandine
Published: January 2024

Context

Obesity is accompanied by damages to several tissues, including the brain. Pathological data and animal models have demonstrated an increased inflammatory reaction in hypothalamus and hippocampus.

Objective

We tested whether we could observe such pathological modifications in vivo through quantitative magnetic resonance imaging (MRI) metrics.

Methods

This prospective study was conducted between May 2019 and November 2022. The study was conducted in the Specialized Center for the Care of Obesity in a French University Hospital. Twenty-seven patients with obesity and 23 age and gender-paired normal-weight controls were prospectively recruited. All participants were examined using brain MRI. Anthropometric and biological data, eating behavior, anxiety, depression, and memory performance were assessed in both groups. The main outcome measure was brain MRI with the following parametric maps: quantitative susceptibility mapping (QSM), mean diffusivity (MD), fractional anisotropy (FA), magnetization transfer ratio map, and T2 relaxivity map.

Results

In the hypothalamus, patients with obesity had higher FA and lower QSM than normal-weight controls. In the hippocampus, patients with obesity had higher FA and lower MD. There was no correlation between imaging biomarkers and eating behavior or anxiety.

Conclusion

Our findings are consistent with the presence of neuroinflammation in brain regions involved in food intake. In vivo brain biomarkers from quantitative MRI appear to provide an incremental information for the assessment of brain damages in patients with obesity.
Depressive Syndromes in Men With Hypogonadism in the TRAVERSE Trial: Response to Testosterone-Replacement Therapy
Authors: Bhasin Shalender , Seidman Stuart , Travison Thomas G , Pencina Karol M , Lincoff A Michael , Nissen Steven E , Miller Michael G , Flevaris Panagiotis , Li Xue , Wannemuehler Kathleen A , Pope Harrison G
Published: January 2024

Context

The effect of testosterone on depressive symptoms in men with hypogonadism remains incompletely understood.

Objective

We assessed the effects of testosterone-replacement therapy (TRT) in improving depressive symptoms in hypogonadal men with and without depressive symptoms enrolled in the TRAVERSE cardiovascular safety trial.

Methods

A randomized, placebo-controlled, double-blind study was conducted at 316 trial sites. Participants included men, aged 45 to 80 years, with 2 fasting testosterone levels less than 300 ng/dL, 1 or more hypogonadal symptoms, cardiovascular disease (CVD), or increased risk of CVD. We evaluated 3 subgroups of participants: (1) men with rigorously defined, late-life-onset, low-grade persistent depressive disorder (LG-PDD, previously “dysthymia”); (2) all men with significant depressive symptoms (Patient Health Questionnaire-9 Score >4); and (3) all randomly assigned men. Intervention included 1.62% transdermal testosterone or placebo gel. Outcome measures included the proportions of participants (1) meeting criteria for LG-PDD or (2) with significant depressive symptoms; and changes in depressive symptoms, energy, sleep quality, and cognition in testosterone-treated vs placebo-treated men in the 3 subgroups.

Results

Of 5204 randomly assigned participants, 2643 (50.8%) had significant depressive symptoms, but only 49 (1.5%) met rigorous criteria for LG-PDD. Among those with LG-PDD, there was no significant difference in any outcome measure between the TRT and placebo groups, possibly reflecting low statistical power. In men with significant depressive symptoms (n = 2643) and in all randomly assigned participants (n = 5204), TRT was associated with modest but significantly greater improvements in mood and energy but not cognition or sleep quality.

Conclusion

Depressive symptoms are common in middle-aged and older men with hypogonadism but LG-PDD is uncommon. TRT is associated with small improvements in mood and energy in hypogonadal men with and without significant depressive symptoms.
Discordant Effects of Polyamine Depletion by DENSpm and DFMO on β-cell Cytokine Stress and Diabetes Outcomes in Mice
Authors: Hammoud Batoul , Nelson Jennifer B , May Sarah C , Tersey Sarah A , Mirmira Raghavendra G
Published: January 2024

Type 1 diabetes (T1D) is an autoimmune disease leading to dysfunction and loss of insulin-secreting β cells. In β cells, polyamines have been implicated in causing cellular stress and dysfunction. An inhibitor of polyamine biosynthesis, difluoromethylornithine (DFMO), has been shown to delay T1D in mouse models and preserve β-cell function in humans with recent-onset T1D. Another small molecule, N1,N11-diethylnorspermine (DENSpm), both inhibits polyamine biosynthesis and accelerates polyamine metabolism and is being tested for efficacy in cancer clinical trials. In this study, we show that DENSpm depletes intracellular polyamines as effectively as DFMO in mouse β cells. RNA-sequencing analysis, however, suggests that the cellular responses to DENSpm and DFMO differ, with both showing effects on cellular proliferation but the latter showing additional effects on mRNA translation and protein-folding pathways. In the low-dose streptozotocin-induced mouse model of T1D, DENSpm, unlike DFMO, did not prevent or delay diabetes outcomes but did result in improvements in glucose tolerance and reductions in islet oxidative stress. In nonobese diabetic (NOD) mice, short-term DENSpm administration resulted in a slight reduction in insulitis and proinflammatory Th1 cells in the pancreatic lymph nodes. Longer term treatment resulted in a dose-dependent increase in mortality. Notwithstanding the efficacy of both DFMO and DENSpm in reducing potentially toxic polyamine levels in β cells, our results highlight the discordant T1D outcomes that result from differing mechanisms of polyamine depletion and, more importantly, that toxic effects of DENSpm may limit its utility in T1D treatment.
Elderly Patients Show Substantial Improvement in Health-Related Quality of Life After Surgery for Degenerative Cervical Myelopathy Despite Medical Frailty: An Ambispective Analysis of a Multicenter, International Data Set
Authors: Pedro Karlo M. , Alvi Mohammed Ali , Hejrati Nader , Moghaddamjou Ali , Fehlings Michael G.
Published: January 2024

BACKGROUND AND OBJECTIVES:

We assessed the relationship between Modified Frailty Index-5 (mFI-5) and neurological outcomes, as well as health-related quality of life (HRQoL) measures, in elderly patients with degenerative cervical myelopathy (DCM) after surgery.

METHODS:

Data from 3 major DCM trials (the Arbeitsgemeinschaft für Osteosynthesefragen Spine Cervical Spondylotic Myelopathy-North America, Cervical Spondylotic Myelopathy—International, and CSM-PROTECT studies) were combined, involving 1047 subjects with moderate to severe myelopathy. Patients older than 60 years with 6-month and 1-year postoperative data were analyzed. Neurological outcome was assessed using the modified Japanese Orthopaedic Association score, while HRQoL was measured using the 36-Item Short Form Health Survey (SF-36) (both Physical Component Summary [SF-36 PCS] and Mental Component Summary [SF-36 MCS] scores) and the Neck Disability Index. Frail (mFI ≥2) and nonfrail (mFI = 0-1) cohorts were compared using univariate paired statistics.

RESULTS:

The final analysis included 261 patients (62.5% male), with a mean age of 71 years (95% CI 70.7-72). Frail patients (mFI ≥2) had lower baseline modified Japanese Orthopaedic Association scores (10.45 vs 11.96, P < .001), SF-36 PCS scores (32.01 vs 36.51, P < .001), and SF-36 MCS scores (39.32 vs 45.24, P < .001). At 6-month follow-up, SF-36 MCS improved by a mean (SD) of 7.19 (12.89) points in frail vs 2.91 (11.11) points in the nonfrail group (P = .016). At 1 year after surgery, frail patients showed greater improvement in both SF-36 PCS and SF-36 MCS composite scores compared with nonfrail patients (7.81 vs 4.49, P = .038, and 7.93 vs 3.01, P = .007, respectively). Bivariate regression analysis revealed that higher mFI-5 scores correlated with more substantial improvement in overall mental status at 6 months and 1 year (P = .024 and P = .009, respectively).

CONCLUSION:

mFI-5 is a clinically helpful signature to reflect the HRQoL status among elderly patients with DCM. Despite preoperative medical frailty, elderly patients with DCM experience significant HRQoL improvement after surgery. These findings enable clinicians to identify elderly patients with modifiable comorbidities and provide informed counseling on anticipated outcomes.

LEVEL OF EVIDENCE:

II.
Performance of Neurosurgeons Providing Safety-Net Care Under Medicare's Merit-Based Incentive Payment System
Authors: Ng Grace Y. , DiGiorgio Anthony M.
Published: January 2024

BACKGROUND AND OBJECTIVES:

Under the Merit-Based Incentive Payment System (MIPS), Medicare evaluates provider performance to determine payment adjustments. Studies examining the first year of MIPS (2017) showed that safety-net providers had lower MIPS scores, but the performance of safety-net physicians over time has not been studied. This study aimed to examine the performance of safety-net vs non–safety-net neurosurgeons in MIPS from 2017 to 2020.

METHODS:

Safety-net neurosurgeons were defined as being in the top quartile according to proportion of dual-eligible beneficiaries and non–safety-net in the bottom quartile. Outcomes were total MIPS scores and dual-eligible proportion over time. In this descriptive study, we evaluated ordinary least squares regression models with SEs clustered at the physician level. Covariates of interest included safety-net status, year, and average Hierarchical Condition Category risk score of beneficiaries.

RESULTS:

There were 2796–3322 physicians included each year between 2017 and 2020. Mean total MIPS scores were not significantly different for safety-net than non–safety-net physicians in 2017 but were greater for safety-net in 2018 (90.7 vs 84.5, P < .01), 2019 (86.4 vs 81.5, P < .01), and 2020 (90.9 vs 86.7, P < .01). Safety-net status (coefficient −9.11; 95% CI [−13.15, −5.07]; P < .01) and participation in MIPS as an individual (−9.89; [−12.66, −7.13]; P < .01) were associated with lower scores while year, the interaction between safety-net status and year, and participation in MIPS as a physician group or alternative payment model were associated with higher scores. Average Hierarchical Condition Category risk score of beneficiaries (−.011; [−.015, −.006]; P < .01) was associated with decreasing dual-eligible case mix, whereas average age of beneficiaries (.002; [.002, .003]; P < .01) was associated with increasing dual-eligible case mix.

CONCLUSION:

Being a safety-net physician was associated with lower MIPS scores, but safety-net neurosurgeons demonstrated greater improvement in MIPS scores than non–safety-net neurosurgeons over time. Providers with higher-risk patients were more likely to decrease their dual-eligible case mix over time.
Cristae shaping and dynamics in mitochondrial function
Authors: Caron Claire , Bertolin Giulia
Published: January 2024

Mitochondria are multifunctional organelles of key importance for cell homeostasis. The outer mitochondrial membrane (OMM) envelops the organelle, and the inner mitochondrial membrane (IMM) is folded into invaginations called cristae. As cristae composition and functions depend on the cell type and stress conditions, they recently started to be considered as a dynamic compartment. A number of proteins are known to play a role in cristae architecture, such as OPA1, MIC60, LETM1, the prohibitin (PHB) complex and the F1FO ATP synthase. Furthermore, phospholipids are involved in the maintenance of cristae ultrastructure and dynamics. The use of new technologies, including super-resolution microscopy to visualize cristae dynamics with superior spatiotemporal resolution, as well as high-content techniques and datasets have not only allowed the identification of new cristae proteins but also helped to explore cristae plasticity. However, a number of open questions remain in the field, such as whether cristae-resident proteins are capable of changing localization within mitochondria, or whether mitochondrial proteins can exit mitochondria through export. In this Review, we present the current view on cristae morphology, stability and composition, and address important outstanding issues that might pave the way to future discoveries.
The Association between Cardiorespiratory Fitness and the Risk of Breast Cancer in Women
Authors: Katsaroli Ioanna , Sidossis Labros , Katsagoni Christina , Sui Xuemei , Cadenas-Sanchez Christina , Myers Jonathan , Faselis Charles , Murphy Rayelynn , Samuel Immanuel Babu Henry , Kokkinos Peter
Published: January 2024

Introduction

Studies have shown an inverse association between the risk of breast cancer in women and physical activity. However, information on the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized test and the risk of developing breast cancer is limited.

Purpose

To examine the CRF-breast cancer risk association in healthy females.

Methods

This retrospective study was derived from the ETHOS cohort (n = 750,302). Female participants (n = 44,463; mean age ± SD; 55.1 ± 8.9 years) who completed an exercise treadmill (ETT) test evaluation (Bruce protocol) at the Veterans Affairs (VA) Medical Centers nationwide from 1999 to 2020 were studied. The cohort was stratified into four age-specific CRF categories (Least-fit, Low-fit, Moderate-fit, and Fit), based on the peak metabolic equivalents (METs) achieved during the ETT.

Results

During 438,613 person-years of observation, 994 women developed breast cancer. After controlling for covariates, the risk of breast cancer was inversely related to exercise capacity. For each 1-MET increase in CRF the risk of cancer was 7% lower (HR 0.93; 95% CI, 0.90-0.95; P < .001). When risk was assessed across CRF categories with the Least-fit group as the referent, the risk was 18% lower for Low-fit women (HR 0.82; 95% CI, 0.70-0.96; P = .013), 31% for Moderate-fit (HR 0.69; 95% CI, 0.58-0.82; P < .001) and 40% for Fit (HR 0.60; 95% CI, 0.47-0.75; P < .001).

Conclusions

We observed an inverse and graded association between CRF and breast cancer risk in women. Thus, encouraging women to improve CRF may help attenuate the risk of developing breast cancer.
Potential Benefits and Risks Given by the Virtual Reality of the Central Nervous System
Authors: Coja Daniel Mădălin , Talaghir Laurențiu Gabriel , Georgescu Luminița , Codreanu Corneliu Mircea
Published: January 2024

The rapid growth and proliferation within healthcare of Virtual Reality (VR) technology's make it a promising platform for treating central nervous system (CNS)-related ailments. From neurorehabilitation to pain management and even cognitive enhancement, there are numerous benefits that VR offers this portion of medicine. Nevertheless, multiple risks among motion sickness and eye strain, exist with utilizing this new tech for CNS treatments. Beyond immediate physical harm concerns like these - researching the long-term impact on this area remains paramount regarding future implementation. The utilization of VR technology in the field of CNS presents considerable promise, the same its potential risks necessitate a meticulous analysis and resolution before its extensive acceptance across clinical settings.
An odd case of immune-mediated necrotizing myopathy, complicated with sagittal, transverse and sigmoid sinus thrombosis
Authors: Trandafir Andreea , Bonjincă Violeta Claudia , Tulba Delia , Onose Gelu
Published: January 2024

INTRODUCTION: Immune-mediated necrotizing myopathy (IMNM) is a rare variant of immune-mediated inflammatory myopathy (IMIM) that exhibits a severe prognosis and is unresponsive to conventional treatment. (1,2)Notably, the incidence of immune-mediated inflammatory myopathies (IMIMs) is low, estimated at 1.16 to 19/million/year and only 3-6% of IMIMs are diagnosed as IMNM. (1,3–5). Systemic inflammation has been found to play a crucial role in promoting the onset of cerebral venous thrombosis. (6,7)
MATERIAL AND METHODS: We present the case of a 46-years-old Chinese woman, without any known prior pathology, who was referred to the Rheumatology Department for symmetrical, proximal muscle weakness of the limbs, dysphagia for solid food, and weight loss (5 kg within 2 months). The pathologic clinical examination revealed itchy erythematous plaques on the posterior thoracolumbar region and signs of muscle weakness. Laboratory workup showed significant inflammatory syndrome, severe muscle and hepatic cytolysis syndrome, and positivity for thyroid-specific autoantibodies but with normal thyroid function, positivity for antinuclear antibodies (more precisely: SS-A, Ro-52, SS-B), and myositis antibodies (SRP, Ro-52, SAE1, PM-Scl, MDA5). The CT scan of the thoracic, abdominal, and pelvis showed fibrosis of the lungs, hepatic hypertrophy, and an enlarged uterus, further diagnosed by transvaginal ultrasound as adenomyosis. The positive diagnosis is immune-mediated necrotizing myopathy. Differential diagnoses included dermatomyositis, toxic/infectious myositis, hypothyroidism, and neuro-muscular diseases (5,8). The initial treatment was made with glucocorticoids (pulse therapy followed by oral therapy) and immunosuppressants (Mycophenolate Mofetil – stopped because of severe dyspepsia and myelosuppression). After five days of pulse therapy, the patient developed muscle weakness and paresthesia on the left side of the body, and the cerebral CT scan revealed sagittal, transverse, and sigmoid sinus thrombosis. Thrombophilia screening uncovered the positivity of the lupus anticoagulant. (9)
RESULTS: The patient was treated with anticoagulants (low molecular weight heparin, and afterward Vitamin K antagonist), low doses of oral glucocorticoids, and immunosuppressant (Methotrexate), without any other adverse event.
CONCLUSION: In the presence of the lupus anticoagulant, even though the antiphospholipid syndrome is not confirmed, the only anticoagulant therapy that has proven its efficacy is the Vitamin K antagonist. Immune inflammatory myopathies, like IMNMs, create a significant inflammatory status that leads to hypercoagulability and endothelial injury, which exposes collagen and tissue factors, promoting further platelet aggregation, and can even lead to cerebral thrombosis. (2,6)
Multiwave Locked System LASER photobiomodulation in the multidisciplinary team approach/ management of a 3rd degree burn on the posterior thorax in an 82-year-old woman – a case study
Authors: Postoiu Ruxandra-Luciana , Marinescu Silviu , Onose Gelu
Published: January 2024

Introduction: In the current study, we aim to demonstrate the efficacy and significance of MLS LASER therapy in the context of post-combustion injuries, through the expeditious improvement of a harmonious healing process for the lesions. A burn is recognized as a significant concern in the medical field [1], as the majority of them are profoundly disabling [2] and negatively impact crucial facets of daily existence, as well as overall quality of life [3].
Material and methods: We hereby present the case of an 82-year-old female patient admitted to our Neuromuscular Rehabilitation Clinic Division following a post-burn incident that occurred in January 2023, characterized by flame burns of IIA-IIB-III degrees on the posterior thorax, bilateral arms, and sacral regions. Initially, the patient received care in the Plastic Surgery Clinic Division of our hospital, and after three weeks, she was transferred to our division. Here, she underwent a tailored rehabilitation program and received notable Multiwave Locked System (MLS) LASER treatment on the posterior thoracic region over ten sessions. The patient’s progress was comprehensively and objectively quantified using assessment scales.
Results: Remarkable results were obtained, consisting a significant reduction in the size of the lesion on the posterior thoracic region after 10 sessions of MLS LASER photobiomodulation, along with a related improvement in locomotor and self-care dysfunctions.
Conclusions: Since references in the literature regarding the use of this type of phototherapeutic intervention are relatively scarce, we consider this case study to contribute to a better understanding and appreciation of it. At the same time, an efficient multidisciplinary collaboration proves advantageous not only for the patient’s well-being, but also for the development of current therapeutic interventions, contributing to the enrichment of this complex domain.
The importance of radiological parameters of proximal femoral morphology in recovery management of patients with avascular necrosis undergoing hip arthroplasty
Authors: Scheau Cristian , Dragosloveanu Șerban , Petre Mihnea-Alexandru , Gherghe Mihai Emanuel , Andrei Constantin Adrian , Georgescu Dragos Eugen , Iliescu Madalina Gabriela , Cergan Romica , Baz Radu Octavian
Published: January 2024

Background and Objectives: Our study aimed to radiologically assess the morphology of the proximal femur in patients with avascular necrosis (AVN). We considered that the correct evaluation of the proximal femur morphology is essential and shows multiple clinical applications that can impact patient recovery and outcome.
Materials and Methods: Our study included 177 patients (85 male and 92 female) with AVN regardless of the degree. The patients were assessed by bilateral hip X-ray in the supine position. We selected the most common radiographic parameters to evaluate for all patients: cortical thickness index (CTI), canal flare index (CFI), calcar-to-canal ratio (CCR), and morphological cortical index (MCI).
Results: Average values for the parameters were: CTI = 0.5192 ± 0.07528, CFI= 3.5515 ± 0.5071, CCR = 0.4469 ± 0.05363 and MCI = 2.7572 ± 0.07704. We found no statistically significant differences between genders, except for CFI (p = 0.0325).
Conclusions: The anatomical configuration of the proximal femur can play a major role in the process of planning the appropriate implant for total hip arthroplasty, as well as in the proper positioning of the implant during the surgical procedure. A thorough knowledge of the proximal femur morphology can be of great use to the orthopedic surgeon and may help decrease perioperative complications.
Desarrollo de habilidades de pensamiento con niños de 9 años mediante la novela filosófica Kio y Gus: asombrándose ante el mundo del programa de Filosofía para Niños.
Authors: Cordero Redondo Joan
Published: January 2024

Este trabajo analiza la influencia de la aplicación del Programa de Filosofía para Niños (P4C) en el desarrollo de habilidades de pensamiento en 12 estudiantes de educación primaria del 4to grado de la Escuela Jesús Jiménez Zamora, Cartago, Costa Rica, por medio de la implementación de diseños didácticos filosóficos, el uso de la novela filosófica Kio y Gus: asombrándose ante el mundo, y el Manual para el docente. El problema de investigación se adscribe a la enseñanza y métodos didácticos para el aprendizaje filosófico y el desarrollo de habilidades de pensamiento. La investigación constata que la implementación del programa de P4C en el cuarto año de educación básica tiene un impacto positivo en el desarrollo de habilidades de pensamiento (cognitivas), pero también se extiende en los ámbitos sociales y de comunidad de investigación.
In-hospital onset of transient myoclonic state in older adults: a case report
Authors: Harada Taku , Yamasato Kazushi , Nakanishi Toshiyuki , Nakai Mori
Published: January 2024

Background: Transient myoclonic (TM) state in older adults is a neurological condition characterised by short-lived, repetitive myoclonus without consciousness disturbance. First reported in 1992, it predominantly affects older individuals with chronic diseases. Despite its clear symptomatology, TM often remains under-recognised, leading to potential misdiagnoses. Case description: We report a case of a 68-year-old woman with a history of chronic heart failure who developed TM during hospitalisation following medication adjustment for acute heart failure. The patient, who had no history of intracranial disease or epilepsy, experienced acute involuntary movements of the face and limbs three days after diuretic adjustment. She responded well to intravenous diazepam and oral clonazepam, with no recurrence of symptoms post-treatment. Discussion: TM presents with bilateral, irregular, and repetitive myoclonus, mostly affecting the head, neck and upper extremities. Diagnosis is clinical, based on symptomatology and normal laboratory results. This case underscores the importance of recognising TM in differential diagnosis, especially in older patients in the acute or recovery phase of infection, or with medication changes. The potential role of fluid volume changes in TM pathophysiology in patients with underlying conditions such as hypertension or chronic heart failure is also highlighted. This case emphasises the need for heightened awareness and knowledge of TM among healthcare professionals. Conclusions: TM, though rare, requires awareness among clinicians for accurate diagnosis and management. It is crucial to avoid misdiagnosis and unnecessary interventions, and to provide appropriate information during care transitions, particularly in older adults with chronic conditions.
An effective treatment for diabetic foot necrosis with traditional Chinese and Western medicine: a case report
Authors: Liang Xinyu , Xu Yongcheng , Zhang Yaxu , Feng Xia , Wang Yuzhen , Zhao Cheng , Cao Yemin
Published: January 2024

Patients with diabetes who undergo a kidney transplant are at a great risk of undergoing amputations, usually associated with severe infection and necrosis. The treatment of severe diabetic foot necrosis is challenging in clinic, and the function of the limb is often hugely compromised. A 74-year-old male who had been diagnosed with severe post-renal transplant diabetic foot necrosis refused the option of below-knee amputation from previous surgeons, and requested to keep his left foot. The patient was treated with integrated traditional Chinese medicine (TCM) and Western medicine, with positive results. TCM therapeutic principles included ‘clearing heat, removing toxicity, regulating Qi, resolving dampness, activating stagnant blood and nourishing yin as well as tonifying Qi and blood’. Treatment with Western medicine included wound debridement, internal fixation or joint fusion, and use of insulin, antibiotics and vasodilators. The patient was treated with a staged and diverse approach (i.e., a combination of TCM and Western medicine, surgical management and education for diabetic foot care), which ultimately helped the patient achieve limb salvage and regain normal function. A combination therapy of Western medicine and TCM may be a promising approach to heal diabetic foot ulcers.
Identifying health-related quality of life concepts to inform the development of the WOUND-Q
Authors: Tsangaris Elena , van Haren Emiel LWG , Poulsen Lotte , Squitieri Lee , Hoogbergen Maarten M , Cross Karen , Sørensen Jens Ahm , van Alphen Tert C , Pusic Andrea , Klassen Anne F
Published: January 2024

Objective:

The impact of hard-to-heal wounds extends beyond traditional clinical metrics, negatively affecting a patient's health-related quality of life (HRQoL). Yet treatment outcomes are seldom measured from the patient's perspective. The purpose of the present study was to perform in-depth qualitative interviews with patients diagnosed with varying types of hard-to-heal wounds to identify outcomes important to them.

Method:

Participants were recruited from wound care clinics in Canada, Denmark, the Netherlands and the US, and were included if they had a hard-to-heal wound (i.e., lasting ≥3 months), were aged ≥18 years, and fluent in English, Dutch or Danish. Qualitative interviews took place between January 2016 and March 2017. An interpretive description qualitative approach guided the data analysis. Interviews were audio-recorded, transcribed and coded line-by-line. Codes were categorised into top-level domains and themes that formed the final conceptual framework.

Results:

We performed 60 in-depth interviews with patients with a range of wound types in different anatomic locations that had lasted from three months to 25 years. Participants described outcomes that related to three top-level domains and 13 major themes: wound (characteristics, healing); HRQoL (physical, psychological, social); and treatment (cleaning, compression stocking, debridement, dressing, hyperbaric oxygen, medication, suction device, surgery).

Conclusion:

The conceptual framework developed as part of this study represents the outcome domains that mattered the most to the patients with hard-to-heal wounds. Interview quotes were used to generate items that formed the WOUND-Q scales, a patient-reported outcome measure for patients with hard-to-heal wounds.
Effects of soft tissue mobilisation on subacute adherent linear scars: a single-group intervention study
Authors: Poddighe Diego , Ferriero Giorgio , Corna Stefano , Bravini Elisabetta , Sartorio Francesco , Vercelli Stefano
Published: January 2024

Objective:

Scar adherence due to a pathological healing process can cause physical and psychological disturbance. Soft tissue mobilisation (STM) techniques are widely used to treat and prevent scar adherence, but little is known on their effects. We aimed to analyse the effect of STM in patients with subacute post-surgical scar adhesions affecting the extremities.

Method:

A single-group quasi-experimental study was conducted on consecutive patients undergoing post-surgery limb rehabilitation. Patients with a baseline Adhesion Severity (AS) index of <0.5 at the worst scar point, as measured by the Adheremeter, were eligible. All patients who completed a minimum of five manual treatment sessions were included. The primary outcome was the AS index and the secondary outcome was the Italian version of the Patient and Observer Scar Assessment Scales (POSAS-I).

Results:

A cohort of 19 patients underwent an average of eight STM sessions over a period of one month. The AS index value increased from a median of 0.12 at baseline (interquartile range (IQR): 0.05–0.25) to 0.41 post-treatment (IQR: 0.26–0.63; median change: 0.24; IQR: 0.16–0.40; p<0.001). A large effect size was observed for both AS and Observer Scar Assessment Scale (OSAS-I) (Cohen r=0.6), with a large probability of superiority (PS) (87% and 86%, respectively). A moderate effect was observed for the Patient Scar Assessment Scale (PSAS-I) (Cohen=0.4; PS=71%). Pre–post treatment changes exceeded the minimal detectable changes for the AS and OSAS-I in 68% of subjects, and for PSAS-I in 21% of subjects.

Conclusion:

STM manual techniques may produce a large effect on the mobility of adherent subacute post-surgical scars.
Use of hyperbaric oxygen therapy to treat a pressure ulcer complicated by osteomyelitis: a case report
Authors: Ghayoumi Shahram , Eslami Reza , Vasei Narges , Darvishi Mohammad , Bordbar Hasan , Poorshafagh Habibeh , MohsseniPour Mehrzad
Published: January 2024

The development of a pressure ulcer (PU) following hospitalisation and immobility can lead to more severe complications, such as osteomyelitis. We report the case of a 60-year-old female patient with a PU complicated with osteomyelitis who was treated with hyperbaric oxygen therapy (HBOT). The patient was diagnosed with an unstageable PU according to the European Pressure Ulcer Advisory Panel classification. A total of 35 HBOT sessions were administered to manage her condition. HBOT is considered a safe and effective treatment for osteomyelitis and decreases mortality rate.
Survival benefit of concurrent chemoradiotherapy for advanced ampulla of Vater cancer
Authors: Kwon Chae Hwa , Seo Hyung Il , Kim Dong Uk , Han Sung Yong , Kim Suk , Lee Nam Kyung , Hong Seung Baek , Ahn Ji Hyun , Park Young Mok , Noh Byeong Gwan
Published: January 2024

BACKGROUND

Currently, there is no standard adjuvant therapy for patients with resected ampulla of Vater (AoV) cancer.

AIM

To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy (CCRT) in patients with advanced AoV cancer who underwent curative resection.

METHODS

This single-centered, retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018. The impact of CCRT on advanced AoV cancer was analyzed.

RESULTS

The 1-, 3-, and 5-yr recurrence-free survival (RFS) rates for patients with advanced AoV cancer were 82.8%, 48.3%, and 40.8%, respectively, and the overall survival (OS) rates were 89.7%, 62.1%, and 51.7%, respectively. Lymphovascular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis, whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis. Compared to the patients who did not receive adjuvant CCRT, those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS, although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.

CONCLUSION

Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer. These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.
Absence of enhancement in a lesion does not preclude primary central nervous system T-cell lymphoma: A case report
Authors: Kim Chan-Seop , Choi Chi-Hoon , Yi Kyung Sik , Kim Yook , Lee Jisun , Woo Chang Gok , Jeon Young Hun
Published: January 2024

BACKGROUND

Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma that originates in the central nervous system (CNS) and is exclusively limited to the CNS. Although most PCNSLs are diffuse large B-cell lymphomas, primary CNS T-cell lymphomas (PCNSTLs) are rare. PCNSTLs typically demonstrate some degree of enhancement on contrast-enhanced magnetic resonance imaging (MRI). To the best of our knowledge, non-enhancing PCNSTL has not been reported previously.

CASE SUMMARY

A 69-year-old male presented to the neurology department with complaints of mild cognitive impairment and gradual onset of left lower leg weakness over a span of two weeks. Initial MRI showed asymmetric T2-hyperintense lesions within the brain. No enhancement was observed on the contrast-enhanced T1 image. The initial diagnosis was neuro-Behçet’s disease. Despite high-dose steroid therapy, no alterations in the lesions were identified on initial MRI. The patient’s symptoms deteriorated further. An MRI performed one month after the initial scan revealed an increased lesion extent. Subsequently, brain biopsy confirmed the diagnosis of PCNSTL. The patient underwent definitive combined chemo-radiotherapy. However, the patient developed bacteremia and died of septic shock approximately three months after diagnosis.

CONCLUSION

The absence of enhancement in the lesion did not rule out PCNSTL. A biopsy approach is advisable for pathological confirmation.
Diagnostic challenges and individualized treatment of cervical adenocarcinoma metastases to the breast: A case report
Authors: Akers Allison , Read Susan , Feldman John , Gooden Casey , English Diana P
Published: January 2024

BACKGROUND

Cervical cancer is a rare primary tumor resulting in metastases to the breast with few cases reported in literature. Breast metastases are associated with poor prognosis. The following case highlights the diagnostic challenges associated with metastatic cervical cancer to the breast along with individualized treatment.

CASE SUMMARY

A 44-year-old G7P5025 with no significant past medical or surgical history presented with heavy vaginal to an outside emergency department where an exam and a pelvic magnetic resonance imaging showed a 4.5 cm heterogenous lobulated cervical mass involving upper two thirds of vagina, parametria and lymph node metastases. Cervical biopsies confirmed high grade adenocarcinoma with mucinous features. A positron emission tomography/computed tomography (PET/CT) did not show evidence of metastatic disease. She received concurrent cisplatin with external beam radiation therapy. Follow up PET/CT scan three months later showed no suspicious fluorodeoxyglucose uptake in the cervix and no evidence of metastatic disease. Patient was lost to follow up for six months. She was re-imaged on re-presentation and found to have widely metastatic disease including breast disease. Breast biopsy confirmed programmed death-ligand 1 positive metastatic cervical cancer. The patient received six cycles of carboplatin and paclitaxel with pembrolizumab. Restaging imaging demonstrated response. Patient continued on pembrolizumab with disease control.

CONCLUSION

Metastatic cervical cancer to the breast is uncommon with nonspecific clinical findings that can make diagnosis challenging. Clinical history and immunohistochemical evaluation of breast lesion, and comparison to primary tumor can support diagnosis of metastatic cervical cancer to the breast. Overall, the prognosis is poor, but immunotherapy can be considered in select patients and may result in good disease response.