bluuebunny/crossref_metadata_2025 huggingface dataset:
E05 Is subchondral bone marrow edema predictive of bone mineral density loss in juvenile idiopathic arthritis?
Authors: Ferjani H , Kharrat L , Ben Nessib D , Rabhi E , Maatallah K , Kaffel D , Hamdi W
Published: August 2023

Introduction

Inflammation plays a crucial role in impaired bone metabolism [1]. Subchondral bone marrow oedema (BME) in Magnetic Resonance Imaging (MRI) was associated to bone mineral density (BMD) loss in adult spondyloarthritis [1]. BME was less studied in juvenile idiopathic arthritis (JIA).

Objectives

We aimed to study the link between MRI BME and BMD in JIA patients.

Methods

We conducted a retrospective study of 44 patients with JIA who fulfilled the International League of Associations for Rheumatology (ILAR) 2001 criteria. For each patient we collected the following data: age, age at the onset of JIA, JIA subtype, disease duration, C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) levels, BMD assessed using bone densitometry and MRI. Disease activity was assessed using the JADAS score.

Statistical analysis was performed using SPSS software.

Results

We included 28 boys and 16 girls. The mean age was 13.65 ± 4.62 years. The mean age at the onset of the disease 9.57 ± 3.97 years. The mean disease duration was 4.34 ± 3.09 years. There was enthesitis-related arthritis in 61% of the cases (n = 27), oligoarticular JIA in 14% of the cases (n = 6), polyarticular JIA in 11% of the cases (n = 5), and psoriatic arthritis in 7% of the cases (n = 3). JIA was undifferentiated in 7% of the cases (n = 3).

The mean CRP and ESR were 14.42 ± 19.67 mg/l and 26.56 ± 20.87 mm, respectively.

The mean JADAS was 6.6 ± 4.7. Bone densitometry was performed in 17 patients. The mean BMD and the mean Z-score were 0.961 ± 0.128 g/cm2 and -0.4 ± 1.16 standard deviation, respectively.

Magnetic resonance imaging (MRI) showed BME in 52% of the patients (n = 23). Bone marrow oedema was present in the sacroiliac joints in 43% of the cases (n = 19), in the coxofemoral joints in 27% of the cases (n = 12), and in the spine in 9% of the cases (n = 4).

The presence of BME was associated with a higher ESR (32.71 ± 25.71 vs 18.94 ± 10.72 mm, P = 0.032), higher JADAS (8.01 ± 5.36 vs 4.75 ± 3.29, P = 0.023), and a lower Z-score (-1.3 ± 0.77 vs 0.4 ± 0.8 standard deviation, P = 0.001).

Conclusion

Our study showed that MRI BME was associated with high disease activity and BMD loss in JIA patients. This result is consistent with those of Akgöl et al. [2]. Bone marrow oedema seems to predict BMD loss in JIA and should lead to optimizing the treatment.

References

[1]. Wang D, Hou Z, Gong Y, Chen S, Lin L, Xiao Z. Bone oedema on magnetic resonance imaging is highly associated with low bone mineral density in patients with ankylosing spondylitis. PLoS One 2017;12:e0189569.

[2]. Akgöl G, Kamanlı A, Ozgocmen S. Evidence for inflammation-induced bone loss in non-radiographic axial spondyloarthritis. Rheumatology 2014;53:497–501.
E35 Achondroplasia: delayed diagnosis of a severe, complicated form
Authors: Rahmoune Hakim , Boutrid Nada , Soualili Zineddine
Published: August 2023

Introduction

Achondroplasia is the most common form of chondrodysplasia. It manifests by marked rhizomelia, hyperlordosis, brachydactyly and macrocephaly with large, prominent forehead and mid-face hypoplasia.

Objective

To describe a case of achondroplasia with delayed diagnosis and severe extra-skeletal complications.

Result

An eight-year-old girl, diagnosed with a bilateral pulmonary ecchinococcosis, was referred for thoracic surgery and a pediatric opinion was required. Physical examination revealed a severe juvenile form of achondroplasia with marked restriction of opening of the mouth and sleep apnea. Pulmonary function tests showed a mild restrictive lung disease.

Her skeletal radiological survey showed the classic signs of achondroplasia and a bilateral coxa vara.

Thoracic surgery was successfully scheduled with a multidisciplinary team encompassing pediatric surgeons, pediatricians, anesthesiologists and specialized nurses. A dedicated ENT and pulmonology team managed her sleep apnea and respiratory disorder respectively, while pediatric orthopedic team managed the hips.

Discussion

Achondroplasia is caused by mutations in the fibroblast growth factor receptor 3 (FGFR3) gene encoding a transmembrane receptor important among other things in the regulation of linear growth of long bones. Diagnosis is mainly based on the presence of specific clinical and radiological features. Strict adherence to recommendations for perioperative and surgical care are essential.

Conclusion

The management of achondroplasia is multidisciplinary, and supportive measures are more than crucial; especially in particular situations, such as anesthesia and surgery, that require additional precautions with prudent perioperative management and prolonged postoperative care.

Evidently, long term follow-up of the respiratory and musculoskeletal systems is essential.

The life expectancy of such patients is close to that of the general population, but patient’s and family’s quality of life is highly impacted.

Ethics

Parental consent taken before case reporting.
E38 Pediatric dermatomyositis, what specificities
Authors: Kamelia Okka , Dehimi A , Fellahi M , Messasset M , Benarab Z , Bouabdallah S , Bioud B
Published: August 2023

Introduction

Dermatomyositis is a rare disease. In children the incidence is 2–3 per million population. It is a potentially serious disease whose mortality is < 5%, but whose complications and long-term prognosis remain poor for some children.

Objectives

We report the epidemiological, clinical, therapeutic and evolutionary characteristics of a retrospective case series of 14 children with dermatomyositis seen at the pediatric center of Setif (Algeria).

Materials and methods

The average age of onset is 8 years (0–15 ½ years), The sex ratio (M/F) was 0.21; The mean duration of symptoms prior to diagnosis was 4.4 months. At the time of diagnosis, 100% of children had skin rash, 84% eyelid telangiectasia, 40% Gottron's papules, 90% muscle weakness, 40% arthritis, 13% fever, and 25% dysphagia. The muscle enzymes were elevated in all, FAN positive in 6 cases, anti-DNA was positive in a single patient with overlapping myositis. The electromyogram cames myogenic for all our 14 patients, 10 patients had muscle biopsy with report of non-specific interstitial and parenchymal myositis Therapeutic regimens were variable, they depended on the severity of the initial picture, Nevertheless all of the children were treated with first-line corticosteroids (100%), methotrexate was prescribed in 12 cases (85%); Mycophenolate mofetil and Rituximab in one patient, and bisphosphonate in a single child with extensive calcinosis.

Polyvalent immunoglobulins were used for 4 cases with swallowing disorders and calcinosis (28%), 4 patients had calcinosis as complication (28%), only one child died from aspiration pneumonitis.

Discussion

The diagnosis is made according to the criteria of Bohan and Peter, given the non-specificity of the muscle biopsies. The clinical and evolutionary characteristics of our serie are consistent with the overall data in the literature with a predominance of skin and muscle involvement. However, some specificities were individualized such as the case of myositis overlapping with lupus. The treatment is essentially based on corticosteroid therapy and methotrexate.

Conclusion

Juvenile dermatomyositis is a rare serious and chronic condition requiring multidisciplinary management.

Ethics

Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria)
E39 Hepatocellular insufficiency and systemic lupus; what is the relationship?!!
Authors: Kamelia Okka , Dehimi A , Fellahi M , Messasset M , Benarab Z , Bouabdallah S , Bioud B
Published: August 2023

Introduction

Systemic lupus erythematosus (SLE) can be associated with several nonspecific hepatic manifestations, but acute lupus hepatitis remains uncommon and rarely constitutes a revelation mode.

Objectives

To report a case of systemic lupus presented by hepatocellular insufficiency.

Materials and methods

The patient was eleven years old when admitted in 2017 for investigation of hepatocellular failure. Physical examination: mucocutaneous jaundice with dark urine without other abnormalities. The biological assessment revealed significant hepatic cytolysis, cholestasis, as well as a biological inflammatory syndrome, polyclonal hypergammaglobulinemia predominant on gamma globulins. Urinary sediment and blood count were normal. Ultrasound and hepatosplenic Doppler showed signs of chronic liver disease: portal hypertension and moderate ascites. Cardiac ultrasound showed pericardial effusion. We carried out an etiological assessment comprising: an exhaustive questioning having eliminated any drug or toxic intake. The serologies for viral hepatitis A, B and C were negative. The search for non-organ-specific anti-tissue antibodies (anti-smooth muscle, anti-mitochondria and anti-LKM1) were negative, as well as a cupric balance. Antinuclear antibody was positive with a titre of 1/1000, anti-DNA was positive (> 866 IU/ml), C3, C4 and CH50 were low, and antiphospholipid antibodies were positive. The diagnosis of systemic lupus erythematosus was made. The patient was on corticosteroid therapy and immunosuppressant. The evolution was marked by the progressive improvement of the hepatic balance sheet.

Discussion

Although hepatic involvement during SLE is not part of the diagnostic criteria, abnormal liver function tests are frequent, ranging from 23% to 60% depending on the series in the literature. However, SLE-specific liver disease or lupus hepatitis is rare, observed in 1% to3% according to the literature. Our patient was symptomatic with hepatocellular insufficiency.

Conclusion

Lupus hepatitis is a rare manifestation of SLE and constitutes a rare presenting mode that should not be overlooked.

Ethics

Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria).
E45 Kawasaki syndrome-related heart disease before and during the COVID-19 pandemic
Authors: Guedri R , Jelassi A , Glai M , Hrizi Houcem , Essaddam L , Fitouri Z , Ben Becher S
Published: August 2023

Introduction

Kawasaki disease (kDa) is an acute febrile systemic panvascularitis that affects medium-caliber arteries with a strong predilection for the coronary arteries. It is the leading cause of acquired heart disease in children under 5 years of age. However, after the COVID-19 pandemic, we see a change in the profile of cardiac involvement.

Objective

To describe the clinical, paraclinical, and evolutionary characteristics of cardiac damage in children managed for Kawasaki or Kawasaki-Like syndrome before and during the Covid19 pandemic.

Materials and Methods

This is a retrospective, descriptive study conducted over a period of five years (1st January 2017 to 31st December 2021).

Result

We collected 30 cases of patients hospitalized with Kawasaki disease, between January 2017 and December 2021: 11 cases with Kawasaki syndrome before COVID-19; and 19 cases with Kawasaki syndrome after COVID-19. The mean age and standard deviation (SD) at diagnosis was 42 (±37.8) months before the pandemic vs 81 (±34.7) months after the pandemic. The sex ratio was 0.5 (4 girls and 7 boys) before the pandemic vs 0.7 (8 girls and 11 boys) after the pandemic. Heart damage was found in 2 cases before the pandemic (coronary aneurysm type) vs 3 cases after the pandemic, mainly cardiogenic shock. The mean time from the first transthoracic ultrasound to fever was 11.3 days before the pandemic, vs 5.8 days after the pandemic. Transthoracic ultrasound showed 2 cases of coronary aneurysm before the pandemic, with a Z score exceeding 2.5SD; vs 7 cases of heart failure after the pandemic with a decrease in left ventricular ejection fraction. The ASAI score (a score that assesses the risk of coronary artery disease) was >6 in 1 case before the pandemic vs in 0 cases after the pandemic. The average predictive score for cardiac involvement was 4.2 (±1.4) before the pandemic, vs 3.5 (±1.5) after the pandemic. The outcome was favorable in all cases despite a more severe picture after the COVID-19 pandemic.

Conclusion

The change in the pattern of cardiac involvement in Kawasaki disease following the emergence of COVID-19 must be taken into account in order to manage an influx of patients with severe Kawasaki disease.
E53 Anti-OJ synthetase syndrome: a pediatric case report
Authors: Hadef Djohra , Ouchen Yamina , Khedri Afaf , Saadi Rayene , Bezziou Khadija
Published: August 2023

Introduction

The antisynthetase syndrome (ASS) is a connectivity with variable clinical expression. It is defined by the presence of anti-tRNA synthetase autoantibodies, associated with a clinical phenotype. It is an overlapping myositis associated with the presence of idiopathic inflammatory myopathy autoantibodies.

Observation

We report the case of an 11-year-old girl with no particular family history. The patient was diagnosed and treated as rheumatic fever 3 years ago and put on extencillin due to arthralgias of large right knee and hip joints with positive antistreptolysin O antibodies and history of repeated angina but without clinical improvement. The polyarthralgias progressed and became bilateral predominantly in the scapular and pelvic girdles associated with intense myalgias of three days before his admission leading to a motor deficit. A biological assessment was requested: creatine phosphokinase (CPK) = 1880UI/l; ASAT = 58UI/l; procalcitonin = 0.15; erythrocytesedimentation rate (ESR) was elevated. The immunological workup showed antibodies specific for myositis; antiRNA synthetase type OJ Positive. Results of immunological tests for other associated autoimmune diseases were (rheumatoid factor, anti-CyclicCitrullinated Peptide antibodies, anti SM and anti-Native DNA) negative. Electromyography showed no abnormalities. A muscle biopsy was not done. Chest CT scan showed no abnormalities. The patient was commenced on corticosteroid therapy at a dose of 1 mg/kg/day for 4–6 weeks then progressive weaning.

Conclusion

ASS is a complex and heterogeneous autoimmune connective disease. In the presence of extra-pulmonary signs and the positivity of the anti-tRNA synthetase antibody, the diagnosis is confirmed. The management often requires multidisciplinary approach.
E54 The Ehlers-Danlos syndrome, a disease of late diagnosis: report two cases
Authors: Rahmoune A , Ferhat A , Bahaz N , Dahou-Makhloufi C
Published: August 2023

Introduction

Ehlers-Danlos syndromes (EDS) are a heterogeneous group of rare inherited collagen disorders. Clinical signs are dominated by generalized joint hyper laxity, skin hyper elasticity and tissue fragility. The diagnosis is clinical in the absence of genetic testing. There is no curative treatment but it is possible today to improve the quality of life of these patients.

We report two cases of EDS from a non-consanguineous marriage, without similar cases in their families.

Observations

CASE 1: Mrs N.B, 31 years old, 2nd of 4 siblings, with a history of heterozygous beta thalassemia, she presented with mechanical gonalgias secondary to patellar dislocations associated with ankle sprains since the age of 5 years.

On clinical examination: generalized hyper mobility (Beighton score 9/9), hyper elasticity of the skin, skin fragility, atrophic scarring, papery skin of the knees, hyper transparency of the skin, epistaxis at the slightest scratching, the rest of the somatic examination was unremarkable.

The standard biological workup, X-ray and ultrasound of the knees and ankles were without abnormalities.

Classic EDS (I and II) was retained according to the 2017 international classification.

The patient responded to tier I analgesics.

Case 2

Mrs B.L, 24 years old, the third of five siblings, with a history of bronchial asthma, presented with bilateral and symmetrical polyarthralgia affecting the large and small joints with mixed type spinal pain associated with spontaneous myalgia in a context of profound asthenia evolving for 14 years.

On osteoarticular examination, generalized joint hypermobility was noted (Beighton score 9/9); on the cutaneous level, transparency and hyperextensibility of the skin with multiple ecchymoses due to tissue fragility associated with delayed healing with cutaneous hyperesthesia, all associated with exertional dyspnea, chronic abdominal pain and gastroesophageal reflux since the onset of his illness.

Biologically, no inflammatory syndrome. The autoimmune workup (RF, ACPA, FAN) was negative and other investigations were without abnormalities.

X-rays of the chest, hands, wrists and knees were unremarkable.

The patient was classified as having hypermobile EDS (type III) according to the international classification of the disease. The patient responded only partially to analgesics (levels I, II and III) and to tricyclic antidepressants.

Conclusion

The diagnosis of EDS must be made early in order to ensure optimal symptomatic management. The management must be multidisciplinary, including an evaluation, a psychological follow-up, a treatment of the pain and physiotherapy.
E57 Osteogenesis imperfecta: about a series of twelve cases in Batna (Algeria)
Authors: Hadef Djohra , Bouhidel Jalaleddine Omar , Zerguine Halima , Hasni Hakima , Gourmat Khaoula , Baaziz Hadda , Khernane Nacer
Published: August 2023

Introduction

Osteogenesis imperfecta (OI), also known as glass bone disease, is a rare inherited disorder characterized by bone fragility and osteopenia. It combines skeletal signs of variable severity (mainly fractures, ligament hyperlaxity, dentinogenesis imperfecta and bone deformities), and inconsistent extra-skeletal signs (such as blue sclerae, deafness and vascular fragility).

Aim

To describe the epidemiologic, clinico-radiologic and therapeutic profile of OI in our department.

Methods

This is a retrospective study of 12 cases of OI collected in the department of Pediatrics of CHU Benflis Touhami Batna during a 6-year study period from 2014 to 2022.

Results

Twelve patients with OI were seen. Five patients were male and eight were female. The mean age at diagnosis was 6 years [1,16 years]. In 67% of cases, our patients were from a consanguineous marriages. Clinical signs were dominated by bone deformities with a history of multiple fractures following minimal trauma. Delayed weight-bearing was noted in five children; blue sclera was found in three children. Confirmation of the diagnosis was aided by radiological findings of diffuse bone demineralization, fracture lines, pelvic and limb deformity, cortical thinning, small ribs and biconcave compression of vertebrae. Bone densitometry showed osteoporosis in 70% of the patients and osteopenia in the rest. All patients were put on biophosphonates. Conclusion Osteogenesis imperfecta is a rare pathology, but it is serious, especially because of the functional disability it induces, hence the importance of an early diagnosis and prompt treatment.
E63 Prevalence and risk factors of low bone mineral density and fractures in children with beta-thalassemia
Authors: Bengana Bilal , Yacoub Saidi , Kheireddine Aggoun , Selma Abdellaoui , Guerboukha Hamida , Boukabous Abdenour , Lefkir-Tafiani Salima
Published: August 2023

Background

Declining bone mineral density can affect children and lead to an increased risk of fractures. Moreover, it is an important cause of morbidity and mortality in people with beta-thalassemia. However, the prevalence of osteoporosis and bone fractures in a young population with beta-thalassemia remains uncertain.

Objective

To investigate the prevalences of low bone density and fractures among beta-thalassemia young patients (homozygous form) and to identify clinical and laboratory factors that are associated with these conditions.

Methods

We collected data of all childrens with beta-thalassemia who were followed up in the hematologic clinic. They were screened to measure bone mineral density (BMD) using the dual energy X-ray absorptiometry (DXA). A retrospective chart review was performed to report the lifetime prevalence of bone fractures and clinical associations with patient data.

Results

We examined 67 young patients with beta-thalassemia, 6–16 years old (median: 12 years). Low BMD was found in 10.8% (spine) and 32% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of splenectomy was associated with lower BMD. Patients with a history of fractures had lower Z-scores for spine BMD (-2.30 vs -0.58, P = 0.01) and total-body BMD (-1.90 vs -0.87, P = 0.04) compared with those without a history of fractures.

Patients with spine BMD Z-score of up to -2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than -2 SD score (10 vs 5%, P = 0.02).

Factors associated with lower mean BMD Z-score were history of splenectomy, vitamin D deficiency when the factors associated with bone fractures were male sex (RR 1.52, 95%CI 1.22–3.21) and haemoglobin level below 7 g/dl (RR 1.76, 95%CI 1.31–4.22).

Conclusion

This study provides information on risk factors for low BMD in pediatric beta-thalassemia. The results reveal the association between low BMD and a history of splenectomy and vitamin D deficiency, and the relationship between bone fractures in boys especially with low BMD.
E69 Localised intraarticular pigmented villonodular synovitis in an adolescent patient: a case-based review of the literature
Authors: Adenitan Ajibade , Yerima Abubakar , Olaosebikan Hakeem , Faleye Ayodele , Lawan Aliyu Ibrahim
Published: August 2023

Introduction

Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive subtype of tenosynovial giant cell tumours that affect the synovium of the joints and tendons, occurring either focally or diffusely associated with the deposition of hemosiderin into the involved joint(s) and soft tissues. Although PVNS is historically considered an inflammatory process, recent evidence suggests the possibility of a neoplastic transformation. In addition, despite being typically found as a monoarticular knee disorder, other large and small joints can also be affected.

The disease is rarely reported in African children, with most reported cases not histologically confirmed. We, therefore, present the first histologically proven case of localised intraarticular PVNS in an African teenager who presented with unilateral left knee swelling and pain.

Method/Setting

We report the case of a 16-year-old male teenager who presented to the rheumatology clinic with a nine-month history of non-traumatic anterior left knee swelling and pain that increased over time with associated difficulty walking and standing without aid. After clinical examination and relevant investigations, Magnetic Resonant Imaging (MRI) was done to confirm our suspicion of PVNS.

Findings/Treatment

Examination revealed a tender, swollen knee with a fluctuant palpable infrapatellar mass. Knee arthrocentesis yielded about 200mls of non-clotted hemorrhagic effusions. The patient had an open synovectomy following MRI, which was highly suggestive of pigmented villonodular synovitis with extensive suprapatellar bursitis. Specific histological findings (below) further confirmed the diagnosis. He commenced early physiotherapy, and symptoms resolved without recurrence of swelling eleven months after surgery.

Conclusion

This case highlights the visual presentation of an uncommon joint disorder and suggests it is considered a differential diagnosis of non-traumatic monoarticular pain and swelling in our rheumatology clinic set-up and among teenagers in whom juvenile rheumatoid arthritis would have been the first differential.

Key words: Pigmented villonodular synovitis, Synovectomy, Multinucleated giant cells

Contribution statement: AA conceived the idea to write the case report, draft the first manuscript, and manage the patient. YA, HO and AF edited the manuscript, while AIL interpreted the histological findings. All the authors approved the final version of the manuscript.

Disclosure statement: None declared.

Ethics and patient consent: This case report adheres to the Helsinki declaration, and the patient’s parents gave written consent to publish the details of the information.

Additional information: Any institution did not fund this publication.

Acknowledgements: We thank Dr Isaac Akanbi and Dr Bukar for interpreting the MRI and performing the surgery.
Workforce survey of PAs' genetic-genomic knowledge, attitudes, and application in practice
Authors: Patterson Wesley G. , Tribble Leta M. , Hopkins Casey S. , Fasolino Tracy K. , Ward Linda D.
Published: August 2023

Objective:

This study surveyed practicing physician associates/assistants (PAs) about their genetics-genomics knowledge, attitudes, and application in practice.

Methods:

A 25-question electronic survey was emailed to each constituent organization of the American Academy of Physician Associates (AAPA) with a description of the study and a request to forward to their members. Additionally, a posting was displayed in the bulletin board section of the online AAPA Huddle.

Results:

Of the 420 PAs who completed the survey, few are knowledgeable (25%) about or confident (13%) in applying a genomic approach to patient care, although most (61%) think genetics-genomics is important to delivering high-quality care. Remarkably, 97% of PAs surveyed are interested in genetics-genomics continuing medical education.

Conclusions:

PAs lack knowledge and confidence in integrating genetics-genomics into patient care; however, they have a positive attitude toward genetics-genomics and want to improve their knowledge and confidence through education.
Whole Blood Administration for Obstetric-Related Hemorrhage During Prehospital Transport
Authors: Polzin Abigail , Smith Kaihlen , Rumpza Thomas
Published: August 2023

BACKGROUND:

Whole blood transfusion has been used for resuscitation in trauma patients; however, case reports of whole blood transfusion for obstetric-related hemorrhage are limited. Whole blood transfusion typically is accomplished with low titer O-positive whole blood, and, despite success in trauma, use in persons with childbearing potential is of concern due to risk of alloimmunization.

CASE:

We present a case series of patients who received low titer O-positive whole blood for obstetric hemorrhage. One patient was Rh-negative and received immune globulin treatment after whole blood transfusion. All patients survived to hospital discharge. None experienced transfusion-related complications.

CONCLUSION:

Whole blood can be successfully administered both in and out of the hospital setting, even for obstetric hemorrhage. The benefits of easily administered balanced resuscitation, limited donor exposure, and improved patient outcomes likely outweigh potential alloimmunization, especially in resource-limited settings. Addressing concerns of alloimmunization cannot be accomplished without more research, and we encourage others to investigate using whole blood in this population.
Urinary levels of cortisol but not catecholamines are associated with those of 8-hydroxy-2’-deoxyguanosine in uncomplicated primary hypertension
Authors: Tomoda Fumihiro , Koike Tsutomu , Nitta Atsumi , Kurosaki Hiroko , Sugimori Hiroko , Oh-hara Maiko , Kinugawa Koichiro
Published: August 2023

Objectives:

The relationships between stress hormones and oxidative DNA damage have not yet been explored in human hypertension. We investigated the associations of urinary levels of cortisol or catecholamines with those of 8-hydroxy-2′-deoxyguanosine, a marker of oxidative DNA damage in primary hypertension.

Methods:

Untreated 156 primary hypertensives without apparent cardiovascular diseases were entered into the study. Following blood sampling after an overnight fast, 24-h blood pressure monitoring and 24-h urinary sampling were performed simultaneously to determine 24-h averaged values for blood pressure and urinary levels of cortisol, catecholamines and 8-hydroxy-2′-deoxyguanosine.

Results:

Urinary cortisol significantly correlated positively with urinary 8-hydroxy-2′-deoxyguanosine in all studied participants (r = 0.334, P < 0.001). Contrary, either urinary adrenaline or urinary noradrenaline did not significantly correlate with urinary 8-hydroxy-2′-deoxyguanosine (r = 0.050, P = 0.553 or r = 0.063, P = 0.435). Additionally, the positive association of urinary cortisol with urinary 8-hydroxy-2′-deoxyguanosine remained highly significant after the adjustments for multiple confounders of oxidative stress such as age, gender, body mass index, smoking status, 24-h blood pressure, C-reactive protein and estimated glomerular filtration rate (partial r = 0.323, P < 0.001), although only approximately 10% of the variance in urinary cortisol was attributable to differences in urinary 8-OHdG (partial r
2 = 0.104). Thus, our data indicate that cortisol but not catecholamines could at least partially contribute to the occurrence of oxidative DNA damage in primary hypertensives.

Conclusion:

The present study suggested the possibility that the overactivation of hypothalamic−pituitary−adrenal axis rather than sympathoadrenal system could enhance oxidative stress and attendant DNA oxidation in uncomplicated primary hypertension.
Pseudoprogression in the era of immunotherapy-based strategies for recurrent head and neck squamous cell carcinoma achieving complete response: A case report
Authors: Zhou Jiawei , Luo Jie , Gu Jiajia , Zhang Jingyuan , Gu Dayong , Zhang Xiuming , Wang Feijiang , He Xia , Wu Lirong
Published: August 2023

Rationale:

In the last few years, treatment of head and neck squamous cell carcinoma (HNSCC) has been enhanced by the emergence of immunotherapy. A biological phenomenon unique to immunotherapy is pseudoprogression, an increase in tumor burden or the appearance of a new lesion subsequently followed by tumor regression.

Patient concerns:

A 78-year-old man complaining of a lump (6*4 cm) gradually swelling on the right side of his neck with recurrent buccal mucosa squamous cell carcinoma presented to our institution. Two months prior, he received resection of the buccal lesion but refused suggested adjuvant chemoradiotherapy after the operation.

Diagnoses:

Recurrent buccal mucosa squamous cell carcinoma.

Interventions:

Induction immunotherapy was initiated, followed by a new node appearing on the surface of the neck mass. We considered the presence of pseudoprogression and continued with immunotherapy. The patient received immunotherapy combined with chemotherapy and intensity-modulated radiation therapy (IMRT) consecutively.

Outcomes:

The patient experienced an excellent recovery with the disappearance of pain and the lump, along with return of a healthy appetite, weight gain and positive outlook. Complete response (CR) was also noted by magnetic resonance imaging (MRI) scan, with the upper right neck mass significantly retreated to unclear display. The patient is still alive with stable, asymptomatic disease at the time of this writing.

Lessons:

These results provide confidence in the safety and efficacy of radical chemo-radio-immunotherapy for the treatment of recurrent, unresectable or metastatic HNSCC.
Effect of tibialis anterior muscle resistance training on ankle and foot dorsum extension function in hypertensive cerebral hemorrhage hemiplegia patients: A randomized controlled trial
Authors: Li Qiaoliang , Chen LiGang
Published: August 2023

Background:

This study aimed to investigate the effect of tibialis anterior muscle resistance training on ankle and foot dorsum extension function in patients with hemiplegia caused by hypertensive cerebral hemorrhage.

Methods:

Fifty cases of hypertensive cerebral hemorrhage in patients with hemiplegia were selected according to the random number table method. The patients were divided into the treatment group and control group. Each group included 25 cases, and the treatment group was given routine rehabilitation treatment and passive and active foot back stretch training (300 times/d). The control group received conventional rehabilitation treatment. The conventional rehabilitation treatment included stretching, muscle strengthening and other conventional rehabilitation treatment techniques. Surface electromyography was used to evaluate the muscle strength and tension of the triceps and tibialis anterior muscles of the affected side of the patients before and after treatment. The root mean square value of the surface electromyography (RMS) of the passive triceps extension before and after treatment was used to evaluate the muscle strength and tension of the affected side. The ratio of passive traction and relaxation of the triceps before and after treatment and the ratio of active contraction and relaxation of the tibialis anterior muscle before and after treatment were recorded.

Results:

There was no significant difference in surface electromyography between the 2 groups before treatment (P > .05). After 2 months of treatment, the results of patients in both groups improved compared with those before treatment. The RMS of triceps in the treatment group was significantly lower than that in the control group, and the ratio of RMS of triceps in the treatment group was significantly lower than that in the control group. The RMS during active contraction and the RMS ratio between active contraction and relaxation of the tibialis anterior muscle in the treatment group were significantly higher than those in the control group (P < .05).

Conclusions:

Tibialis anterior muscle resistance training can effectively improve the strength of the tibialis anterior muscle in patients with hemiplegia caused by hypertensive cerebral hemorrhage, reduce tension in the triceps calf muscle, and improve ankle joint function and foot dorsum extension.
Application of split pancreatic duct stent in laparoscopic pancreaticoduodenectomy
Authors: Tu Jianhua , Huang Changwen , Xu Wenyan , Gong Shuaichang , Cao Zhenjun , Wan Ping , Ying Junxiang , Rao Xuefeng
Published: August 2023

Laparoscopic pancreaticoduodenectomy (LPD) is a classic surgical method for diseases, such as tumors at the lower end of the common bile duct, pancreatic head, and benign and malignant tumors of the duodenum. Postoperative pancreatic fistula (POPF) is one of the most serious complications of LPD. To reduce the incidence of grade B or C POPF and other complications after LPD, we applied a split pancreatic duct stent combined with the characteristics of internal and external stent drainage. Between September 2020 and September 2022,12 patients underwent placement of the Split pancreatic duct stent during LPD. Data on basic characteristics of patients, surgical related indicators and postoperative POPF incidence were collected and analyzed. The results showed that the average operation time was 294.2 ± 36 minutes, average time for pancreaticojejunostomy was 35.9 ± 4.1 minutes, and average estimated blood loss was 204.2 ± 58.2 mL. Biochemical leakage occurred in 2 patients (16.7%), whereas no grade B or C POPF, 1 case (8.3%) had postoperative bleeding, and no death occurred within 30 days after the operation. Preliminary experience shows that the split pancreatic duct stent can effectively reduce the incidence of complications after LPD, especially grade B or C POPF.
Evaluating the efficacy of moving cupping for chronic low back pain using shear wave elastography: A parallel-arm, randomized controlled trial
Authors: Kim Yeonhak , Kim Jihun , Lee Taewook , Kim Eunseok , Kim Kun Hyung , Yang Gi Young
Published: August 2023

Background:

Chronic low back pain (CLBP) is a common condition that affects millions of people worldwide. Moving cupping has gained popularity as a complementary therapy for managing CLBP owing to its noninvasive and cost-effective nature. However, the lack of objective measures to assess its therapeutic effect has been a considerable challenge in evaluating the effectiveness of moving cupping for CLBP management.

Methods:

We developed a randomized controlled trial (RCT) protocol for evaluating the effectiveness of a noninvasive treatment using moving cupping by assessing muscle relaxation with shear wave elastography (SWE). It involves the recruitment of 68 patients with CLBP and randomly assigns them to either the treatment or control group. The treatment group will receive moving cupping therapy for 2 weeks, while the control group will receive placebo treatment. It will utilize SWE to evaluate muscle relaxation at baseline, after 2 weeks of treatment, and 1 week after the end of treatment. Subjective reports of pain intensity and quality of life are also recorded at each time point.

Discussion:

The protocol developed here utilizes SWE to objectively measure muscle stiffness, and coupled with moving cupping therapy, may be effective in conveying relative comparisons before and after treatment. Moving cupping therapy is expected to promote muscle relaxation and pain relief in patients with CLBP. This study has the potential to contribute to the development of objective measures for evaluating the therapeutic effects of traditional therapies and to provide valuable insight into their efficacy.
Surgical treatment of subchondral osteonecrosis of the humeral head: A case report and literature review
Authors: Liu Yongsheng , Zhong Jia , Jiang Zhaowei , Shen Duo , Zhao Daohong
Published: August 2023

Background:

Osteonecrosis of the humeral head is an uncommon subchondral bone disease with many etiologies, and there is currently no definite evidence to support an optimal surgical treatment plan. We report a case of surgical treatment of left humeral head necrosis. To the best of our knowledge, this is the youngest patient with non-drug-induced humeral head necrosis and the largest collapsed area.

Case presentation:

The case involved a 16-year-old male who injured his left shoulder 1 year ago. The patient was admitted to the hospital because of shoulder pain after activity in the year following the injury. During the physical examination, the left glenohumeral joint space was tender, the pain was obvious when the shoulder joint was rotated and squeezed, and the active and passive range of motion was normal. X-ray, magnetic resonance imaging, and computed tomography + 3D computed tomography scans all showed subchondral osteonecrosis of the left humeral head. Left humeral head lesion removal and autologous osteochondral transplantation were performed, and the patient was followed up.

Conclusion:

Non-drug-induced humeral head necrosis is rare. Autologous osteochondral transplantation is currently one of the most mature and effective treatment methods. The short-term curative effect in this patient is satisfactory, but the patient is young and has a large collapsed area, so long-term follow-up is worthwhile.
Efficacy and safety of an extended-release sebacoyl dinalbuphine ester for laparoscopic cholecystectomy: A randomized controlled trial
Authors: Lee Ying-En , Fu Chen-Yu , Shiue Yow-Ling , Lu Chu-Yun , Chen Chung-Yen , Chen Jian-Han , Chen Jen-Lung , Lam Chen-Fuh
Published: August 2023

Background:

A long-acting κreceptor agonist parenteral analgesic may theoretically improve acute pain and reduce incidence of chronic postsurgical pain (CPSP) after laparoscopic cholecystectomy with minimal drug-related side effects of the traditional μreceptor opioids.

Methods:

Eighty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned to receive single intramuscular injection of an extended-release sebacoyl dinalbuphine ester (SDE, Naldebain 150 mg; n = 40) or placebo (n = 40) after anesthesia induction. Standard multimodal analgesia (MMA) was administered for postoperative pain control. The primary endpoint was pain intensity within 7 days after surgery. The secondary endpoints were incidence CPSP at 3 months and adverse reactions up to 7 days after surgery.

Results:

The highest visual analogue scale (VAS) and area under the curve of VAS 0 to 48 hours after operation were not different between the two groups and a similar proportion of patients requested rescue parenteral analgesics. Average pain intensities were also not different at 72 hours and 7 days after surgery. Incidence of CPSP was 22.5% and 13.1% in patients who received placebo and SDE treatment, respectively (P = .379). Significantly higher incidence of drug-related adverse events, including dizziness, nausea and injection site reactions, were recorded in the SDE group.

Conclusion:

A single dose of extended-release analgesic SDE given intraoperatively did not provide sufficient add-on effect for acute and chronic pain management after laparoscopic cholecystectomies in patients who received standard postoperative MMA. Intramuscular injection of 150 mg SDE in patients with average body mass causes adverse events that could have been overlooked. More clinical studies are warranted to determine the target populations who may benefit from SDE injections for improvement of acute and chronic postsurgical pain management.
Lung volume reduction for emphysema using one-way endobronchial valves: An Australian cohort
Authors: Sidhu Calvin , Wilsmore Nicholas , Shargill Narinder , Rangamuwa Kanishka
Published: August 2023

Emphysema can be associated with gas trapping and hyperinflation, which negatively impacts on quality of life, life expectancy, and functional capacity. Lung volume reduction (LVR) surgery can reduce gas trapping and improve mortality in select patients but carries a high risk of major complications. Bronchoscopic techniques for LVR using one-way endobronchial valves (EBV) have become an established efficacious alternative to surgery. A bi-center retrospective cohort study was conducted on patients with severe emphysema who underwent endoscopic lung volume reduction (ELVR) using Pulmonx Zephyr EBVs. Symptomatic patients with gas-trapping and hyperinflation on lung function testing were selected. Target-lobe selection was based on quantitative imaging analysis and ventilation-perfusion scintigraphy. Successful procedures were determined from clinical review, imaging and follow-up testing. Thirty-nine patients underwent ELVR. Mean pre-procedure forced expiratory volume in 1 second (FEV1) was 0.75 L, residual volume (RV) was 225% predicted and total lung capacity was 129% predicted. Most common treated-lobe was left upper lobe. Post-procedure pneumothorax occurred in 36.5% of patients with 73% requiring intercostal catheter insertion for drainage. Mean FEV1 improvement was +140 mL and 57% of patients achieved minimal clinical important difference FEV1 increase of ≥12%. Maximal mean RV change was −1010 mL with 69% of patients achieving minimal clinical important difference RV decrease of ≥350 mL. Clinician-determined success of ELVR was 78%. Procedure-related mortality was absent. LVR using EBVs is safe and can lead to significant improvements in lung function, particularly reduction of gas trapping and hyperinflation. Occurrence of pneumothorax post-procedure is a complication that must be monitored for and managed appropriately.
Classification and clinical significance of the posterior group of renal calyces
Authors: Qi Yucheng , Lin Fangyou , Li Bojun , Han Shangting , Yu Weimin , Rao Ting , Zhou Xiangjun , Ning Jinzhuo , Xiong Zhuang , Cheng Fan
Published: August 2023

To study the anatomical orientation of the posterior group of calyces based on reconstructed images of computerized tomography urography (CTU) and provide a novel classification with its clinical significance. Clinical data of a total of 1321 patients, who underwent CTU examination in our hospital were retrospectively analyzed. Among these, a total of 2642 3-dimensional reconstructed images of CTU scans were considered in this study. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group renal calyces are classified into 3 major types including pot-belly type, classically branched and elongated branched. The classically branched type is further classified into 3 sub-types: a, b and c, based on the association of minor calyces of the posterior group to the major calyces. Type a is derived from 1 group of major calyces only, type b is derived from 2 groups of major calyces simultaneously, and type c is derived from 3 groups of major calyces simultaneously. Statistical findings revealed that all kidneys possess posterior group calyces. The percentage of occurrence of pot-belly type, classically branched and elongated branched is 8.06%, 73.13%, and 18.81%, respectively. The anatomical typing of the classical branching type occurred in 19.36%, 68.17%, and 12.47% for types a, b, and c, respectively. In this study, the posterior group calyces were found to be present across all patients. The posterior group calyces were highest in the classical branching type, of which anatomical typing was highest in type b. The typing of the posterior group of calyces could provide an anatomical basis for percutaneous nephrolithotomy (PCNL) puncture from the posterior group.
Quantitative MR texture analysis for the differentiation of uterine smooth muscle tumors with high signal intensity on T2-weighted imaging
Authors: Kumagai Kazuki , Yagi Takuya , Yamazaki Motohiko , Tasaki Akiko , Asatani Mina , Ishikawa Hiroyuki
Published: August 2023

The purpose of this study was to distinguish leiomyosarcomas/smooth muscle tumors of uncertain malignant potential (STUMP) from leiomyomas with high signal intensity (SI) on T2-weighted imaging (T2WI) using quantitative MR texture analysis combined with patient characteristics and visual assessment. Thirty-one leiomyomas, 2 STUMPs, and 6 leiomyosarcomas showing high SI on T2WI were included. First, we searched for differences in patient characteristics and visual assessment between leiomyomas and leiomyosarcomas/STUMPs. We also compared the MR texture on T2WI and the apparent diffusion coefficient (ADC) to identify differences between leiomyomas and leiomyosarcomas/STUMPs. In the univariate analysis, significant differences between leiomyomas and leiomyosarcomas/STUMPs were observed in age, menopausal status, margin, hemorrhage, long diameter, T2-variance, T2-volume, ADC-variance, ADC-entropy, ADC-uniformity, ADC-90th and 95th percentile values, and ADC-volume (P < .05, respectively). There were significantly more postmenopausal patients with leiomyosarcomas/STUMPs than with leiomyomas, and leiomyosarcomas/STUMPs had more irregular margins, more frequent presence of hemorrhage and exhibited larger tumor diameters, T2-volume, T2-variance, ADC-volume, ADC-variance, ADC-entropy, and higher ADC-90th and 95th percentile values but lower ADC-uniformity. Multivariate analyses revealed that the independent differentiators were menopausal status, hemorrhage and ADC-entropy (P < .05, respectively). The area under the curve obtained by combining the 3 items was 0.980. The best cutoff value for ADC-entropy was 9.625 (sensitivity: 100%, specificity: 58%). The combination of menopausal status, hemorrhage, and ADC-entropy can help accurately distinguish leiomyosarcomas/STUMPs from leiomyomas with high SI on T2WI; however, external validation in a larger population is required because of the small sample size of our study.