bluuebunny/crossref_metadata_2025 huggingface dataset:
The Feasibility of Harvesting an Innervated Profunda Artery Perforator Flap for Breast Reconstruction
Authors: Yano Tomoyuki , Karakawa Ryo , Yoshimatsu Hidehiko , Fuse Yuma , Shibata Tomoyoshi , Kuramoto Yukiko , Suesada Nobuko , Miyashita Hiroki
Published: April 2021

The profunda artery perforator (PAP) flap has become an alternative option for breast reconstruction. Reliable perforators arise through the adductor magnus muscle, and dissection of the perforator is straightforward. Recently, we have found that the PAP flap with the sensory nerves can be harvested as an innervated flap. We discuss the feasibility of PAP flap neurotization. We reviewed 13 patients for whom innervated PAP flap harvesting was considered. The average age was 50.7 years. There are 3 different patterns of innervated PAP flap harvesting, Type 1: including a sensory nerve that can be found in the adipose tissue around the PAP flap, Type 2: including a sensory nerve that runs along the medial femoral circumflex system, and Type 3: including a sensory nerve that runs along the profunda artery perforators. The average flap harvest time was 2:11 ± 0:31, and a sensory nerve was identified in 10 of 13 cases (77%). No sensory nerves were found in the other 3 cases. The length of the included sensory nerve was 5.5 ± 1.6 mm on average. Types 1 and 2 were found in 3 patients (30%), Type 3 was found in 2 patients (20%), and combined Types 1 and 3, 2 and 3 were found in one patient each (10%). As sensory nerves run around the PAP flap or close to the perforators, it is easy to perform flap neurotization with the PAP flap. We believe that the PAP flap could be an alternative option to achieve sensate breast reconstruction.
Temporal Fossa Atrophy in Aesthetic Medicine: Anatomy, Classification, and Treatment
Authors: Idone Francesco , Bolletta Elisa , Piedimonte Andrea , Paternostro Ferdinando
Published: April 2021

Hyaluronic acid fillers indisputably represent an important tool for face rejuvenation and volume restoration. The temporal area has recently been considered as a potential site of injection. As it happens in the middle face and in other regions of the face, the temporal fossa changes according to the aging process. In a young person, the temple profile has a fullness aspect, and this contributes to giving the face a beautiful and healthy appearance. With age, the loss of volume leads the bone prominences to be visible. The aim of this article is to classify the temporal fossa atrophy and get better into the anatomy, identifying the ideal plane to inject in, through the use of a safe and reliable technique. Cadaver dissections have been performed to specifically describe the anatomy of the temple layer by layer. The authors’ preferred technique, called interfascial by cannula implantation, is discussed. All the treated patients reported a good improvement by survey according to the Global Aesthetic Improvement Scale scale. No major complications were detected. No ecchymosis neither swelling were documented. Although further studies are necessary to broaden the casuistry and better verify the potentiality of this technique, the authors do believe that it could be considered a very reliable procedure with pretty consistent results, if supported by an adequate and imperative anatomical knowledge.
“On Arrival Block”—Management of Upper Extremity Trauma with Resuscitation in the Operating Room
Authors: Sabapathy S. Raja , Venkateswaran G. , Boopathi V. , Subramanian J. Balavenkat
Published: April 2021

“On Arrival Block,” wherein a brachial block is given to a severely injured upper extremity as the first step of the management protocol in the main operating room, bypassing the emergency department, has been found to be a “game changer” in trauma care. Immediate pain relief on arrival builds confidence in the system, allows pain-free initial examination, facilitates use of tourniquet if there are major bleeding wounds, and allows us to obtain good radiographs without an overlap of bones, which usually happens when the radiographs are taken within a bandage. Using the “On Arrival Block” system, emergency room assessment and resuscitation is bypassed. The patient is resuscitated only once, instead of twice. This avoids much duplication of effort, wasted time, patient suffering, unnecessary costs, and mistakes generated by miscommunication between 2 resuscitation teams. This can be done only in the place where all the resuscitative equipment and drugs are available. A senior anesthesiologist and surgeon must be available. The only contraindication is the suspicion of a brachial plexus injury, which can cause the local anesthetic to seep in through the open dural sleeve and cause total spinal anesthesia. “On Arrival Block” was set up at Ganga Hospital, Coimbatore, India, during the early 90s by the anesthesiologist Ravindra Bhat and the plastic surgeon Raja Sabapathy out of necessity, who recognized its value and made it the standard of care.
Nasal Tip Delamination: A Technique for Nasal Tip Projection and Control in Rhinoplasty
Authors: Gfrerer Lisa , Riesel Johanna N. , Bartlett Richard A.
Published: April 2021

Background:

Control of tip projection and rotation is critical to a successful rhinoplasty. Suture techniques that change the relationship of the medial crura to the caudal septum can effectively manage tip position, but may be technically challenging or require specialized sutures. The authors present a technique (“tip delamination”) that allows symmetrical exposure of the medial crura and caudal septum for accurate placement of projection control sutures using commonly available suture materials.

Methods:

We describe a novel technique to completely expose (or delaminate) the medial crura of the lower lateral cartilages to allow for 360-degree access to and manipulation of these critical structures. We present a case series of 3 patients.

Results:

Exemplary cases with 1 intraoperative video will be reviewed to demonstrate how tip delamination allows for more precise control of the medial crura and nasal tip.

Conclusions:

Nasal tip delamination is a simple technique for manipulating the medial crura and nasal tip in rhinoplasty procedures. Nasal tip delamination adds minimal time and morbidity to the procedure and offers significant control for the surgeon, with beneficial outcomes for the patient.
Cardioplastic Approach to Omental Flap Coverage for Severe Aortic Root Infections in the Opioid Era
Authors: Bonaroti Alisha R. , Edmunds R. Wesley , DeCoster Ryan C. , Liau James Y. , Sekela Michael E. , Vasconez Henry C.
Published: April 2021

Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four patients were treated with pedicled omental flap coverage after aortic root reconstruction. All patients had successful flap healing with no evidence of recurrent infection. This series demonstrates the technical feasibility and clinical utility for providing soft tissue coverage and antimicrobial protection when used in aortic root reconstruction.
The Race for a COVID-19 Vaccine: Current Trials, Novel Technologies, and Future Directions
Authors: Brown Stav , Brown Tal , Cederna Paul S. , Rohrich Rod J.
Published: April 2021

The Coronavirus Disease 2019 (COVID-19) pandemic has presented a major threat to public health worldwide alongside unprecedented global economic and social implications. In the absence of a “gold standard” treatment, the rapid development of a safe and effective vaccine is considered the most promising way to control the pandemic. In recent years, traditional vaccine technologies have seemed insufficient to provide global protection against the rapid spread of emerging pandemics. Therefore, the establishment of novel approaches that are independent of whole pathogen cultivation, cost-effective, and able to be rapidly developed and produced on a large scale are of paramount importance for global health. This article summarizes the current efforts to develop a COVID-19 vaccine, including the ongoing and future anticipated clinical trials. We also provide plastic and reconstructive surgeons with insight into the novel technologies currently utilized for COVID-19 vaccine development, focusing on the very promising viral-vector-based and gene-based vaccine technologies. Each platform has its own advantages and disadvantages related to its efficacy and ability to induce certain immune responses, manufacturing capacity, and safety for human use. Once the fundamental key challenges have been addressed for viral-vector-based and gene-based vaccines, these novel technologies may become helpful in winning the fight against COVID-19 and transforming the future of health care.
Assessing State Variation in Plastic Surgeons’ Risk of Hepatitis C Exposure: Revisit in Methodology
Authors: Hardy Kristen M. , Mullens Cody L. , Mason Aaron C.
Published: April 2021

Background:

As the national opioid epidemic escalates, rates of the Hepatitis C (HCV) infection have similarly risen. Surgeons exposed intraoperatively secondary to sharp instrument or needle-sticks are affected both socioeconomically and physically. Current treatment strategies involve antiretroviral agents that have not been universally available. This study evaluates the current risk of surgeon exposure to HCV.

Methods:

CDC data regarding state-by-state HCV diagnosis reporting were combined with the plastic surgery workforce data from the ASPS. Proxy variables for exposure risk to HCV were generated for each state and compared.

Results:

West Virginia plastic surgeons were found to have a significantly elevated risk of exposure (60.0 versus 18.7, P < 0.0001). Their exposure risk is a notable outlier compared with the rest of the country (Risk >3 × IQR + 75th percentile). Similarly, states within the Ohio Valley were found to be at increased risk (34.8 versus 16.0, P = 0.05). States most heavily burdened by the opioid crisis were found to be at an increased risk for HCV exposure (40.8 versus 13.6, P = 0.0003).

Conclusions:

Plastic surgeons employed in states within the Ohio Valley were found to be at an increased risk of exposure to HCV. Plastic surgeons operating in states severely impacted by the opioid crisis were found to be at an increased risk of exposure. These findings underscore the importance of reducing the risk in the operating room and the need for better data collection to better understand this association and mitigate the risk to the operating surgeon.
Peters Anomaly in Nail-Patella Syndrome: A Case Report and Clinico-Genetic Correlation
Authors: Ramappa Muralidhar , Gandhi Uppal , Chaurasia Sunita , Kabra Meha , Kaur Inderjeet , Mittal Ruchi , Mishra Dilip Kumar , Chakrabarti Subhabrata , Edward Deepak P.
Published: April 2021

Purpose:

The purpose of this study was to report the clinicopathological features of Peters anomaly in a child with nail-patella syndrome.

Methods:

Nail-patella syndrome (NPS) is a rare autosomal dominant connective tissue disorder characterized by several anomalies of the extremities, joints and nails, glomerulopathy, and rarely ocular involvement. NPS is caused by heterozygous loss-of-functional mutations in the LMX1B gene that encodes the LIM homeodomain proteins.

Results:

This case reports a new association of Peters anomaly in a child with NPS that also had classic skeletal/nail anomalies and protein losing nephropathy. Furthermore, DNA sequence analysis identified a novel missense heterozygous mutation in the LMX1B gene (Transcript ID: NM_001174146) resulting in the replacement of tryptophan by serine in codon 266, suggesting that the mutation (p.Trp.266Ser) affects LMX1B function by disturbing its interactions with other proteins. To the best of our knowledge, this association of Peters anomaly is novel and has not been reported earlier in the ophthalmic and systemic literature on NPS.

Conclusion:

The corneal findings in our case with NPS are similar to those seen in congenital corneal opacification because of Peters anomaly. This novel association of Peters anomaly with NPS may be related to the effects of the LMX1B mutation on corneal development.
Corneal Neurotization: A Novel Surgical Procedure for Neurotrophic Keratopathy
Authors: Giannaccare Giuseppe , Bolognesi Federico , Pellegrini Marco , Spena Rossella , Allevi Fabiana , Marchetti Claudio , Scorcia Vincenzo , Biglioli Federico
Published: April 2021

Purpose:

The aim of this study is to describe techniques, results, and open issues of corneal neurotization (CN) for the treatment of neurotrophic keratopathy (NK).

Methods:

An overview of the most important studies of CN is provided. The 2 main surgical approaches (namely, direct CN and indirect CN) with specific advantages and disadvantages are described. The results regarding changes of corneal sensitivity and clarity, visual acuity, and in vivo confocal microscopy metrics are summarized. Ex vivo studies with histopathology of the neurotized cornea are reported. Intraoperative and early and late postoperative complications are described along with current open issues to be further clarified.

Results:

Corneal sensitivity improves after both direct and indirect CN. Corneal reinnervation allows the healing of NK in almost the totality of the operated eyes, determining a corresponding improvement of corneal clarity and visual acuity. Regeneration of corneal nerve fibers is confirmed by means of either in vivo confocal microscopy or ex vivo histopathology. Few self-limiting complications are reported during the postoperative course. Current open issues concern the identification of the technique of choice, the use of autograft or allograft, and the timing of CN either when performed alone or when combined with other surgeries.

Conclusions:

CN represents a game-changing surgical procedure for NK, which has the potential to restore corneal sensitivity in all stages of the disease regardless of the mechanism of denervation. Further long-term results are needed to confirm its efficacy over time. The design of randomized clinical trials comparing CN with noninterventional therapies could further validate the adoption of this technique.
Pericarditis as the Main Clinical Manifestation of COVID-19 in Adolescents
Authors: Dimopoulou Dimitra , Spyridis Nikolaos , Dasoula Foteini , Krepis Panagiotis , Eleftheriou Eirini , Liaska Marianthi , Servos Giorgos , Maritsi Despoina , Tsolia Maria
Published: April 2021

Children and adolescents with severe acute respiratory syndrome coronavirus 2 infection usually have a milder illness, lower mortality rates and may manifest different clinical entities compared with adults. Acute effusive pericarditis is a rare clinical manifestation in patients with COVID-19, especially among those without concurrent pulmonary disease or myocardial injury. We present 2 cases of acute pericarditis, in the absence of initial respiratory or other symptoms, in adolescents with COVID-19.
Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials
Authors: Buzasi Eva , Kurakata Hiroshi , Gandhi Akash , Birch Helen L. , Zarnegar Roxaneh , Best Lawrence
Published: April 2021

Our objective was to investigate the effectiveness of booster sessions after self-management interventions as a means of maintaining self-management behaviours in the treatment of chronic musculoskeletal pain. We searched MEDLINE, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, and PsychINFO. Two authors independently identified eligible trials and collected data. We calculated the odds ratio for the analyses of dichotomous data and standardised mean differences (SMDs) with 95% confidence interval (CI) for continuous variables. Our search identified 14 studies with a total of 1695 patients. All studies were at high risk of bias and provided very low quality evidence. For the primary outcomes, booster sessions had no evidence of an effect on improving patient-reported outcomes on physical function (SMD −0.13, 95% CI −0.32 to −0.06; P = 0.18), pain-related disability (SMD −0.16, 95% CI −0.36 to 0.03; P = 0.11), and pain self-efficacy (SMD 0.15, 95% CI −0.07 to 0.36; P = 0.18). For the secondary outcomes, booster sessions caused a significant reduction in patient-reported pain catastrophising (SMD −0.42, 95% CI −0.64 to −0.19; P = 0.0004) and no evidence of an effect on patient-reported pain intensity, depression, coping, or treatment adherence. There is currently little evidence that booster sessions are an effective way to prolong positive treatment effects or improve symptoms of long-term musculoskeletal conditions after self-management interventions. However, the studies were few with high heterogeneity, high risk of bias, and overall low quality of evidence. Our review argues against including booster sessions routinely to self-management interventions for the purpose of behaviour maintenance.
Medical Diagnoses in a University Athlete Training Room Clinic
Authors: McMurray Nathan , Reinke Emily , Riboh Jonathan , Pyles Courtney , Bytomski Jeffrey
Published: April 2021

Introduction:

Approximately 560 000 student–athletes participate in university athletic programs every year. These athletes develop a variety of medical injuries and illnesses during their time at the university. There is currently a paucity of data with regarding medical encounters in a dedicated university athlete training room clinic.

Objective:

This study aims to provide data regarding medical diagnoses from a university athlete training room clinic.

Study design:

Descriptive epidemiology study.

Setting:

University athlete training room clinic.

Patients:

University athletes.

Methods:

The electronic medical record for a year-round, athlete-only training room clinic at a private US university was reviewed. Athlete age, sex, sport, date of medical encounter, and encounter diagnoses across 5 calendar years were recorded; medical diagnoses were then manually stratified into diagnostic categories and subgroups.

Results:

A total of 1258 university athletes were evaluated during 5303 medical encounters. Approximately two-thirds of athletes were evaluated one or more times per year. Average number of encounters per athlete per year was 2.2 (0.6-3.8, 95% confidence interval). The football team accounted for the greatest number of encounters (15.2% of total encounters). The most common medical diagnosis category was otorhinolaryngology (30.6% of total diagnoses). The most common diagnosis subgroup was upper respiratory infection (14.8% of total diagnoses).

Conclusions:

Approximately two-thirds of athletes were evaluated annually with an average of 2 encounters per athlete per year. Upper respiratory infection represented the most common individual diagnosis. The results reported in this study may be useful in directing future care and research of university athletes.
Assessment of Saccades and Gaze Stability in the Diagnosis of Pediatric Concussion
Authors: Storey Eileen P. , Corwin Daniel J. , McDonald Catherine C. , Arbogast Kristy B. , Metzger Kristina B. , Pfeiffer Melissa R. , Margulies Susan S. , Grady Matthew F. , Master Christina L.
Published: April 2021

Objective:

To evaluate the discriminatory ability of different repetition increments of saccades and gaze stability testing for diagnosing concussion in adolescents.

Design:

Cross-sectional.

Setting:

Suburban high school and academic pediatric tertiary care center.

Participants:

Sixty-nine adolescent athletes within 28 days of a sports- or recreation-related concussion and 69 adolescent athletes without recent concussion.

Assessment of Independent Variables:

Symptom provocation with horizontal and vertical saccades and gaze stability testing performed up to 30 repetitions.

Main Outcome Measures:

Sensitivity and specificity at 10-repetition increments (≤10, ≤20, ≤30) and area under the receiver operating characteristic curves (AUC) of a visio-vestibular examination (VVE) subscore, scored 0 to 4 based on the number of assessments with symptom provocation, at each repetition increment.

Results:

Sensitivity improved when increasing from ≤10 to ≤20 to ≤30 repetitions for horizontal (25% to 50% to 69%) and vertical (32% to 52% to 74%) saccades and horizontal (19% to 45% to 71%) and vertical (23% to 45% to 72%) gaze stability. Specificity was comparable at ≤10 and ≤20 repetitions, but decreased at ≤30 repetitions across assessments. For a VVE subscore (0-4) based on the number of symptomatic assessments, the discriminatory ability of the test was highest at ≤20 repetitions (AUC of 0.79) with an optimal subscore of one (sensitivity 59%, specificity 96%).

Conclusions:

A VVE including a higher threshold level of repetitions for saccades and gaze stability has improved discriminatory ability for concussion, with an optimized AUC of 0.79 at ≤20 repetitions.

Clinical Relevance:

The findings in this study suggest that a higher threshold level of repetitions of 2 commonly used visio-vestibular assessments enables clinicians to more accurately diagnose youth concussion.
Risk Factors for Persistent Pain Requiring Surgical Treatment in Adult Symptomatic Accessory Navicular
Authors: Park Young Hwan , Kim Woon , Choi Jung Woo , Kim Hak Jun
Published: April 2021

Objective:

Identifying the risk factors for persistent pain despite proper conservative treatment in adult symptomatic accessory navicular may reduce the need for surgical treatment. The aim of this study was to identify any such risk factors.

Design:

Cohort study.

Setting:

University hospital foot and ankle clinic.

Patients:

A retrospective review of 313 patients who presented with adult symptomatic accessory navicular was performed.

Assessment of Risk Factors:

Potential risk factors were identified via medical records and foot radiographs. The possible risk factors included age, gender, body mass index, smoking status, occurrence/cause of symptoms, occupation, type of accessory navicular, and radiographic foot parameters.

Main Outcome Measures:

Predictors that relate to persistent pain requiring surgical treatment in adult accessory navicular were analyzed using logistic regression analysis.

Results:

Of the 313 patients included, 30 (9.6%) underwent surgical treatment due to failure of conservative treatment. The odds of needing surgical treatment decreased by 0.96 per year of age at symptom onset (P = 0.030), but those odds were 8.52 times higher in patients who had a type IIB accessory navicular (P = 0.001). Other variables did not reach statistical significance.

Conclusions:

Younger age at symptom onset and type IIB were the risk factors for persistent pain requiring surgical treatment in adult symptomatic accessory navicular.
No correlation between mean platelet volume and carotid artery thickness in patients with diabetes at intermediate or high risk for cardiovascular diseases
Authors: Sadatani Keita , Niiya Kenji , Miyamoto Ichiyo , Nakano Mari , Habara Toshiyuki , Sezaki Nobuo
Published: April 2021

The number of patients with diabetes with a risk of cardiovascular diseases (CVDs) is increasing worldwide, leading to a higher demand for evaluating atherosclerosis. Recently, the mean platelet volume (MPV) available from complete blood count is gaining attention as a marker of underlying atherosclerotic lesions. In the current study, we examined whether MPV can predict carotid atherosclerosis in patients with diabetes at an intermediate or high risk for CVD. A total of 224 patients with diabetes aged 36–85 years who underwent carotid ultrasound examination were assessed. The risk of CVD was evaluated using the Suita score. The greatest carotid intima–media thickness (IMT) in each common carotid artery (CCA Max-IMT), carotid bulb, internal carotid artery, or external carotid artery (Total Max-IMT) was measured. Subsequently, the relationship between MPV and IMT was analyzed. Patients were divided into three groups according to their MPV values (<9.5 fl, tertile 1; 9.5–10.2 fl, tertile 2; and >10.2 fl, tertile 3). A correlation was observed between MPV and platelet count (P < 0.001), platelet distribution width (P < 0.001), and glycated hemoglobin (P = 0.04); however, multivariate logistic regression analyses demonstrated no relationship between MPV and CCA Max-IMT [odds ratio, 0.89 (0.60–1.29), P = 0.54] or Total Max-IMT [odds ratio, 0.87 (0.61–1.24), P = 0.45]. MPV did not correlate with carotid artery thickness. Therefore, it is difficult to determine the significance of MPV in atherosclerotic conditions from this study.
Bilateral chorioretinal folds in patients with central serous chorioretinopathy
Authors: Terubayashi Yuya , Kida Teruyo , Morishita Seita , Kobayashi Takatoshi , Sato Takaki , Sato Bunpei , Ikeda Tsunehiko
Published: April 2021

Introduction:

Chorioretinal folds accompanied by central serous chorioretinopathy (CSC) are relatively uncommon. Here, we report CARE-compliant 2 patients with bilateral CSC chorioretinal folds and CSC that was followed-up for 2 years.

Patient concerns:

Case 1 was a 68-year-old female who complained of central visual field disturbance in her left eye. At the initial visit, her visual acuity (VA) was 20/20 in her right eye and 20/40 in her left. She had a history of systemic hypertension and an optic neuropathy in her left eye 20 years previously. Case 2 was a 63-year-old female with CSC in her right eye. Her VA at her first visit was 20/200 in her right eye and 20/20 in her left.

Diagnosis:

In case 1, an examination revealed serous retinal detachment (SRD) in the macula and optic disc atrophy in her left eye and both fundi showed chorioretinal folds. Fluorescein angiography showed a fluorescein leakage area in her left eye. In case 2, examination of fundus showed marked SRD in her right macula and both fundi had chorioretinal folds. fluorescein angiography showed a fluorescein leakage area and indocyanine green angiography showed vascular hyperpermeability, but no choroidal neovascularization.

Interventions and outcomes:

In case 1, the patient rejected the photocoagulation treatment. Her SRD resolved spontaneously and the VA improved to 20/20 in her left eye nine months after the first visit. But the chorioretinal folds in both eyes remain till date. In case 2, photodynamic therapy was planned; however, her SRD disappeared spontaneously. Photocoagulation therapy was performed at the leak point and her VA improved to 20/20, but the bilateral chorioretinal folds remain till date. There has been no recurrence of CSC in both the patients in the 2 year follow-up.

Conclusions:

The exact mechanism of CSC remains uncertain. Choroidal vascular abnormalities, such as choroidal hyperpermeability and dilated choroidal vessels associated with congested vortex veins, have been previously reported even in the unaffected eye of CSC patients. We theorize that the bilateral chorioretinal folds in CSC patients were possibly induced by the outflow congestion of the vortex vein due to the marked CSC and choroidal dysregulation. As the choroid expanded due to CSC, the overlying Bruch membrane was forced into folds. Further investigation of the pathophysiology of CSC is needed.
Septic coronary embolism treated with manual aspiration thrombectomy
Authors: Cardoso Monti Sousa Luhanda Leonora , de Carvalho Andreucci Torres Leal Tatiana , de Matos Soeiro Alexandre , Soares Paulo Rogério , Scudeler Thiago Luis
Published: April 2021

Rationale:

Systemic embolism is a known complication of infective endocarditis (IE), but it rarely presents as acute myocardial infarction (AMI). Aspiration thrombectomy without stenting is a possible approach in this context. The authors present a rare case of coronary embolism caused by Aggregatibacter aphrophilus IE successfully treated with manual aspiration thrombectomy.

Patient concerns:

A 19-year-old man with previous valve disease was admitted to the emergency department with fever and dyspnea. The next day, the patient presented with chest pain and hemodynamic instability.

Diagnosis:

Transesophageal echocardiography confirmed the presence of infectious endocarditis at the mitro-aortic junction. Blood cultures identified Aggregatibacter aphrophilus. Electrocardiogram showed significant ST segment elevation in leads V1 to V5, indicating AMI. Coronary angiography revealed total occlusion of the left anterior descending artery. The histopathological examination of the material aspirated from the coronary artery showed fibrin thrombi containing gram-negative cocci.

Interventions:

Manual aspiration thrombectomy was performed without stent implantation. No antithrombotic therapy was needed during and post-procedure. After clinical stabilization, the patient underwent cardiac surgery.

Outcomes:

Transesophageal echocardiogram before discharge showed preserved left ventricular function, with no segmental left ventricular wall motion abnormalities, and the aortic metal prosthesis without dysfunction. After discharge, a new transesophageal echocardiogram was performed with 1 month of follow-up. No evidence of recurrence of IE was found in the first postoperative review and the patient remained stable.

Lessons:

Manual aspiration thrombectomy without stenting and antithrombin therapy is feasible in patients with AMI due to IE.
High frequency spinal cord stimulation can be more effective than traditional spinal cord stimulation in treating complex regional pain syndrome
Authors: Massey Harrison R. , Massey Benjamin H. , Stitik Todd P.
Published: April 2021

Introduction:

This case report demonstrates the effectiveness of high frequency 10 kHz spinal cord stimulation (HF10 therapy SCS) in the treatment of Complex Regional Pain Syndrome (CRPS) when compared with other treatment modalities including traditional SCS. Traditional SCS is believed to exert its action through stimulating the dorsal columns mitigating the hyperexcitable afferent signals from the periphery. Hf10 SCS delivers more stimulation to the dorsal horns targeting specifically the wide dynamic range neurons (pain projecting neurons). This creates a greater potential to suppress the sympathetic overactivity seen in CRPS while additionally removing the paresthesia's generated with dorsal column stimulation, which many find unpleasant.

Patient concerns:

59-year-old Caucasian male presented with classic right lower limb symptoms of CRPS and longstanding low back pain with right-sided radiculopathy.

Diagnosis:

The patient developed CRPS after right leg open thrombectomy.

Interventions:

The patient received para-sagittal steroid epidural injections and lumbar sympathetic blocks with inadequate pain relief. He failed to improve using traditional SCS and was referred for evaluation using high frequency 10 kHz spinal cord stimulator, which the SENZA-RCT showed superior pain relief when compared to traditional stimulation.

Outcome:

This case is unique because the patient had no improvement with traditional SCS and reported 100% relief of CRPS pain and associated symptoms and 40% reduction in back pain while using HF10. This also is significant because back pain tends to be refractory when treated with traditional SCS.

Conclusion:

High frequency 10 kHz spinal cord stimulator might be an effective means of managing the symptoms of CRPS and reducing axial back pain.
HELLP syndrome complicated by subcapsular liver hematoma
Authors: Fan HuiKang , Zhang Ping , Yang Daji , Sun Lu , Zhao WenChao , Pan Deng , Qi Jun
Published: April 2021

Rationale:

Subcapsular liver hematoma (SLH) is a rare but potentially fatal complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The SLH incidence rate is about 1% to 2% in patients with preeclampsia and HELLP syndrome.

Patient concerns:

A 28-year-old woman (gravida 3, parity 2) was admitted to the hospital at 26+1 gestation weeks because of upper abdominal discomfort of 2 weeks duration.

Diagnoses:

The patient was diagnosed with pre-eclampsia and HELLP syndrome. CT scan confirmed the presence of SLH.

Interventions:

The patient was treated with magnesium sulphate and Glucocorticoid was given for fetal lung maturation. But the blood pressure continued to rise. Cesarean section was performed, and a male infant was delivered with APGAR score 7.

Outcomes:

SLH resolved after the operation and the patient was discharged 6 days later. The newborn was discharged 1 month later from the intensive care.

Lessons:

HELLP syndrome complicated with SLH is a life-threatening condition for pregnant women and fetus. The decrease in blood volume due to bleeding can mask the underlying pre-eclampsia and delay the diagnosis and treatment.
Successful concomitant therapy with tofacitinib for anti- melanoma differentiation associated gene 5 antibody-positive rapidly progressive interstitial lung disease with poor prognostic factors
Authors: Machiyama Tomoaki , Shirai Tsuyoshi , Fujita Yoko , Sato Hiroko , Fujii Hiroshi , Ishii Tomonori , Harigae Hideo
Published: April 2021

Rationale:

Rapidly progressive interstitial lung disease (RP-ILD) is a severe complication of anti- melanoma differentiation associated gene 5 (MDA5) antibody-positive dermatomyositis and has an extremely poor prognosis.

Patient concerns:

We describe the case of a 62-year-old Japanese male with progressive hypoxemia. Laboratory examinations revealed elevated levels of serum ferritin, KL-6, myogenic enzymes, liver enzyme, inflammatory markers and Anti-MDA5-antibody positivity. Chest computed tomography revealed consolidation along the bronchovascular bundle with air bronchograms, predominantly in the inferior lobe of both lungs.

Diagnosis:

The patient was diagnosed as anti-MDA5 antibody-positive RP-ILD.

Interventions:

Respiratory failure continued to worsen even after conventional therapy with glucocorticoids and intravenous cyclophosphamide. Due to the severity of his symptoms, tofacitinib was used in combination with tacrolimus, rituximab, and plasma exchange.

Outcomes:

The severity of his respiratory symptoms dramatically decreased and he was discharged without the need for supplemental oxygen.

Lessons:

This case suggests that multi-target immunosuppressive therapy including tofacitinib can be useful for anti-MDA5 antibody-positive RP-ILD in patients with poor prognostic factors.
Cerebral vasculopathy in systemic sclerosis
Authors: Iwata Mai , Nakai Noriyoshi , Kunitake Katsuhiko , Inagakai Ryosuke , Furukawa Soma , Suzuki Junichiro , Nishida Suguru , Itoh Takayuki , Ito Yasuhiro
Published: April 2021

Introduction:

Systemic sclerosis (SS) is 1 of the representative connective tissue diseases commonly affecting vascular endothelial cells and has an unknown pathogenesis. In comparison with other connective tissue diseases, vascular involvement in the brain is relatively rare in SS.

Patient concerns:

A 40-year-old woman developed neurological symptoms at 1 year after the diagnosis of SS. Head magnetic resonance imaging demonstrated diverse neuroradiologic abnormalities indicating brain edema, ischemic lesions and vasodilation or microbleeds from small vessels. 99mTc-ethyl cysteinate dimer-single photon emission computed tomography revealed decreased blood flow in both frontal lobes.

Diagnosis:

The patient was diagnosed with cerebral vasculopathy in SS.

Interventions:

Oral administration of prednisolone 50 mg/d was started and gradually tapered.

Outcomes:

Her neurologic symptoms improved, and most of the neuroradiologic abnormalities were also resolved.

Conclusions:

Our case sheds light on the rare cerebral vasculopathy associated with SS and the importance of head magnetic resonance images and single photon emission computed tomography in the diagnosis and assessment of therapeutic efficacy.
A large cervical lymphatic malformation in a neonate successfully treated with Kampo medicine
Authors: Nakahata Kengo , Ogawa-Ochiai Keiko , Yamanaka Hiroaki , Noguchi Yuki , Saka Ryuta , Takama Yuichi , Ueno Takehisa , Tazuke Yuko , Hidaka Kuniyuki , Osuga Keigo , Okuyama Hiroomi
Published: April 2021

Introduction:

Recently the application of Kampo, or Japanese traditional medicine, to lymphatic malformation (LM) has been reported, but there are no reports of its effects against neonatal LM. We herein report a case of a neonatal huge cervical LM successfully treated with eppikajutsuto and ogikenchuto without tracheostomy or sclerotherapy.

Patient concerns:

A baby boy with a huge cyst in his right neck was delivered by Caesarean section without a prenatal diagnosis. The cyst extended and slightly compressed the trachea on the 7th day after birth.

Diagnosis:

The patient was diagnosed with LM by ultrasonography.

Interventions:

Although we planned sclerotherapy with OK-432 followed by tracheostomy, his parents refused tracheostomy. Therefore, we started the administration of eppikajutsuto (0.5 g/kg/d) on the 26th day of life instead of sclerotherapy. As the cyst was slightly enlarged at the beginning of eppikajutsuto administration, we increased the dose of eppikajutsuto to 0.75 g/kg/d and added ogikenchuto (0.4 g/kg/d), expecting greater regression of the lesion than with the initial regimen.

Outcomes:

After a few days, the cyst started to diminish in size. Six months later, magnetic resonance imaging showed remarkable regression of the LM without tracheal compression.

Lessons:

The combination of eppikajutsuto and ogikenchuto was thus found to be effective in the treatment of a neonatal LM. This is the first report to demonstrate that the dose-escalation of eppikajutsuto may therefore be effective without any severe adverse effects, even in neonates.
Acute ischemic stroke due to posterior cerebral artery P2 segment occlusion treated with mechanical thrombectomy
Authors: Zhang Donghuan , Liu Yifeng , Gao Jun , Wang Ning , Zhang Baochao , Kang Meijuan , Yu Yang , Chen Di , Liu Shaozhe , Wang Jie , Wen Changming
Published: April 2021

Introduction:

Mechanical thrombectomy (MT) has become part of the standard treatment for patients who have acute ischemic stroke due to large-vessel occlusion in the anterior cerebral circulation. But the safety and effectiveness of MT for posterior cerebral artery (PCA) is still controversial.

Patient concerns:

We report a 40-year-old man with a medical history of hypertension who was non-compliant with the treatment. He presented to the hospital with right extremity paralysis, aphasia, and left gaze paralysis due to the occlusion of left PCA P2 segment (National Institutes of Health Stroke Scale Score 16). Head computed tomography showed infarction area of left temporal lobe and occipital lobe.

Diagnosis:

A head computed tomography angiography examination showed left PCA P2 segment occlusion.

Interventions:

The patient underwent MT and subsequent angiography showed left PCA P2 segment occlusion was recanalized after MT.

Outcomes:

The patient's symptoms improved completely after MT.

Conclusion:

The clinical symptoms due to PCA P2 segment occlusion may be mistaken clinically for MCA stroke syndrome, which may lead to severe functional deficit. MT seems to be safe and effective in treating PCA P2 segment occlusion.
Traditional Korean medicine as second-line treatment of metastatic colorectal cancer
Authors: Lee Dong-hyun , Seong Sin , Won Yunsik
Published: April 2021

Rationale:

As a standard chemotherapy treatment of colorectal cancer, 5-fluorouracil alone or in combination with capecitabine, irinotecan, and/or oxaliplatin has been used as the first-line treatment. However, the first-line treatment alone for colorectal cancer may not be effective for all patients. Moreover, interest among the colorectal patients towards Traditional Korean Medicine (TKM) as the second-line treatment is increasing.

Patient concerns:

We present a 69-year-old Korean male with lung metastasis from rectal adenocarcinoma who refused to receive further standard chemotherapy. After refusing further chemotherapy, the patient started TKM treatment.

Diagnoses:

The patient was diagnosed as colorectal cancer with multiple lymph nodes and lung metastases at our hospital in February 2016.

Interventions:

The patient was treated with Intravenous Wild Ginseng Pharmacopuncture, Hae, Soramdan, Gunchildan, SD nebulizer solution, and SSR.

Outcomes:

After 6 weeks of TKM treatment, there was clinical improvement, and the further spread of metastasis was reduced with diminished size of metastatic nodules throughout the treatment course and a six-month follow-up.

Lessons:

A definitive conclusion on the effectiveness of TKM treatment for colorectal cancer cannot be made based on the case report alone. However, TKM treatment may be considered as the second-line treatment for treating metastatic colorectal cancer in selected cases.
Non-functioning parathyroid cyst
Authors: Tsu-Hao Liu , Ming-Hong Yan
Published: April 2021

Rationale:

Parathyroid cysts are rare lesions which are classified as functioning and non-functioning, based on the hormone activity. We report an incidental finding of a non-functioning parathyroid cyst in a patient who showed good prognosis after surgery.

Patient concerns:

A 63-year-old female patient had a medical history of stage III chronic kidney disease, asthma, and idiopathic hypothyroidism. She underwent low-dose lung computed tomography and a suspected enlarged lymph node in the suprasternal region was identified.

Diagnoses:

The nodular site was considered relatively safe, thus, we did not arrange for further examinations and decided to perform a surgical biopsy intervention first. Consequently, immunohistological examination findings led to the diagnosis of parathyroid cyst. The patient's serum calcium level was normal. Thus, she was diagnosed with a non-functioning parathyroid cyst.

Interventions:

Surgery was performed with a 3-cm long incision on the midline of the upper chest wall for biopsy. A 19 mm × 15 mm × 7 mm cystic lesion was excised.

Outcomes:

No complications were observed after the surgical biopsy. The patient remains asymptomatic with no recurrence or serum biochemical abnormalities during the 1-year follow-up.

Lessons:

In cases of non-functioning parathyroid cysts, it is difficult to precisely diagnose it before surgery. We report a case of an incidental finding of a parathyroid cyst and the patient had a good prognosis after excision of the parathyroid cyst.
Treatment for a grade 4 diabetic foot patient with necrotizing fasciitis
Authors: Huang Renyan , Yang Xiao , Fan Weijing , Hu Xiaoming , Xv Feng , Liu Guobin
Published: April 2021

Rationale:

Grade 4 diabetic foot with necrotizing fasciitis is a severe infection that can cause septicemia, amputation and even death. Timely control of infection is the key measure in the treatment of diabetic foot with necrotizing fasciitis.

Patient concerns:

A 40-year-old male patient with long-term diabetes complicated with chronic renal insufficiency was admitted with grade 4 diabetic foot with necrotizing fasciitis. The patient had a concurrent nutritional deficiency and anemia.

Diagnoses:

The patient was diagnosed with type 2 diabetes mellitus, grade 4 diabetic foot with necrotizing fasciitis, chronic renal insufficiency, acute renal failure, hypoproteinemia, and moderate anemia.

Interventions:

Treatment with systemic antibiotics combined with dexamethasone was performed for eliminating systemic infection. Debridement was done to remove the devitalized tissues while preserving the skin of the ankle and calf.

Outcomes:

During the treatment procedure, the necrotic 2nd to 5th toe was removed. The infection gradually decreased after half a month of systemic treatment which included antibiotics combined with dexamethasone mainly, combined with local dressing of the wound. Hence high location amputation was avoided.

Lessons:

The application of antibiotics combined with dexamethasone in diabetic foot patient with necrotizing fasciitis can be an effective measure to reduce the risk of diabetic foot amputation and death.
Effects of Baduanjin qigong exercise in diabetes mellitus
Authors: Zhang Bei , Wang Zhe , Peng Fucong , Fang Jiaxin , Guo Liqun , Lu Chunli , Liu Hongxia
Published: April 2021

Objective:

To investigate the effects of Baduanjin exercise in diabetes mellitus.

Methods:

Literature retrieval will be performed in seven databases, including China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, PubMed, The Cochrane Library, and Embase from inception to December 31, 2020. Systematic reviews of randomized controlled trials on investigating the effects of Baduanjin exercise in diabetic patients will be identified. To assess the reporting and methodological quality of the included systematic reviews by means of preferred reporting items for systematic review and meta-analysis statement and a measurement tool to assess systematic reviews -2 tool.

Results:

The umbrella review results will indicate the effects of Baduanjin exercise in diabetes mellitus, and these results will be disseminated through peer-reviewed journals and conferences.

Conclusion:

The study will provide more convincing evidence for the effects of Baduanjin exercise in diabetes mellitus. In addition, it might provide some specific suggestions for Chinese medical clinical practice or guideline.

Ethics and dissemination:

No ethical approval is required since the study data are sourced from published literature.

Protocol registration number:

PROSPERO CRD42020211398.
Efficacy and Safety of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombus: A Systematic Review and Meta-analysis
Authors: Burmeister Cameron , Beran Azizullah , Mhanna Mohammed , Ghazaleh Sami , Tomcho Jeremy C. , Maqsood Aadil , Sajdeya Omar , Assaly Ragheb
Published: April 2021

Background:

Left ventricular thrombus (LVT) may develop in systolic heart failure or after acute myocardial infarction. The current recommendations support the use of vitamin K antagonists (VKAs) for the treatment of LVT. Limited data exist regarding the use of direct oral anticoagulants (DOACs) in patients with LVT. This meta-analysis aims to investigate the efficacy and safety of DOACs versus VKAs for LVT.

Methods:

We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases through November 2020 for all studies that evaluated the efficacy and safety of DOACs versus VKAs in patients with LVT. The primary outcomes were LVT resolution, overall thromboembolic events, and thromboembolic stroke. The secondary outcomes were major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel–Haenszel method within a random-effects model. Heterogeneity was assessed by I
2 statistic.

Results:

A total of 11 studies including 2153 patients with LVT on anticoagulation (570 on DOACs vs. 1583 on VKAs) were included. LVT resolution was significantly higher in DOACs compared with VKAs [RR: 1.18 (95% CI: 1.04–1.35); P = 0.01, I
2 = 25%]. However, no significant difference existed between DOACs and VKAs regarding overall thromboembolic events [RR: 1.10 (95% CI: 0.75–1.62); P = 0.61, I
2 = 0%] and thromboembolic stroke [RR: 0.63 (95% CI: 0.39–1.02); P = 0.06, I
2 = 0%]. Major bleeding [RR: 1.00 (95% CI: 0.66–1.51); P = 0.99, I
2 = 4%] and all-cause mortality [RR: 0.84 (95% CI: 0.50–1.43); P = 0.53, I
2 = 0%] were similar between the 2 groups.

Conclusions:

DOACs seem to be more efficacious in achieving LVT resolution compared with VKAs. However, there was no significant difference between the 2 groups in thromboembolic events, major bleeding, and all-cause mortality. Randomized controlled trials are needed to confirm our findings.