Clinical Reports Research Articles

An Empirical Study on the Effect of Blended Scents in Driving Environments From a Neuro-Cognitive Perspective.

An effective method that is easy to implement and widely applicable for improving driving performance and reducing driving risks remains a challenge. Although fragrances are widely used in daily driving, there is a gap between empirical research on everyday blended fragrances and functional fragrances clinical reports. In this study, a deliberately chosen blend of scent without overtly stimulating or functional proven evidence was tested for its potential to enhance performance in a driving environment. Thirty qualified young drivers were recruited to participate in the experiment. They were asked to watch a 15-min first-person perspective driving video to simulate a driving environment and then complete questionnaires and three sets of behavioral experiments while their brain activity was monitored by EEG. Participants in the scented environment exhibited statistically significant advantages in two cognitive tasks during behavioral measures. These findings were effectively supported by the EEG data, showing that beta waves exhibited more activity in the occipital and prefrontal cortex, enhanced theta waves were observed in the prefrontal cortex, and the TAB index characterizing driving fatigue was suppressed in the prefrontal cortex. This empirical evidence highlights the potential of pleasant, natural, and blended scents in enhancing driving performance, suggesting that promoting the aromatherapy while driving as an easily applicable approach in daily life seems justified and expands the application of aromatherapy in daily life.

Limits of prosthetic rehabilitation of cocaine-induced midline destructive lesions: Time to change the paradigm

The steady rise in cocaine consumption, particularly in its snorted form, has led to the increased incidence of cocaine-induced midline destructive lesions (CIMDLs), a severe condition resulting from chronic cocaine use that leads to significant tissue destruction in the nasal and palatal regions. Four patients with CIMDLs are presented, all characterized by nasopalatine perforation. Each patient reported a spontaneous onset of tissue loss in the hard palate near the midline, with the affected area ranging from 2.3 to 5.1 cm². All patients had a history of psychiatric conditions, including depressive episodes but without other significant medical conditions, which contributed to an average delay of 9 months before seeking initial medical consultation. Treatment, which included the use of palatal obturators to improve quality of life, remains nonstandardized and, combined with the patients' continued cocaine use and refusal of addiction care, led to poor follow-up and persistent tissue damage. This clinical report underscores the need for a paradigm shift in managing CIMDLs, emphasizing the integration of addiction treatment and psychological support with prosthetic rehabilitation to optimize long-term outcomes and prevent relapse.

Non-metal framework for removable partial dentures – A 2-year follow-up clinical report

Traditional removable partial dentures (RPDs) with cobalt-chromium frameworks have been used for several decades, restoring the masticatory function. However, these frameworks have been documented as aesthetically unacceptable due to the display of metal clasps. The patients' increased demands regarding the aesthetic aspects of rehabilitation treatment led to the introduction of new, more aesthetic materials in clinical practice. One of the main materials is polyetheretherketone (PEEK). This clinical report presents PEEK as an alternative material for fabricating RPD frameworks for a Class III Kennedy partial edentulous mandible. The framework was constructed using CAD/CAM manufacturing, and the process combined laboratory scanning, digital framework design, resin try-in milling, and PEEK framework milling. The framework showed good adaptation to the abutment teeth and surrounding tissues. The patient was followed for 2 years without complaints and was grateful for the aesthetics. During this period, there were no signs of degradation in the framework, and the clasps were still as retentive as they were at the initial appointment, with only some pigmentation of the structure being observed.

ASYMMETRICAL CORTICAL VEIN SIGN (ACVS) PREDICT NEUROLOGICAL AND RADIOLOGICAL IMPROVEMENT IN LARGE AND DISTAL VESSEL OCCLUSION POST REPERFUSION THERAPY

ABSTRACT Purpose To investigate the dynamic changes in ACVS on SWIs in patients who underwent reperfusion therapy and evaluate their association with neurological and radiological improvement Materials and Methods All patients treated for acute ischemic stroke between June 2020 and June 2022, in a single tertiary centre (Hospital Sultan Abdul Aziz Shah) who underwent reperfusion therapy and MRI imaging were retrospectively identified based on clinical and radiology reports. Expected Results This study hypothesizes an improvement in ACVS is expected to correlate with favourable neurological outcomes (MRS at 3 months and NIHSS score) and radiological outcome (DWI / ASPECT scores and Modified Mori score). Conversely, a worsening of ACVS is anticipated to be associated with unfavourable neurological and radiological outcomes. Conclusion Asymmetrical Cortical Vein Signs (ACVS) can serve as a valuable predictor of neurological and radiological outcomes in patients with large and distal vessel occlusion after reperfusion therapy Keywords: ACVS (The Asymmetrical cortical vein sign), Ischemic penumbra , Large vessel occlusion (LVO), Distal vessel occlusion (DVO)

Dapagliflozin-associated euglycemic diabetic ketoacidosis in 66-year-old with type 2 Diabetes: A clinical case report

Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication of type 2 diabetes, often associated with the use of SGLT2 inhibitors. This case report describes an episode of EDKA in a 66-year-old male with a long history of type 2 diabetes and multiple comorbidities, who developed this complication following the introduction of dapagliflozin. Although his blood glucose levels remained within normal limits, laboratory tests revealed elevated ketonemia and severe metabolic acidosis. The patient was successfully treated with intravenous hydration and insulin therapy, leading to a rapid improvement in his clinical condition. This case underscores the importance of clinical vigilance and patient education for those treated with SGLT2 inhibitors to prevent and effectively manage this potentially life-threatening complication.

Myelodysplastic syndrome (MDS)/Myeloproliferative neoplasm (MPN) with loss of long arm of chromosome 5 (del 5q): Clinical case and treatment perspectives.

this clinical case report presents a patient diagnosed with a myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN), specifically myelofibrosis with a deletion of the long arm of chromosome 5 (del 5q), an exceedingly rare anomaly in chronic myeloproliferative disorders. We performed a thorough analysis of the patient’s clinical, laboratory, and molecular-genetic characteristics to evaluate their impact on prognosis, treatment decisions, and therapeutic outcomes. After excluding other genetic abnormalities, the patient was treated with lenalidomide and prednisolone, resulting in improved clinical and hematological parameters. These findings are consistent with previous studies and suggest the potential efficacy of lenalidomide in treating patients with MDS/MPN characterized by del 5q, especially when no additional genetic abnormalities are present.

Minimal Invasive Approach to The Branchial Neck Cyst.

Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck. They may not present clinically until later in life. Surgical excision is a definitive treatment for branchial cleft cysts. This article presents the clinical report where the big inflamed cysts were excised under local anesthesia. It also presents guidelines for minimally invasive surgery under local anesthesia, which can be used in adequately selected cases.

Primary robot-assisted laparoscopic partial nephrectomy for hemorrhage secondary to angiomyolipoma: a retrospective study from a large tertiary hospital in China

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14–56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization.

Hospital Re-Admission Prediction Using Named Entity Recognition and Explainable Machine Learning.

Early hospital readmission refers to unplanned emergency admission of patients within 30 days of discharge. Predicting early readmission risk before discharge can help to reduce the cost of readmissions for hospitals and decrease the death rate for Intensive Care Unit patients. In this paper, we propose a novel approach for prediction of unplanned hospital readmissions using discharge notes from the MIMIC-III database. This approach is based on first extracting relevant information from clinical reports using a pretrained Named Entity Recognition model called BioMedical-NER, which is built on Bidirectional Encoder Representations from Transformers architecture, with the extracted features then used to train machine learning models to predict unplanned readmissions. Our proposed approach achieves better results on clinical reports compared to the state-of-the-art methods, with an average precision of 88.4% achieved by the Gradient Boosting algorithm. In addition, explainable Artificial Intelligence techniques are applied to provide deeper comprehension of the predictive results.

Differential susceptibility of human motor neurons to infection with Usutu and West Nile virus

West Nile virus (WNV) and Usutu virus (USUV) are closely related flaviviruses with differing capacities to cause neurological disease in humans. WNV is thought to use a transneural route of neuroinvasion along motor neurons and causes severe motor deficits. The potential for use of transneural routes of neuroinvasion by USUV has not been investigated experimentally, and evidence from the few clinical case reports of USUV-associated neuroinvasive disease is lacking. We hypothesised that, compared with WNV, USUV is less able to infect motor neurons, and therefore determined the susceptibility of human induced pluripotent stem cell (iPSC)-derived spinal cord motor neurons to infection. Both viruses could grow to high titres in iPSC-derived neural cultures. However, USUV could not productively infect motor neurons due to restriction by the antiviral response, which was not induced upon WNV infection. Inhibition of the antiviral response allowed for widespread infection and transportation of USUV along motor neurons within a compartmented culture system. These results show a stark difference in the ability of these two viruses to evade initiation of intrinsic antiviral immunity. Our data suggests that USUV cannot infect motor neurons in healthy individuals but in case of immunodeficiency may pose a risk for motor-related neurological disease and transneural invasion.

Atypical changes in the nail apparatus in a patient with atopic dermatitis – a clinical case report

Atopic dermatitis is a chronic recurrent skin disease characterised by itching and eczematous skin lesions. The paper presents the case of a 62-year-old female patient suffering from atopic dermatitis, in whom symptoms were observed within the nail apparatus of the hand, including red rings, Beau lines, lack of cuticle and lichenification with erosions, cracks, scabs, and residual blisters on the backs of the hands. The patient experienced severe itching, which led to increased manipulations within the nail apparatus (onychotillomania), which was reflected in the presence of the so-called tare nails. The patient’s treatment included the use of topical medications, including clobetasol propionate, mometasone, and tacrolimus 0.1%, as well as intensive hand lubrication and the use of specialised hand cleansers. Intensification of mental health care was also recommended. The presented case highlights the importance of a comprehensive approach to the treatment of atopic dermatitis, especially in the era of new therapeutic methods.

A rare case of Pancreatic lesion: Pancreatic mass and chronic pancreatitis caused by parasitic infection

A middle-age male patient was hospitalized for six-months upper abdominal pain. The patient had experienced 3 episodes of acute pancreatitis in the past 6 years. All the examination pointed to chronic pancreatitis and tumor, which, however, covering up the truth that the patient was in infection with Clonorchis sinensis in his pancreas. As the condition met the surgical indications, we performed pancreaticoduodenectomy and found the infection of Clonorchis sinensis in the postoperative pathological report. The patient maintain healthy during subsequent follow-up. Pancreatic mass with Clonorchis sinensis infected were rarely seen clinically, here we report the case which indicate us that further study on parasite and pancreatic lesion should be implemented. This case report is in accordance with Strengthening the reporting of Clinical Case Report and Helsinki Declaration.

Computer-Assisted Porcelain Laminate Veneer Preparation: A Scoping Review of Stereolithographic Template Design and Fabrication Workflows.

Computer-assisted preparation of porcelain laminate veneers (PLVs) using stereolithographic templates has been developed to enhance the accuracy of tooth preparation. However, the digital workflows involved in guided PLV preparation remain inconsistently defined across various practices. Therefore, this scoping review aimed to examine publications on computer-assisted PLV preparation to identify the key stage of digital workflows involved in designing and fabricating stereolithographic templates, as well as to highlight the limitations of various template designs. This scoping review aimed to identify publications on digital workflows for designing and fabricating stereolithographic templates in computer-assisted porcelain laminate veneer preparation. A systematic search on MEDLINE/PubMed, Web of Science and Scopus identified English-language articles published from 2014 to March 2024. Eligible articles focused on digitally designed and fabricated tooth reduction templates for porcelain laminate veneers, excluding conventional tooth preparation procedures for tooth reduction assessment. Seven clinical reports were included, demonstrating various 3D data acquisition techniques for virtual patient generation. All articles described virtual diagnostic wax-ups on digital casts, with two using a virtual articulator. Only five articles documented chair-side mock-ups with resin trial restorations to evaluate planned dental esthetics. Additionally, virtual tooth preparation prior to templates design was included in only four articles. The templates were designed using different software and ranged from simple designs with access windows to complex stacked templates with rotary instrument sleeved windows. Each template design had limitations affecting tooth reduction accuracy. All articles reported printing templates in clear acrylic resin using different technologies. In conclusion, the review highlights a lack of standardization in the digital workflow for designing stereolithographic templates for PLVs. Establishing a sound protocol for designing the tooth reduction templates is essential to ensure the accuracy and consistency of veneer preparation.

Tick-Borne Encephalitis the situation in Poland 2024 - concern that warrants attention?

Introduction Tick-borne encephalitis (TBE) is a zoonotic infectious disease and the leading cause of viral meningitis in Poland. In recent years, there has been a marked increase in TBE cases, a trend possibly linked to global climate changes that are facilitating the spread of its primary vector, the Ixodes Ricinus tick species. Aim of the Study This paper aims to review the current understanding of tick-borne encephalitis and emphasize the importance of preventive measures. Materials and Methods This review compiles data from various sources, including recent epidemiological studies, clinical reports, and public health records. It examines the clinical progression of TBE, from the initial viremic phase to the possible development of severe neurological symptoms. Epidemiological data are analyzed to identify trends in TBE incidence, with a particular focus on how climate change affects the distribution and activity of tick populations. Conclusions The review underscores that TBE is an escalating public health issue in Poland, with incidence rates increasing alongside climate-induced changes in tick habitats. Effective prevention, particularly through vaccination, is essential for reducing the impact of TBE. However, despite the availability of effective vaccines, vaccination rates remain low in Poland. This highlights the need for improved public health efforts to promote vaccination and educate at-risk populations. Addressing the TBE threat requires a comprehensive strategy that includes better surveillance, preventive measures, and strong public health initiatives to protect against this increasingly common disease.

Tooth Eruption Disorders: Literature Review and Clinical Case Reports

Introduction and purpose: Tooth eruption disorders are complex issues that can affect both primary and permanent teeth. The process of tooth eruption is a natural stage of development, but it can sometimes be disrupted. Common eruption disorders include delayed eruption, tooth impaction, premature eruption, and abnormalities in the location and direction of eruption. In each case, consultation with a specialist is required, along with early diagnosis and subsequent planning of appropriate treatment. State of knowledge: Impacted teeth are a common occurrence in dentistry and they occur in 0.8–3.6% of the general population The most frequently impacted teeth, in decreasing order of prevalence, are third molars, maxillary canines, mandibular premolars, and maxillary central incisors. Factors contributing to tooth impaction can be general, local, or genetic. Impacted teeth and difficulties with eruption may be associated with complications such as follicular cysts and a variant of these cysts known as eruption cysts. Summary: Tooth eruption disorders require an individualized diagnostic and therapeutic approach. Depending on the issue, treatment may involve observation, orthodontic interventions, and in some cases, surgical procedures. Early diagnosis and appropriate treatment are crucial to prevent complications such as malocclusion, damage to adjacent teeth, or unsatisfactory aesthetics. Radiographs can help confirm the presence of impacted teeth or in some cases, CBCT may be used for more detailed imaging.

Special Requirements of Electronic Health Record Systems in Pediatrics: Clinical Report.

Pediatricians' use of electronic health record (EHR) systems has become nearly ubiquitous in the United States, yet many systems lack full functionality to deliver effective and efficient pediatric care. This clinical report seeks to provide a compendium of core pediatric functionality of importance to child health care providers that may serve as the focus for EHR developers and clinicians as they evaluate their EHR needs. Also reviewed are important but less critical functions, any of which might be of importance in a specific pediatric context. The major areas described here are immunization management, growth and development, social drivers of health tracking, decision support for orders, patient identification, data normalization, privacy, and system functionality standards in pediatric contexts.

Remimazolam attenuates lipopolysaccharide-induced neuroinflammation and cognitive dysfunction

ObjectiveRemimazolam, a novel benzodiazepine, is widely used as an anesthetic in endoscopic procedures; however, its effects on cognitive function remain unclear, limiting its broader application in general anaesthesia. Neuroinflammation is a well-established key factor in the etiology and progression of cognitive dysfunction, including conditions such as Alzheimer's disease, Parkinson's disease, postoperative delirium, and postoperative cognitive dysfunction. Preclinical studies have demonstrated that remimazolam exerts anti-inflammatory and neuroprotective effects, and clinical reports indicate a reduced incidence of postoperative delirium in patients treated with remimazolam. Nevertheless, whether remimazolam improves cognitive function through its anti-inflammatory properties remains uncertain. This study aimed to investigate the neuroprotective effects of remimazolam and its underlying mechanism in a lipopolysaccharide (LPS)-induced model of neuroinflammation, neuronal injury, and cognitive dysfunction MethodsC57BL/6 J male mice were administered LPS intraperitoneally to establish a model of neuroinflammation-induced cognitive impairment. A subset of mice received remimazolam via intraperitoneal injection 30 minutes prior to LPS administration. Cognitive performance was evaluated using behavioural tests, including the Morris Water Maze (MWM), Novel Object Recognition (NOR) test, and Open Field Test (OFT). Hippocampal tissues were analyzed by haematoxylin-eosin (HE) staining to assess structural changes. Inflammatory markers, including Interleukin (IL)-6, IL-1β, and tumor necrosis factor-α, were quantified using enzyme-linked immunosorbent assay (ELISA) and real-time quantitative PCR. Immunofluorescence was used to detect translocator protein (TSPO) and markers of microglia activation (IBA-1, CD16/32, and CD206). Results(1) Remimazolam reversed LPS-induced cognitive deficits, as evidenced by shorter spatial exploration latency and increased platform crossings in the MWM, and an elevated recognition index in the NOR test. (2) Remimazolam improved hippocampal morphology, reducing LPS-induced neuronal damage. (3) Remimazolam significantly decreased levels of hippocampal inflammatory cytokines, inhibited microglial activation, promoted M2-type microglia polarization, and increased TSPO expression. ConclusionRemimazolam demonstrated neuroprotective and anti-neuroinflammatory effects in a mouse model of LPS-induced cognitive impairment. These effects are likely mediated through the regulation of TSPO, which inhibits microglial activation and promotes the polarization of microglia from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype.

Mobilizing Stockpile of Nature: Phytochemicals, Herbal Extracts, and Dietary Supplements for Managing Metabolic Diseases with Concentric Focus on Obesity

Obesity and associated health impairments are proven to exhibit multifocal health disorders along with increasing co-morbidity. Underlying obesity pathology is linked up with almost every major disease, which may increase the risk of heart disease, hypertension, diabetes, cancer, osteoarthritis, etc. The prevalence of overweight and obesity is on the rise around the world, which enormously affects the life span of individuals. Due to the foggier nature of the underlying pathology, the efficacy is questionable for conventional treatments. The traditional therapy of obesity may involve synthetic moieties and surgical procedures, which have many harmful side effects and chances of recurrent severity. Scientists are continuously focusing on prophylactic remedies alongside maintaining a proper lifestyle. In that context, nature always helped with traditional medications. As per folklore medicine reports, many plants have been used to treat obesity and its associated complications. This review compiles a vast array of datasets, including the impact of obesity and the need for the introduction of phytochemicals in place of conventional pharmacotherapies, the impact of phytochemicals along with the reported mechanisms of action, recent clinical trial reports, and recently explored dietary supplements. The primary objective of this presentation is to chart the future trajectory of phytochemical research for metabolic disorders, establishing a foundational framework for future investigations to build upon.

Recognizing Statistical Problems in Reports of Clinical Trials: A Readers' Aid. Part 33 of a Series on Evaluation of Scientific Publications.

Readers of clinical trial reports should be able to critically evaluate the design, results, and conclusions of the trial. There are internationally accepted guidelines that define methodological standards for trial planning, statistical methods, and the display and interpretation of the results. Publications may nonetheless contain erroneous findings and interpretations. Statistical errors can arise in the planning of the trial, the analysis and display of the results, as well as in the interpretation of p-values and treatment effects in experimental and observational clinical trials. A useful aid for readers of medical publications should include a description of the potential statistical problems without complex theoretical background information. With this aim, we discuss certain major types of statistical error that the reader should be familiar with in order to be able to interpret the conclusions of these publications more easily. Statistical errors can already arise at an early stage through the choice of the wrong question to be addressed or the wrong population to be analyzed; such errors will inevitably have consequences. Before the start of any clinical trial, a primary endpoint must be defined, the sample size must be calculated, and the trial must be appropriately registered (among other requirements). With regard to the analysis, readers should for example take into account whether a statistical analysis plan with an intention-to-treat analysis existed for the study in question. They must be able to recognize erroneous methods of displaying and comparing data, confounding, as well as incorrect interpretations of p-values, and should take these problems into account when interpreting the findings. The problem of invalid causal inferences is not restricted to observational studies. Statistical errors do, indeed, arise. They should be detected as early as possible in various test instances. Nonetheless, readers should be able to judge independently whether the published clinical trial reflects meticulous and correct trial planning, appropriate display of the trial's results, and a proper, reasoned interpretation of the findings. The published checklists are a good aid for this purpose.

The Role of the N-Terminal Domain of Thrombomodulin and the Potential of Recombinant Human Thrombomodulin as a Therapeutic Intervention for Shiga Toxin-Induced Hemolytic-Uremic Syndrome.

Hemolytic-uremic syndrome (HUS) is a rare complication of an infection with Shiga toxin (Stx)-producing Escherichia coli (STEC-HUS), characterized by severe acute kidney injury, thrombocytopenia and microangiopathic hemolytic anemia, and specific therapy is still lacking. Thrombomodulin (TM) is a multi-domain transmembrane endothelial cell protein and its N-terminal domain has been implicated in the pathophysiology of some cases of HUS. Indeed, the administration of recombinant human TM (rhTM) may have efficacy in HUS. We used a Stx-based murine model of HUS to characterize the role of the N-terminal domain of TM. We show that mice lacking that domain (TMLed (-/-)) are more sensitive to Stx, with enhanced HUS progression seen at 4 days and increased mortality at 7 days post-HUS induction. In spite of these changes, renal function was less affected in surviving Stx-challenged TMLed (-/-) mice compared to their wild-type counterparts TMLed (+/+) at 7 days. Contrary to few clinical case reports from Japan, the administration of rhTM (0.06 mg/kg) to wild-type mice (C57BL/6J) with HUS did not protect against disease progression. This overall promising, but also contradictory body of evidence, requires further systematic preclinical and clinical investigations to clarify the role of TM in HUS as a potential therapeutic strategy.