Favorable Recovery Research Articles

Analysis of the clinical manifestations and diagnostic process of the pleural effusion associated with constrictive pericarditis

ObjectivesThe primary objective of this study is to analyze the clinical manifestations, diagnostic procedures, and outcomes of patients with pathologically confirmed constrictive pericarditis who presented with bilateral pleural effusions. We aim to outline a stepwise diagnostic approach that could assist clinicians in identifying CP in similar cases.MethodsIn this study, we conducted a retrospective analysis of 19 cases of pathologically confirmed constrictive pericarditis. These patients were admitted to our hospital between January 2019 and December 2022 after pericardial stripping. The collected data included imaging findings, clinical manifestations, pleural effusion characteristics, postoperative pathology, and the diagnostic process.ResultsIn this study, the age of the 19 patients ranged from 25 to 74 years, with a median age of 59 years. All patients presented with bilateral pleural effusions, with or without pericardial lesions such as pericardial effusion or thickening. Pleural effusion biochemistry did not exhibit specific characteristics, and both etiology and pleural pathology were negative. Radiographic examinations, including cardiac ultrasound and chest CT, revealed signs of pericardial thickening and/or pericardial effusion or no abnormalities. Pericardial stripping was performed in all patients, and the postoperative pathology confirmed various degrees of thickened pericarditis, consistent with constrictive pericarditis. During a follow-up period of 6–18 months, most patients (17 out of 19) showed favorable recovery with no recurrence of bilateral pleural effusions.ConclusionThis study emphasizes the importance of pleural effusion as a clinical sign of constrictive pericarditis and highlights that a stepwise diagnostic approach, guided by clinical presentation and imaging, can enhance its recognition, particularly in cases with bilateral pleural effusions.

A simple and enzyme-free method for sensitive p53 analysis based on DNAzyme-mediated signal amplification

There is an urgent demand for a simple yet extremely accurate biosensor to analyze tumorigenesis. Herein, we present a novel fluorescent and enzyme-free approach for detecting p53 gene cascading proximity ligation-mediated catalytic hairpin assembly and DNAzyme-assisted signal reaction. When the target p53 gene is present, the interaction between p53 and L1 and L2 chains initiates catalytic hairpin assembly and subsequently exposes DNAzyme in the P3 probe. The exposed DNAzyme binds with the loop region of the P4 probe and generates a nicking site, resulting in the release of a significant amount of ATMND that is conjugated in the stem section of P4. This leads to an amplified fluorescence response, which serves as a fluorescence signal for the detection of the p53 gene. This method allows for the accurate and sensitive identification of the p53 gene, exhibiting a linear reaction range of 1 fM to 1 nM, with a limit of detection as low as 0.23 fM. Furthermore, this fluorescent method has been utilized for the examination of clinical samples with a favorable recovery rate. Crucially, this versatile platform may be expanded to analyze different targets by changing the corresponding recognition unit, showing great potential for point-of-care testing in tumorigenesis analysis.

A School-Goer’s Nightmare: Case Report of CABG in an 8 Year-Old with Kawasaki Disease

Introduction: Kawasaki disease (KD) is an acute vasculitis primarily affecting medium-sized arteries, particularly the coronary arteries (CA). Its impact varies, with some patients developing transient dilation while others experience severe coronary artery aneurysms (CAA), leading to complications such as thrombosis, stenosis, and myocardial ischemia. Male gender, delayed diagnosis, incomplete presentation of KD, and resistance to Intravenous Immunoglobulin (IVIG) therapy are risk factors for CAA. The Japanese Ministry of Health classifies CAAs by size, with giant aneurysms (>8 mm) carrying significant long-term risks, including coronary thrombosis and acute coronary syndrome. Case Report: We report the case of an 8-year-old Malay boy with giant CAA secondary to KD. The patient presented with classical KD symptoms and inflammatory markers, with echocardiography revealing a giant aneurysm (8.7 mm) in the left anterior descending artery (LAD), alongside smaller aneurysms in the left circumflex and right coronary arteries (RCA). Initial management included IVIG, aspirin, and heparin, with warfarin and clopidogrel added subsequently. Coronary angiography indicated severe LAD stenosis (95%) with total occlusion and an aneurysmal segment distal to the occlusion. A multidisciplinary team determined that coronary artery bypass grafting (CABG) using bilateral internal mammary arteries was the optimal intervention. The patient had a favourable recovery and was stable at discharge. Discussion: CABG is recognized as a preferred treatment for severe or multivessel coronary involvement in KD, offering lower reintervention rates compared to percutaneous coronary intervention (PCI). Studies support CABG’s efficacy in managing coronary complications in KD, especially for complex or multivessel cases. Conclusion: This case illustrates the complexities of managing giant CAAs in paediatric KD and underscores the necessity of a multidisciplinary approach and long-term monitoring to

A hydrogel sensor based on conic baston structure

AbstractResistive flexible pressure sensors are extensively employed in wearable devices owing to their wide operational range and straightforward construction. This study presents a conic bastion‐structured sensor microunit to improve the sensor sensitivity. The base hydrogel is synthesized using acrylamide (AM), with Mg2+ and Na+ acting as conductive ions. The sensor is fabricated using digital light processing (DLP) 3D printing technology and is subjected to experimental evaluation. The findings indicate that the hydrogel sensor with a 50 wt% AM composition demonstrates enhanced mechanical strength and conductive properties, achieving a peak sensitivity of 0.534 kPa−1 within a pressure range of 0–0.8 kPa. Furthermore, the sensor exhibits favorable response characteristics (30 ms) and recovery characteristics (40 ms), along with stability. The proposed sensor is suitable for wearable devices and live joint angle detection. Additionally, the “handwriting fingerprint” pattern recognition and document verification proposed in this article make it applicable in scenarios, such as banking, notarization, and other handwriting and seal verification contexts.

A Technique Avoiding Cardioplegia Delivery Complications: A Case Using Systemic Hyperkalemia Cardiopulmonary Bypass Combined with Circulatory Arrest

We conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicted mortality rate of 20%. Initial antegrade cardioplegia successfully induced cardiac arrest, which was administered every 30 minutes. However, upon infusion of the second dose of cardioplegia, the aortic root pressure was approximately 20 mmHg. Despite multiple attempts to re-cross clamp, the aortic root pressure did not improve. Consequently, retrograde cardioplegia was considered, but due to significant adhesion of the inferior vena cava, this approach was abandoned. Thus, the procedure was altered to utilize systemic hyperkalemia without aortic cross-clamping. Given the preoperative transesophageal echocardiography (TEE) diagnosis of mild aortic regurgitation, maintaining a clear surgical field was challenging, necessitating the combination of redo-MVR with circulatory arrest. This case exemplifies the successful management of cardioplegia delivery complications using systemic hyperkalemia and circulatory arrest, resulting in a favorable postoperative recovery for the patient.

Vitrectomy combined with inverted internal limiting membrane flap insertion or single-layered flap covering technique for highly myopic macular holes with macular retinoschisis.

To investigate the anatomical and visual outcomes of inverted internal limiting membrane (i-ILM) flap insertion versus single-layered i-ILM flap covering in highly myopic macular holes (HMMHs) associated with macular retinoschisis (MRS). A retrospective study compared 23G vitrectomy with i-ILM flap insertion (30 eyes) or covering (31 eyes) in HMMH patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis (MHS) was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA. The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group (P=0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group (P=0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared to the insertion group (1/28) finally (P=0.026). Final BCVA improved significantly in both groups (P<0.001), the BCVA was better in closed HMMHs in the covering group (P=0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β=0.386, P=0.001) and MHS stage (β=0.309, P=0.004) were independent predictive factors for the final BCVA. The single-layered i-ILM flap covering favored foveal structure recovery and provided a better visual prognosis in closed HMMHs compared with insertion. The preoperative BCVA and MHS stage were independent predictors of visual outcomes in patients with HMMHs.

B-156 Extraction strategy for therapeutic drug monitoring of sirolimus and tacrolimus using volumetric absorptive microsampling

Abstract Background Following organ transplantation, patients are placed on immunosuppressant drugs (ISDs) to minimize the risk of rejection. Sirolimus and tacrolimus are two of the most widely used ISDs, however, due to their narrow therapeutic indices, patients require frequent therapeutic drug monitoring (TDM). Recurrent venipuncture can become uncomfortable and disruptive, especially in the pediatric population. Therefore, we describe an extraction method using dried whole blood from volumetric absorptive microsampling (VAMS) devices for the detection of sirolimus and tacrolimus by turbulent flow liquid chromatography tandem mass spectrometry (TFC-MS/MS). The use of VAMS in the clinical laboratory will provide ISD patients with a convenient alternative to traditional blood draws. Methods MassTrak immunosuppressant calibrators based on a whole blood matrix (Waters) were applied to 30 μL VAMS Mitra devices (Neoteryx) and dried overnight. To extract the whole blood off of VAMS tip, we tested various methanol:water solvent ratios, of which 30 μL was added to the device. Tips were extracted using ultrasonication (30 min), vortexing (5 min), and centrifugation. Once extracted from the tip, 25 mM zinc sulfate was added to whole blood extract at a 1:1 (v/v) ratio. An acetonitrile and methanol extraction reagent was then added to the whole blood/zinc sulfate solution at a 2:1 (v/v) ratio. After brief vortexing, samples were centrifuged at 16,060 × g (10 min) and tested using an established TFC-MS/MS method which deploys a TLX-2 system for sample preparation coupled to a Q-Trap tandem mass spectrometer (AB Sciex 5500). Results A 80:20 (v/v) water:methanol extraction solvent yielded the greatest extraction efficacy for both sirolimus and tacrolimus from the VAMS tips compared to other tested ratios. We established a 5-point calibration curve to correlate the measured values of ISDs with known MassTrak calibration standard concentrations. The resulting average calibration curve from 3 independent experiments was highly linear for both sirolimus (R2= 0.992; slope= 1.1; intercept= 0.94) and tacrolimus (R2= 0.996; slope= 1.1; intercept = 0.8819). Our VAMS whole blood extraction strategy was correlated to the established neat whole blood protocol, which utilized all of the sample preparation steps outlined above except the initial extraction from the VAMS tip. The average extraction efficacy was 89.1% for sirolimus with an average coefficient of variation (CV%) of 12.1% across 3 independent experiments. For tacrolimus, we demonstrated an average extraction efficacy of 100.1% with an average CV% of 8.4%, again across 3 independent experiments. Conclusions We demonstrate the feasibility of using a VAMS approach to TDM of sirolimus and tacrolimus. Our results demonstrate favorable recoveries for both of the tested drugs, evidenced by high recoveries of the external calibration standards. Additionally, our method exhibited high extraction efficacy and low variability. Further validation studies, including the utilization of clinical samples is necessary to confirm our preliminary findings.

IMPROVEMENT IN LV END-DIASTOLIC PRESSURE AFTER PRIMARY PCI AND ITS IMPACT ON PATIENTS’ RECOVERY

Left ventricular end-diastolic pressure (LVEDP) is a crucial indicator of cardiac function, particularly in patients with acute ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the standard of care for STEMI, but its impact on LVEDP and patient recovery remains to be thoroughly studied. Objective: This study aimed to evaluate the improvement in LVEDP following primary PCI in patients with acute STEMI and to assess its impact on recovery and clinical outcomes. Methods: This prospective study included 100 patients with acute STEMI treated by primary PCI. LVEDP was recorded at four-time points: before PCI, and at one week, one month, and three months post-PCI. Demographic and clinical characteristics were also collected. Statistical analysis was performed to compare LVEDP values at different time intervals using paired t-tests and repeated measures ANOVA to assess significant changes over time. Results: The mean LVEDP significantly decreased from 18 ± 4 mmHg before PCI to 12 ± 3 mmHg at one week, 10 ± 2 mmHg at one month, and 9 ± 2 mmHg at three months post-PCI (p &lt; 0.001). This demonstrated a consistent improvement in left ventricular function and hemodynamic status, suggesting favorable patient recovery post-intervention. Conclusion: Primary PCI significantly reduces LVEDP in patients with acute STEMI, leading to improved cardiac function and patient recovery. Monitoring LVEDP post-PCI can serve as a valuable predictor of patient prognosis and long-term outcomes. Further studies are warranted to explore additional therapies that may further enhance recovery and improve the quality of life in STEMI patients.

Comparison of Clinical Characteristics between Responders and Non-Responders to Hamstring Stretching in Individuals with Chronic Low Back Pain.

Background/Objectives: Hamstring muscle (HM) flexibility is frequently compromised in people with chronic low back pain (CLBP), contributing to disability and leading to a less favorable recovery. In a previous article, we presented the results of a study on the immediate effect of passive HM stretching on flexibility in 90 people with CLBP. There was considerable variability in the changes after stretching. The objective of this supplementary analysis was to compare the clinical characteristics of individuals who experienced a significant improvement in flexibility with those who did not. Methods: We fixed a threshold of 7° to indicate an improvement in passive Straight Leg Raise (SLR) angle and differentiate between 'Responders' and 'Non-responders' regarding passive HM stretching. Results: Only body mass index differed between groups; it was significantly smaller in Responders (p = 0.007). The majority of Non-responders experienced workplace accidents, but this was of marginal difference compared to Responders (p = 0.056). Conclusions: Further studies should consider a broader clinical analysis with a larger sample size to understand which factors influence the HM stretching response in CLBP patients.

Impact of socioeconomic status on cardiac arrest outcomes during COVID-19 pandemic

IntroductionThe coronavirus disease 19 (COVID-19) pandemic has affected healthcare services, potentially leading to inequitable outcomes based on patients’ socioeconomic status (SES). This study aimed to evaluate the impact of COVID-19 on out-of-hospital cardiac arrest (OHCA) outcomes by examining disparities across SES levels. MethodsThe study analyzed non-traumatic OHCA cases registered in the Korean Out-of-Hospital Cardiac Arrest Registry from 2010 to 2021, encompassing 238,668 patients aged 18 years and older. SES was assessed at both the individual (Medicaid vs non-Medicaid) and area levels using a deprivation index. Outcomes included any return of spontaneous circulation, survival to admission, survival to discharge, and favorable neurological recovery. Logistic regression and generalized additive models (GAMs) were used for analysis. ResultsOHCA outcomes—including survival to admission, survival to discharge, and favorable neurological recovery—improved over the years, peaking in 2019 before subsequently declining. Logistic regression showed that the lowest SES area was associated with lower rates of ROSC (adjusted odds rations [aOR] 0.82, 95 % confidence interval [CI] 0.75–0.88) and survival to admission (aOR 0.56, 95%CI 0.49–0.64) and discharge (aOR 0.78, 95%CI 0.61–0.98) during the pandemic. GAM analysis revealed that lower SES groups (deprivation index levels 4 and 5) experienced higher-than-expected survival to admission and discharge rates, as well as favorable neurological recovery. Although outcomes in the deprivation index level 1 group (5.5 % in 2021) remained superior, indicating poor outcomes for the lowest SES area group (3.43 % in 2021), the disparity decreased following the pandemic. ConclusionLower levels of SES are a significant risk factor for unfavorable neurological recovery in OHCA, independent of the COVID-19 pandemic. However, SES-related disparities in the outcomes decreased post-pandemic. Despite the overall negative impact of COVID-19, certain lower SES groups showed improved survival rates, likely due to differences in the EMS response and healthcare burden across regions.

Twenty-Four-Hour Post-Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study.

This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). ENCHANTED was an international, multicenter, 2×2 quasifactorial, prospective, randomized open trial of low-dose versus standard-dose intravenous alteplase and intensive versus guideline-recommended blood pressure lowering in thrombolysis-eligible patients with acute ischemic stroke. Absolute (baseline minus 24 hours) and percentage (absolute change/baseline × 100) changes in NIHSS scores were calculated. Receiver operating characteristic curve analyses assessed performance of different NIHSS measurements on 90-day favorable functional recovery (modified Rankin Scale [mRS] score 0-2) and excellent functional recovery (mRS score 0-1). Youden index was used to identify optimal predictor cutoff points. A total of 4410 patients in the ENCHANTED trial were enrolled. The 24-hour NIHSS score had the highest discriminative ability for predicting favorable 90-day functional recovery (mRS score 0-2; area under the curve 0.866 versus 0.755, 0.689, 0.764; P<0.001) than baseline, absolute, and percentage change of NIHSS score, respectively. The optimal cutoff point of 24-hour NIHSS score for predicting favorable functional recovery was ≤4 (sensitivity 66.5%, specificity 87.1%, adjusted odds ratio, 9.44 [95% CI, 7.77-11.48]). The 24-hour NIHSS score (≤3) was the best predictor of 90-day excellent functional recovery (mRS score 0-1). Findings were consistent across subgroups, including sex, race, baseline NIHSS score, stroke subtype, and age. In thrombolysis-eligible patients with acute ischemic stroke, 24-hour NIHSS score (optimal cutpoint of 4) is the strongest predictor of 90-day functional recovery over baseline and early change of NIHSS score. URL: https://clinicaltrials.gov. Unique Identifier: NCT01422616.

Minimally invasive technique facilitates early extubation after cardiac surgery: a single-center retrospective study

BackgroundPostoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation.MethodsData from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People’s Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan–Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed.ResultsAfter propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01).ConclusionsSuccessful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate.

Efficacy of different remineralization agents on microhardness and chemical composition of enamel white spot lesion

Background White spot lesions (WSLs) are frequently linked with low microhardness and mineral content changes. several strategies have been employed to deal with these problems. This investigation aimed to analyze the microhardness and mineral content changes after remineralization with bioactive glass (BAG) and casein phospho-peptide-amorphous calcium phosphate with fluoride (CPP-ACPF). Methods Twenty sound maxillary first premolars extracted were used to obtain a total of one hundred enamel samples. forty enamel slabs were split into four experimental groups (n = 10 each): Group I, BAG; Group II, BAG+CPP-ACPF; Group III, CPP-ACPF varnish; and Group IV, artificial saliva (negative control). To create artificial WSLs, all samples were preserved in a prepared demineralizing agent for 72 h before treatment with remineralizing agents. Vickers microhardness test was performed. Additionally, 60 enamel samples were selected for analysis using energy dispersive spectroscopy (EDX) and assigned to six experimental groups; the first four groups were similar to that used in the microhardness test along with Group V: WSLs, and Group VI: baseline. The statistical analyses employed in this study included Tukey’s HSD (p&lt;0.05), one-way ANOVA, and Shapiro-Wilk. Result Regarding surface microhardness, the BAG+CPP-ACPF group showed the most favorable recovery, which was better than the outcomes of the BAG and CPP-ACPF groups. A statistically significant change (p &lt;0.05) was not observed between them. Similarly, for mineral content change, the BAG+CPP-ACPF group demonstrated the greatest result, The BAG group came next, and the CPP-ACPF group came last. Conclusion The BAG+CPP-ACPF group might be regarded as the best course of treatment for enhancing both the surface microhardness and mineral content (Ca, P), while the control group (Artificial saliva) showed the least satisfactory results in comparison. After demineralization, mineral content and microhardness decreased in all samples. Therefore, BAG+CPP-ACPF significantly improved the surface microhardness and mineral content.

Prolonged Venous Transit Is Associated With Lower Likelihood of Favorable Clinical Recovery in Reperfused Anterior Circulation Large‐Vessel Occlusion Stroke

Background Unfavorable clinical outcomes in patients with acute ischemic stroke caused by large‐vessel occlusions despite successful reperfusion have been associated with poor venous outflow. The objective of this study is to assess the relationship between prolonged venous transit (PVT), a novel perfusion imaging surrogate for poor venous outflow, and likelihood of favorable clinical recovery. Methods In this retrospective review of prospectively collected data of consecutive patients (2017–2022) with successfully reperfused, anterior circulation acute ischemic stroke caused by large‐vessel occlusions, we assessed the association between PVT+, defined as time to maximum ≧10‐second timing delays within either the posterior superior sagittal sinus, torcula, or both regions on pretreatment perfusion imaging, and favorable clinical outcomes defined as 90‐day modified Rankin Scale score of 0 to 2. Patients were dichotomized into PVT+ and PVT− for analysis. Multivariable logistic regression analyses for favorable recovery were performed with demographic variables and stroke characteristics. Results A total of 127 consecutive patients (median age, 71 [interquartile range 61—77] years; 59.1% women) were included, and 40 of 127 (31.5%) were PVT+. PVT+ (adjusted odds ratio [aOR], 0.23 [95% CI, 0.07–0.81]; P = 0.02) and advanced age (aOR, 0.92 [95% CI, 0.88–0.97]; P = 0.01) were significantly associated with the primary outcome. Conclusion PVT+ was associated with a lower likelihood of achieving favorable clinical recovery in successfully reperfused patients with acute ischemic stroke caused by large vessel occlusion. PVT may serve as a clinically useful adjunctive imaging parameter.

Microvascular Decompression for Oculomotor Nerve Palsy Due to Nonaneurysmal Neurovaslur Conflict: 5 Cases Report and Literature Review

BackgroundOculomotor nerve palsy (ONP) is frequently caused by aneurysm compression and diabetes mellitus. However, non-aneurysmal compression (nAVC) of the oculomotor nerve is a condition rarely reported in the literature. Cases treated with microvascular decompression (MVD) for nAVC-induced ONP (nAVC-ONP) are exceptionally rare. MethodsBetween October 2022 and October 2023, we performed MVD surgery on five patients diagnosed with nAVC-ONP. The clinical symptoms, imaging characteristics, and intraoperative findings of these patients were reviewed and analyzed using a self-developed evaluation scale (S-T Evaluation Scale) to guide diagnosis and corresponding treatment plans. ResultsAll patients underwent MVDs and demonstrated favorable recovery and a good prognosis. No postoperative complications occurred in any of the patients. The superior cerebellar artery (SCA) and posterior cerebral artery (PCA) were common offending vessels in these cases. ConclusionNeurovascular conflict has been proposed as another possible cause of ONP in a limited number of cases. Based on our findings, MVD is a potentially effective solution for patients experiencing oculomotor nerve palsy resulting from non-aneurysmal neurovascular conflicts. It holds great promise for significantly alleviating symptoms and improving overall quality of life..

A case report on Madelung’s disease and comprehensive review of the literature

BackgroundMadelung’s disease (MD), alternatively referred to as benign symmetric lipomatosis, multiple symmetric lipomatosis, or Launois–Bensaude syndrome, is an uncommon benign disorder marked by symmetric proliferation of adipose tissue in the head, neck, and torso regions.Case descriptionIn this case, the patient was a female with the late middle-aged demographic, diagnosed with Type I MD. Notably, she exhibited no prior history of alcohol consumption, and there was no family history of MD. Subsequent to the clinical diagnosis, the patient underwent medical imaging assessments to delineate the surgical parameters. Post-surgery, she demonstrated a favorable recovery trajectory, marked by the absence of any surgical complications.ResultThe patient underwent successful surgical excision of the lipomatous mass. Postoperatively, she had an uneventful recovery with no complications and no recurrence observed during the follow-up period of seven months.ConclusionTimely diagnosis and early surgical intervention play a pivotal role in enhancing the quality of life for individuals with MD. Preoperative medical imaging examinations function as highly effective tools, contributing to heightened surgical safety and a decreased probability of encountering complications during the surgical procedure.

Pilon fracture with central articular surface collapse treated by posterior tibial fenestration indirect reduction and compression technique: Two cases report.

Central collapsed fracture blocks traditionally require either an anteromedial or anterolateral approach for reduction. However, existing techniques face challenges such as soft tissue damage and compromised tibial strength, especially in pilon fractures with central articular surface collapse and an intact anterior cortex, as classified under 43B2.3 in the 2018 Orthopaedic Trauma Association/Association for the Study of Internal Fixation Fracture and Dislocation Classification Compendium. We address the management of pilon fractures with central articular surface collapse, focusing on 2 cases where conventional reduction techniques posed a risk to soft tissues and tibial integrity. The patients presented with pilon fractures characterized by a central articular surface collapse and an intact anterior cortex, aligning with the 43B2.3 classification. A novel approach was employed, utilizing posterior tibial fenestration and indirect reduction with compression techniques. This method leveraged the talus as a template for precise articular surface realignment. Both cases demonstrated excellent reduction of the distal tibial articular surface and achieved favorable functional recovery of the ankle, evidenced by high American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale scores during the 3-year follow-up. The posterior tibial fenestration technique offers significant advantages for distal tibial pilon fracture reduction. It allows for precise articular realignment, facilitates bone grafting, and minimizes soft tissue and cortical bone disruption. This method is particularly effective for pilon fractures with an intact anterolateral cortex and central articular collapse, providing a valuable surgical alternative.

Temporary diverting loop ileostomy in Crohn's disease surgery; indications and outcome.

Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks. In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation. In total, 168 patients were included. The median age of the patients was 38 years (IQR 27-51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41-61] vs. 37 [IQR 27-50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006). Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery.

Transition-metal-doped biphenylene for enhanced CO detection: A high-throughput first-principles study

Our study examines the CO detection capabilities of pristine biphenylene (BP) and transition-metal-doped BP (M–BPx, x = 1 or 2), a novel two-dimensional nano-carbon material. Despite BP’s potential in toxic gas detection, its low CO adsorption energy (Eads) of 0.134 eV limits its application. Utilizing a combined strategy of high-throughput computational screening and DFT technique, we accurately identified the ground state configurations of CO-adsorbed M–BPx (M = Sc, Ti, Fe, Co, Ni, and Zn) and confirmed M doping significantly boosts BP’s CO adsorption ability, with Eads values ranging from 2.809 to 8.206 eV. This improvement is supported by ab initio molecular dynamics simulations and ionic d-p bonding interactions observed in electron localization functions, densities of state (DOS), and bond population analysis. Additionally, CO adsorption induces notable DOS changes in the M–BPx systems, validating the potential of M–BPx as suitable materials for CO detection. Notably, Zn-BP2 show notable work function shift after CO adsorption (0.36 eV), outperforming pristine BP’s 0.30 eV shift, and favorable recovery time (8.940 s). These shifts underscore the potential of Zn-BP2 for work function-based high-temperature CO sensor, marking it as a promising material for sensitive CO detection.

Skeletal Muscle-Derived Stem Cell Transplantation Accelerates the Recovery of Peripheral Nerve Gap Injury under 50% and 100% Allogeneic Compatibility with the Swine Leucocyte Antigen.

Pig skeletal muscle-derived stem cells (SK-MSCs) were transplanted onto the common peroneal nerve with a collagen tube as a preclinical large animal experiment designed to address long nerve gaps. In terms of therapeutic usefulness, a human family case was simulated by adjusting the major histocompatibility complex to 50% and 100% correspondences. Swine leukocyte antigen (SLA) class I haplotypes were analyzed and clarified, as well as cell transplantation. Skeletal muscle-derived CD34+/45- (Sk-34) cells were injected into bridged tubes in two groups (50% and 100%) and with non-cell groups. Therapeutic effects were evaluated using sedentary/general behavior-based functional recovery score, muscle atrophy ratio, and immunohistochemistry. The results indicated that a two-Sk-34-cell-transplantation group showed clearly and significantly favorable functional recovery compared to a non-cell bridging-only group. Supporting functional recovery, the morphological reconstitution of the axons, endoneurium, and perineurium was predominantly evident in the transplanted groups. Thus, Sk-34 cell transplantation is effective for the regeneration of peripheral nerve gap injury. Additionally, 50% and 100% SLA correspondences were therapeutically similar and not problematic, and no adverse reaction was found in the 50% group. Therefore, the immunological response to Sk-MSCs is considered relatively low. The possibility of the Sk-MSC transplantation therapy may extend to the family members beyond the autologous transplantation.