Results Of Clinical Examination Research Articles

Clinical features of anti-neurofascin-155 antibody positive autoimmune nodopathy in 6 children

Objective: To analyze the clinical features of anti-neurofascin-155 (NF155) antibody positive autoimmune nodopathy in children. Methods: This was a case series study. A total of 6 children who were diagnosed accurately as anti-NF155 antibody positive autoimmune nodopathy by cell immunofluorescence assay at the Children's Hospital of Fudan University from January 2020 to December 2023 were collected. This study retrospectively analyzed 6 pediatric children's clinical manifestations, laboratory and electrophysiological examination results, and treatment outcomes. Results: Among 6 children with anti-NF155 antibody positive autoimmune nodopathy, there were 4 boys and 2 girls. The onset age of 6 children ranged from 3 years and 8 months to 12 years. All 6 children had extremity weakness (more severe in the distal and the lower extremities than in the upper extremities), 5 children had sensory deficits such as numbness or pain in the extremities, 4 children had tremors and ataxia, 3 children had cranial nerve involvement. Among the 6 children, 4 children had protein-cell separation in cerebrospinal fluid examinations. Among the 6 children, 1 child had central nervous system demyelination, the brain magnetic resonance imaging showed multiple abnormal signals in the bilateral cerebral hemispheres. Four children showed motor and sensory nerve damage in electrophysiological examination, and 2 children only showed motor nerve damage. Three children showed myelin and axonal damage, and 3 children only showed axonal damage. Among the 6 children, 5 children were treated with intravenous immunoglobulin and steroids. Among them, 2 children underwent plasma exchange due to poor efficacy, and subsequently, rituximab was added. There was 1 child changed the treatment with olfatomumab since the symptoms did not significantly improve after using rituximab. After treatment for 4-15 months, 2 children had no clinical symptoms, 1 child had improvement in clinical symptoms, 2 children had no significant improvement in clinical symptoms, and 1 child who did not receive the immunotherapy had no significant change in clinical symptoms. Conclusions: Anti-NF155 antibody positive autoimmune nodopathy in children presents with varying degrees of clinical manifestations. It is mainly characterized by extremity weakness, numbness and pain, often accompanied bytremorsand ataxia. Some pediatric patients may also have central nervous system demyelination. Cerebrospinal fluid and electrophysiological examination are important auxiliary examination methods. If steroid therapy is not effective, plasma exchange and rituximab treatment should be used as soon as possible.

How effective is our current follow-up for patients with hypopharyngeal carcinoma?

The study aimed to evaluate the diagnostic efficacy of routine follow-up in detecting recurrent disease in hypopharyngeal carcinoma. Data from 76 patients with a total of 620 follow-up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms. All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients' symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001). Symptom assessments and clinical examinations are highly efficient for detection of local failures.

Effects of venoactive drug therapy and ovarian vein interventions on vasoactive neuropeptide and cytokine levels in patients with pelvic venous disorders

ObjectiveTo study and compare the effects of venoactive drug (VAD) therapy and ovarian vein embolization or resection (OVE or OVR, accordingly) on the levels of vasoactive peptides and cytokines in patients with pelvic venous disorders (PeVD). MethodsThe study included 70 consecutive female patients with PeVD symptoms, such as chronic pelvic pain (CPP), dyspareunia, dysuria, and vulvar varicosities. Based on the results of clinical examination and duplex ultrasound (DUS) of the pelvic veins, the patients were allocated to the VAD therapy (n=38) or OVE/OVR (n=32). Additionally, the enzyme-linked immunosorbent assay (ELISA) tests were performed to determine levels of calcitonin gene-related peptide (CGRP), substance P (SP), interleukins 6 and 8 (IL-6, IL-8) and monocyte chemotactic protein-1 (MCP-1) after a 2-month course of VAD therapy and at 3 months after OVE/OVR. ResultsThe VAD therapy was associated with a significant decrease in CPP in 84% of patients with PeVD and isolated lesions of the parametrial veins (PVs) and uterine veins (UVs). VAD had no significant effect on the pelvic venous reflux. No changes in the CGRP, SP, IL-6, IL-8 and MCP-1 levels were detected after treatment. At 3 months after OVE or OVR, all patients with PeVD and combined lesions of the ovarian veins (OVs), PVs and UVs reported almost complete relief of CPP. Along with elimination of reflux in OVs, the disappearance of reflux in PVs and UVs was noted. A decrease in the CGRP and SP levels was observed (0.7 ± 0.1 ng/mL and 0.12 ± 0.02 ng/mL before treatment; 0.5 ± 0.12 ng/mL and 0.09 ± 0.06 ng/mL after treatment, respectively; all P<0.05). No changes in cytokine levels were revealed. ConclusionTreatment with VAD is associated with the CPP relief, but has no significant effect on the CGRP, SP, IL-6, IL-8, and MCP-1 levels. OVE/OVR results in the CPP relief, elimination of the pelvic venous reflux and a significant decrease in the CGRP and SP levels, but does not change cytokine levels.

TG/HDL-C Ratio for Predicting Insulin Resistance in Obese Children from Beijing, China.

International studies have found that the blood triglycerides to highdensity lipoproteins (TG/HDL-C) ratio predicted insulin resistance in children with overweight and obesity. However, there is a lack of such reports on children from China. The objective of this study is to explore the ability of the TG/HDL-C ratio as a blood biomarker for insulin resistance (IR) in obese children in Beijing. We evaluated 262 children with obesity from our paediatric outpatient clinic in a cross-sectional study. Detailed medical histories of all children were ascertained, as were clinical examination and laboratory test results, including blood lipids, fasting glucose, insulin, and glycated haemoglobin. We divided them into age groups of 6-9 and 10-13.5 years and then into IR and non-IR groups based on the homeostatic model assessment for IR (HOMA-IR). Analysis was accomplished with SPSS software (version 22.0). The TG/HDL-C ratio was higher in children with IR in the 6-9 and 10-13.5-year age groups (p < 0.001). Univariate and multivariate analyses displayed that the TG/HDL-C ratio and HOMA-IR were correlated in the 6-9 and 10-13.5-year-old groups (p < 0.05). In the 6-9-yearold group, IR identified by a TG/HDL-C ratio ≥ 0.645 had a sensitivity, specificity, and an area under the curve (AUC) of 79.1%, 60.9%, and 0.734, respectively. In the 10-13.5-year-old group, IR identified by a TG/HDL-C ratio ≥ 0.725 had a sensitivity, specificity, and an AUC of 79.4%, 62.9%, and 0.724, respectively. We showed the application of the TG/HDL-C ratio to predict insulin resistance in obese children in Beijing with different diagnostic thresholds based on age (6-9-year-old group with TG/HDL-C ≥ 0.645; 10-13.5-year-old group with TG/HDL-C ≥ 0.725), which were lower compared with the diagnostic threshold for insulin resistance in children reported in other countries.

RISK FACTORS AND PROGNOSTIC MODELS OF DIABETIC RETINOPATHY AND OPPORTUNITIES OF PRECISION MEDICINE (analytical review)

Background. One of the priority directions of modern medicine development is prognostication, the purpose of which is to increase the accuracy and reliability of forecasts of outcomes related to diseases. In diabetes mellitus (DM), the task of precision medicine is to adapt diagnostic and treatment methods to subgroups of the population with similar characteristics in order to achieve maximum effectiveness. Currently, most forecasting methods are too narrowly focused on the blood glucose level, which makes the wide implementation of precision medicine approaches promising. Aim: to determine risk factors, existing prognostic models and possibilities of precision medicine to improve the effectiveness of diagnosis and treatment of diabetic retinopathy (DR). Materials and methods. The search for sources of Ukrainian and foreign literature for the analytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 470 sources were selected, of which 46 were selected for this article. Results. It was established that the progression of DR in the initial stages is a consistent, significant and independent predictor of proliferative DR. The condition of the retina reflects the influence of the systemic environment and, in turn, has prognostic value for cardiovascular, renal and other complications. Most of the new biomarkers have yet to be tested in clinical practice, which requires additional studies to predict DR and clinical outcomes of its treatment. Most models include age, sex, ethnicity, and lifestyle variables as predictors: smoking, medical history, glycated hemoglobin, and DM duration. Increasing age of patients, DM duration and concomitant arterial hypertension are independent predictors of microvascular complications. We collected a database including 359 patients (359 eyes) with type 2 diabetes with DR of varying severity, the results of clinical, ophthalmological and laboratory examinations. Models for predicting progression and effectiveness of individualized treatment are being developed.

Endodontic Management of Mandibular Second Molar with Middle Distal Canal

Mandibular second molar is often associated with variations in root canal morphology. Despite the intricate association, the occurrence of middle distal canal in endodontic literature is limited, with an incidence of 0.2% to 3%. Therefore, this study presents a case report describing a clinical situation in mandibular second molar that shows four canals, opening into different apical foramens. A 30-year-old male patient came to the Rumah Sakit Gigi dan Mulut of Universitas Sumatera Utara with the main complaint of intermittent pain in the lower right tooth persisting for two days. The results of clinical examination of the lower right second molar labeled as #47, showed a temporary filling, while radiography indicated widened periodontal ligament space and termination of lamina dura. After receiving informed consent, root canal therapy was carried out, and a direct resin composite onlay was selected for final restoration. To locate and treat hidden and unusual anatomy, dentists are often required to possess a comprehensive understanding of internal dental anatomy and use modern instruments, such as the dental operating microscope and ultrasonic tips. In certain clinical, direct resin composite onlay restorations can represent a valid alternative to traditional indirect restorations. In conclusion, this study shows that a comprehensive understanding of the potential variances in the internal anatomy of human teeth is essential to achieving successful outcomes in endodontic therapy.

Correlation analysis of patients with diabetic foot ulcers treated with tibial cortex transverse transport surgery and platelet-to-lymphocyte ratio and monocyte-to-neutrophil ratio.

Diabetic foot ulcers (DFUs) represent one of the most severe late-stage complications of diabetes. Tibial cortex transverse transport (TTT) surgery stands as the prevailing method for addressing DFUs. This surgical intervention holds the promise of expediting DFU wound healing and diminishing the rate of amputations, with the mitigation of inflammatory responses playing a pivotal role. In this study, we aim to explore the correlation between inflammation and TTT surgery, with the overarching goal of facilitating swift prognostic assessments in clinical practice. The correlation between the severity of DFUs and clinical test results remains ambiguous. A clinical prediction model was devised to explore the connection between DFU severity and the efficacy of TTT surgery, utilizing straightforward and efficient clinical indicators. Clinical data and examination results were gathered by tracking hospitalized DFU patients who underwent TTT surgery at the First Affiliated Hospital of Guangxi Medical University (Nanning, China). Indicators associated with DFU severity and wound healing time post-surgery were identified through logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses. Subsequently, a clinical prediction model was constructed. Finally, the intersection of these 2 sets of indicators revealed factors correlated with wound severity and post-operative healing duration. Our study was comprised of 202 patients who were categorized into 2 groups based on Wagner's grading classifications. Utilizing Student's t-tests, LASSO regression and logistic regression analyses, we identified 3 factors indicative of DFU severity: platelet-to-lymphocyte ratio (PLR), mixed lymphocyte reaction (MLR) and hemoglobin (HGB). Univariate COX regression analysis revealed 12 factors such as: white blood cells (WBC), neutrophils (NEUT), monocytes (MO), PLR, MLR, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), age, lymphocytes (LY), monocyte-to-neutrophil ratio (MNR), uric acid (UA), and albumin (ALB) associated with the postoperative healing duration. Ultimately, we identified 2 factors, PLR and MNR, at the intersection of these 2 datasets. Platelet-to-lymphocyte ratio and MNR were identified as factors associated with both the severity of DFUs and the prognosis following TTT surgery.

Correlation between short-chain fatty acids and peri-implant disease: A cross-sectional study.

To explore the correlation between short-chain fatty acids (SCFAs) in the peri-implant sulcular fluid (PISF) and peri-implant diseases. PISF samples were obtained from implants that have been placed for at least 5years, and peri-implant clinical parameters were examined. Gas chromatography-mass spectrometry and high-performance liquid chromatography were used to detect SCFAs in PISF. The correlation between SCFAs and clinical parameters was analyzed by Spearman's correlation. SCFAs related to peri-implant disease were identified by logistic regression and ranked by random forest analysis. Eighty-six implants were divided into a peri-implant health group (PIH-group, 35 implants), peri-implant mucositis group (PIM-group, 25 implants), and peri-implantitis group (PI-group, 26 implants) according to clinical and radiographic examination results. The PIM-group had significantly lower formic acid detection rate than the other two groups (p<0.001). The PIM-group had significantly higher levels of acetic, propionic, and isovaleric acids than the PIH-group (p<0.05). The PI-group had significantly higher levels of propionic, butyric, isobutyric, valeric, and isovaleric acids than the PIH-group (p<0.05). The PI-group had significantly higher levels of butyric, isobutyric, and isovaleric acids than the PIM-group (p<0.05). SCFAs (apart from hexanoic and succinic acids) were significantly and positively correlated with clinical parameters (p<0.05). SCFAs related to peri-implant disease were ranked as follows: butyric, isovaleric, isobutyric, propionic, acetic, formic, and lactic acids. Elevated specific SCFAs are correlated with peri-implant disease. Recognition of this correlation may help in early identification of peri-implant disease and guide further clinical interventions.

Establishment and evaluation of a 3D quantitative analysis method for dental plaque based on an intraoral scanner technique.

Quantitative dental plaque evaluation is necessary for clinical and scientific work. The present study aimed to examine the reliability of a 3D image analysis method by digitally analyzing the color 3D images obtained from an intraoral scanner (IOS) and then detecting and quantifying the plaque information and comparing it with the clinical examination results. A total of 140 teeth from five subjects with a standard dentition were enrolled. Plaque examination was performed at two different time points: after 24 h without oral hygiene (T1), and after habitual brushing (T2). At each time point, the Quigley-Hein Plaque Index (PI) of each tooth surface was recorded separately, followed by color 3D images obtained using an IOS, and image analysis and calculation using Geomagic Wrap 2021 software. The percentage of plaque staining area calculated from the 3D image analysis correlated well with the PI recorded during the clinical examination: the Spearman correlation coefficients were 0.9136 and 0.9061 (P < 0.001) for all tooth surfaces at T1 and T2, respectively. The measurements of the three investigators were in good agreement, with intraclass correlation coefficients of 0.989 and 0.992 (P < 0.001) for the vestibular and lingual surfaces at T1, respectively, and 0.964 and 0.983 (P < 0.001) for the vestibular and lingual surfaces at T2, respectively. In the present study, a digital 3D evaluation system of dental plaque suitable for research and clinical practice was initially developed and its reliability demonstrated.

Alpha-fetoprotein and APRI as predictive markers for patients with Type C hepatitis B-related acute-on-chronic liver failure: a retrospective study

BackgroundType C hepatitis B-related acute-on-chronic liver failure (HBV-ACLF), which is based on decompensated cirrhosis, has different laboratory tests, precipitating events, organ failure and clinical outcomes. The predictors of prognosis for type C HBV-ACLF patients are different from those for other subgroups. This study aimed to construct a novel, short-term prognostic score that applied serological indicators of hepatic regeneration and noninvasive assessment of liver fibrosis to predict outcomes in patients with type C HBV-ACLF.MethodPatients with type C HBV-ACLF were observed for 90 days. Demographic information, clinical examination, and laboratory test results of the enrolled patients were collected. Univariate and multivariate logistic regression were performed to identify independent prognostic factors and develop a novel prognostic scoring system. A receiver operating characteristic (ROC) curve was used to analyse the performance of the model.ResultsA total of 224 patients with type C HBV-ACLF were finally included. The overall survival rate within 90 days was 47.77%. Age, total bilirubin (TBil), international normalized ratio (INR), alpha-fetoprotein (AFP), white blood cell (WBC), serum sodium (Na), and aspartate aminotransferase/platelet ratio index (APRI) were found to be independent prognostic factors. According to the results of the logistic regression analysis, a new prognostic model (named the A3Twin score) was established. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.851 [95% CI (0.801-0.901)], the sensitivity was 78.8%, and the specificity was 71.8%, which were significantly higher than those of the MELD, IMELD, MELD-Na, TACIA and COSSH‐ACLF II scores (all P < 0.001). Patients with lower A3Twin scores (<-9.07) survived longer.ConclusionsA new prognostic scoring system for patients with type C HBV-ACLF based on seven routine indices was established in our study and can accurately predict short-term mortality and might be used to guide clinical management.

Fabry disease caused by the GLA p.Gly183Asp (p.G183D) variant: Clinical profile of a serious phenotype

BackgroundThe detailed clinical phenotype of patients carrying the α-galactosidase gene (GLA) c.548 G > A/p.Gly183Asp (p.G183D) variant in Fabry disease (FD) has not been thoroughly documented in the existing literature. MethodsThis paper offers a meticulous overview of the clinical phenotype and relevant auxiliary examination results of nine confirmed FD patients with the p.G183D gene variant from two families. Pedigree analysis was conducted on two male patients with the gene variant, followed by biochemical and genetic screening of all high-risk relatives. Subsequently, evaluation of multiple organ systems and comprehensive instrument assessment were performed on heterozygotes of the p.G183D gene variant. ResultsThe study revealed that all patients exhibited varying degrees of cardiac involvement, with two demonstrating left ventricular wall thickness exceeding 15 mm on echocardiography, and the remaining six exceeding 11 mm. Impaired renal function was evident in all six patients with available blood test data, two of whom underwent kidney transplantation. Eight cases reported neuropathic pain, and five experienced varying degrees of stroke or transient ischemic attack (TIA). ConclusionThis study indicates that the GLA p.G183D gene variant can induce premature organ damage, particularly affecting the heart, kidneys, and nervous system.

Tethered cord syndrome from pediatric and adult perspectives: a comprehensive systematic review of 6135 cases.

This study aimed to investigate the differences in clinical features, diagnostic examination, treatment, and pathological results between adult-onset and pediatric-onset tethered cord syndrome (TCS). The authors searched the PubMed, Embase, and Cochrane Library databases through January 2023 for reports on TCS, extracting information on clinical features, imaging data, treatment modalities, prognosis, and pathological research results. A total of 6135 cases from 246 articles were included in the analysis. This review was conducted in accordance with the 2020 PRISMA guidelines and registered on PROSPERO. The most common adult clinical manifestations were pain, urinary symptoms, and numbness; in children, they were urinary symptoms, skin lesions, bowel symptoms, and unspecific motor deficits. Surgical treatment was the primary approach for both adults and children, with a higher clinical improvement rate observed in adults. However, adults also had a higher rate of surgical complications than children. TCS pathological studies have not yet identified the differences between adults and children, and the pathogenesis of adult-onset TCS requires further investigation. Adult-onset and pediatric-onset TCS exhibit certain differences in clinical characteristics, diagnostic examinations, and treatments. However, significant differences have not been found in current pathological studies between adults and children. Systematic review registration no.: CRD42023479450 (www.crd.york.ac.uk/prospero).

Predictive value of monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) for poor prognosis after intravenous thrombolytic therapy for acute ischaemic stroke

IntroductionThe purpose of this study was to examine the relationship between monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and poor short-term 3-month and long-term 6-month prognosis after intravenous thrombolysis in patients with acute ischaemic stroke.Material and methodsBy retrospective analysis, 763 eligible patients with acute ischaemic stroke with intravenous thrombolysis were included in the study, and the general data and clinical laboratory examination results of the patients were collected. The relationship between MHR and poor prognosis at 3 and 6 months in patients with intravenous thrombolysis was derived by stepwise regression using the R language, followed by 1:1 propensity score matching to determine the MHR threshold and to investigate the relationship between high and low MHR values and poor prognosis.ResultsMHR level was found to predict the prognosis of intravenous thrombolysis patients with acute ischaemic stroke, and it was an effective predictor of poor prognosis at 3 and 6 months after intravenous thrombolysis. MHR has a threshold of 0.584. High MHR levels were strongly associated with a poor 3-month prognosis of intravenous thrombolysis in patients with acute ischaemic stroke (OR = 5.657; 95% CI: 4.124–7.762; p &lt; 0.001). High MHR level was closely associated with poor prognosis of acute ischaemic stroke patients with intravenous thrombolysis at 6 months (OR = 4.923; 95% CI: 3.603–6.726; p &lt; 0.001).ConclusionsMHR level is a valid predictor for poor prognosis at 3-6 months after intravenous thrombolysis in patients in acute ischaemic stroke.

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records.

Tuberculosis (TB) causes over 1million deaths annually. Providing effective treatment is a key strategy for reducing TB deaths. In this study, we identified factors associated with unsuccessful treatment outcomes among individuals treated for TB in Brazil. We obtained data on individuals treated for TB between 2015 and 2018 from Brazil's National Disease Notification System (SINAN). We excluded patients with a history of prior TB disease or with diagnosed TB drug resistance. We extracted information on patient-level factors potentially associated with unsuccessful treatment, including demographic and social factors, comorbid health conditions, health-related behaviors, health system level at which care was provided, use of directly observed therapy (DOT), and clinical examination results. We categorized treatment outcomes as successful (cure, completed) or unsuccessful (death, regimen failure, loss to follow-up). We fit multivariate logistic regression models to identify factors associated with unsuccessful treatment. Among 259,484 individuals treated for drug susceptible TB, 19.7% experienced an unsuccessful treatment outcome (death during treatment 7.8%, regimen failure 0.1%, loss to follow-up 11.9%). The odds of unsuccessful treatment were higher with older age (adjusted odds ratio (aOR) 2.90 [95% confidence interval: 2.62-3.21] for 85-100-year-olds vs. 25-34-year-olds), male sex (aOR 1.28 [1.25-1.32], vs. female sex), Black race (aOR 1.23 [1.19-1.28], vs. White race), no education (aOR 2.03 [1.91-2.17], vs. complete high school education), HIV infection (aOR 2.72 [2.63-2.81], vs. no HIV infection), illicit drug use (aOR 1.95 [1.88-2.01], vs. no illicit drug use), alcohol consumption (aOR 1.46 [1.41-1.50], vs. no alcohol consumption), smoking (aOR 1.20 [1.16-1.23], vs. non-smoking), homelessness (aOR 3.12 [2.95-3.31], vs. no homelessness), and immigrant status (aOR 1.27 [1.11-1.45], vs. non-immigrants). Treatment was more likely to be unsuccessful for individuals treated in tertiary care (aOR 2.20 [2.14-2.27], vs. primary care), and for patients not receiving DOT (aOR 2.35 [2.29-2.41], vs. receiving DOT). The risk of unsuccessful TB treatment varied systematically according to individual and service-related factors. Concentrating clinical attention on individuals with a high risk of poor treatment outcomes could improve the overall effectiveness of TB treatment in Brazil.

#1763 Risk factors and clinical prediction models for osteoporosis in predialysis chronic kidney disease patients

Abstract Background and Aims The research concerning osteoporosis among individuals with predialysis chronic kidney disease (CKD) has been relatively neglected in existing literature. Furthermore, the risk factors for osteoporosis in this demographic have not been adequately investigated. The objective of this study was to explore the risk factors associated with osteoporosis in predialysis CKD patients and to construct a predictive model capable of estimating the likelihood of osteoporosis in these individuals. Method A retrospective study was conducted on 326 predialysis CKD patients. Relevant clinical examination results and measurements of bone mineral density (BMD) using dual-energy X-ray absorptiometry were collected. Binary logistic regression was utilized to explore the risk factors associated with osteoporosis and to develop predictive models. Results In male predialysis CKD patients, age represents a risk factor, while 25-(OH)-Vitamin D acts as a protective factor against osteoporosis. Among female patients, age, underweight status, NBAP, and advanced CKD (G5) are significant risk factors for osteoporosis, whereas PTH serves as a protective factor. In pre-dialysis CKD patients in stages CKD1-4, age, underweight status, and NBAP are identified as risk factors for osteoporosis. For G5 predialysis patients, advanced age and NBAP pose a high risk of osteoporosis, while 25-(OH)-Vitamin D and PTH exhibit protective effects. Additionally, nomogram models illustrating the risk of osteoporosis in pre-dialysis patients of different genders and renal function stages were created. Conclusion Age, underweight, severity of renal dysfunction, NBAP, PTH, and 25-(OH)-vitamin D are strongly associated with osteoporosis in predialysis CKD patients.

Low Rate of AVN and Complications in Unstable SCFE With Epiphyseal-metaphyseal Discontinuity After Treatment With a Modified Dunn Procedure

Background The risk of developing avascular necrosis (AVN) in the setting of an unstable slipped capital femoral epiphysis (SCFE) that is undergoing treatment with the modified Dunn procedure is not well understood. In addition, since the Loder classification of unstable is reportedly different than actual intraoperatively observed instability (that is, discontinuity between the femoral head epiphysis and proximal femoral metaphysis), the overall risk of developing AVN, as well as the potential complications of treatment of these patients with the modified Dunn procedure, are unknown. Questions/purposes To evaluate the modified Dunn procedure for the treatment of patients with epiphyseal-metaphyseal discontinuity, we asked: (1) What was the survivorship free from AVN at 10 years? (2) What was the survivorship free from subsequent surgery and/or complications at 10 years? (3) What were the clinical and patient-reported outcome scores? Methods In a retrospective analysis, we identified 159 patients (159 hips) treated with a modified Dunn procedure for SCFE between 1998 and 2020, of whom 97% (155 of 159) had documentation about intraoperatively observed epiphyseal-metaphyseal stability. Of those, 37% (58 of 155) of patients were documented to have intraoperatively observed epiphyseal-metaphyseal discontinuity and were considered eligible for inclusion, whereas 63% (97 of 155) had documented epiphyseal-metaphyseal stability and were excluded. No patients were lost to follow-up before the 2-year minimum. All patients were assessed for survival, but 7% (4 of 58) did not fill out our outcomes score questionnaire. This resulted in 93% (54 of 58) of patients who were available for outcome score assessment. Additionally, 50% (29 of 58) of patients had not been seen within the last 5 years; they are included, but we note that there is uncertainty about their status. The median (range) age at surgery was 13 years (10 to 16), and the sex ratio was 60% (35 of 58) male and 40% (23 of 58) female patients. Sixty-four percent (37 of 58) of patients were classified as acute-on-chronic, and 17% (10 of 58) of patients were classified as acute. Forty-seven percent (27 of 58) of patients presented with severe slips and 43% (25 of 58) of patients with moderate slips based on radiographic classification. All patients underwent surgical hip dislocation with the modified Dunn procedure to correct the slip deformity and provide stabilization. Complications and reoperations were assessed from a review of electronic medical records, and a Kaplan-Meier estimator was used to estimate survivorship free from complications and reoperations at 10 years. Clinical examination results and questionnaire responses were evaluated at minimum 2-year follow-up. Results Kaplan-Meier survivorship free from AVN was 93% (95% CI 87% to 100%) at 10 years. Survivorship free from any reoperation was 75% (95% CI 64% to 88%) at 10 years. In addition, survivorship free from complications, defined as development of AVN, reoperation, or a Sink Grade II complication or higher, was 57% (95% CI 45% to 73%) at 10 years. The median (range) Merle D’Aubigne Postel score was 18 (14 to 18) for the patients who did not develop AVN, and 12 (6 to 16) for the four patients who developed AVN (p &lt; 0.001). The median modified Harris hip score was 100 (74 to 100) in the non-AVN cohort and 65 (37 to 82) in the AVN cohort (p = 0.001). Median HOOS total score was 95 (50 to 100) in the non-AVN cohort and 53 (40 to 82) in the AVN cohort (p = 0.002). Conclusion Although the modified Dunn procedure is technically challenging, this study shows that in experienced hands, patients with who have demonstrated epiphyseal-metaphyseal discontinuity can be treated with a low risk of AVN and subsequent surgery. Referral of these patients to specialists who have substantial expertise in this procedure is recommended to improve patient outcomes. Prospective, long-term observational studies will help us identify these high-risk patients preoperatively and determine the long-term success of this procedure. Level of Evidence Level IV, therapeutic study.

Prediction of cervicalgia regression after surgery for cervical osteochondrosis

In the medical rehabilitation of patients with cervical osteochondrosis, a surgery is one of the stages in the treatment of this spinal pathology. However, the use of modern high-tech diagnostic and treatment methods does not always make it possible to achieve such a result of surgical intervention that would satisfy both the patient and the attending physicians. Due to this, we are obliged to constantly study and develop new diagnostic and therapeutic measures that could help improve the quality of treatment of clinical manifestations of cervical osteochondrosis. The multifactorial analysis of data about patients with cervical osteochondrosis allowed creating a database of various diagnostic and prognostic factors, on the basis of which the «Method for predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis» was developed depending on the severity of the identified diagnostic and prognostic factors and the volume of the upcoming surgical intervention. The proposed method of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis can serve as an integral part of a comprehensive preoperative examination of patients with this spinal pathology. As a result of applying the proposed diagnostic method, additional opportunities arise to guide the surgeon to an individual set of surgical measures with the most promising outcome. Moreover, comfortable psychological conditions are created for the patient as fear and uncertainty in the result of the upcoming treatment are eliminated, which gives him / her confidence in the outcome of the upcoming operation and helps to improve treatment results and reduce the disability of patients. The work is based on the analysis of the results of a comprehensive clinical examination, treatment, and follow-up of 457 patients who underwent surgical treatment for cervical osteochondrosis. The reliability of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis is 96.9 %.

Traumatic and iatrogenic sciatic nerve injury in 38 dogs and 10 cats: Clinical and electrodiagnostic findings.

Reports describing sciatic nerve injuries (SNI) and their outcome are scarce in veterinary medicine. Describe the causes of traumatic and iatrogenic SNI and evaluate which clinical and electrodiagnostic findings predict outcome. Thirty-eight dogs and 10 cats with confirmed SNI referred for neurologic and electrodiagnostic evaluation. Clinical and electrodiagnostic examination results, including electromyography (EMG), motor nerve conduction studies, muscle-evoked potential (MEP), F-waves, sensory nerve conduction studies, and cord dorsum potential (CDP), were retrospectively evaluated. Quality of life (QoL) was assessed based on owner interviews. Surgery (42%) and trauma (33%) were the most common causes of SNI; in dogs, 24% were caused by bites from wild boars. Ability to flex and extend the tarsus was significantly associated with positive outcome in dogs. Mean time from onset of clinical signs until electrodiagnostic evaluation was 67 ± 65 (range, 7-300) days and 65 ± 108 (range, 7-365) days for dogs and cats, respectively. A cut-off amplitude of 1.45 mV for compound motor action potentials (CMAP) was predictive of positive outcome in dogs (P = .01), with sensitivity of 58% and specificity of 100%. Clinical motor function predicts recovery better than sensory function. Electrodiagnostic findings also may play a role in predicting the outcome of SNI. Application of the proposed CMAP cut-off amplitude may assist clinicians in shortening the time to reassessment or for earlier suggestion of salvage procedures. Owners perceived a good quality of life (QoL), even in cases of hindlimb amputation.

Angioedema induced by ofloxacin

A 42-year-old woman was prescribed the second-generation 4-fluoroquinolone antibiotic ofloxacin to cure loose movements. However, after taking the medication, she developed lip edema. Antibiotics called fluoroquinolones are frequently administered for a variety of medical disorders. The patient was successfully treated with corticosteroids after the diagnosis of ofloxacin-induced hypersensitive reaction was made based on the patient's history, clinical examination, and normal test results. Because ofloxacin, this type of reaction is extremely uncommon. Anti-allergic medicines and drug cessation were used to treat the disease.

THE USE OF LABORATORY CRITERIA IN THE RISK ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AFTER TRANSPEDICULAR FIXATION OF THE LUMBAR SPINE

Objective. To investigate the peculiarities of the development of postoperative complications after surgical treatment of degenerative diseases of the lumbar spine with transpedicular fixation of the vertebrae and their relationship with changes in preoperative laboratory parameters. Methods. A retrospective analysis of the biochemical examination data of 35 patients with degenerative diseases of the lumbar spine who underwent discectomy with transpedicular fixation was performed. In four groups of patients with postoperative complications: 10 patients — inflammation of the what fabrics around metal structures and 5 patients — instability of the metal structure. The results of the examination of 20 people without specified complications served as a comparison group. Comparison was made with a control group (20 practically healthy people). Results. Patients have a significant increase in serum ALT activity by 42.29 and AST by 63.55 %, by 38.37 % of the level of CS content, by 37.21 % of total glycoproteins compared to those in the control group. In patients with soft tissue inflammation around the serum instrument zone, the content of LDLP was recorded by 29.27 %, by 23.53 % of the UA, by 12.34 % of TP results higher by 32.01 % ALT activity and 83 %, 49 % AST, 54.96 % AlP activity, 31.40 % — AlP/AcP, 60.47 % — concentration of CS, 95.57 % — total glycoproteins than in persons in the control group. In the serum of patients with the development of instability of metal structures, 28.55 % was observed by activity of the ALT, AlP — by 38.47 %, AcP — by 48.84 %, less by 58.35 % of AlP/AcP, the CHOL content of 13 88 %, higher by 25.43 % of the LDLP content than such persons in the control group. Content of the P was lower by 31.51 % and the Ca/P ratio was higher by 38.95 %, the content of CS by 83.72 %, total glycoproteins — by 48.83 %. Conclusions. Comparative analysis of the results of preoperative clinical and laboratory examination of patients with degenerative spinal diseases with transpedicular fixation which is reflected in the deviations of their preoperative laboratory parameters from such persons with uncomplicated course of the postoperative period after similar surgery.