Significant Clinical Improvement Research Articles

Preventive Approach to Type II Diabetes Mellitus: A Case Study

The escalating prevalence of Type 2 Diabetes Mellitus (T2DM) in India necessitates effective preventive strategies, particularly for individuals at high risk of developing the condition. This case study examines the application of an integrative Ayurvedic approach to prevent the progression of prediabetes in a 48-year-old male, identified as high-risk using the Indian Diabetes Risk Score (IDRS). The treatment protocol focused on addressing Kapha and Meda imbalances, incorporating Shamana therapy along with tailored dietary recommendations, lifestyle modifications, and stress management strategies. Significant clinical improvements were observed, including a reduction in symptoms such as fatigue, polyuria, and polydipsia. Objective metabolic parameters, including fasting and postprandial blood glucose, HbA1c, and IDRS score, showed notable improvement over six months. This case highlights the potential of Ayurveda to provide effective, personalized, and evidence-based preventive care, supporting the management of prediabetes and mitigating the risk of T2DM progression

A CLINICAL STUDY TO EVALUATE THE EFFECT OF NAGARADI KWATHA AND CHANDRAPRABHA VATI IN MOOTRASHMARI W.S.R. TO UROLITHIASIS

Ashmari is the formation of stone in Mootravaha srotas, resulting in severe pain as given by the enemy. It is an effect of the complex, physicochemical process that involves a sequence of events in the formation of any urinary stones, including urinary saturation, supersaturation, nucleation and growth of crystals, aggregation and retention of crystals, and finally, stone formation. It affects about 12% of the world's population at some stage in their lifetime in all age groups, sexes, and races but occurs more frequently in men than women aged 20 to 49 years. In India, about 12% of the total population is expected to have urinary stones in their life, out of which 50% may end up with loss of kidney function. Contemporary treatment such as Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL), Retrograde Intra-renal surgery (RIRS), and Laparoscopic Ureter lithotomy adopted in the condition of Urolithiasis is quite costly with high incidence of recurrence. For the present study, Nagaradi Kwatha and Chandraprabha Vati were administered for 14 days. Each patient was observed on the 0-day, 7th, and 15th day of drug intervention with said parameters. The study showed significant clinical improvement in reducing the shoola, mootradosha, Kruchramutrata, and Sarakta mootrata and showed good response in disintegration and the expulsion of Ashmari.

A rare case of limited granulomatosis with polyangiitis presenting as bilateral parotitis

Background: Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis affecting small and medium-sized vessels, commonly involving the respiratory tract and kidneys. Salivary gland involvement, particularly bilateral parotitis, is an uncommon presentation of GPA. Case Report: We report the case of a 38-year-old Asian male who presented with left ear pain and parotid swelling after a water park visit. Initially treated with antibiotics for suspected otitis externa, his symptoms worsened, leading to bilateral parotitis, facial palsy, and otomastoiditis. Imaging revealed parotid abscesses and lab results showed elevated antineutrophil cytoplasmic antibodies (ANCA), specifically cytoplasmic ANCA directed against proteinase 3, confirming the diagnosis of GPA. Cultures and autoimmune workups for other causes, such as Sjogren’s syndrome and immunoglobulin G4-related disease, were negative. Treatment with high-dose corticosteroids and methotrexate resulted in significant clinical improvement. Conclusion: This case highlights the importance of considering GPA in atypical presentations such as parotitis, even in the absence of renal involvement. Early diagnosis and appropriate immunosuppressive therapy are critical to prevent further complications in multisystem involvement.

Exercise program based on the pilates method for muscle flexibility in poultry workers

Background: Musculoskeletal (MS) disorders in poultry workers range from mild ailments to severe pain and illness; caused by lack of flexibility. Pilates exercises have positive effects on physical condition. Objective: Apply a Pilates-based exercise program to improve muscle flexibility in poultry workers. Methods: A study was developed in 29 workers who met the inclusion criteria. The intensity of pain was assessed with the visual analog scale and the level of flexibility with the Flexitest, to determine the needs of the workers and design the program based on Pilates. The program was validated by expert judgment and applied for 12 weeks, pain intensity and flexibility level were reassessed. Results: They demonstrated significant clinical and statistical improvements in the entire population, decreasing the intensity of pain from moderate and severe to mild (p<0.005) and improving flexibility from levels 1 and 2, which are poor and medium, to level 3, which is good flexibility. (p<0.005) after the program. Conclusion: The Pilates-based exercise program improves muscle flexibility and decreases pain intensity in poultry workers.

HI Acquired palmoplantar keratoderma in an immunocompromised patient: A case report.

Syphilis, known for its capacity to mimic various diseases, has seen rising incidence, particularly in adolescents, men who have sex with men (MSM), and individuals with HIV. Palmoplantar keratoderma (PPK), a rare manifestation of secondary syphilis, poses diagnostic challenges due to its resemblance to other conditions. We report the case of a 42-year-old man living with HIV presenting with acquired PPK, characterized by hyperkeratotic plaques on the palms and soles, alongside syphilitic roseola. Histopathology confirmed psoriasiform dermatitis with spirochetes. The patient received weekly intramuscular benzathine penicillin G, leading to significant clinical improvement without relapse. This case underscores the importance of recognizing atypical infectious presentations in individuals living with HIV and highlights the need for careful differential diagnosis in acquired PPK cases.

Macrophage activation syndrome in a patient with systemic lupus erythematous triggered by tuberculous meningitis

Background: Hemophagocytic lymphohistiocytosis (HLH), is characterized by systemic uncontrolled inflammation resulting from immune dysregulation secondary to various triggers, including genetics, infections, autoimmune diseases, and malignancies. Macrophage activation syndrome (MAS) is an immune dysregulation phenomenon, in which an underlying rheumatological disease is present. We report a rare, interesting case of a middle-aged female, with a systemic lupus erythematosus (SLE) flare complicated by macrophage activation syndrome (MAS), in which tuberculous meningitis (TBM) was the identified trigger. Case report: A 48-year-old female with an African ethnic background, diagnosed with SLE, presented with a 2-week history of high-grade fever, cough, and worsening arthralgia. She was initially admitted with suspected SLE flare secondary to community acquired pneumonia and was started on broad-spectrum antibiotics. Later during her hospital stay, she underwent extensive workup because of her clinical condition, as she had continuous spikes of fever, progressive cytopenia, accompanied with acute confusion state despite treatment. She was ultimately diagnosed with SLE flare complicated by MAS secondary to TBM in view of persistent fever, neuropsychiatric symptoms, hyperferritinemia and hypertriglyceridemia, supported by bone marrow aspiration findings, a tuberculosis (TB) positive contact and supporting cerebrospinal fluid analysis suggestive of TBM. She was immediately started on pulse doses of steroids and anti-tuberculosis medications in which significant clinical improvement was observed. She was discharged home, with continuity of care done at the outpatient department in addition to continuity of physical rehabilitation. Conclusion: Given the wide range of clinical presentations and similarities between SLE and the life-threatening MAS, it is essential to maintain a high level of suspicion to establish the diagnosis and promptly start the necessary treatment to ensure better clinical and survival outcomes.

A Rare Case of Dilated Cardiomyopathy in Sjögren’s Syndrome

Dilated Cardiomyopathy (DCM) is a rare but significant complication in patients with primary Sjögren’s Syndrome (pSS), a systemic autoimmune disease that primarily affects the exocrine glands. Cardiac involvement in pSS is uncommon, making the recognition of DCM in these patients crucial for timely intervention. This is a case of a 44-year-old female with well-controlled hypertension who developed progressively worsening shortness of breath, chest pain and bilateral pedal oedema. She also had a two-month history of dry eyes and dry mouth, indicative of sicca symptoms. Clinical examination revealed signs of fluid overload, a pansystolic murmur and sicca features. Electrocardiogram (ECG) and echocardiography demonstrated severe left ventricular dysfunction with an ejection fraction of 15%, consistent with DCM. Laboratory investigations revealed elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) levels and positive anti-Ro52 and anti-La antibodies, pointing to an autoimmune aetiology. Cardiac Magnetic Resonance (CMR) Imaging confirmed non ischaemic DCM, ruling out ischaemic causes. The patient was diagnosed with DCM secondary to pSS. She was treated with diuretics, Angiotensin Converting Enzyme (ACE) inhibitors and immunosuppressive therapy, including methylprednisolone and a tapering course of prednisolone over six months. Significant clinical improvement was observed on follow-up. This case highlights the importance of recognising autoimmune aetiologies, such as pSS, in patients presenting with unexplained cardiomyopathy. Early diagnosis and interdisciplinary management are essential in preventing severe cardiac complications and improving patient outcomes in rare presentations of Sjögren-associated cardiomyopathy

Autologous Bone Marrow-Derived Mesenchymal Stem Cell Transplantation for Decompensated Post-Hepatitis B Cirrhosis: A Case Report

End-stage liver disease (ESLD) represents the terminal phase of chronic liver injury, characterized by overt clinical manifestations and severe complications that significantly impair the quality of life. The condition often culminates in a variety of symptoms, including jaundice, ascites, and hepatic encephalopathy, which reflect the liver's inability to perform its essential functions. Liver transplantation remains the definitive treatment for ESLD; however, limitations in donor organ availability necessitate exploration of alternative therapeutic strategies. we present a case of a 71-year-old Asian male with decompensated post-hepatitis B cirrhosis, who had a one-year history of hematemesis and melena. Endoscopic evaluation confirmed the presence of esophageal-gastric varices, further corroborating portal hypertension and hypersplenism. This patient underwent treatment with autologous bone marrow-derived mesenchymal stem cell (BM-MSC) transplantation. Following the procedure, the patient demonstrated significant clinical improvement, suggesting the safety and potential feasibility of BM-MSC transplantation for patients with ESLD. The field of BM-MSC transplantation has witnessed significant progress in recent years, emerging as a promising therapeutic approach for ESLD. This innovative treatment modality harnesses the regenerative capabilities of stem cells to promote liver repair and function. Notably, BM-MSCs possess immunomodulatory properties that may mitigate inflammation and fibrosis in the liver, thereby addressing some of the underlying pathophysiology associated with ESLD. This case presentation highlights the potential application of BM-MSC therapy in patients with decompensated cirrhosis. The findings underscore the need for further research and refinement of clinical application techniques to fully realize the broad therapeutic possibilities of BM-MSC transplantation for ESLD. As we advance our understanding of stem cell therapies, it is crucial to conduct larger studies to evaluate long-term outcomes and establish standardized protocols for treatment.

Predictors for quality of life improvement following rTMS treatment in neuropathic pain patients.

Recently, Repetitive Transcranial Magnetic Stimulation (rTMS) has gained attention for its potential in relieving neuropathic pain (NP). NP encompasses central and peripheral neuralgia, characterized by sensory abnormalities and spontaneous pain. Pharmacological treatments often provide partial relief with significant side effects, making rTMS an attractive alternative. This study aimed to assess the efficacy of rTMS in treating NP and its impact on quality of life over three months. A total of 51 patients with drug-resistant NP were included, undergoing 15 sessions of rTMS targeting motor cortex areas over three weeks. Clinical response was evaluated using various psychometric scales, including VAS for pain and PGIC. Quality of life was assessed using the SF-36 questionnaire. Results showed significant clinical improvements in pain severity and quality of life following rTMS treatment. Predictive factors of quality of life improvement were identified, with mental health being crucial across all NP areas. Notably, patients with cerebral NP showed improvements linked to physical dimensions, emphasizing tailored treatment approaches. This study underscores the efficacy of rTMS in managing NP, highlighting sustained improvements in pain severity and quality of life. The findings offer valuable insights for personalized treatment approaches and optimizing patient outcomes in NP management.

Pulmonary lymphangiomatosis: insights into an ultra-rare disease

BackgroundPulmonary lymphangiomatosis (PL) is an ultrarare disease characterized by diffuse infiltration of the lung, pleura and/or mediastinum by abnormal lymphatic proliferation. Consented diagnostic or treatment approaches are not established. We therefore aimed to collect data on diagnostics and treatments in a cohort of patients with PL from a tertiary center for rare lung diseases.MethodsClinical, radiological and outcome data from PL patients were collected retrospectively.Results12 patients were diagnosed between 1996 and 2022 in our center. PL was diagnosed more commonly in female (58%), never smokers (75%) and younger patients (mean age 42 years). Main clinical symptoms comprised haem- and chyloptysis (58%) and dyspnea on exertion (83%). Pulmonary function was mostly restrictive (mean VC 59%) with impaired DLCO (mean 65%). Radiological assessment mainly showed mediastinal involvement (83%), and pleural effusion (67%), pleural thickening (67%) and bronchial wall thickening (67%) while interstitial changes were rare. Diagnosis was confirmed by surgical or transbronchial cryobiopsy. 8 patients were treated with sirolimus, 3 of these combined with a surgical intervention and in one case surgical intervention was necessary 9 months after initiation of sirolimus. Clinical and radiological improvement was demonstrated for all patients treated with sirolimus. 1 patient received a lung transplant due disease progression. Survival rates were 90% after a mean follow up of at least 3 months.ConclusionThis case series illustrates the variability of the clinical presentation of PL. Among our patients, those treated with sirolimus showed significant clinical, functional and radiological improvement. However, further investigation is needed to understand the pathogenesis of lymphangiomatosis in order to establish therapeutic approaches.

Tuberculosis presenting with multiple osteolytic lesions in an adolescent boy with fanconi anemia

Tuberculosis (TB) is well known to present with varied clinical and radiological features. Multifocal bone involvement in tuberculosis is rare. Multiple lytic lesions raise the possibility of malignancy usually, especially, in children with predisposing conditions like Fanconi anemia. However, a thorough evaluation with repeated attempts at histopathological confirmation and microbiological evaluation is mandatory in children with unique presentations with inconclusive initial diagnostic tests. We report an adolescent boy with an underlying Fanconi anemia who presented with fever, cough and respiratory distress. On evaluation, he had pallor, wasting, features of right upper lobe consolidation and multiple lytic lesions. Initial diagnostic evaluation including bone marrow evaluation and a diagnostic biopsy from ribs and bronchoalveolar lavage failed to yield a conclusive diagnosis. After nearly 5 weeks of broad-spectrum antibiotics and antifungals, as the clinical signs were progressing, a complete re-evaluation including biopsy from the rib lesion was done and further, he was diagnosed to have skeletal tuberculosis based on the Mycobacterium Growth Indicator Tube (MGIT) culture for Acid Fast bacilli (AFB). Child was empirically started on anti-tuberculous therapy pending cultures, which have led to significant clinical improvement in 2 weeks of therapy. Low bacterial load in skeletal TB reduces the chance to diagnosis, hence making clinical judgment imperative in diagnosis; and repeated testing is mandatory when there is high index of suspicion.

Arthroscopic suture anchor repair and debridement for refractory lateral epicondylitis show significant clinical improvement

PurposeTo retrospectively compare the clinical outcomes of arthroscopic suture anchor repair of the common extensor tendon (CET) and arthroscopic debridement of CET for the treatment of refractory lateral epicondylitis. MethodsPatients with refractory lateral epicondylitis who underwent arthroscopic surgery between August 2018 and September 2022 with a minimum of 1-year follow-up were included. All patients were divided into two groups based on whether they underwent suture anchor repair. The modified Nirschl technique was used to debride the CET lesions in all patients, and modified anchor repair was used for CET insertion reconstruction in patients after January 2021. In short, suture anchor fixation (single-row) was used in patients with tear areas less than 50% of the CET insertion, and suture-bridge fixation (double-row) was used in patients with tear areas greater than 50%. The outcomes, including the visual analog scale (VAS) score for pain, the Mayo Elbow Performance Score (MEPS), the quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and surgical satisfaction, were measured one day preoperatively and at the latest follow-up. The proportion of patients achieving the minimal clinically important difference (MCID) was compared between the groups. ResultsA total of 62 patients (60% female) were included in the final analysis (30 in the debridement group and 32 in the repair group). The mean age of the cohort was 47.6 ± 7.3 years, with 77% of patients affecting the dominant arm. The follow-up time was 29.3 ± 3.2 (range: 19 - 35) months for the debridement group and 27.2 ± 5.4 (range: 20 - 37) months for the repair group (P = 0.073). Preoperative patient-reported outcomes were comparable between the groups and were significantly improved after surgery. Postoperatively, patients in the repair group had better MEPS score (95.8 ± 6.9 vs 91.2 ± 8.0; P = 0.017) and quick DASH scores (2.2 ± 3.9 vs 4.2 ± 3.9; P = 0.043), while there were no differences between the two groups in terms of VAS scores for pain during rest (0.1 ± 0.4 vs 0.1 ± 0.3; P = 0.933) or during activity (0.3 ± 0.8 vs 0.4 ± 0.6; P = 0.639). MCID achievement of VAS score during rest was similar between the repair group (97%) and the debridement group (93%, P = 0.607), while MCID achievement in the VAS score during activity, MEPS score, and quick-DASH score was 100% in both groups. ( All patients resumed their daily life and work after surgery, for a surgical satisfaction rate of 98.4%. ConclusionArthroscopic suture anchor repair and debridement of the CET insertion resulted in significant clinical improvement in patients with refractory lateral epicondylitis. Level of evidenceRetrospective comparative case series; level 3.

Paradoxical Deterioration During Treatment of Tuberculous Meningitis Responded to Infliximab But Not to Steroids.

Patients with tuberculous meningitis may experience a paradoxical deterioration in spite of correct antituberculosis treatment.The paradoxical deterioration may have a severe clinical presentation, requiring high vigilance and consideration of treatment escalation.Here we report that off-label administration of tumour necrosis factor-alpha blocker infliximab induced a significant clinical and radiological improvement in a severe case of paradoxical deterioration in a patient with tuberculous meningitis, suggesting its potential as a treatment when standard therapies fail.

Management of Acute Compartment Syndrome During the Al Haouz Earthquake - Department of Reconstructive and Aesthetic Plastic Surgery, CHU Mohammed VI, Marrakech

On September 8, 2023, a devastating earthquake struck the Al Haouz region of Morocco, causing significant injuries, including cases of acute compartment syndrome (ACS), a surgical emergency. This report presents a case of a patient from the earthquake, treated for ACS at Mohammed VI University Hospital in Marrakech. The patient, who suffered limb trauma from debris crushing, presented with rhabdomyolysis and signs of ACS in the left upper and lower limbs. Clinical findings included functional impairment, "Coca-Cola" urine, and high creatine kinase levels (60,000), accompanied by renal failure. Decompression surgery (aponevrotomies) was performed to relieve intracompartmental pressure, followed by a directed healing protocol using the "shoe-lace" technique for wound closure. Post-operative management included antibiotics, hemodialysis for acute renal failure, nutritional support, and motor rehabilitation. Complications, such as surgical site infection and hematoma, were addressed with revision surgery and adjusted antibiotic therapy. Despite these challenges, the patient showed significant clinical improvement and resumed normal activity within three months post-operatively. This case highlights the critical importance of timely surgical intervention in ACS, particularly in disaster settings. Early diagnosis, prompt fasciotomy, effective wound management, and multidisciplinary care are essential to prevent severe complications, such as septic wounds or amputation, and ensure successful recovery.

Abstract 4136203: Risk of Mortality and Heart Failure with Myosin Inhibition Among Hypertrophic Cardiomyopathy Patients

Background: While prior studies have established that mavacamten therapy in symptomatic obstructive hypertrophic cardiomyopathy (oHCM) leads to significant clinical and functional improvement, long-term data on the effect of mavacamten on mortality and heart failure with reduced ejection fraction (HFrEF) in these patients is lacking. Methods: In this retrospective cohort study utilizing electronic health record data from the TriNetX Network, we aimed to assess the association of mavacamten therapy with mortality and HFrEF compared to medical management among patients with oHCM between 04/2022 and 04/2024. The hazard ratio (HR) and 95% confidence interval (CI) for the study outcomes were estimated by comparing propensity-score matched groups. Results: Among 47,601 adults (45.4% females; mean age: 63.5±16.6 years), 701 and 46,900 patients were included in the mavacamten and medical management groups, respectively. ( Table ) In the propensity-matched analysis, mavacamten was associated with a lower risk of mortality (HR=0.40;95%CI:0.21-0.73,p=0.002), but a similar risk of incident HFrEF (HR=1.03;95%CI:0.56-1.88,p=0.93) compared with medical management. ( Figure ) Conclusions: The current study is among the first to report improved survival with mavacamten therapy among patients with oHCM utilizing real-world data. The similar risk of HFrEF between the mavacamten and medical management cohorts highlighted in this study indicates the efficacy of the Risk Evaluation and Mitigation Strategy (REMS) program in maintaining patient safety and offsetting any potential excess risk of HFrEF.

Mixed Connective Tissue Disease Presenting as Diabetic Ulcer in a 52 Year Old Female Patient: A Case Report

Mixed connective tissue disease (MCTD) is a rare and complex autoimmune condition characterized by overlapping features of systemic lupus erythematosus (SLE), systemic sclerosis, polymyositis/dermatomyositis, and rheumatoid arthritis. Due to the varied clinical presentation and the absence of validated classification criteria, early diagnosis can be challenging, often leading to misclassification or delayed recognition. Here, we report a case of a 52-year-old female with MCTD and vasculitis, underscoring the importance of considering uncommon autoimmune etiologies in patients with non-healing ulcers. The patient presented with skin tightening, Raynaud’s phenomenon, and chronic non-healing ulcers, initially attributed to diabetic complications. Diagnostic evaluation revealed high-titre anti-U1-RNP antibodies, confirming MCTD. Treatment with oral steroids, cyclophosphamide, and sildenafil led to significant clinical improvement, particularly in ulcer resolution. This case emphasizes the critical need for early intervention and a multidisciplinary approach in managing autoimmune vasculitis associated with MCTD to prevent progression and optimize patient outcomes.

Disseminated Tuberculosis in an Immunocompetent Adult: A Rare Clinical Presentation and Diagnostic Challenge

Disseminated tuberculosis (TB) is a rare and life-threatening form of TB, particularly when it occurs in immunocompetent individuals. A 52-year-old diabetic male presented with tachypnea, tachycardia, and chronic low back pain. Comprehensive imaging revealed pulmonary involvement, lumbosacral vertebral destruction (L5-S1), genitourinary TB, hepatitis, and psoas abscesses. Ultrasound-guided drainage and CB-NAAT analysis confirmed Mycobacterium tuberculosis. Given the patient's deranged liver function tests, a modified antitubercular therapy regimen, including levofloxacin, amikacin, and ethambutol, was administered. The patient demonstrated significant clinical improvement, with resolution of symptoms and normalization of liver function on follow-up. This case underscores the diagnostic complexity of disseminated TB in immunocompetent patients, highlighting the importance of early detection and individualized treatment. Further research is needed to develop standardized treatment protocols, particularly for cases involving multi-organ involvement and liver dysfunction.

RADT-33. GAMMA KNIFE RADIOSURGERY FOR ORBITAL CAVERNOUS HEMANGIOMA: A SYSTEMATIC REVIEW AND SINGLE-ARM META-ANALYSIS

Abstract Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH. Following the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH, including complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate. From 1856 search results, six studies with 100 patients were included. Only five minor complications related to GKRS were reported, including three with orbital pain and two with periorbital chemosis, resulting in a complication rate of 13% (95% CI: 7% - 25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI: 63% - 96%) and 71% (95% CI: 47% - 95%), respectively. Proptosis improved in 94% of cases (95% CI: 83% - 100%). The tumor reduction rate was 77% after GKRS (95% CI: 69% - 85%). In conclusion, GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by the absence of a control group, and additional studies are needed to evaluate the relative efficacy of GKRS compared with alternative surgical modalities for OCH.

EPCO-09. DICER1-MUTANT PRIMARY INTRACRANIAL SARCOMA: ASSESSING THE ONCOGENIC ROLE OF MIRNA DYSREGULATION

Abstract Cross-cancer profiling has shown that mutations in human DICER1 are recurrent in diverse cancers including intracranial sarcoma. Due to the rarity of these tumors, treatment options for these patients remain poorly defined. DICER1 encodes an endoribonuclease that processes the hairpin precursor microRNAs (miRNAs) into functionally mature miRNAs. In particular, hotspot mutations in the RNase IIIb domain of DICER1 are predicted to confer an oncogenic role although the precise mechanism is unknown. In a case of a 28-year-old male who presented with multicentric right frontal dural and parenchymal enhancing masses and underwent partial resection, pathology showed a DICER1-mutant primary intracranial sarcoma with a hotspot E1813G mutation in the RNase IIIb domain. Additionally, due to a family history of an unknown fatal brain tumor in his mother, the patient had additional molecular testing which revealed a germline BRCA2 mutation. After surgery, the patient received intensity-modulated radiation therapy followed by 6 cycles of ICE (ifosfamide, carboplatin, etoposide) chemotherapy with significant radiographic response and clinical improvement. He remains progression-free on radiological surveillance for 13 months since diagnosis. The treatment was well tolerated with clinically manageable myelosuppression (including grade 3 thrombocytopenia). This is the first reported case of an adult DICER1-mutant primary intracranial sarcoma patient with a germline BRCA2 mutation although the interaction between these oncogenic mechanisms is unclear. Based on the role of DICER1 in miRNA processing and to test the hypothesize that DICER1 mutations drive primary intracranial sarcoma through dysregulation of miRNA function, we have established a multi-institutional collaboration that is collecting and profiling DICER 1 mutant primary intracranial sarcoma cases from across the United States preliminary results of which will be presented. Identification of a miRNA-driven oncogenic mechanism in these tumors may yield novel targeted approaches beyond intensive chemotherapy for these patients.

Traditional Chinese herbal compound as complementary treatment for nonspecific low back pain: A randomized controlled trial.

This prospective randomized controlled trial was designed to evaluate the clinical efficacy and safety of Bu Shen Tong Luo herbal compound as a complementary treatment for nonspecific low back pain (NSLBP). A total of 76 patients with NSLBP included from January 2022 to June 2023 according to the criteria were randomly divided into Bushen Tongluo formula (BSTL) group (n = 38) and celecoxib group (n = 38). According to Traditional Chinese Medicine principles, patients of 2 groups were divided into 5 syndrome types. Celecoxib or BSTL herbal compound were used to treat NSLBP of each group for 3 weeks, every week the Visual Analog Scale (VAS), Oswestry Disability Index, and Japanese Orthopaedic Association scores of each patient was record and compared to evaluate the clinical efficacy, and adverse reaction was reported to evaluate the safety of 2 interventions. A total of 71 patients finished the follow-up, including 36 patients in BSTL group and 35 patients in celecoxib group. The result showed that within 3 weeks, both BSTL and celecoxib interventions were able to treat NSLBP, with improvements in VAS scores and waist function index. However, there were no significant differences in clinical outcomes between these 2 interventions. Then we divided the patients into 5 syndromes on the basis of traditional Chinese medicine principles and observed their clinical outcomes. We found that celecoxib had similar improvements in VAS score and waist function index for each syndrome type and most of the syndromes in the BSTL group, except for the SRBZ syndrome. In the treatment of SRBZ syndrome, BSTL prescription showed no statistically significant clinical improvement. Meanwhile, in the treatment of HSBZ syndrome of NSLBP, BSTL prescription showed better clinical results than celecoxib, although there was no difference in VAS scores between the 2 groups, patients in BSXL group had better waist function than those in celecoxib group. Both BSTL herbal compound and celecoxib are effective and safe in the clinical treatment of NSLBP, and BSTL herbal compound had unique advantages in the treatment of HSBZ syndrome type of NSLBP especially in waist function improvement.