World Journal of Clinical Cases最新文献

Background: Neuralgic amyotrophy (NA) is a rare disease with sudden upper limb pain followed by affected muscle weakness. The most commonly affected area in NA is the upper part of the brachial plexus, and the paraspinal muscles are rarely affected (1.5%), making these cases difficult to distinguish from cervical radiculopathy.

Case summary: A 76-year-old male presented to the emergency department with left hip pain post-fall. After undergoing left femoral neck fracture surgery, he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness. Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space. Three weeks later, an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root. Magnetic resonance neurography was performed for a differential diagnosis. Contrast enhancement was identified at the upper trunk of the brachial plexus, including the C5 nerve root. A suprascapular nerve hourglass-like focal constriction (HLFC) was also identified, confirming NA. After being diagnosed with NA, the patient received 15 mg prednisolone, twice daily, for 3 weeks. Physical therapy was initiated, including left arm strengthening exercises and electrical stimulation therapy. Left shoulder muscle strength significantly improved one month after comprehensive rehabilitation.

Conclusion: NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis, avoiding confusion with cervical radiculopathy.

Integration of virtual reality (VR) technology into preoperative patient education has shown potential to improve nursing practice. The study by Kim et al examines the impact of VR on nurse satisfaction, usability, and burnout. A prospective study involving 20 nurses and 80 patients was conducted, comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital. Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses, while also reducing emotional exhaustion, a critical factor in nurse burnout. Consistency in education quality was also improved, ensuring uniform patient care. These results underscore the importance of VR in reducing the stress of repetitive tasks, improving job satisfaction, and potentially enhancing nurse retention. Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice. The study by Kim et al highlights VR's transformative potential in preoperative education for both patients and healthcare providers.

A case report by Liu et al describes the characteristics of metastatic clear cell sarcoma (CCS) of the pancreas and provides valuable therapeutic insights for this rare malignancy. This case is interesting because of its rarity, suggesting that the pancreas may be a potential target organ for CCS, either primary or metastatic. At the same time, the authors also emphasize the importance of regular postoperative follow-up for timely detection of recurrent lesions, as CCS is characterized by a high degree of malignancy and a high rate of recurrent metastases. Considering that CCS of the gastrointestinal tract is easily confused with malignant melanoma (MM) of the gastrointestinal tract, here we compare the clinical features, histopathological and immunohistochemical characteristics, diagnosis, treatment, and prognosis of CCS and MM of the gastrointestinal tract, hoping to provide a reference for clinical work.

This editorial comments on an article recently published by López del Hoyo et al. The metaverse, hailed as "the successor to the mobile Internet", is undoubtedly one of the most fashionable terms in recent years. Although metaverse development is a complex and multifaceted evolutionary process influenced by many factors, it is almost certain that it will significantly impact our lives, including mental health services. Like any other technological advancements, the metaverse era presents a double-edged sword for mental health work, which must clearly understand the needs and transformations of its target audience. In this editorial, our primary focus is to contemplate potential new needs and transformation in mental health work during the metaverse era from the perspective of multimodal emotion recognition.

The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery. One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit, causing unexpected effects at a site distant from that of the initial injection, including ophthalmoplegia, ptosis and even visual compromise. Acute vision loss following filler injection is a devastating complication, occurring in up to 0.0008% of cases. The greatest risk of this complication occurs with nasal augmentation, followed by glabellar wrinkle treatment. While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery, hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally. Treatment interventions include thrombolysis, hyperbaric oxygen therapy, oral aspirin, cobamamide and acetazolamide and administration of corticosteroids. However, most studies show a poor prognosis in the form of partial or no recovery of vision. Hence, prevention is of paramount importance. A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.

In this editorial, I address the mental health status of patients who have been discharged from intensive care units (ICUs) after battling coronavirus disease 2019 (COVID-19). An ICU admission is generally a stressful experience, and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences. These individuals may experience psychiatric distress, including symptoms such as insomnia, anxiety, depression, and even post-traumatic psychological issues. Research indicates that during the first 6 months to 1 year following an ICU stay, nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder. Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic, particularly for those who underwent an ICU stay. The ICU environment itself is inherently stressful, filled with the constant noise of various medical devices. Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.

Background: Mucocutaneous separation (MCS) is a common postoperative complication in enterostomy patients, potentially leading to significant morbidity. Early identification of risk factors is crucial for preventing this condition. However, predictive models for MCS remain underdeveloped.

Aim: To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.

Methods: A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study. Patients were divided into two groups, the MCS group (n = 110), and the non-MCS (n = 382) based on the occurrence of MCS within the first 3 weeks after surgery. Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed. Receiver operating characteristic curve analysis was used to assess the model's performance.

Results: The postoperative MCS incidence rate was 22.4%. Suture dislodgement (P < 0.0001), serum albumin level (P < 0.0001), body mass index (BMI) (P = 0.0006), hemoglobin level (P = 0.0409), intestinal rapture (P = 0.0043), incision infection (P < 0.0001), neoadjuvant therapy (P = 0.0432), stoma site (P = 0.0028) and elevated intra-abdominal pressure (P = 0.0395) were potential predictive factors of MCS. Suture dislodgement [P < 0.0001, OR: 28.0075 95%CI: (11.0901-82.1751)], serum albumin level (P = 0.0008, OR: 0.3504, 95%CI: [0.1902-0.6485]), BMI [P = 0.0045, OR: 2.1361, 95%CI: (1.2660-3.6235)], hemoglobin level [P = 0.0269, OR: 0.5164, 95%CI: (0.2881-0.9324)], intestinal rapture [P = 0.0351, OR: 3.0694, 95%CI: (1.0482-8.5558)], incision infection [P = 0.0179, OR: 0.2885, 95%CI: (0.0950-0.7624)] and neoadjuvant therapy [P = 0.0112, OR: 1.9769, 95%CI: (1.1718-3.3690)] were independent predictive factors and included in the model. The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.

Conclusion: The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.

The article demonstrates that health belief model (HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months. The HBM addresses perceived barriers, benefits, susceptibility, severity, and self-efficacy, leading to better health behaviors. HBM-based education has been effective in various contexts, including managing chronic diseases, promoting cancer screenings, and preventing infectious diseases. However, the model has limitations, such as cultural applicability and addressing complex health behaviors influenced by environmental factors. Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts. Despite these limitations, HBM-based education significantly improves patient outcomes, highlighting its potential in health education and promotion when appropriately adapted and implemented. This reinforces the model's value in designing effective health interventions and advancing public health.

In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

IgG4-related sclerosing cholangitis (IgG4-SC) is an inflammatory disease that leads to bile duct stricture, characterized by the infiltration of IgG4-positive plasma cells into the bile duct wall, thickening of the bile duct wall, and narrowing of the lumen. The differential diagnosis of IgG4-SC mainly includes primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic cancer. IgG4-SC is often associated with autoimmune pancreatitis and can be accurately diagnosed based on clinical diagnostic criteria. However, isolated IgG4-SC is difficult to distinguish from biliary tumors. Given the significant differences in biological behavior, treatment, and prognosis between these diseases, accurately identifying isolated IgG4-SC has very important clinical significance.