Annals of Medicine and Surgery最新文献

Introduction: This systematic review and meta-analysis quantified the effect of tart cherry juice (TCJ) supplementation on exercise-induced muscle damage (EIMD). Evidence supported TCJ's beneficial effects on muscular function and inflammatory biomarkers interleukin (IL)-6 and IL-8.

Method: PubMed, Scopus, and Web of Science were searched up to January 2024. Risk of bias was assessed using RevMan® software. Mean differences and 95% confidence intervals (CIs) of maximal voluntary isometric contraction (MVIC), inflammatory markers, creatine kinase (CK), and visual analog scale (VAS) score were pooled using fixed- or random-effect models. Heterogeneity was assessed using Chi-square or I ² statistics.

Results: Ten trials were included in the analysis. TCJ supplementation significantly improved MVIC [weighted mean difference (WMD) = 9.13%, 95% CI (6.42-11.84), I ² = 62.3%] and decreased IL-6 [WMD = -0.4 pg/ml, 95% CI (-0.68 to -0.11), I ² = 62.2%] and IL-8 [WMD = -0.3 pg/ml, 95% CI (-0.6 to -0.0), I ² = 46.3%]. No significant changes were found in CK, C-reactive protein, IL-1β, tumor necrosis factor-alpha, or VAS score. Dose-response analysis revealed a significant non-linear association between daily TCJ dose and MVIC effect size.

Conclusion: TCJ supplementation may improve muscle function and some inflammatory biomarkers in EIMD. Further high-quality studies with larger sample sizes are needed to determine TCJ's long-term effects.

Introduction: The complete absence hepatic portion of the inferior vena cava (IVC) is known as "interruption" of the IVC. Congenital interruption of the IVC can rarely occur in patients with a normal visceroatrial situs.

Case presentation: We present a case of an 8-year-old male child who exhibited mild dyspnea. Further evaluation revealed an interruption of the IVC and pulmonary valve stenosis, without heterotaxy.

Discussion: It is important to recognize that interruption of the IVC can occur independently or as part of a syndrome. Therefore, thorough investigations should be conducted for each patient.

Conclusion: More research is needed to explore the associations between IVC interruption and pulmonary valve stenosis.

Introduction and importance: Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disorder, characterized by high-grade fever, arthritis, and a variety of systemic signs/symptoms. AOSD is very often misdiagnosed because of the overlapping clinical features, necessitating a thorough differential diagnosis, especially in cases of fever of unknown origin (FUO).

Case presentation: A 55-year-old male with high-grade fever, myalgia, and arthralgia for the past 4 weeks. Yamaguchi criteria for AOSD met following an extensive evaluation. Laboratory findings showed leukocytosis with neutrophilic predominance, elevated ferritin levels, and mild abnormalities in liver function tests. The patient was started on intravenous corticosteroids, followed by oral corticosteroids in tapering dose of the drug and the introduction of methotrexate as a steroid-sparing agent (DMARDs).

Clinical discussion: The case illustrates the diagnostic challenges associated with AOSD in older persons and the importance to consider this condition in the context of a FUO. The diagnosis of AOSD remains exclusive, yet effective management typically involves corticosteroids and DMARDs.

Conclusion: AOSD, though rare, can occur uncommonly in older populations. This case highlights the need for awareness among clinicians to ensure early diagnosis and appropriate management, ultimately aiding in better outcomes of patient.

Introduction: Lutembacher syndrome (LS) is a rare condition with congenital atrial septal defect (ASD) and mitral stenosis (MS), often post-rheumatic illness. Diagnosis uses Doppler echocardiography, and treatment may involve surgery or percutaneous options.

Case presentation: An 18-year-old female presented with worsening dyspnea, orthopnea, and potential undiagnosed rheumatic fever. Chest X-ray showed cardiomegaly. An echocardiogram revealed left atrial dilation and mitral stenosis with regurgitation, aortic valve showed thickening without stenosis, and the right ventricle was mildly dilated; an interatrial shunt was present. Mitral stenosis worsened left-to-right shunt.

Discussion: LS results from the balance of ASD and MS. Factors influencing prognosis include pulmonary resistance, ASD size, and mitral stenosis severity. Echocardiography is essential for diagnosis, which revealed left atrial dilation, normal left ventricular function, severe mitral stenosis, and pulmonary valve changes. ECG indicated right ventricular hypertrophy. CXR showed left atrial enlargement and right ventricle enlargement. Treatment included an open heart surgery which replaced the mitral valve and closed the ASD.

Conclusion: Lutembacher syndrome, a rare condition combining ASD and mitral stenosis, can cause cardiac failure and pulmonary hypertension if untreated. Given the patient's stable condition in the early stages of the disease, early surgical or percutaneous intervention is advisable.

Introduction: An ectopic ureter is the one that reaches any place other than the trigone in the bladder, in the bladder neck or distal to it and is often associated with a single or duplicated collecting system, associated with renal dysplasia and obstruction. Ectopic ureter opening into the scrotal base as urocutaneous fistula is a rare finding.

Case presentation: A 14 years old male child presented with intermittent serous discharge from the base of scrotum for 2 months, and unilateral scrotal swelling for 1 week. On evaluation of the condition as scrotal sinus, the X-ray fistulogram and micturating cystourethrogram suggested to be urocutaneous fistula, later confirmed with computed tomography of abdomen and pelvis to be right ectopic ureter opening into scrotum associated with hypoplastic right kidney. The patient underwent open excision of ectopic ureter with right nephrectomy. The histopathological report also confirmed our diagnosis.

Discussion: An ectopic ureter, a congenital anomaly, may open anywhere from the bladder neck to the perineum and into the vagina, uterus and even the rectum; however commonly in posterior urethra, seminal vesicle, prostatic utricle, and ejaculatory duct in boys. Scrotum is an unusual site for single right ectopic ureter opening, as presented in our case. For this urocutaneous fistula associated with non-functioning atrophic right kidney, the complete removal of the right kidney and ectopic ureter was performed.

Conclusion: Ectopic ureter can present rarely as scrotal fistula. Although difficult to diagnose, early suspicion of ectopic ureter in symptomatic pediatric age group with proper imaging modality can help to evaluate the disease condition, help in timely treatment and decrease the morbidity.

Background: Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an alternative to conventional TKA (C-TKA), aiming to improve surgical precision and patient outcomes. This systematic review and meta-analysis study compares the efficacy of RA-TKA versus C-TKA.

Methods: A comprehensive search of five databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Library) was conducted. We included all published randomized controlled trials (RCTs) from inception to August 2024. Meta-analysis was done using RevMan 5.4 package.

Results: Twenty-one RCTs involving 2692 patients were involved. RA-TKA demonstrated significantly lower mechanical alignment outlier rates (risk ratio = 0.33, 95% confidence interval (CI)[0.19, 0.59], P = 0.0002) and less deviation from neutral mechanical axis (mean difference, MD = -0.93° [-1.20, -0.66], P < 0.00001) compared to C-TKA. No significant differences were found in WOMAC or Oxford Knee Scores at various follow-up points. RA-TKA was associated with longer operative times (MD = 19.94 minutes [9.2, 30.68], P = 0.0003) but showed no significant difference in intraoperative blood loss. Postoperative Knee Society Scores were slightly higher in the RA-TKA group (MD = 1.03 [0.50, 1.57], P = 0.0002).

Conclusion: RA-TKA offers improved mechanical alignment accuracy compared to C-TKA but does not demonstrate superior short to medium-term functional outcomes. The technology is associated with longer operative times. These findings suggest that while RA-TKA may enhance surgical precision, its clinical benefits and cost-effectiveness require further evaluation, particularly in long-term studies.

Introduction: Villaret's syndrome involves unilateral palsy of cranial nerves IX to XII, often with Horner's sign, commonly caused by benign neoplasms or vascular issues. This report highlights glomus jugulare-induced Villaret syndrome, stressing careful evaluation for persistent otologic symptoms.

Case presentation: A 43-year-old woman with a history of chronic suppurative otitis media (CSOM) presented with recurrent ear discharge, pain, and severe mixed hearing loss. Despite a left tympanoplasty, symptoms persisted, leading to a canal wall down mastoidectomy. Six months later, she developed facial numbness, hoarseness, and dysphagia. Physical exam showed unilateral cranial nerve palsies with Horner's syndrome, consistent with Villaret's syndrome. Imaging confirmed a glomus jugulare tumor. After digital subtraction angiography and balloon occlusion test, surgical resection was performed. Postoperatively, she showed gradual cranial nerve recovery and remains under follow-up.

Discussion: Jugular foramen syndrome involves unilateral cranial nerve palsies, including Villaret's syndrome, where cranial nerves IX-XII and cervical sympathetic fibers are affected. Most often linked to benign neoplasms like paragangliomas, glomus jugulare tumors are slow-growing, often benign, and predominantly affect middle-aged females. Diagnosis relies on MRI's "salt-and-pepper" imaging, with high-resolution CT for bony involvement. Treatment, including surgery with embolization, aims to reduce cranial nerve deficits. Radiotherapy and radiosurgery are options for non-surgical candidates or recurrence cases.

Conclusion: This case underscores the diagnostic challenges of Villaret's syndrome caused by glomus jugulare. Initially masked by symptoms of chronic otitis media and mastoiditis, cranial nerve deficits eventually revealed the underlying tumor, highlighting the importance of vigilant assessment and imaging in persistent otologic cases.

Introduction: Sustained fetal tachycardia is an uncommon phenomenon in gestations (approximately 0.1%). Atrial flutter (AF) accounts for 10-30% of fetal tachyarrhythmias, which is characterized by a rapid atrial rate estimated at 300-600 beats per minute, associated with variable degrees of atrioventricular conduction.

Case presentation: A 29-year-old asymptomatic woman, pregnant for the third time, was diagnosed with a male fetus at 25 weeks gestation exhibiting sustained atrial flutter with rapid ventricular response (2:1 and 1:1 AV block). Maternal digoxin reduced the fetal ventricular rate to 120 bpm, mitigating hydrop risk. The infant was delivered via cesarean at 35 weeks, presenting with low blood pressure (80/50 mmHg) and an irregular pulse (160 bpm). The electrocardiogram showed AF; intravenous amiodarone was administered, and the rhythm successfully converted to a normal sinus rhythm.

Clinical discussion: Fetal arrhythmias in pregnant women require detailed assessment and treatment, including maternal history, electrocardiogram, and renal function assessment. The approach to treatment involves the use of transplacental antiarrhythmics, where digoxin is considered the first line of treatment. Other options include sotalol and flecainide. The mother should be monitored for side effects, with follow-up in the postpartum period for the infant.

Conclusion: Fetal AF may occur in the second trimester and requires an increased awareness of this life-threatening arrhythmia. Whatever the gestational age, early recognition of fetal tachycardia is important due to the potential for adverse and life-threatening outcomes.

Background: Acquired resistance to temozolomide is a major challenge for the effective treatment of glioblastoma (GBM). TRIML2, a member of the TRIM family, plays an important role in cancer genesis, progression, and treatment resistance. However, its mechanism of action in GBM resistance to temozolomide remains unclear.

Methods: RNA bulk sequencing data from temozolomide-resistant U87 cells and wild-type U87 cells were downloaded from the NCBI public database (GEO: GSE193957) and analyzed. A temozolomide-resistant cell line (U87-TR) was induced with temozolomide, and the expression of TRIML2 in temozolomide-resistant and wild-type cell lines (U87-WT) was verified by cell activity assays, wound-healing assays, and western blotting. The alteration of resistance to temozolomide was assessed following the overexpression of TRIML2 in the resistant cell line by lentiviral transfection. The differences in TRIML2 expression between primary GBM and recurrent GBM after temozolomide chemotherapy were verified by immunofluorescence, immunohistochemistry, and western blotting.

Results: The expression of TRIML2 was significantly lower in U87-TR cells than in U87-WT cells. After the TRIML2 overexpressed in U87-TR cells, their resistance to temozolomide was significantly decreased and became sensitive to temozolomide treatment. TRIML2 expression was significantly decreased in the temozolimide-resistant GBM tumors; in contrast, TRIML2 was relatively high expressed in the temozolimide-sensitive GBM tumors.

Conclusions: TRIML2 inhibits temozolomide resistance in GBM and thus may serve as a novel therapeutic target for overcoming GBM resistance to temozolomide.