Continuous Unilateral Cephalalgia Due to Systemic Lupus Erythematosus: A Case Report / Cefaleia unilateral contínua por lúpus eritematoso sistêmico: relato de caso

BACKGROUND: Hemicrania continua is a rare form of cephalalgia featuring a chronic and persistent headache in only one side of the head. OBJECTIVES: In this report, we present a case of a patient with hemicrania continua and systemic lupus erythematosus (SLE). METHODS: We collected patient data through the electronic medical record. Afterward, we reviewed the literature regarding hemicrania continua and its pathophysiology and correlation with neurovascular alterations, inflammation, and SLE. RESULTS: A 42-year-old woman visited the emergency department due to worsening constant unilateral cephalalgia that had been present for the past 6 months. The patient reported a highly intense (10/10) headache in the entire left hemicrania that radiated to the left shoulder. During physical examination, she presented with nystagmus, vertigo, and aggravated cephalalgia associated to body movement and, despite having no optic nerve thickening. In addition, she had jaundice, tachycardia, and splenomegaly. Complimentary exams found deep anemia, depletion in complement system and anti-nuclear factors, suggesting a possible hemolytic anemia (AIHA) due to SLE. Treatment was initiated with hydrocortisone and prednisone, associated with amitriptyline, fluoxetine and diazepam, reaching full remission. CONCLUSION: These syndromes have aggravated each other, and possibly the explanation for the cephalalgia remission was the control of AIHA and SLE. It features a rare case in literature and thus warrants discussion.

INTRODUÇÃO: Hemicrania contínua é uma forma rara de cefaléia caracterizada por cefaleia crônica e persistente em apenas um lado da cabeça. OBJETIVOS: Neste relato apresentamos o caso de um paciente com hemicrania contínua e lúpus eritematoso sistêmico (LES). MÉTODOS: Coletamos dados dos pacientes por meio do prontuário eletrônico. Posteriormente, revisamos a literatura sobre a hemicrania contínua e sua fisiopatologia e correlação com alterações neurovasculares, inflamação e LES. RESULTADOS: Uma mulher de 42 anos recorreu ao serviço de urgência devido ao agravamento da cefaleia unilateral constante, presente nos últimos 6 meses. O paciente relatou cefaleia de alta intensidade (10/10) em toda a hemicrânia esquerda com irradiação para o ombro esquerdo. Ao exame físico apresentava nistagmo, vertigem e cefaléia agravada associada à movimentação corporal e, apesar de não apresentar espessamento do nervo óptico. Além disso, ela apresentava icterícia, taquicardia e esplenomegalia. Os exames complementares evidenciaram anemia profunda, depleção do sistema complemento e fatores antinucleares, sugerindo uma possível anemia hemolítica (AIHA) por LES. Iniciou-se tratamento com hidrocortisona e prednisona, associadas a amitriptilina, fluoxetina e diazepam, atingindo remissão completa. CONCLUSÃO: Essas síndromes agravaram-se mutuamente e possivelmente a explicação para a remissão da cefaléia foi o controle da AIHA e do LES. Apresenta um caso raro na literatura e, portanto, merece discussão.

Is it Always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

Introduction: Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice. Methods: This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature. Reflection: This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis. Conclusion: LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient's symptoms.

Introducción: El reflujo laríngeo-faríngeo (LPR, por sus siglas en inglés) se manifiesta con una serie de síntomas comunes en la garganta y signos no concluyentes en el examen larinoscópico. Es un diagnóstico que a menudo se realiza clínicamente y que puede llevar a la prescripción de inhibidores de la bomba de protones que son innecesarios y potencialmente perjudiciales. La insuficiencia glótica (IG) y los comportamientos laríngeos hiperfuncionales que la acompañan también pueden presentar síntomas de garganta comunes similares, que pueden o no incluir un cambio cualitativo en la voz. Métodos: Este es un artículo de reflexión. Está escrito para resumir, explicar y respaldar con evidencia la opinión del autor sobre cómo los síntomas de los trastornos de la voz pueden confundirse fácilmente con los síntomas del LPR. La reflexión ofrecida se basa en su experiencia, investigación y la literatura disponible. Reflexión: Este artículo tiene la intención de explorar las similitudes entre la IG y el LPR, cómo diferenciarlos finalmente y cómo abordar el tratamiento con un diagnóstico diferencial más amplio. Conclusión: El LPR y la IG pueden presentar síntomas idénticos y vagos en la garganta y la voz. Puede ser necesario realizar ensayos de medicación empírica, intervenciones conductuales y pruebas objetivas de laringovideostroboscopia, reflujo basado en impedancia y motilidad esofágica, a veces de manera experimental, para diagnosticar y tratar correctamente los síntomas de un paciente.

Leiomyoma of the palatine tonsil - report of a rare and unusual tumor at this site

A leiomyoma is a remarkably rare cause of a benign, one-side tonsillar enlargement. The diagnosis is essentially histologic and will not normally be suspected clinically. Immunohistochemistry is needed for substantiation of the morphology and confirmation. We submit this illustrative case report.

A CASE REPORT OF RIGHT UNILATERAL PULMONARY ARTERY ATRESIA (UPAA) MISDIAGNOSED AS RIGHT CHRONIC PULMONARY THROMBO-EMBOLISM

Unilateral pulmonary artery atresia is a rare condition with clinical presentation as exercise intolerance, recurrent infections, hemoptysis to asymptomatic state with incidental diagnosis. Common modalities of management include medical management for pulmonary hypertension , angioembolisation of collaterals followed by pneumonectomy. However surgical reconstruction of atretic pulmonary artery segment is an uncommon surgical management strategy employed in our case with satisfactory outcome

AURAL SYRINGING: A ONE SIZE FITS ALL SOLUTION FOR EAR FOREIGN BODIES?

Objectives: To ascertain if aural syringing is a one size ?ts all solution for aural foreign body removal in a rural setting A Record based descriptive study was looked at paediatric and adult patients Methods: with Aural FB (foreign bodies) who visited ER (Emergency) and ENT-OPD (Out Patient Department) of a single institution between January 2022 and December 2022.The Diagnosis of Aural foreign bodies was based on personal history and Otoscopic ?ndings. Patient characteristics, foreign body type, removal attempts and complications were evaluated with respect to clinical setting and patient outcome. The Data was obtained from the records. 86 patients were brought to Results: the emergency department and ENT-OPD over a 12-month period with foreign bodies of the EAC (External Auditory Canal). Otolaryngologists used otoscope and standard metallic aural syringe as their mainstay of management. Analysis of ER and OPD cases revealed Inorganic aural foreign bodies were 65.11% and 34.88% were Organic foreign bodies. Unilateral Purulent Aural Discharge was in 46.51% (40) patients, pain in 17.44% (15), Ear Bleeding in 8.13% (7), conductive hearing loss and tinnitus was 10.46% (9) and itching in 4.65% (4). Duration of Symptoms was <1 week in 65.11% (56) cases ,1-2 weeks in 22.09% (19) and 2-4 weeks in 12.79% (11) cases. Successful removal of foreign bodies from ear by only applying aural syringing was achieved in 91.86% of cases, and usage of other methods of aural foreign body removal Forceps, Hook and Suction in 5.8% and foreign body removal under GA was 2.32% were recorded Aural foreign bodies were commonly seen in paediatric Conclusion population. Patients commonly present to the ER and OPD for removal of EAC foreign bodies. The common inorganic aural foreign bodies were cotton tip, stone and eraser whereas ?y, lice and bee were the organic FB. The most common symptoms and complications of aural FBs, were unilateral purulent discharge followed by pain, ear Bleeding, Tympanic membrane perforation, external meatus laceration, chronic otitis media and facial Nerve paralysis. The most common procedures used were Syringing followed by Forceps, hook and suction. It is observed that aural syringing performed by the trained hands of an otolaryngologist is a very effective method and can almost be described as a one size ?ts all solution for managing foreign bodies in EAC with some notable exceptions.

Comportamiento de la maloclusión funcional e interferencias oclusales en niños con dentición mixta

Introducción: las interferencias oclusales no controladas precozmente pueden producir desviación de la mandíbula en sentido anteroposterior o transversal. El manejo de las mordidas cruzadas se debe iniciar en el momento del diagnóstico, preferiblemente en edades tempranas, con el fin de tratarlas en el nivel primario de prevención. Objetivo: determinar el comportamiento de la maloclusión funcional causada por interferencias oclusales en niños con dentición mixta de la Escuela Primaria Mártires del Corynthia, entre octubre de 2019 y junio de 2021. Materiales y métodos: se realizó un estudio observacional descriptivo de corte transversal en la Escuela Primaria Mártires del Corynthia, del Área de Salud José Jacinto Milanés, del municipio de Matanzas, entre octubre de 2019 y junio de 2021. El universo estuvo conformado por 66 niños. Se utilizó una planilla de recolección de datos y se solicitó el consentimiento informado a los tutores de los niños. Resultados: las edades donde los niños presentaron mayor afectación fueron de 6 a 7 años y de 8 a 9 años, ambos rangos con un 10,6 %. El 27,3 % presentó interferencias oclusales y mordida cruzada posterior unilateral. El 48,5 % fue del sexo femenino y el 30,3 % tenían edades de 6 a 7 años. El 71,2 % eran simétricos y presentaron mordida cruzada posterior unilateral. Los simétricos y con línea media coincidente representaron un 36,4 %. Conclusiones: la maloclusión funcional más frecuente en niños con dentición mixta fue la mordida cruzada posterior unilateral, que se relacionó de manera directa con las interferencias oclusales. Las asimetrías faciales y la línea media desviada estuvieron asociadas a dicha maloclusión.

Introduction: early uncontrolled occlusal interferences can produce anterior-posterior jaw deflection. Management of cross-bites should be initiated at the time of diagnosis, preferably at early ages, in order to treat them at the primary level of prevention. Objective: to determine the behavior of functional malocclusion caused by occlusal interferences in children with mixed dentition from the Martires del Corynthia primary school between October 2019 and June 2021. Materials and methods: a cross-sectional, observational, descriptive study was carried out at the Martires del Corynthia Primary School, of the Jose Jacinto Milanes Health Area, Matanzas municipality, between October 2019 and June 2021. The universe consisted of 66 children. A data collection form was used and informed consent was requested from the children's guardians. Results: the ages where the children presented more affectation were from 6 to 7 years and from 8 to 9 years, both ranges with 10.6%. 27.3% presented occlusal interferences and posterior unilateral cross-bite. 48.5% were female and 30.3% were 6 to 7 years old. 71.2% were symmetrical and presented unilateral posterior cross-bite. Symmetric patients and with a coincident midline represented 36.4%. Conclusions: the most frequent functional malocclusion in children with mixed dentition was the unilateral posterior cross-bite, which was related to occlusal interferences in a direct way. Facial asymmetries and a deviated midline were associated with the before mentioned malocclusion.

Clinical application of modified radical neck dissection by gasless unilateral axillary approach in papillary thyroid cancer / 中华内分泌外科杂志

Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.

Cardiac dosimetry analysis and quality of life evaluation of internal breast lymph node irradiation in postoperative left breast cancer / 国际肿瘤学杂志

Objective:To analyze the cardiac dosimetry of lymph node irradiation in the internal breast region after left-sided breast cancer surgery and to assess its impact on patients' quality of life.Methods:The clinical data of 108 patients who underwent inverse intensity modulated radiotherapy (IMRT) after left-sided breast cancer surgery in Cancer Hospital of Nantong University from May 2019 to May 2021 were collected and retrospectively analyzed, and divided into a study group (with internal breast, 55 cases) and a control group (without internal breast, 53 cases) according to whether the postoperative radiotherapy included lymph node irradiation in the internal breast region. The dosimetric indexes of planned target area (PTV) , cardiac tolerance, serum myocardial injury markers and quality of life before and after radiotherapy were compared between the two groups.Results:In terms of PTV dosimetry, the conformality index (CI) of the study group and the control group were 0.73±0.07 and 0.75±0.08, the homogeneity index (HI) were 0.17±0.03 and 0.17±0.02, the D max were (55.69±1.02) Gy and (55.46±1.13) Gy, the D mean were (50.54±0.23) Gy and (50.48±0.21) Gy respectively, there were no statistically significant differences ( t=1.38, P=0.169; t<0.01, P>0.999; t=1.11, P=0.269; t=1.41, P=0.160) . In terms of cardiac receptivity, the D mean of the two groups were (5.93 ± 0.32) Gy, (5.64 ± 0.30) Gy, V 40 were (0.47 ± 0.10) %, (0.41 ± 0.11) %, and V 30 were (2.48 ± 0.51) %, (2.06 ± 0.49) % respectively, and there were statistically significant differences ( t=4.86, P<0.001; t=2.97, P=0.004; t=4.36, P<0.001) . The levels of serum troponin Ⅰ (cTnⅠ) before radiotherapy in the study group and the control group were (0.09±0.02) ng/ml and (0.09±0.01) ng/ml, creatine kinase isoenzyme MB (CK-MB) were (0.27±0.08) U/L and (0.25±0.08) U/L, myoglobin (MYo) were (3.84±1.02) μg/L and (3.69±0.97) μg/L, and brain natriuretic peptide (BNP) were (172.35±16.24) pg/ml and (169.81±15.93) pg/ml respectively, there were no statistically significant differences ( t<0.01, P>0.999; t=1.30, P=0.197; t=0.78, P=0.436; t=0.82, P=0.414) . One month after radiotherapy, the levels of serum cTnⅠ in the two groups were (0.09±0.03) ng/ml and (0.09±0.02) ng/ml, CK-MB were (0.29±0.09) U/L and (0.28±0.08) U/L, MYo were (4.06±1.08) μg/L and (4.01±1.03) μg/L, and BNP were (175.13±17.09) pg/ml, (172.47±16.28) pg/ml respectively, there were no statistically significant differences ( t<0.01, P>0.999; t=0.61, P=0.544; t=0.25, P=0.806; t=0.83, P=0.410) . The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores before radiotherapy in the study and the control groups were (60.24±5.13) points and (61.19±5.46) points, (74.12±7.20) points and (75.35±7.88) points at 1 month after radiotherapy, (77.53±7.14) points and (78.95±7.08) points at 6 months after radiotherapy, and (75.02±6.93) points and (76.68±6.74) points at 1 year after radiotherapy respectively, there were no statistically significant differences ( t=0.93, P=0.353; t=0.85, P=0.399; t=1.04, P=0.302; t=1.26, P=0.210) . The EORTC QLQ-C30 scores at 1 month, 6 months, and 1 year after radiotherapy were higher than those before radiotherapy in the two groups, and there were statistically significant differences (all P<0.001) . Conclusion:IMRT containing lymph node irradiation in the internal breast region after left breast cancer surgery brings a certain degree of increased cardiac dose, but it is feasible to control it within a certain range and does not affect the patients' cardiac function or quality of life in the short term.

Effects of obacunone on renal interstitial fibrosis and ferroptosis in unilateral ureteral obstruction model mice / 中国药房

OBJECTVE To study the improvement effects of obacunone on renal interstitial fibrosis （RIF） in unilateral ureteral obstruction （UUO） model mice， and to investigate its mechanism based on ferroptosis mediated by nuclear factor erythroid 2- related factor 2（Nrf2）/glutathione peroxidase 4 （GPx4） signaling pathway. METHODS Thirty mice were randomly divided into sham operation group， model group， irbesartan group （positive control， 20 mg/kg）， obacunone low-dose and high-dose groups （10， 40 mg/kg）， with 6 mice in each group. Except for sham operation group， UUO model was established by ligation of unilateral ureter in other groups. After operation， administration groups were given intraperitoneal injection of relevant medicine， and sham operation group and model group were given intraperitoneal injection of constant volume of normal saline， once a day， for 7 consecutive days. The levels of creatinine （Cr） and blood urea nitrogen （BUN）， the content of malondialdehyde （MDA） and the activities of total superoxide dismutase （T-SOD） in serum and the concentration of Fe2+ in renal tissue were all detected. HE staining and Masson staining were performed to observe the morphology and the fibrosis of renal tissues. Immunohisto- chemical staining was used to determine expressions of the fibronectin （Fn）， α-smooth muscle actin （α-SMA）， GPx4 964083717@qq.com and Nrf2 in renal tissue. Western blot and real-time quantitative polymerase chain reaction （RT-qPCR） were used E-mail：834300205@qq.com to detect the protein and mRNA levels of Fn， α-SMA， Nrf2， GPx4 and SLC7A11 in the renal tissues. RESULTS Compared with sham operation group， serum levels of Cr and BUN， the concentration of Fe2+ in renal tissue， the protein and mRNA levels of Fn and α-SMA in model group were increased significantly （P＜0.05）， while the activity of T-SOD in serum， protein and mRNA expressions of Nrf2， GPx4， SLC7A11 in kidney tissue were significantly decreased （P＜0.05）； in the kidney tissue， the renal tubules were dilated， the collagen deposition was obvious， the fibrous bands were thicker and darker， and the renal interstitial inflammatory cells infiltrated significantly. After intervened with obacunone， the levels of above indexes （except for mRNA expression of SLC7A11 in obacunone low-dose group） in serum and renal tissue were reversed significantly （P＜0.05）， and pathological damage and collagen deposition of kidney tissue were alleviated. CONCLUSIONS Obacunone can improve renal interstitial fibrosis of UUO model mice， the mechanism of which may be associated with activating the Nrf2/GPx4 pathway and then inhibiting ferroptosis to relieve RIF in UUO model mice.

Development of a tau-V337M mouse model using CRISPR/Cas9 system and enhanced ssODN-mediated recombination / 生物工程学报

The generation of a tau-V337M point mutation mouse model using gene editing technology can provide an animal model with fast disease progression and more severe symptoms, which facilitate the study of pathogenesis and treatment of Alzheimer's disease (AD). In this study, single guide RNAs (sgRNA) and single-stranded oligonucleotides (ssODN) were designed and synthesized in vitro. The mixture of sgRNA, Cas9 protein and ssODN was microinjected into the zygotes of C57BL/6J mice. After DNA cutting and recombination, the site homologous to human 337 valine (GTG) in exon 11 was mutated into methionine (ATG). In order to improve the efficiency of recombination, a Rad51 protein was added. The female mice mated with the nonvasectomy male mice were used as the surrogates. Subsequently, the 2-cell stage gene edited embryos were transferred into the unilateral oviduct, and the F0 tau-V337M mutation mice were obtained. Higher mutation efficiency could be obtained by adding Rad51 protein. The F0 tau-V337M point mutation mice can pass the mutation on to the F1 generation mice. In conclusion, this study successfully established the first tau-V337M mutation mouse by using Cas9, ssODN and Rad51. These results provide a new method for developing AD mice model which can be used in further research on the pathogenesis and treatment of AD.

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Early-effectiveness of unilateral biportal endoscopic laminectomy in treatment of two-level lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS).@*METHODS@#The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L 2, 3 and L 3, 4 in 2 cases, L 3, 4 and L 4, 5 in 29 cases, L 4, 5 and L 5, S 1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated.@*RESULTS@#All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%.@*CONCLUSION@#UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia: a tertiary care center experience / 亚洲男科学杂志(英文版)

Patients with congenital unilateral absence of the vas deferens (CUAVD) manifest diverse symptoms from normospermia to azoospermia. Treatment for CUAVD patients with obstructive azoospermia (OA) is complicated, and there is a lack of relevant reports. In this study, we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA. From December 2015 to December 2020, 33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital (Shanghai, China). Patient information, ultrasound findings, semen analysis, hormone profiles, and treatment information were collected, and the clinical outcomes were evaluated. Of 33 patients, 29 patients were retrospectively analyzed. Vasoepididymostomy (VE) or cross VE was performed in 12 patients, the patency rate was 41.7% (5/12), and natural pregnancy was achieved in one of the patients. The other 17 patients underwent testicular sperm extraction as the distal vas deferens (contralateral side) was obstructed. These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA, even with a relatively low rate of patency and natural pregnancy.

Delayed-onset unilateral facial paralysis after mastoidectomy: A case report

Objective@#To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.@*Conclusion@#Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Hearing rehabilitation of children and adolescents with unilateral hearing loss / Reabilitação auditiva de crianças e adolescentes com perda auditiva unilateral

ABSTRACT Purpose To describe the audiological characteristics and the type of intervention chosen on unilateral hearing loss cases in children and adolescents as well as to analyze correlations between the degree of hearing loss, the indication and the use of electronic devices. Methods Observational, descriptive and retrospective study, carried out with information of 34 medical records from children and adolescents with unilateral hearing loss, assessed by two auditory rehabilitation services of medium complexity, throughout 2016 to 2019. Descriptive and Inferential statistical analysis were performed with the data. Results A predominance of profound sensorineural unilateral hearing loss in the right ear, of pre-lingual character, with 20.6% of malformations. The most adopted intervention was the hearing aid indication, although its use is low, regardless of the degree of the hearing loss. An association was found between the degree of the hearing loss and the healthcare professionals in indicating the use of the devices. Conclusion The indication of hearing aids is the most frequent and this decision is influenced by the degree of the hearing loss, in which the devices are mostly indicated for mild to severe losses, with bigger divergence of conduct for profound hearing losses.

RESUMO Objetivo Descrever as características audiológicas e o tipo de intervenção tomada em casos de perda auditiva unilateral em crianças e adolescentes e analisar correlações entre o grau da deficiência auditiva, a indicação e o uso de auxiliares de audição. Método Estudo observacional, descritivo e retrospectivo, realizado com informações dos prontuários de 34 crianças e adolescentes com perda auditiva unilateral, atendidos em dois serviços de reabilitação auditiva de média complexidade, no período de 2016 a 2019. Realizou-se a análise estatística descritiva e inferencial dos dados. Resultados Predomínio de perda auditiva unilateral do tipo neurossensorial, de grau profundo à direita, pré-lingual com 20,6% de malformações. A intervenção mais adotada foi a indicação de prótese auditiva, porém o uso é baixo, independente do grau da perda. Houve associação entre o grau da perda auditiva e a decisão dos profissionais em indicar o uso dos dispositivos. Conclusão A indicação de próteses auditivas é a mais frequente e esta decisão é influenciada pelo grau da perda auditiva, sendo os aparelhos auditivos indicados para as perdas leves a severas, com uma maior divergência de condutas para as perdas profundas.

Síndrome de cascanueces y agenesia renal derecha. Una rara asociación

Introducción: El síndrome de cascanueces se considera una anomalía infrecuente y poco pensada en la práctica médica; su incidencia no está bien establecida debido a su sintomatología variada. La agenesia renal unilateral se estima entre 1/2500 y 1/4000 nacidos vivos. Objetivos: Describir una paciente de 18 años con sospecha prenatal de agenesia renal derecha confirmada por imágenes después del nacimiento, que ingresó por proteinuria. Presentación del caso: Paciente de 18 años con agenesia renal derecha conocida, en la que un examen de orina detectó proteinuria desde los 13 años. En su estudio se clasificó como proteinuria ortostática y evolutivamente refirió dolor lumbar izquierdo ligero y transitorio. En el ultrasonido renal, realizado para valorar crecimiento del riñón único, se detectó dilatación de la vena renal izquierda. Se repitió el estudio ecográfico para precisar ángulo aorto-mesentérico y dilatación de vena renal izquierda, y se confirmó el síndrome de cascanueces. Conclusiones: La asociación entre agenesia renal derecha y síndrome de cascanueces, resulta extremadamente rara, y, cuando se presenta con proteinuria ortostática y dolor lumbar ocasional, debe seguirse en forma expectante, pero no se necesita tratamiento quirúrgico en la mayoría de los casos.

Introduction: Nutcracker syndrome is considered an infrequent and poorly thought out anomaly in medical practice; its incidence is not well established due to its varied symptomatology. Unilateral renal agenesis is estimated to be between 1/2500 and 1/4000 live births. Objectives: To describe an 18-year-old female patient with suspected pre-natal imaging-confirmed right renal agenesis after birth, who was admitted due to proteinuria. Case presentation: An 18-year-old female patient with known right renal agenesis, in whom a urine test detected proteinuria from the age of 13. In the study it was classified as orthostatic proteinuria and evolutionarily she referred mild and transient left low back pain. Renal ultrasound, performed to assess single kidney growth, showed dilation of the left renal vein. The ultrasound study was repeated to specify aorto-mesenteric angle and left renal vein dilation, and nutcracker syndrome was confirmed. Conclusions: The association between right renal agenesis and nutcracker syndrome is extremely rare, and, when it presents with orthostatic proteinuria and occasional low back pain, it should be followed expectantly, but surgical treatment is not needed in most cases.

Activation characteristics of motor cortex during mirror visual feedback based on electroencephalography / 中国康复理论与实践

ObjectiveTo explore the activation of motor cortex and brain lateralization of healthy male subjects during mirror visual feedback (MVF) of dominant and non-dominant hands. MethodsFrom March to September, 2021, 17 right-handed male subjects were recruited in Shenyang Sport University. The eegoTMmylab electroencephalography (EEG) system was applied to acquire the EEG and surface electromyography (sEMG) signals of digital extensor muscle during MVF. The subjects were completed unilateral finger stretching exercise, including left/right hand MVF and left/right hand visual feedback (VF). Each paradigm was repeated 80 trials, and the four paradigms were divided into two experiments, with one week between each experiment. The time-domain characteristics of sEMG signals and the time-frequency characteristics of α-band (8 to 13 Hz) and β-band (13 to 20 Hz) EEG signals which were closely related to motion were analyzed. Activation and asymmetry of motor cortex during MVF in dominant and nondominant hands were measured with event-related desynchronization/synchronization (ERD/ERS) and asymmetric index (AI). ResultsWhen the relaxed hand was right hand, the sEMG amplitude of digital extensor muscle were more in MVF and VF than in resting state (P < 0.05). In α bands, the main effect of training state on ERD/ERS was significant (F = 14.125, ηp2 = 0.469, P = 0.002), and it was higher in MVF than in VF. In β band, the main effect of training state on ERD/ERS was significant (F = 9.704, ηp2 = 0.378, P = 0.007), the interaction effect of moving hand and training state was significant on ERD/ERS (F = 8.014, ηp2 = 0.334, P = 0.012); for VF, ERD/ERS was higher in right hand movement than in left hand movement (F = 7.267, ηp2 = 0.312, P = 0.016); for right hand movement, ERD/ERS was higher in MVF than in VF (F = 17.530, ηp2 = 0.523, P = 0.001). At the position of C4 electrode, ERD/ERS was higher in right hand movement than in left hand movement under VF (t = -3.201, P = 0.006, Cohen's d = 0.776), and ERD/ERS was higher in MVF than in VF under right hand movement (t = -4.060, P = 0.001, Cohen's d = 0.985). Main effect of training state was significant on AI at β band (F = 5.796, ηp2 = 0.266, P = 0.028), and it was higher in MVF than in VF. ConclusionMVF may improve the activity of motor cortex neurons on the ipsilateral side of the motor hand through recruitment of frontal and parietal mirror neurons and reduction of interhemispheric and intracortical inhibitory activities, and it is more effective for the dominant hand training.

Effect of hand controlled rhythm music therapy on unilateral spatial neglect after stroke / 中国康复理论与实践

ObjectiveTo observe the clinical effect of hand controlled rhythm music therapy on unilateral spatial neglect for stroke patients. MethodsFrom September, 2020 to September, 2022, 52 patients with unilateral spatial neglect after stroke in Wuxi Central Rehabilitation Hospital were randomly divided into control group (n = 26) and observation group (n = 26). Both groups accepted routine rehabilitation, and the observation group accepted hand controlled rhythm music therapy in addition, for eight weeks. Before and after treatment, the patients were assessed with Chinese Behavioral Inattention Test-Hong Kong version (CBIT-HK) routine tests (line crossing, letter cancellation, star cancellation, line bisection, figure and shape copying, and representational drawing) and modified Barthel Index (MBI). ResultsAfter treatment, six scores of CBIT-HK routine tests and the scores of MBI increased in both groups (|t| > 3.077, P < 0.05), and they were higher in the observation group than in the control group (|t| > 2.639, P < 0.05). ConclusionHand controlled rhythm music therapy could effectively alleviate the symptoms of unilateral spatial neglect after stroke, and improve the activities of daily living.

Effect and Mechanism of Baoshen Prescription in Alleviating Renal Fibrosis in UUO Mice by Regulating ERK/p38 MAPK Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the protective effect of Baoshen prescription against renal fibrosis and explore its underlying mechanism through network pharmacology， molecular docking， and in vivo experiments. MethodAll mice were randomly divided into sham surgery group， model group， low-， medium-， and high-dose Baoshen prescription groups， and a benazepril hydrochloride group. Unilateral ureteral obstruction （UUO） was performed to establish a renal fibrosis model， and the administration of Baoshen prescription at low， medium， and high doses （0.455， 0.91， and 1.82 g·kg-1）， and benazepril hydrochloride （1.68 mg·kg-1） or distilled water began on the same day as model preparation. Mice in the model group and the sham surgery group were given an equal volume of distilled water. The intervention was carried out once daily for 14 days. Mouse serum levels of blood urea nitrogen （BUN） and creatinine （Cr） were measured. Hematoxylin-eosin （HE） staining and Masson staining were used to observe renal pathological changes. Western blot and immunohistochemistry were used to assess the expression of fibronectin （FN）， α-smooth muscle actin （α-SMA）， and E-cadherin， which are related to renal fibrosis. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to measure the mRNA expression of transforming growth factor-β1 （TGF-β1）， tumor necrosis factor-α （TNF-α）， NOD-like receptor protein 3 （NLRP3）， and monocyte chemoattractant protein-1 （MCP-1） in renal tissues. The mechanism of Baoshen prescription in improving renal fibrosis was explored through network pharmacology， molecular docking， and Western blot experiments. ResultCompared with the sham surgery group， the model group showed significantly increased levels of BUN and Cr （P<0.01）. The model group exhibited abnormal renal glomerular morphology， loss of tubular brush borders， tubular dilation， and an enlarged area of blue collagen fibers. Mice in the model group showed significantly elevated levels of FN and α-SMA （P<0.01）， significantly decreased expression of E-cadherin （P<0.01）， and significantly increased expression of TGF-β1， TNF-α， NLRP3， and MCP-1 mRNA （P<0.05， P<0.01）. Compared with the model group， the Baoshen prescription groups showed significantly reduced BUN and Cr levels （P<0.01）， alleviated renal pathological damage， improved fibrosis， reduced expression of FN and α-SMA （P<0.01）， increased E-cadherin expression （P<0.01）， and downregulated mRNA expression of TGF-β1， TNF-α， NLRP3， and MCP-1 （P<0.05， P<0.01）. Network pharmacology and molecular docking predicted that Baoshen prescription could potentially improve renal fibrosis through the extracellular signal-regulated kinase （ERK）/p38 mitogen-activated protein kinase （MAPK） signaling pathway. Pharmacological research showed that compared with the sham surgery group， the model group exhibited significantly increased expression of phosphorylated （p）-ERK and p-p38 （P<0.05， P<0.01）. Compared with the model group， medium- and high-dose Baoshen prescription groups showed significantly downregulated expression of p-ERK and p-p38 proteins （P<0.05， P<0.01）. ConclusionBaoshen prescription can effectively improve renal fibrosis induced by UUO in mice， and its mechanism of action may be related to the ERK/p38 MAPK signaling pathway.