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Asthma is a chronic illness of the airways that affects approximately 300 million individuals worldwide. While it is commonly accepted that high ozone levels exacerbate asthma symptoms, the impact of low to moderate ozone levels on asthma symptoms has received little attention. The purpose of this research was to determine the relationship between hospital visits by asthma patients showing the severity of their symptoms and moderate ozone levels. Statistical analyses were performed on hospital visit big data for asthma patients in Seoul, Korea, collected between 2013 and 2017. The data set includes outpatient hospital visits (n = 17,787,982), hospital admissions (n = 215,696), and emergency department visits (n = 85,482). The frequency of hospital visits by asthma patients was evaluated in relation to low ozone levels (< 0.03 ppm) and moderate ozone levels (0.03-0.06 ppm) in the Seoul environment. In comparison to low ozone levels, moderate ozone levels resulted in a reduction in outpatient hospital visits (t = 7.052, P < .001). When ozone levels were low to moderate, there was a negative correlation between ozone levels and outpatient visits (r = -0.281, 95% CI: -0.331 to -0.228). Negative associations were also identified between ozone levels and new hospital admissions (t = 2.909, P < .01; r = -0.125, 95% CI: -0.179 to -0.070) and emergency treatments (t = 2.679, P < .01; r = -0.132, 95% CI: -0.186 to -0.076). Additionally, it was verified that moderate ozone levels one day before the visits resulted in a reduction in outpatient visits (t = 5.614, P < .001; r = -0.207, 95% CI: -0.259 to -0.153). A strong relationship was identified between moderate atmospheric ozone levels and a reduction in asthma patient hospital visits., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Accumulating evidence supports the active involvement of vascular inflammation in atherosclerosis pathogenesis. Vascular inflammatory events within atherosclerotic plaques are predominated by innate antigen-presenting cells (APCs), including dendritic cells, macrophages, and adaptive immune cells such as T lymphocytes. The interaction between APCs and T cells is essential for the initiation and progression of vascular inflammation during atherosclerosis formation. B7-CD28 family members that provide either costimulatory or coinhibitory signals to T cells are important mediators of the cross-talk between APCs and T cells. The balance of different functional members of the B7-CD28 family shapes T cell responses during inflammation. Recent studies from both mouse and preclinical models have shown that targeting costimulatory molecules on APCs and T cells may be effective in treating vascular inflammatory diseases, especially atherosclerosis. In this review, we summarize recent advances in understanding how APC and T cells are involved in the pathogenesis of atherosclerosis by focusing on B7-CD28 family members and provide insight into the immunotherapeutic potential of targeting B7-CD28 family members in atherosclerosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: To date, there has been little agreement on what drug is the "best" drug for treating severe COVID-19 patients. This study aimed to assess the efficacy and safety of different medications available at present for severe COVID-19., Methods: We searched databases for randomized controlled trials (RCTs) published up to February 28, 2022, with no language restrictions, of medications recommended for patients (aged 16 years or older) with severe COVID-19 infection. We extracted data on trials and patient characteristics, and the following primary outcomes: all-cause mortality (ACM), and treatment-emergent adverse events (TEAEs)., Results: We identified 4021 abstracts and of these included 48 RCTs comprising 9147 participants through database searches and other sources. For decrease in ACM, we found that ivermectin/doxycycline, C-IVIG (i.e., a hyperimmune anti-COVID-19 intravenous immunoglobulin), methylprednisolone, interferon-beta/standard-of-care (SOC), interferon-beta-1b, convalescent plasma, remdesivir, lopinavir/ritonavir, immunoglobulin gamma, high dosage sarilumab (HS), auxora, and imatinib were effective when compared with placebo or SOC group. We found that colchicine and interferon-beta/SOC were only associated with the TEAEs of severe COVID-19 patients., Conclusion: This study suggested that ivermectin/doxycycline, C-IVIG, methylprednisolone, interferon-beta/SOC, interferon-beta-1b, convalescent plasma (CP), remdesivir, lopinavir/ritonavir, immunoglobulin gamma, HS, auxora, and imatinib were efficacious for treating severe COVID-19 patients. We found that most medications were safe in treating severe COVID-19. More large-scale RCTs are still needed to confirm the results of this study., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Approximately 23% to 55% of patients have memory impairments with a greatly negative effect on daily life 3 months after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the rehabilitation of stroke as it is safe, painless, and noninvasive. Moreover, few studies have investigated the effect of rTMS on poststroke memory disorder (PSMD). However, the efficacy of rTMS is not consistent and the optional stimulation frequency is unclear. Therefore, this protocol aims to evaluate the clinical effect and safety of rTMS on PSMD by analyzing results from randomized controlled trials., Methods: Search strategies will be performed on seven databases: PubMed, EMBASE, CENTRAL, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and Technology Periodical Database (VIP). Only randomized controlled trials registered before August 2021 will be included. Additionally, the language will be limited to English or Chinese. For the outcome, we will focus on the Rivermead Behavioral Memory Test. Additionally, the Montreal Cognitive Assessment, Mini-mental State Examination, Modified Barthel Index, and advent events will be included. Two authors will independently select the study, extract data, and assess quality. Moreover, disagreements will be resolved by the third author. STATA 14 and Review Manager 5.4 will be used to perform the analysis. We will evaluate bias risk in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. To assess the quality of evidence, the Grading of Recommendations Assessment, Development, and Evaluation method will be employed., Results: This study will provide a comprehensive analysis of the current evidence on rTMS for PSMD., Conclusion: A reliable conclusion regarding whether rTMS is an effective and safe intervention for patients with PSMD and the effect of stimulation frequency and sham stimulation will be provided. This study will provide new insights for TMS in treating PSMD, and offer appropriate treatmentoptions to patients and clinicians., Prospero Registration Number: CRD42021282439., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a promising serum marker for hepatocellular carcinoma (HCC). There are limited data on its cutoff value in HCC for Taiwanese cirrhosis patients. This study aimed to investigate the diagnostic value of PIVKA-II levels in patients with suspected HCC. In total, 88 patients with chronic hepatitis and suspected HCC by ultrasound, elevated α-fetoprotein (AFP) or PIVKA-II levels were consecutively enrolled. Their baseline characteristics and findings on dynamic phases of computed tomography (CT) or magnetic resonance imaging (MRI) were examined. Sixty participants had cirrhosis and 34 had HCC. The median levels of PIVKA-II in non-cirrhosis and cirrhosis patients without or with HCC were 28.0, 48.0, and 847.0 mAU/mL, respectively. The optimal cutoff value of PIVKA-II in predicting HCC was 78.0 mAU/mL. Combining AFP with PIVKAII mildly increased its diagnostic performance for HCC, yielding higher specificity and positive predictive value. Significant factors predicting HCC in multivariate regression analysis were PIVKA >78.0 mAU/mL and fatty liver. Monitoring PIVKA-II level is suitable for noninvasively assessing HCC in patients with chronic hepatitis, particularly with AFP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

This empirical study identifies the negative aspects of private health insurance (PHI) by analyzing the association between subjective health conditions, 2 weeks of outpatient care, chronic diseases, and hospitalizations for 1 year. We used frequency analysis, χ2 testing, an analysis of variance, and logistic and multiple logistic regression models to analyze the association between PHI and subjective health conditions, outpatient care, chronic disease status, and hospitalization. The PHI group had good subjective health but had more outpatient care for 2 weeks. There were few chronic diseases in the private insurance group, and there was no significant difference in hospitalizations for 1 year. Hospitalization may occur when essential medical care is required, regardless of health insurance type. This study confirmed that as the PHI lowers the burden of personal medical expenses, the PHI can lead to an increase in the medical resource expenditures on the outpatient medical service and higher public health costs. The government should work to redefine the role of private and national health insurance. Also, the effectiveness of PHI should be reevaluated so that it does not lead to indiscriminate use of medical services by minimizing the burden of private insurance., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Irritable bowel syndrome (IBS) is a common pediatric functional gastrointestinal disorder. It is characterized by recurrent abdominal pain and changes in bowel habits and is more prevalent in obese patients. We investigated the association between obesity and IBS in pediatric patients through fecal calprotectin testing. Patients under 18 years of age with IBS who underwent fecal calprotectin testing from January 2015 through April 2020 were retrospectively investigated. The patients were divided into groups based on body mass index (BMI): group I (BMI < 85th percentile) and group II (BMI ≥ 85th percentile). Group II was divided into group IIa, overweight (85th percentile ≤ BMI < 95th percentile), and group IIb, obese (BMI ≥ 95th percentile). Among 277 included patients, 202 (72.9%) were in group I, and 75 (27.1%) were in group II (mean calprotectin levels, 75.60 ± 103.48 vs 45.89 ± 66.57 µg/g, respectively; P = .006). There were significant differences in mean calprotectin levels between groups I and IIa (75.60 ± 103.48 vs 45.45 ± 63.38 µg/g, respectively; P = .028) and groups I and IIb (75.60 ± 103.48 vs 46.22 ± 69.59 µg/g, respectively; P = .025). There was a significant difference in mean calprotectin levels between groups I and II (85.69 ± 142.13 vs 32.04 ± 28.17 µg/g, respectively; P = .029) among patients between 6 and 12 years of age but not among adolescents aged between 12 and 18 years (P = .139). Fecal calprotectin was lower when moderate-to-severe fatty livers were observed by ultrasound compared with normal livers (68.52 ± 97.22 vs 18.53 ± 18.56 µg/g, respectively; P = .017). Fecal calprotectin levels were higher in normal-weight pediatric IBS patients than in their obese counterparts, and this difference was more prominent in younger patients. In young children, IBS symptoms are thought to be influenced more by factors other than intestinal inflammation., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

AbstractParaspinal (erector spinae and multifidus) and psoas muscles contribute to spinal stability, but no study has yet examined the relationship between muscle mass and recurrent lumbar disc herniation (rLDH). The purpose of this study was to investigate the effect of psoas and paraspinal muscle mass on recurrent Lumbar disc herniation (LDH). This retrospective study included 49 patients with LDH (22 men, 27 women; mean age: 59.9 years; range 32-80) who underwent discectomy and partial laminectomy without fusion and underwent both pre- and postoperative magnetic resonance imaging. The presence of rLDH was determined using medical records and postoperative magnetic resonance imagings. Patients were divided into an rLDH group (26 patients) and a without-rLDH group (23 patients). Clinical characteristics, segmental motion, and paraspinal and psoas muscle mass were compared between the groups. Using ImageJ software, the cross-sectional area (CSA), lean muscle mass (LMM), and skeletal muscle index (SMI) were measured on T2 axial preoperative magnetic resonance images at L2-L3, L3-L4, and L4-L5 disc levels to represent muscle mass. Univariate and multivariate logistic regression analyses were performed. In the rLDH group, patients were younger (52.6 years vs 68.2 years; P = .001), segmental instability was more common (50.0% vs 4.3%; P = .001), and the CSA, LMM, CSASMI, and LMMSMI of psoas muscles were larger (5851.59 mm2 vs 4264.93 mm2, 5456.59 mm2 vs 4044.77 mm2, 18.77 cm2/m2 vs 13.86 cm2/m2, and 17.52 cm2/m2 vs 12.98 cm2/m2; P < .01 for all 4 variables). On multivariate logistic regression, age and segmental instability were independent risk factors for rLDH (odds ratio 0.886 and 18.527; P = .01 and P = .02, respectively). In middle-aged and elderly patients with lumbar disc herniation, relatively younger age, segmental instability, and greater psoas muscle mass may be risk factors for recurrence., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Bone cement leakage is a common complication of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) surgery and has also been reported in posterior decompression and cement-enhanced pedicle screw fixation. When bone cement leaks through the venous system, it will have serious consequences and even endanger the life of the patient, especially when the bone cement causes intracardiac embolism., Patient Concerns: A 70-year-old woman developed chest tightness and decreased blood oxygen saturation following posterior decompression and cement-enhanced pedicle screw fixation., Diagnosis: After the patient was given symptomatic treatment, the symptoms were not relieved, the high-sensitivity troponin I level continued to rise, the electrocardiogram results were abnormal, and chest computed tomography (CT) revealed multiple flaky and strip-shaped dense shadows in the heart., Intervention: The patient underwent removal of foreign bodies from the heart under cardiopulmonary bypass and tricuspid valvuloplasty, removal of intracardiac bone cement, and repair of the tricuspid valve and chordae., Outcome: The patient recovered well postoperatively and was discharged from the hospital after 3 weeks. There were no intracardiac foreign bodies observed on chest CT after the operation., Lessons: For patients with cardiopulmonary discomfort after posterior decompression and bone cement-enhanced pedicle screw fixation, in view of the limitations of radiographic examination, we recommend performing chest CT examination to confirm the diagnosis. For patients with intravascular foreign body embolism, multidisciplinary team joint treatment saves lives., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Respiratory disease has emerged as a global issue due to COVID-19. In particular, there has been an increased frequency of occurrence of symptoms such as cough, sputum, and dyspnea, which commonly accompany chronic obstructive pulmonary disease (COPD). Liriope platyphylla (LP) extract is known to improve respiratory function. LP extract ameliorates the symptoms commonly seen in bronchitis, asthma, and COPD and enhances immunity, as it has anti-inflammatory properties. In a previous study in rats, LP effectively improved respiratory inflammation levels. However, few randomized controlled trials have verified the effects of LP in respiratory disease and there have been no studies to determine the appropriate dose and duration to make it a more convenient functional health product. Based on previous studies, we would like to proceed with this clinical trial under the assumption that LP will help improve respiratory function and produce anti-inflammatory effects., Methods: This will be a single-center, randomized, double-blind, placebo-controlled pilot trial. Participants will randomly be allocated to receive either 1000 mg LP or placebo. The total duration of the clinical trial will be 4 to 6 weeks. A follow-up assessment will be conducted 4 weeks after screening, and the effect and safety of LP application will be assessed at this second visit. The primary outcome will be the breathlessness, cough, and sputum scale score. Secondary outcomes will include pulmonary function, clinical symptoms of cough and sputum (reported through a questionnaire), changes in immune cells, changes in immune factors used to analyze allergic inflammation in bronchi, antioxidant enzyme activity, nitric oxide level, and COPD assessment test score., Discussion: This study has limited inclusion and exclusion criteria and the intervention will be well-controlled. This will be the first randomized controlled trial to assess the efficacy and safety of LP extract in adults with cough and sputum. This study will provide insight into the mechanisms of the anti-inflammatory effects and improvement of respiratory function of LP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: Preoperative hypoalbuminemia from malnutrition is associated with increased morbidity and mortality after geriatric hip fracture surgery. However, little is known regarding the correlation between postoperative hypoalbuminemia and mortality. This study aimed to evaluate whether postoperative hypoalbuminemia could predict 1-year mortality after intertrochanteric femoral fracture surgery in elderly patients.The medical records of 263 geriatric patients (age ≥65 years) who underwent intertrochanteric femoral fracture surgery between January 2013 and January 2016 in a single hospital were reviewed retrospectively. The patients were allocated to 2 groups based on lowest serum albumin levels within 2 postoperative days (≥3.0 g/dL [group 1, n = 46] and <3.0 g/dL [group 2, n = 217]. Data between the non-survival and survival groups were compared. Multivariable logistic regression analysis was conducted to identify the independent predictor for 1-year mortality.The 1-year mortality rate was 16.3% after intertrochanteric femoral fracture surgery. Multivariable logistic regression analysis revealed that postoperative hypoalbuminemia was significantly associated with 1-year mortality (adjusted odds ratio, 8.03; 95% confidence interval, 1.37-47.09; P = .021). The non-survival group showed a significantly increased incidence of postoperative hypoalbuminemia (95.4% vs 80.0%, P = .015) and intensive care unit admission (11.6% vs 2.7%, P = .020), older age (82.5 ± 5.8 years vs 80.0 ± 7.2 years, P = .032), lower body mass index (20.1 ± 3.2 kg/m2 vs 22.4 ± 3.8 kg/m2, P < .001), and increased amount of transfusion of perioperative red blood cells (1.79 ± 1.47 units vs 1.43 ± 2.08 units, P = .032), compared to the survival group.This study demonstrated that postoperative hypoalbuminemia is a potent predictor of 1-year mortality in geriatric patients undergoing intertrochanteric femoral fracture surgery. Therefore, exogenous albumin administration can be considered to improve postoperative outcomes and reduce the risk of mortality after surgery for geriatric hip fracture., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: We aimed to investigate the rate of loss of correction and the factors thereof in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity.Between July 2008 and July 2017, we treated 30 patients who underwent osteotomy for cubital varus. We compared the preoperative and postoperative clinical and imaging findings, including the H-Cobb and Baumman angles, in all patients. Postoperative evaluation was performed by telephonic interviews.Our patients consisted of 17 males and 13 females. The mean age was 75 months. At the first follow-up, approximately 80% of patients had experienced a loss of correction of the humerus-cobb angle (H-Cobb angle); at the second follow-up, the incidence was 83%. Meanwhile, 57% and 43% of patients experienced a loss of correction of the Baumman angle at the first and second follow-ups, respectively. The average interval between the first and second follow-ups was 24 days, and the mean loss in the H-Cobb angle was 2.4°. There was a significant difference between the H-Cobb angles as measured before and after surgery (P < .05). There was no significant difference between the H-Cobb angles of the affected side and the contralateral healthy elbow at the third postoperative follow-up; however, there was a significant difference between the Baumman angle between before and after surgery (P < .05). The Baumman angles as measured at the second and third postoperative follow-ups differed significantly from those of the contralateral healthy elbow joint. According to the survival curve analysis, the median survival times of the H-Cobb and Baumman angles were 27 and 34 months, respectively.The postoperative loss of the 2 angles occurred mainly during the first and second follow-up periods. Therefore, patient follow-up is particularly important in the period directly following the operation. Additional measures may be necessary to avoid rapid angle loss., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The treatment of an atlas burst fracture depends on whether transverse atlantal ligament (TAL) injury is present. We compared the radiologic parameters associated with the presence of a TAL injury as detected using magnetic resonance imaging (MRI), and verified whether the lateral mass displacement (LMD) criteria currently used to diagnose TAL injuries in atlas burst fractures are reliable or need revision.Thirty patients who presented with isolated atlas burst fractures were included in this retrospective observational study. We measured radiologic parameters, including LMD, atlanto-dental interval, basion-dens interval, internal lateral mass displacement, and external lateral mass displacement, in each patient at the time of initial presentation. The presence of TAL injury was evaluated using MRI. We compared the radiologic parameters and characteristics of patients who presented with TAL injury. We also determined the sensitivity and specificity of an LMD test to accurately diagnose TAL injury based on MRI. Finally, we compared the radiologic parameters according to the presence of surgical treatment and patient union status.Twenty patients presented with an intact TAL, while 10 patients had a TAL injury on MRI. LMD was significantly higher in patients with TAL injury (9.61 vs 3.73 mm, P < .001). In multivariable logistic regression analysis, LMD was also significantly higher in patients with TAL injury. The sensitivity and specificity of LMD for diagnosing TAL injury based on MRI in patients with isolated C1 fractures were 90% and 100%, respectively. The incidence of an LMD greater than 8.1 mm was statistically higher in patients than in those without TAL injury (90% vs 0%, P < .001).Nine patients underwent surgery for isolated atlas burst fractures, and 21 did not. LMD (9.56 vs 4.03 mm, P < .001) and fracture gap (7.96 vs 4.01 mm, P < .001) were significantly higher in patients who underwent surgery.Among the various radiologic parameters, LMD closely correlated with the presence of TAL injury, as patients with an LMD greater than 8.1 mm were more likely to have a TAL injury in the case of atlas burst fractures. LMD is a good method for predicting the presence of TAL injury if MRI is not available., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Ramsay Hunt syndrome is a type of herpes zoster infection involving geniculate ganglion and facial nerve. Unilateral facial palsy, otalgia, and painful vesicular rash on the auricle and external auditory canal are the typical symptoms. Although postherpetic neuralgia (PHN) is a devastating complication of herpes zoster infection, PHN following Ramsay Hunt syndrome has rarely been reported., Patient Concerns: A 55-year-old immunocompetent female patient visited our pain clinic, for left-sided refractory otalgia (PHN) that persisted for 3 months after she was diagnosed with Ramsay Hunt syndrome. Although facial palsy and tinnitus had recovered within 2 to 4 weeks after symptom onset, the patient had been experiencing a persistent and severe otalgia radiating to mandibular angle, temporal and upper cervical area of neuropathic nature., Diagnoses: The patient's pain persisted despite conservative medication and administration of ultrasound-guided stellate ganglion block, facial nerve block, and great auricular nerve block several times., Interventions: The patient was treated with the application of ultrasound-guided pulsed radiofrequency (PRF) to the great auricular nerve., Outcomes: The patient experienced significant pain reduction more than 50% on a numeric rating scale after 2 weeks of PRF treatment., Lessons: Chronic otalgia might be a type of PHN after Ramsay Hunt syndrome with cervical nerve involvement. PRF treatment to the great auricular nerve can be a therapeutic option for refractory otalgia following Ramsay Hunt syndrome., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Several reports have described retinal pigment epithelial (RPE) tears in central serous chorioretinopathy (CSC). However, there have been no reports of spontaneously large RPE tears in acute CSC without bullous retinal detachment (RD). Herein, we report and provide sequential images of a case of bilateral spontaneous large RPE tears in patient with acute CSC without bullous RD., Patient Concerns: An 88-year-old female patient was admitted with impaired vision in both eyes, which began 10 days prior. The visual acuity was 0.4 and 0.5 in the right and left eye, respectively. She had started taking oral steroids 2 weeks prior for polymyalgia., Diagnosis: Ophthalmologic examinations, including fundus photography, optical coherence tomography, and fluorescence angiography, were performed, and she was diagnosed with steroid-induced acute CSC in both eyes with large pigment epithelial detachment (PED) of approximately 4-disc diameter. Discontinuation of steroids and follow-up ophthalmic examinations were performed. However, a spontaneous large RPE tear occurred in the right eye., Interventions: We performed follow-ups more frequently and CSC treatment such as laser photocoagulation, photodynamic therapy, and anti-vascular endothelial growth factor injections were not performed., Outcomes: Nine months later, a spontaneous large RPE tear occurred sequentially in the left eye. Her final visual acuity was 0.3 and 0.15 in the right and left eye, respectively., Lessons: Patients may spontaneously develop large RPE tears in both eyes, despite no treatment for acute CSC with non-bullous RD. Large PED and old age may affect this. Therefore, for a CSC patient with a large PED and advanced age, attention must be paid when determining treatment., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: To explore the diagnostic value of computed tomography (CT) imaging for duodenal lipoma and the potential clinical significance of the findings., Methods: Clinicopathological and CT data from 57 patients, who were diagnosed with duodenal lipoma at the first affiliated Hospital of Zhengzhou University (Zhengzhou, China) between June 2014 and March 2019, were retrospectively reviewed. Data collected included location and size of the tumor, morphological manifestations (shape, density, boundary), concomitant diseases, pathology and gastroscopy results, and follow-up. Follow-up was performed via telephone, and surgical patients were followed-up for recurrence, metastasis and tumor size, and morphological changes. The follow-up period was up to January 2019., Results: Of the 57 patients with duodenal lipoma, contrast-enhanced scanning was performed in 7 cases. The tumor was located in the descending duodenum in 33 cases, the ascending in 4 cases, the horizontal in 16 cases, and the bulb in 4 cases. Mean tumor size was 13.0 ± 5.8 mm. CT morphological features of the tumor were as follows: tumor shape, round, quasi-round, or oval (n = 42); long strip (n = 3); nodular (n = 2); triangular (n = 1); and irregular lobulated (n = 9). Among the 57 patients, tumor density was homogeneous in 52 cases, inhomogeneous in 4 cases, and nodular with calcification in 1 case. The tumor boundary was classified as clear and with no capsule. Diseases concomitant with the tumor were as follows: gastritis (n = 23), gastric adenocarcinoma (n = 1), and gastric lymphoma (n = 1). Esophageal disease was found in 16 cases, including reflux esophagitis (n = 12) and esophageal cancer (n = 4). There were 13 cases of gallbladder and biliary disease, including cholecystolithiasis and cholecystitis (n = 9), common bile duct disease (n = 2), colorectal cancer (n = 4), lung cancer (n = 2), duodenal carcinoma with obstruction (n = 1), and ureteral space narrowing (n = 1)., Conclusion: CT was an effective, non-invasive method for diagnosis of duodenal lipoma. CT imaging could clearly discern location, size, shape, and nature of duodenal lipomas. Duodenal lipoma can be associated with digestive tract inflammatory diseases and tumors in different locations, and its diagnosis is potentially valuable for their prevention and treatment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ± 5.6 vs 277.3 ± 88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ± 46.8vs 105.8 ± 61.7IU/L P = .018) and aspartate aminotransferase (72.8 ± 39.7 vs 100.2 ± 16.7 IU/L P = .028). The postoperative hospital stays (7.02 ± 1.56 vs 8.50 ± 2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ± 19.2 vs 57.7 ± 23.9 mg/L P = .019), and POD5 (13.3 ± 4.2 vs 17.5 ± 7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)