MRI诊断女子排球运动员髌腱腱病

目的 探讨女子排球运动员髌腱腱病(PT)的MRI表现。方法 回顾性分析34名中国国家女子排球队运动员60个膝关节的MRI资料。结果 60个膝关节中,41个(26例)有PT(PT组),患病率76.47%,其中信号增强2级以上占82.93%(34/41)。13名19个膝关节阴性为对照组。PT组髌腱近端、中点、下止点前后径分别为(9.21±2.31)mm、(5.39±1.01)mm、(6.53±1.32)mm,与对照组相比差异有统计学意义(P<0.01)。PT组髌腱近端前后径与分级相关(r=0.334,P<0.01)。PT急性期髌腱近端增粗,T1WI低信号,T2WI中、高信号,FS-PDWI高信号;慢性期髌腱近端呈"V"形增粗增厚,T1WI低信号,T2WI中、低信号,FS-PDWI中等信号。髌腱近端后缘紊乱不清晰、髌腱中部和下止点信号增强以及髌骨下极增生等在两组间差异均有统计学意义(P<0.05)。所有患膝可见髌骨下极不规则片状、大小不一的信号增强。结论 女子排球运动员PT患病率较高。MRI有助于明确诊断、分期分级,鉴别髌骨下极损伤,监控康复效果以及评估运动能力。     

Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy

PurposeThe efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy.Materials and methodsAutologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 ± 16 years, range 20–61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests.Results20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57–75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler.ConclusionPRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy.     

High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study

Purpose. To evaluate a novel conservative management modality for patellar tendinopathy.

Methods. We recruited nine patients with patellar tendinopathy who had failed conservative management and showed evidence of neovascularisation on power Doppler scanning. A high volume ultrasound guided injection at the interface between the patellar tendon and Hoffa's body. The injection contained 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone, and between 12 and 40 ml normosaline. 100 mm visual analogue scales (VAS) for pain and for function, and Victorian Institute of Sport Assessment – Patellar tendon (VISA-P) questionnaires at an average of 9 months from the injection.

Results. All but one patient (whose pain was unchanged) improved (p = 0.028). The mean improvement in function 2 weeks after injection was 58 mm on VAS (interquartile range 27 – 88, p = 0.018). The mean improvement in pain 2 weeks after injection was 56 mm on a VAS scale (interquartile range 32 – 80, p = 0.018). At a mean follow up of 9 months, an improvement of 22 points from a baseline score of 46 on the VISA-P questionnaire (100 being normal) was established.

Conclusion. High volume injections to mechanically disrupt the neovascularisation in patellar tendinopathy are helpful in the management of this condition. Controlled trials would be warranted to investigate in a more conclusive fashion this management modality.     

Caregivers’ roles in preventing patients with severe Alzheimer’s disease from becoming distracted during mealtimes: two case reports

[Purpose] The purpose of this study was to identify the roles of caregivers in preventing patients with severe Alzheimer’s disease with loss of language skills from becoming distracted while eating their meals. [Participants and Methods] The study was conducted on two residents of a nursing home with severe Alzheimer’s disease who had lost their language skills. In this study, by comparing the scenes in which the two participants were distracted and not distracted from eating, we analyzed the factors associated with patients with severe Alzheimer’s disease who had lost their language skills becoming distracted and factors that prevented them from becoming distracted from eating at mealtimes and considered the roles of caregivers. [Results] The participants became distracted from eating where they were in a lively environment. On the other hand, they were not distracted when they were made to sit and eat in quiet environments. [Conclusion] Patients with severe Alzheimer’s disease who have lost their language skills cannot filter out a range of other information around them and focus on the information necessary to oneself. The role of caregivers is to serve as filters for patients with severe Alzheimer’s disease who have lost their language skills and whose selective attention abilities have become impaired.     

Bilateral pneumothorax and pneumomediastinum during colonoscopy in a patient with intestinal Behcet’s disease: A case report

BACKGROUNDColonoscopy is essential for the diagnosis of intestinal Behcet’s disease (BD), which is characterized by a typical oval-shaped ulcer in the ileocecal region. However, potential risks of colonoscopy have rarely been reported.CASE SUMMARYHerein, we describe a patient with intestinal BD who presented with decreased oxygen saturation and shortness of breath during a diagnostic colonoscopy. Bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema of the neck, chest, abdomen, back and scrotum were confirmed by computed tomography scan. The sudden change in condition was considered to be associated with iatrogenic bowel perforation. After receiving closed thoracic drainage and conservative therapy, the patient was discharged in stable condition.CONCLUSIONEndoscopists should be aware of the risks of colonoscopy in patients with intestinal BD and the possibility of pneumothorax associated with intestinal perforation and make adequate preparations before colonoscopy.     

Olfactory identification ability in patients with mild cognitive impairment and Alzheimer’s disease

[Purpose] To examine the olfactory identification abilities and specify the difficult-to-identify odors in community-dwelling individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). [Participants and Methods] We included, 12 and 17 patients with MCI (MCI group) and AD (AD group), respectively, and 30 community-dwelling older adults with no history of MCI or a dementia diagnosis (control group). Scores on the Japanese odor stick identification test (OSIT-J), an olfactory identification ability test, were compared among the three groups with intergroup differences examined accordingly. Next, we performed intergroup comparisons of the ratios of correct responses for each odor, and the difficult-to-identify odors were examined. [Results] OSIT-J scores of the MCI and AD groups were significantly lower than those of the control group. There were no intergroup differences in the correct identification of pungent odors. No patients in the AD group could identify the odor of cooking gas. The ability to identify food-related odors was reduced in the MCI and AD groups. [Conclusion] Patients with MCI and AD had reduced olfactory identification abilities in comparison to community-dwelling older adults without cognitive decline. These findings suggest the importance of olfactory evaluation before providing patients with dementia with therapeutic interventions associated with olfactory stimuli.     

Beneficial effect of transient desflurane inhalation on relieving inflammation and reducing signaling induced by MPTP in mice

ObjectiveTo determine if the beneficial effects of transient desflurane application mitigates inflammation and decrease associated signaling induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) in mice.MethodsMice were induced to develop Parkinson’s disease (PD) by intraperitoneal injection with MPTP for 20 consecutive days, and validated mice were randomly allocated to four groups. Collected samples from euthanized mice were designated for the following analyses: 1) immunohistochemical staining for positive dopaminergic neurons in the substantia nigra and striatum, 2) immunofluorescence staining for ionized calcium binding adaptor molecule-1 (Iba1) and glial fibrillary acid protein (GFAP), and 3) western blotting for p38, p-p38, toll-like receptor 4, and tumor necrosis factor (TNF)-α.ResultsThe inhalation of desflurane for 1 hour ameliorated locomotory dysfunctions of PD mice by recovering the loss of Iba1- and GFAP-positive dopaminergic neurons, deactivating microglial cells and astrocytes, and decreasing the amounts of inflammatory cytokines (TNF-α).ConclusionsThese findings suggest that transient desflurane inhalation may provide some benefits for PD through ameliorating inflammation and enhancing locomotor activity.     

Pulmonary amyloidosis and multiple myeloma mimicking lymphoma in a patient with Sjogren’s syndrome: A case report

BACKGROUNDSjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far. CASE SUMMARYA 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported.CONCLUSIONThis is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.     

A survey on consciousness towards the proper use of metformin and medical cost in Japanese patients with type 2 diabetes

To investigate the patients’ consciousness regarding the use of metformin and medical cost in Japanese patients with type 2 diabetes taking metformin. This cross-sectional study investigated patients’ general characteristics and consciousness regarding medical cost, kidney function, liver function, and metformin usage, using a self-administered, internet-based questionnaire. Among 1,000 patients, 81.0% felt unsatisfied with treatment for type 2 diabetes, with the main reason for dissatisfaction being high medical cost, with 540 patients reporting this. In addition, 16.8% of patients experienced treatment disruption and among them, 48.2% (81/168) answered that the reason was high medical cost. Over half of the patients did not understand their kidney and liver functions, respectively. Only 8.9% and 7.1% of patients knew both the words and meanings behind sick days and lactic acidosis, respectively. In conclusion, many patients with type 2 diabetes taking metformin were not satisfied with their treatments, with the main reason being high medical cost. Moreover, they did not have sufficient knowledge of sick days and/or lactic acidosis.     

Relationship between hand-behind-back motion and internal rotation with the shoulder in extension

[Purpose] The purpose of the present study was to investigate whether the extent of shoulder internal rotation measured in the extended position of the shoulder could be a good indicator of hand-behind-back motion ability. [Participants and Methods] We measured internal rotation with the shoulder in extension in 26 healthy adults (average age, 25.2 ± 2.5 years). Internal rotation was measured passively in the supine position at 30° of shoulder extension. Additionally, a hand-behind-back motion was performed, and the hand-behind-back distance was measured. The relationship between the angle of internal rotation with the shoulder in extension and hand-behind-back distance was evaluated using Pearson’s product-moment correlation. The level of significance was set at 5%. [Results] The angle of internal rotation with the shoulder in extension and the hand-behind-back distance correlate significantly. [Conclusion] Internal rotation with the shoulder in extension is a good indicator of hand-behind-back motion.     

Edible bird’s nest extract downregulates epidermal apoptosis and helps reduce damage by ultraviolet radiation in skin of hairless mice

The purpose of the present study was to examine whether daily intake of edible bird’s nest extract reduced ultraviolet-induced damage to skin. Twenty-one female HR-1/Hos mice were divided into control (C, n = 7), low-dose (2 mg/kg body weight/day of edible bird’s nest extract) (L, n = 7), and high-dose (20 mg/kg body weight/day of edible bird’s nest extract) (H, n = 7) groups. With their left back skin covered with aluminum sheet to prevent exposure, mice were radiated with either ultraviolet A (20 J/cm²) or ultraviolet B (40 mJ/cm²) in an alternate manner once daily for 10 weeks. They were gavaged either a solution of saline or edible bird’s nest extract every day. The moisture content of the ultraviolet-exposed right back skin was significantly higher in H than in C or L. Histochemical analysis showed that the number of apoptotic epidermal cells on the ultraviolet-exposed skin was significantly lower in L and H than in C. In H, the mRNA expression of superoxide dismutase 2 was significantly higher on ultraviolet-exposed skin than on unexposed skin. Our data suggested that edible bird’s nest extract enhanced superoxide dismutase 2 expression and downregulated apoptosis in their epidermis, which likely helped reduce skin damage.     

Increased risk of all-cause,Alzheimer’s,and vascular dementia in adults with migraine in Korea: a population-based cohort study

BackgroundStudies investigating the association between migraine and dementia have reported inconsistent findings. This study aimed to evaluate whether patients with migraine have an increased risk of dementia compared to individuals without migraine.MethodsWe obtained data from the 2002–2019 Korean National Health Insurance Health Screening Cohort. Non-migraine controls were selected using a 1:1 risk-set matching with a time-dependent propensity score. The main outcome was the development of all-cause dementia, and the secondary outcome was the development of each cause of dementia (Alzheimer’s, vascular, mixed or other specified, and unspecified dementia). The incidence rate of dementia was calculated using Poisson regression, and the association between migraine and dementia was evaluated using Cox proportional hazards regression.ResultsAmong 88,390 participants, 66.1% were female, and the mean baseline age was 55.3 ± 9.4 years. During the study period, dementia cases were identified in 4,800 of the 44,195 patients with migraine and 3,757 of the 44,915 matched controls. The incidence rate of dementia was 139.6 (95% confidence interval [CI], 135.7–143.5) and 107.7 (95% CI, 104.3–111.1) cases per 10,000 person-years in patients with migraine and matched controls, respectively. Patients with migraine had a 1.30 (hazard ratio [HR], 1.30; 95% CI, 1.25–1.35), 1.29 (HR, 1.29; 95% CI, 1.23–1.35), 1.35 (HR, 1.35; 95% CI, 1.19–1.54), 1.36 (HR, 1.36; 95% CI, 1.00–1.83), and 1.30 (HR, 1.30; 95% CI, 1.17–1.45) times higher risk of developing all-cause dementia, Alzheimer’s dementia, vascular dementia, mixed or other specified dementias, and unspecified dementia than their matched controls, respectively.ConclusionOur results suggest that migraine is associated with an increased risk of subsequent dementia. Further research is warranted to confirm these findings and to reveal the underlying mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-022-01484-y.     

Further evidence for Zenker’s diverticulum in a slim woman with body figure predisposition: a case report and literature review

Zenker’s diverticulum (ZD) is a bag-like pharyngeal pouch that protrudes to the outside of the pharynx. It is thought to be an acquired disease that occurs following the dysfunction of laryngopharynx muscle, and certain body shapes may be predisposed to this condition. We report a 56-year-old female of slim build with ZD. Computed tomography scanning revealed a hypodense lesion on the left posterior side of her upper esophagus that was filled with air and had no obvious wall. To verify this finding, a barium esophagogram was carried out which showed a round pouch at the level of the 6th cervical vertebral body that communicated with the esophagus through a narrow neck. ZD was subsequently confirmed by endoscopy. These findings provide further evidence in support of a body shape predisposition for ZD.     

Correlation between vitamin D levels and bone metabolism in children with cow’s milk allergy

ObjectiveResearch is limited regarding biochemical markers of bone metabolism among children with cow’s milk protein allergy (CMPA). We aimed to determine differences in vitamin D and bone metabolism markers between infants with CMPA and healthy infants and explore relationships between these in a cross-sectional study.MethodsIn total, we included 41 children diagnosed with CMPA and under systematic medical and nutritional care at our center, and 50 healthy children as a control group. We reviewed demographic and clinical characteristics and measured serum biomarkers.ResultsWe found that serum 25-hydroxyvitamin D (25(OH)D) levels among infants in the CMPA group were significantly lower than those in the control group, and levels of bone-specific alkaline phosphatase (BALP), serum phosphorus, and serum calcitonin were reduced. Pearson correlation analysis showed that serum 25(OH)D concentrations in the CMPA group were negatively correlated with parathyroid hormone but not significantly correlated with calcitonin and BALP. Logistic regression showed that CMPA was a risk factor for vitamin D deficiency.ConclusionsOur study indicated that CMPA was associated with disturbances in bone metabolism. Levels of vitamin D in children with CMPA were lower than those in healthy children. CMPA was a risk factor for vitamin D deficiency.     

Comparison of mucosa-associated microbiota in Crohn’s disease patients with and without anti-tumor necrosis factor-α therapy

Most studies on the gut microbiome of Crohn’s disease have been conducted using feces, instead of intestinal mucus to analyze the mucosa-associated microbiota. To investigate the characteristics of mucosa-associated microbiota in Crohn’s disease patients and the effect of anti-tumor necrosis factor (TNF)-α therapy on mucosa-associated microbiota, we analyzed microbiota in Crohn’s disease patients using brushing samples taken from terminal ileum. The recruited subjects were 18 Crohn’s disease patients and 13 controls. There were 10 patients with anti-TNF-α therapy in Crohn’s disease group. Crohn’s disease patients had significantly reduced α-diversity in Shannon index compared to the controls. The comparative analysis of the taxonomic composition at the genus level between the Crohn’s disease group and the controls indicated that butyrate-producing bacteria were less abundant in the Crohn’s disease group compared to the controls. There were no differences in the diversity between the patients taking anti-TNF-α therapy and the patients without. The comparative analysis of the taxonomic composition at the genus level between the two groups indicated that some of anti-inflammatory bacteria were less abundant in the anti-TNF-α therapy group than the other. Reduction of specific bacteria producing anti-inflammatory molecules, especially butyrate-producing bacteria may play important roles in the pathophysiology of Crohn’s disease.     

Low serum interleukin‐38 levels in patients with Graves’ disease and Hashimoto’s thyroiditis

BackgroundAutoimmune thyroid disease (AITD) mainly includes Graves’ disease (GD) and Hashimoto''s thyroiditis (HT), which is caused by individual genetics, autoimmune dysfunction, and a variety of external environmental factors. Interleukin (IL)‐38 is involved in a wide range of autoimmune diseases, but little is known about IL‐38 expression in AITD.MethodsFifty patients with GD, 50 with HT, and 50 healthy controls (HC) were enrolled in this study. Basic information of the participants was obtained through a physical examination. Immunological data were obtained by an automatic chemiluminescence immunoanalyzer. C‐reactive protein (CRP) concentrations and the white blood cell count were measured. Serum IL‐38 levels were determined by an enzyme‐linked immunosorbent assay.ResultsSerum IL‐38 levels were significantly lower in the GD and HT groups than in the HC group (both p < 0.01). Serum CRP concentrations were significantly lower in the HT group than in the HC group (p < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve was 0.7736 (p < 0.01) for IL‐38 and 0.7972 (p < 0.01) for IL‐38 combined with CRP in the GD group. In the HT group, the area under the curve was 0.7276 (p < 0.01) for IL‐38 and 0.7300 for IL‐38 combined with CRP (p < 0.01).ConclusionsThe results suggest that serum IL‐38 level is a potential new diagnostic biomarker in patients with GD and HT.     

Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital

Background Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is of increasing concern. This study aimed to investigate the molecular epidemiology and antimicrobial susceptibilities of toxigenic C. difficile isolated from IBD patients and to evaluate the risk factors for CDI in IBD population.MethodsLoose or watery stools from IBD patients were tested for glutamate dehydrogenase, C. difficile toxins A&B and anaerobic culture. Toxigenic C. difficile isolates were characterized by multi‐locus sequence typing, ribotyping and antimicrobial susceptibility testing.ResultsThe prevalence of CDI in IBD patients was 13.6% (43/317). The dominant sequence types (STs) were ST35 (20.9%), ST2 (18.6%) and ST37 (16.3%). The most common ribotypes (RTs) were RT 017 (18.6%), RT 012 (14.0%), and RT 220 (14.0%), whereas RT 027 and RT 078 were not detected in this study. All the isolates were susceptible to vancomycin and metronidazole. The multidrug resistance rate of C. difficile RT 017 was higher (p < 0.01) than that of other RT strains. Recent hospitalization, use of corticosteroids and proton pump inhibitors were related to increased risk of CDI in IBD patients; of these, recent hospitalization and proton pump inhibitors use were independent risk factors.ConclusionPatients with IBD have a relatively high incidence rate of CDI. C. difficile RT 017 is most frequently isolated from IBD patients in this region and warrants more attention to its high resistance rate. Clinicians should pay greater attention to CDI testing in IBD patients with diarrhea to ensure early diagnosis and initiation of effective treatment.