Introduction: The primary issue following lumbar discectomy for disc herniation is the risk of reherniation in the post-operative period. Many surgical techniques have been proposed to treat disc reherniation, however, the optimal one remains variable. This meta-analysis aimed to investigate the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the contributing factors. Materials and methods: Identification of published literature was performed on PubMed, Google Scholar, Scopus, and Web of Science databases. Studies published until 14 February 2024 reported the prevalence of symptomatic reherniation after using a Bone-anchored annular closure device following lumbar discectomy and the associated contributing factors. A random effects model was used to conduct Bayesian frequentist network meta-analysis and pair-wise meta-analysis, with the assessment based on standardised mean difference (SMD) and 95% confidence interval (CI). Results: Eleven studies published in 2012 − 2022 recruiting a total of 5195 patients were included in the meta-analysis. The prevalence of reherniation in ACD and control groups was 23.2% (95% CI: 18.2% − 28.1%) and 36.4% (95% CI: 28.2% − 44.5%), respectively. The moderator effect of sample size is significant for pooled data of the ACD group (p-mod=0.002), but not for the control group (pmod=0.278). After the adjustment with sample size, the prevalence rates were 13.6% (95% CI: 6.2% − 21.1%) and 29.6% (95% CI: 14.9% − 33.2%) for ACD and control groups, respectively. Conclusion: Comparatively to lumbar discectomy alone, using a Bone-anchored annular closure device following lumbar discectomy decreased the symptomatic reherniation rate and post-operative complications, as well as the necessity for subsequent surgeries.

Arsenic trioxide (ATO) serves as a component of traditional Chinese medicine and a modern anticancer agent, demonstrating remarkable efficacy in the long-term treatment of acute promyelocytic leukemia. With increasing research into its application in solid tumors, ATO's diverse mechanisms of action and potential clinical value have attracted widespread attention. ATO can inhibit tumor cell proliferation by inducing various forms of cell death, such as apoptosis, autophagy, pyroptosis, necroptosis, and ferroptosis, as well as by regulating cell differentiation. Moreover, its modulatory effects on the tumor immune microenvironment provide a new aspectto its antitumor activity. Nevertheless, the clinical application of ATO in solid tumors faces challenges such as low bioavailability, inadequate targeting, and adverse effects. The development of nanocarriers and targeted delivery systems has emerged asa key strategy for enhancing the therapeutic efficacy of ATO. This review systematically summarizes the multiple mechanisms of action of ATO in solid tumors and recent advances in nanodelivery technologies, explores the potential of ATO-based combination therapies, and discusses future directions, aiming to provide a theoretical foundation and practical guidance for the clinical application of ATO in solid tumors.

Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Septic shock, a severe subset of sepsis, must be promptly recognized and managed as a medical emergency. We present the case of a 51-year-old male who developed shock during hospitalization for infected leg ulcers, with a background of chronic heart failure (HF), hypertension, and poorly controlled type 2 diabetes mellitus. Despite his history of HF, bedside echocardiography revealed low systemic vascular resistance and preserved cardiac output, findings more consistent with septic shock than cardiogenic shock. This case underscores the pivotal role of early hemodynamic assessment, particularly with echocardiography, in accurately identifying the type of shock in patients with pre-existing HF. Differentiating the underlying etiology is essential to initiate appropriate therapy and improve clinical outcomes.

Pulmonary atresia and ventricular septal defect (PA-VSD) with major aorto-pulmonary collaterals (MAPCAs) is a complex and extremely heterogeneous anomaly. Most untreated patients die in their first decade of life because of intractable congestive heart failure or respiratory distress. PA-VSD is characterized by a wide variety of anatomy of central pulmonary artery and nature of collateral lung perfusion. In most patients, collateral perfusion is provided either by MAPCAs or by patent ductus arteriosus (PDA). The management of infants and children with pulmonary atresia, ventricular septal defect, and MAPCAs has proven to be challenging. Therapeutic approaches include onestage surgical repair, staged unifocalization, shunting, and coiling of collateral vessels. Results have been variable and frustrating. In this case report, we discuss the characteristic, variants, and how far we can manage the patient who suffered from PA-VSD.

Rheumatic fever is the main cause of mitral stenosis worldwide. Ortner’s syndrome (cardio-vocal syndrome) is a rare complication of rheumatic mitral stenosis. It is caused by recurring paralysis of the left laryngeal nerve, mainly caused by mechanosuppression of the nerve from enlarged cardiovascular structures. A 76-year-old woman with chronic rheumatic heart disease (RHD) complained of hoarseness for 17 days, accompanied by shortness of breath, nausea, and vomiting for 1 week. Auscultatory examination revealed a loud first heart sound in the mitral region as well as an irregular rhythm. An electrocardiogram examination revealed right axis deviation and atrial fibrillation. Chest X-ray showed cardiomegaly. Despite normal left and right ventricular function, echocardiography showed severe mitral stenosis with mild mitral regurgitation. Conservative treatment was given with a combination of diuretics, beta-blockers, vitamin K antagonists, and angiotensin receptor blockers. An otolaryngologist was consulted, and the patient was treated conservatively.

Ventricular septal rupture (VSR) after acute myocardial infarction (MI) is a rare yet fatal complication. Although surgical repair is essential, the optimal timing remains controversial. We report a case of ST-Elevation Myocardial Infarction (STEMI) complicated by VSR. Fibrinolytic therapy was initially considered successful; however, the patient developed worsening dyspnoea. Further evaluation confirmed an apical VSR by echocardiography. The patient received intensive monitoring and supported with an Intra-Aortic Balloon Pump (IABP). Surgical repair was performed on day 26. Hemodynamic initially improved postoperatively, but the condition deteriorated again on the ninth day after surgery, and the patient ultimately died. This case underscores that while surgical repair is the preferred definitive treatment for VSR, the timing of intervention is critical. Proper timing requires balancing surgical risks with tissue readiness and hemodynamic stability. The interval between VSR detection and surgical repair plays a pivotal role in determining patient survival.

BACKGROUND: The proportion of patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations is relatively high in China. However, these patients currently lack significant benefits from available neoadjuvant treatment options. This study aims to explore the potential application value of neoadjuvant targeted therapy by evaluating its efficacy and safety in patients with EGFR-mutant resectable lung adenocarcinoma. METHODS: A multicenter retrospective study was used to analyze the treatment effect of patients with stage IIA-IIIB EGFR-mutant lung adenocarcinoma who underwent surgical resection after receiving neoadjuvant targeted therapy from July 2019 to October 2024. RESULTS: A total of 24 patients with EGFR-mutant lung adenocarcinoma from three centers were included in this study. All patients successfully underwent surgery and achieved R0 resection of 100.0%. The objective response rate (ORR) was 83.3% (20/24) . The major pathologic response (MPR) rate was 37.5% (9/24), with 2 patients (8.3%) achieving pathological complete response (pCR). During neoadjuvant therapy, 13 out of 24 patients (54.2%) experienced adverse events of grade 1-2, with no occurrences of ≥ grade 3. The most common treatment-related adverse events were rash (n=4, 16.7%), mouth sores (n=2, 8.3%), and diarrhea (n=2, 8.3%). The median follow-up time was 33.0 months, no deaths occurred in all patients, and the overall survival (OS) rate was 100.0%. The 1-year disease-free survival (DFS) rate was 91.1%, and the 2-year DFS rate remained at 86.2%. CONCLUSIONS The application of neoadjuvant targeted therapy in patients with EGFR-mutant resectable lung adenocarcinoma is safe and feasible, and is expected to become a highly promising neoadjuvant treatment option for the patients with EGFR-mutant lung adenocarcinoma.
Humans ; ErbB Receptors/metabolism* ; Male ; Female ; Middle Aged ; Adenocarcinoma of Lung/surgery* ; Neoadjuvant Therapy ; Lung Neoplasms/surgery* ; Aged ; Retrospective Studies ; Mutation ; Adult

BACKGROUND: Prior studies have shown that drivers with type 2 diabetes are more likely to be involved in motor vehicle collisions (MVCs) compared to the general population. Certain meteorological factors have been increasingly recognized as contributors to MVC risk. This study aims to examine the association of MVCs with temperature, rainfall, wind speed, and sunshine duration among drivers with type 2 diabetes. METHODS: Using Taiwan's National Health Insurance data (2019-2021), we identified individuals diagnosed with type 2 diabetes and linked their records to the Police-Reported Traffic Accident Registry to obtain daily MVC counts. Meteorological data were sourced from the Central Weather Administration. Associations between daily weather conditions and MVCs were assessed using a Distributed Lag Non-Linear Model. RESULTS: Over the 1,096-day study period, 170,468 MVC events involving drivers with type 2 diabetes were recorded. A U-shaped association was observed between same-day temperature and MVC rates. Compared with the reference temperature of 17.5 °C, both lower temperatures (≤15 °C; rate ratio [RR] = 1.014-1.053) and higher temperatures (≥30 °C; RR = 1.062) were associated with increased MVC risk. Rainfall showed an inverse relationship with MVCs. Compared with 70 mm of rainfall, the lowest MVC rate occurred at 129 mm (RR = 0.873), while the highest was on rain-free days (0 mm; RR = 1.068). Stronger effects were observed when lag periods up to 14 days were considered. Wind speed and sunshine duration were not significantly associated with MVC risk. CONCLUSIONS These findings suggest that drivers with type 2 diabetes should exercise greater caution on days with extreme temperatures or in days with lesser rainfall, as these conditions may elevate MVC risk.
Humans ; Diabetes Mellitus, Type 2/epidemiology* ; Taiwan/epidemiology* ; Accidents, Traffic/statistics & numerical data* ; Male ; Middle Aged ; Female ; Weather ; Aged ; Adult ; Temperature ; Risk Factors