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Vocal Cord Palsy due to Spontaneous Dissection of Internal Carotid Artery: A Case Report and Literature Review

Dissection of internal carotid artery (ICA) can cause paralysis of lower cranial nerves. We present a rare case of vagus nerve palsy secondary to spontaneous dissection of extracranial ICA. A 55-year-old healthy man suffered hoarseness for 5 days. Paralysis of left vocal cord was found by laryngoscope examination. Phonation evaluation revealed moderate to severe dysphonia. Computed tomography (CT) of the head and neck region identified medial displacement of left vocal cord and intramural hematoma in left cervical ICA at the level of skull base. The results of blood chemistry study and extensive immune evaluation were within normal ranges. Antithrombotic therapy, Clopidogrel 75 mg QD, was applied under the impression of vagal nerve paralysis secondary to spontaneous ICA dissection. His symptom recovered and phonation was almost normal about 3 months after medical treatment. Restoration to normal position of left vocal cord and resolution of intramural hematoma were identified by magnetic resonance imaging (MRI) within 3 months. Pain in the head or neck, partial Horner's syndrome and symptoms related to cerebral ischemia are most frequent presentations of spontaneous ICA dissection. Multiple lower cranial neuropathies involving cranial nerves IX, X, XI and XII have also been reported. But isolated paralysis of vagal nerve secondary to spontaneous ICA dissection is extremely rare. There are only 10 cases (F/M = 5/5, age = 29 - 63 y/o) found in the literature. Recovery after antithrombotic therapy within 1 - 3 months is noted in most of the reported cases. MRI is the imaging modality of choice for evaluating the evolution of intramural hematoma in a dissected ICA. It is suggested that stenting and coiling are reserved for patients with rapid symptom progression despite medical treatment. In conclusion, spontaneous ICA dissection should be included in the list of differential diagnosis for vocal cord palsy, especially in a young adult with acute onset of hoarseness.

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A young male with recurrent dizziness caused by Spontaneous intracranial hypotension

Dizziness is a common clinical chief complaint and encompasses a wide range of diverse and complex diseases. This case involves a 25-year-old man who experienced repeated dizziness following a car accident. Despite having sought medical treatment several times, his symptoms were not relieved. He was admitted to the hospital due to dizziness combined with diplopia and blurred vision. Medical history taking revealed that the dizziness began after the traumatic car accident. The symptoms were induced by standing posture and alleviated when lying down. A neurological examination revealed abnormal cerebellar function, and a brain MRI was arranged to rule out acute infarction and hemorrhage. Due to severe dizziness and symptoms of cerebellar ataxia, a lumbar puncture was performed to rule out cerebellitis. The cerebrospinal fluid pressure was found to be profoundly low. Spinal magnetic resonance imaging confirmed a cerebrospinal fluid leak at the 12th thoracic vertebra. The patient was diagnosed with intracranial hypotension syndrome and treated with an epidural blood patch, successfully curing it. The chronological relationship between dizziness and trauma history, along with posture-induced symptoms, were pivotal diagnostic clues. We hope to use this case to raise colleagues' awareness of this disease.

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Integrating Machine Learning and Multi-Omics to Uncover Ferroptosis-Driven Mechanisms in Breast Cancer Prognosis

Breast cancer remains a leading cause of cancer-related deaths among female patients globally. Ferroptosis, a recently identified form of regulated cell death, is characterized by the accumulation of iron-dependent lipid peroxidation and plays a pivotal role in various pathophysiological conditions, including breast cancer. Machine learning algorithms play a significant role in identifying prognostic biomarkers for breast cancer patients by leveraging their ability to process complex, high dimensional biological data and uncover meaningful patterns. However, the ability of machine learning approaches to identify critical ferroptosis-associated genes for breast cancer prognosis has not been thoroughly examined. Clinical and genetic data were based on The Cancer Genome Atlas (TCGA). Differential gene expression was assessed using GSCA platform. Important genes were selected using Elastic Net algorithm. A prognostic gene panel was established using the Kaplan-Meier (K-M) Plotter. Additional analyses, including the Cox proportional hazards model, differential gene expression heatmaps grouped by specific genes, and tumor immune microenvironment (TIME) evaluation, were conducted using the TCGAplot R package. The biological relevance of these differentially expressed genes was explored using Gene Set Enrichment Analysis (GSEA). Pharmacogenetic analysis was performed using Q-omics. Seven differentially expressed ferroptosis-associated genes were identified: SLC7A11, FANCD2, CISD2, VDAC1, VDAC3, CISD1, and GPX4. Elastic Net highlighted four significant prognostic genes: CISD1, VDAC1, VDAC2, and VDAC3. A risk score model based on these four genes outperformed individual genes in prognostication, with CISD1 demonstrating the highest weight coefficient. Notably, CISD1 exerted the most significant impact on the hazard ratio in the breast cancer cohort compared to other cancer types. GSEA and mutation landscape profiling revealed the involvement of CISD1-associated gene networks in cell cycle regulation and driver gene mutations, respectively. TIME analysis uncovered a positive correlation between CISD1 expression and immune checkpoint-related genes, indicative of an immunosuppressive microenvironment. Importantly, breast cancer cell lines with elevated CISD1 levels exhibited resistance to cetuximab while demonstrated sensitivity to sorafenib. In conclusion, our study identified a prognostic panel based on four ferroptosis-associated genes, with CISD1 contributing the highest prognostic weight. Elevated CISD1 levels are associated with poor outcomes, activation of the cell cycle, mutations in driver genes, and an immunosuppressive microenvironment. Furthermore, CISD1 expression may serve as a biomarker for precision medicine development, highlighting its potential to guide therapeutic interventions for breast cancer.

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Traditional Chinese Medicine Treatment for Menopausal Hot Flashes

Hot flashes are a common clinical symptom of menopause, particularly in female patients, and often have a significant impact on daily life and work performance. This report presents a case of a 51-year-old female patient who experienced irregular menstruation for one year and developed sudden-onset hot flashes over the past six months. Her symptoms were accompanied by night sweats, irritability, and mood swings, which significantly affected her job performance. She frequently woke up at night due to excessive sweating and heat sensations, making it difficult to fall back asleep. Additionally, she often experienced occipital headaches the following day. The patient was diagnosed with menopausal syndrome by a Western medicine gynecologist but opted against hormone replacement therapy and instead sought treatment in Traditional Chinese Medicine (TCM). Based on TCM syndrome differentiation, the patient exhibited signs of liver and kidney yin deficiency, as well as hyperactive fire due to yin deficiency. Therefore, the treatment focused on nourishing the liver and kidneys while replenishing yin and reducing internal heat. After undergoing TCM treatment, the patient's menopausal symptoms significantly improved, leading to a notable enhancement in her quality of life. MENQOL is used to assess the severity of menopause symptoms. After Chinese medicine treatment, each indicator decreased from scores of 4-5 to 0-1. This case highlights the potential efficacy of TCM in managing menopausal syndrome, providing an alternative treatment approach worthy of further investigation and application.

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Extended reality and 3D reconstruction for surgical education and patients' engagement

The rapid advancements in technology have significantly transformed surgical training and patient engagement. Traditional surgical education, which followed an apprenticeship-based model, has evolved with the incorporation of structured curricula and technological innovations. However, the increasing demand for patient safety and the reduction in training hours necessitate alternative educational methodologies. Extended reality (XR) and 3D reconstruction offer promising solutions, enhancing simulation-based learning and interactive patient involvement. Virtual reality (VR) simulators, augmented reality (AR) applications, and 3D printing have revolutionized skill acquisition and preoperative planning. Additionally, patient engagement has improved through immersive experiences, allowing for better comprehension of surgical procedures. This paper explores the role of XR and 3D reconstruction in surgical training, surgical planning, and patient-centered care, emphasizing their potential benefits and current limitations.

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Redirection quadricepsplasty as a salvage procedure for recurrent habitual dislocation of patella with vastus lateralis fibrosis - -report of an innovative technique and 4 cases

Painless habitual dislocation of the patella (HDP) is a condition that patella is insecurely held, either congenital or acquired, in the intercondylar groove during ordinary movement of knee joint. Surgical intervention is recommended but recurrent dislocation of patella is not uncommon. We report a novel surgical treatment as salvage and the clinical short-term outcome for HDP secondary to vastus lateralis (VL) fibrosis. From 2002 to 2008, we have successfully treated seven failed cases of HDP following soft tissue release with an innovative procedure called redirection quadricepsplasty which consists of lateral release, medial redirection of the extensor mechanism, optional V-Y lengthening and medial plication. Intramuscular injection-related vastus lateralis fibrosis, instead of congenital origin, was proved to be the cause of HDP in all cases. There was no recurrence of dislocation following redirection quadricepsplasty in all cases. In this paper, we would like to report the technique and surgical outcome. The patients were followed to an average of 45 months (range 24-63) with satisfactory functional results and full active range of motion. According to our experience, redirection quadricepsplasty might be an optional salvage procedure after failed surgery or in failed cases of HDP after primary surgery.

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The Role of Ultrasound in the Rapid Diagnosis of Post-Influenza Pneumonia

Ultrasound has emerged as a valuable imaging tool for the rapid diagnosis of lung parenchyma disorders, including post-influenza pneumonia. This manuscript highlights the advantages of lung ultrasound (LUS) in detecting pneumonia-related changes, particularly in emergency and bedside settings. Compared to traditional imaging modalities such as chest X-rays and CT scans, ultrasound offers real-time assessment, portability, and radiation-free imaging, making it a superior choice in critical care and resource-limited environments.

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Latex Allergy

Latex products, including latex gloves, may trigger type I immediate hypersensitivity reactions. Individuals who frequently come into contact with latex products, have allergic predispositions, or suffer from hand eczema are at a higher risk of developing latex allergies. Allergic contact urticaria is the most common manifestation of latex allergy, but severe allergies can lead to systemic urticaria, angioedema, and even anaphylactic shock. Diagnostic tools for latex allergy include skin testing, allergen testing, basophil activation tests, and provocation tests. Component-resolved diagnostics can enhance the accuracy of skin tests and allergen testing. High-risk groups, such as healthcare workers, should avoid or minimize the use of latex products as much as possible. If feasible, it is preferable to use non-latex gloves or powder-free, low-protein latex gloves instead of powdered latex gloves. For individuals who have already developed latex sensitization but have not yet experienced a latex allergy, avoiding latex products can help prevent the occurrence of latex allergies.

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Multiple Ureteral Inflammatory Polyps Causing Hydronephrosis in a 6-Year-Old Boy with Recent COVID-19 Infection History-a case report

The ureteric inflammatory polyp is an extremely rare cause of hydronephrosis in children. Here, we report a 6-year-old boy with a recent COVID-19 infection who suffered from acute hydronephrosis caused by multiple ureteral inflammatory polyps. Excision and ablation of these polyps were performed under ureteroscopy. However, ureteral strictures were noted after excision. We also reviewed the literature for clinical cases.

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Mucinous Borderline Ovarian Tumors in Elderly Patients: Insights from a Case Series

Borderline tumors are rare malignant epithelial ovarian tumors, and as a result, experience with their diagnosis and treatment remains limited. This report highlights two rare cases of epithelial proliferation within mucinous cystadenomas, posing diagnostic challenges in evaluating complex pelvic lesions. The patients a 64-year-old woman (G5P4SA1) and a 72-year-old woman (G9P7A2) presented with symptoms of abdominal fullness, early satiety, and increased urinary frequency. Clinical assessments, including serum cancer antigen 125 (CA-125) testing, along with imaging, indicated ovarian neoplasms. Subsequent biopsies confirmed the diagnosis of mucinous borderline ovarian tumors. Given the elevated risk of invasive recurrence associated with mucinous tumors compared to their serous counterparts, both patients successfully underwent surgery. They were discharged in stable condition with scheduled outpatient follow-up. These cases underscore the importance of a multidisciplinary approach in the diagnosis and management of complex pelvic lesions, while also highlighting the need to consider reproductive history and cancer risk factors in comprehensive patient care.