Postoperative abdominal herpes zoster complicated by intestinal obstruction: A case report.

BACKGROUND: Intestinal obstruction is a common occurrence in clinical practice. However, the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare. In the diagnostic and treatment process, clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis. CASE SUMMARY: Herein, we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery. Combining the patient's clinical manifestations and relevant laboratory tests, it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery, causing herpes zoster. Subsequently, the herpes virus invaded the visceral nerve fibers, causing gastrointestinal dysfunction and loss of intestinal peristalsis, which eventually led to intestinal obstruction. The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital. CONCLUSION: Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes. In cases of inexplicable intestinal obstructions, considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses.

Exercise-induced Musclin determines the fate of fibro-adipogenic progenitors to control muscle homeostasis.

The effects of exercise on fibro-adipogenic progenitors (FAPs) are unclear, and the direct molecular link is still unknown. In this study, we reveal that exercise reduces the frequency of FAPs and attenuates collagen deposition and adipose formation in injured or disused muscles through Musclin. Mechanistically, Musclin inhibits FAP proliferation and promotes apoptosis in FAPs by upregulating FILIP1L. Chromatin immunoprecipitation (ChIP)-qPCR confirms that FoxO3a is the transcription factor of FILIP1L. In addition, the Musclin/FILIP1L pathway facilitates the phagocytosis of apoptotic FAPs by macrophages through downregulating the expression of CD47. Genetic ablation of FILIP1L in FAPs abolishes the effects of exercise or Musclin on FAPs and the benefits on the reduction of fibrosis and fatty infiltration. Overall, exercise forms a microenvironment of myokines in muscle and prevents the abnormal accumulation of FAPs in a Musclin/FILIP1L-dependent manner. The administration of exogenous Musclin exerts a therapeutic effect, demonstrating a potential therapeutic approach for muscle atrophy or acute muscle injury.

[Clinical study of sinus tarsal approach combined with Herbert screw and minimally invasive calcaneal locking plate in the treatment of Sandersâ ¡ and â ¢ calcaneal fractures].

OBJECTIVE: To investigate the clinical effect of the tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate compared with traditional lateral L-shaped incision approach combined with plate internal fixation in the treatment of SandersⅡ and Ⅲ calcaneal fractures. METHODS: Total of 110 patients with SandersⅡ and Ⅲ calcaneal fractures admitted from March 2018 to March 2020 were selected. There were 66 males and 44 females, ranging in age from 20 to 72 years old, with an average of (48.82±8.03) years old. There were 48 SandersⅡ patients and 62 Sanders Ⅲ patients, including 41 left calcaneal fractures and 69 right calcaneal fractures. According to the surgical approach, the patients were divided into the tarsal sinus approach group and the L-shaped incision approach group, 55 cases in each group. The L-shaped incision approach group was treated with traditional lateral L-shaped incision approach combined with internal fixation plate, while the sinus tarsal approach group was treated with tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate. The operative time, intraoperative blood loss, length of hospital stay and time of fracture healing were recorded to evaluate the surgical effect. The B?hler angle, Gissane angle, calcaneal length and width of the patients before and after surgery were examined by X-ray and the surgical reduction was highly evaluated. Foot function recovery was evaluated by American Orthopedic Foot and Ankle Society (AOFAS) Maryland Scale, and postoperative complications were recorded. RESULTS: All patients were followed up to 12 months after surgery, the operation time and hospitalization time of patients in the sinus tarsal approach group were shorter than those in the L-shaped incision approach group (P<0.05), and the amount of intraoperative blood loss was lower than that in the L-shaped incision approach group(P<0.05). One year after surgery, B?hler angle, Gissane angle, calcaneus length and height were increased(P<0.05), calcaneus width was decreased (P<0.05). One year after the operation, the Maryland scores of the two groups were increased(P<0.05). During the follow-up period, the incidence of postoperative complications (incision infection, joint pain, soft tissue injury) in the sinus tarsalapproach group was lower than that in the L-shaped incision approach group(P<0.05). CONCLUSION: The traditional lateral L-shaped incision approach and the tarsal sinus approach are both good for the treatment of SandersⅡand Ⅲ calcaneal fractures, but the latter can shorten the surgical treatment time and reduce the incidence of complications.

[Case-control study on the treatment of single-segment lumbar spinal stenosis with modified interlaminar approach and traditional approach].

OBJECTIVE: To explore the clinical effect of modified interlaminar approach for the treatment of single-segment lumbar spinal stenosis. METHODS: From February 2015 to August 2017, 80 patients with single-segment lumbar spinal stenosis planned to undergo endoscopic surgery were selected, including 38 males and 42 females;aged 33 to 69 (47.6±9.5) years old. Using random number table method, the patients were divided into study group and traditional group, 40 cases in each group, and underwent surgical treatment through modified translaminar approach and traditional approach respectively. The operation time, intraoperative blood loss, and hospital stay were recorded;visual analogue scale (VAS) and Oswestry Disability Index (ODI) before and after operation were compared between two groups;spinal canal arca, spinal canal diameter, disc yellow space and surgical complications were observed. RESULTS: All 80 patients were followed up for at least 3 months. Two patients had incision infection, both of them were in traditional group;there was no significant difference in operation time between two groups(P>0.05). Intraoperative blood loss and hospital stay in study group were lower than those in traditional group(P<0.05). At 1 week and 3 months after operation, VAS and ODI of all patients were significantly lower than before operation (P<0.05), but the difference between two groups was not statistically significant (P>0.05). At 3 months after surgery, measured values of spinal canal area and spinal canal diameter were larger in study group than in traditional group (P<0.05). The operative complication rate of the study group was 5.00% compared with 12.50% of the traditional group, and the difference was not statistically significant (P>0.05). CONCLUSION: Compared with the traditional approach, the modified interlaminar approach has advantages of less trauma, faster recovery and better postoperative spinal space recovery in the treatment of single-segment lumbar spinal stenosis.

Enhanced atrial internal-external neural remodeling facilitates atrial fibrillation in the chronic obstructive sleep apnea model.

OBJECTIVE: Autonomic imbalance plays a crucial role in obstructive sleep apnea (OSA) associated atrial fibrillation (AF). Here, we investigated the potential neural mechanism of AF induced by OSA. METHODS: Ten dogs were divided into control group (n = 5) and OSA group (n = 5). The chronic OSA model was established by repeat apnea-ventilation cycles for 4 hours a day for 12 weeks. During the process of model establishment, arterial blood gases, atrial effective refractory period (AERP), AF inducibility, normalized low-frequency power (LFnu), normalized high-frequency power (HFnu), and LFnu/ HFnu were evaluated at baseline, 4th week, 8th week, and 12th week. Nerve activities of left stellate ganglion (LSG) and left vagal nerve(LVN) were recorded. Tyrosine hydroxylase(TH), choline acetyltransferase(CHAT), PGP9.5, nerve growth factor(NGF), and c-Fos were detected in the left atrium, LSG, and LVN by immunohistochemistry and western blot. Moreover, high-frequency stimulations of LSG and LVN were conducted to observe the AF inducibility. RESULTS: Compared with the control group, the OSA group showed significantly enhanced neural activity of the LSG, increased AF inducibility, and shortened AERP. LFnu and LFnu/HFnu were markedly increased in the OSA group, while no significant difference in HFnu was observed. TH-positive and PGP9.5-positive nerve densities were significantly increased in the LSG and left atrium. Additionally, the protein levels of NGF, c-Fos, and PGP9.5 were upregulated both in the LSG and left atrium. AF inducibility was markedly increased under LSG stimulation without a stimulus threshold change in the OSA group. CONCLUSIONS: OSA significantly enhanced LSG and left atrial neural remodeling, and hyperactivity of LSG may accelerate left atrial neural remodeling to increase AF inducibility.

[Analysis of risk factors for preoperative mechanical ventilation in patients with acute traumatic cervical spinal cord injury].

OBJECTIVE: To analyze the risk factors associated with mechanical ventilation before surgery in patients with acute traumatic cervical spinal cord injury(TCSCI). METHODS: According to whether preoperative mechanical ventilation, 59 patients with TCSCI admitted to our hospital from November 2016 to May 2018 were divided into mechanical ventilation(MV)group (37 cases) and non-mechanical ventilation(non-MV) group (22 cases). Falling from height was the most common causes of injury(30 cases, 50.8%), then was traffic accident(22 cases, 37.3%). The most common paraplegic plane was in C1-C4(36 cases, 61%). American Spinal Cord Injury Association(ASIA) injury degree and ASIA exercise score(AMS) were used to assess the extent of affected neurological plane and spinal cord injury. Trauma severity score(ISS) was used to evaluate the severity of the injury. Multivariate Logistic regression was used to analyze the risk factors for mechanical ventilation in TCSCI. ROC curves were used to assess the value of AMS and ISS in predicting mechanical ventilation. RESULTS: Univariate analysis showed that the percentage of male, complete injury and related injuries in the MV group were significantly higher than those in the non-MV group(P<0.05). The AMS score of the MV group was significantly lower than that of the non-MV group (16.4±10.7 vs 39.1±9.5, P<0.001), and the ISS score was significantly higher than that of the non-MV group(31.6±8.0 vs 26.5±6.7, P=0.015). Multivariate Logistic regression analysis showed that AMS[OR=3.340, 95% CI(1.321, 6.242), P<0.001] and ISS [OR=1.120, 95% CI(0.306, 3.786), P<0.001] were significant risk factors on predicting the need for mechanical ventilation.The ROC analysis showed that the area under the ROC curve(AUC) of AMS was significantly higher than that of ISS(0.899 vs 0.685, P<0.05). CONCLUSIONS: AMS and ISS at admission can be used as predictors of early mechanically assisted ventilation.

Diverse combination therapies of Chinese Medicine in treating Hypertension.

OBJECTIVE: There are more than 300 million patients with hypertension in China, and at least 1 in 5 is using or has ever used Chinese Medicine (CM) treatment. SCOPE: This article reviews the efficacy and safety of CM as monotherapy and in combination with western medicine (WM) to explore its potential role in the clinical management of hypertension. METHODS: Relevant articles were identified through PubMed, Chinese National Knowledge Infrastructure (CNKI) Database, VIP Chinese Journal Database, Wanfang Database, and China Biological Medicine Database (CBM-disc) search (up to 31 March, 2013). FINDINGS: A total of 27 RCTs and 7 systematic reviews (including meta-analyses) were identified. These articles suggested that although as monotherapy, CM has limited effect for hypertension, while combined with WM, it does have a favorable effect of antihypertension. The combination therapy could not only improve the quality of life and the symptoms of hypertensive patients, such as dizziness and headache, but also stabilize blood pressure variability (BP). Moreover, the combined treatment of CM and WM may further reduce BP to the target levels for patients failed with hypertension control. Besides, the combination therapy also has more favorable effects than any WM monotherapy in protecting target organs as well as avoiding adverse reactions. CONCLUSION: When combined with WM, CM as a complementary treatment approach has certain effects for the control of hypertension and protection of target organs. However, more well-designed studies should be conducted to make a solid conclusion.