Spinal arteriovenous malformation with a calcified nodule: illustrative case.

BACKGROUND: This article describes a rare case of cervical spinal arteriovenous malformation (AVM) mimicking a neurogenic spinal tumor. OBSERVATIONS: A 22-year-old female presenting with a C6-7 AVM with a calcification nodule experienced new-onset acute right upper radiculopathy associated with extradural compression of the spinal cord. Note that spinal AVMs with a calcified nodule are rare. Endovascular embolization is generally used to relieve the symptoms of AVM; however, this procedure cannot relieve cord compression, particularly in cases complicated by calcified nodules. This article discusses treatment options. LESSONS: Decompression surgery is preferable to endovascular embolization because it alleviates symptoms while preventing cord compression and minimizing the risk of recurrence.

Original Article: The impacts of DRG payment system on financial balance of multiple trauma: Experiences of three trauma centers in Taiwan.

INTRODUCTION: There are concerns regarding the adequacy of applying the diagnosis-related groups (DRG) payment system for multiple traumas (i.e., major diagnostic category 24, MDC-24) patients in Taiwan. Therefore, this study used a multi-center dataset to assess the influence of the DRG payment system on the cost and outcome of multiple trauma care. MATERIALS AND METHODS: We collected data of all multiple trauma patients from the Trauma Registry of three hospitals from 2014 - 2017. Next, we selected patients who met the criteria of MDC-24 and calculated the corresponding DRG payment. Subsequently, we combined the clinical care information with health insurance information to analyze the problems of applying the DRG payment system to multiple trauma care. RESULTS: Overall, of 465 cases, 367 met the criteria of MDC-24, and the mean injury severity score (ISS) was high (average 20.1). The total deficit of the polytrauma DRG cases amounted to 131,445 USD, and the average deficit in each case was 397 USD. In the multivariable analysis, higher revised trauma score and specific lower abbreviated Injury Scale (AIS) scores in certain body regions resulted in profits, while increased length of stay in intensive care units, longer operative time, and higher AIS score in the thorax were significantly correlated with deficits in medical costs. CONCLUSION: Our study revealed that the current DRG payment system results in financial losses for hospitals. Further, the payment grouping of MDC-24 should consider adding more disease severity factors to reduce the financial constraints faced by trauma centers.

Clinical Benefits and Challenges in Application of Novel Portable Gastric Capsule Endoscopy for Home Healthcare Patients.

Portable magnetic-assisted capsule endoscopy (MACE) provides satisfactory patient experience and safety with comparable performance in diagnosis of organic lesions when compared to conventional upper gastrointestinal endoscopy. In this study, a total of 58 homecare patients were included for MACE either in the hospital (n = 42) or at home (n = 16), with mean age of 71.1 ± 12.4 years. A total of 55 patients (94.83%) had completed the MACE with diagnosis of reflux esophagitis (43.6%), gastritis (54.5%), erosions (21.8%), fundic polyps (14.5%), peptic ulcers (25.9%), etc. Most patients (n = 47, 85.5%) were satisfied with the experience, and all patients who received MACE at home (n = 15, 100%) appreciated the convenience of endoscopy at home. Less than half of the patients (n = 24, 43.6%) could afford MACE if the expense was not covered by health insurance (USD 714). Time consumption from both traffic and capsule manipulation was also challenging for the physicians, as it took an average of 24.7 min to complete MACE, but it added up to a total of 92.7 min at home, which is about 15 times that of conventional endoscopy in hospital. More efforts are needed to ease the financial burden of patients, and optimization of workflow in community practice may help lift the obstacles revealed in this study.

Herniated disc of lumbar spine caused by bone cement leakage after kyphoplasty - A case report and literature review.

INTRODUCTION AND IMPORTANCE: To describe an unusual case with herniated disc caused by bone cement leaking to disc space after kyphoplasty. CASE PRESENTATION: We reported a 72-year-old woman with L4 osteoporotic compression fracture. New-onset of left sciatica, numbness and intermittent claudication suffered her immediate after kyphoplasty. Herniated disc caused by bone cement leaking to disc space after kyphoplasty. The patient was post decompressive operation of L34 and the symptoms subsided well then. CLINICAL DISCUSSION: Percutaneous vertebroplasty (PVP) was a common procedure today. Especially to back pain caused by osteoporotic fracture, reported pain relief rate was satisfactory. Current studies about bone cement leakage showed kyphoplasty less than vertebroplasty. However, for the mechanism and stress effect of balloon expansion, new weak points and cracks over endplate was created, which may cause bone cement leakage to disc space and related symptoms. CONCLUSION: Kyphoplasty was a common, effective and minimal invasive operation for patients with compression fracture of spine. Cement leakage to intervertebral disc space was generally asymptomatic, but it should be avoided as much as possible. The leakage could affect the stability and weight-bearing of spinal column. Accelerated degenerative process of disc would be found and newly herniated disc would be noted. It should be ceased the procedure when relative amount of bone cement leakage to disc space during kyphoplasty.

Feasibility of Upper Gastrointestinal Examination in Home Care Setting with a Magnetically Assisted Capsule Endoscopy System: A Retrospective Study.

The magnetic assisted capsule endoscope (MACE) with a hand-held magnetic field navigator (MFN) for upper gastrointestinal examination achieved satisfactory results in a healthy volunteer study. We evaluated the feasibility of upper gastrointestinal examination in the home care setting with the MACE system. Home care patients with upper gastrointestinal symptoms that received an MACE exam were enrolled in the study. MACE procedure time; completeness of observation of important anatomical landmarks; endoscopic diagnosis; patient tolerance during the procedure; and patient data, including age, sex, comorbidities, symptoms, body weight, and height, were retrieved from hospital information system for data analysis. A total of 16 participants were enrolled with a mean age 74.3 ± 15.4 years (47 to 99 years). One patient failed to swallow the capsule and was excluded. The average procedure time was 23.7 ± 10.0 min (14.1 to 42.5 min) to complete each endoscopic exam for the remaining 15 patients. The overall maneuverability in the esophagus, stomach, and duodenum was 93.75%, 87.5%, and 75%, respectively. Overall completeness in the aforementioned regions was 93.75%, 81.25%, and 75%, respectively. No severe adverse events were noted. The results clearly demonstrate the promise of using this MACE system to perform endoscopic examination outside the hospital for patients confined to the community and home.

Prevalence and Risk Factors of Metabolic Syndrome among the Homeless in Taipei City: A Cross-Sectional Study.

The safety and health of homeless people are important social issues. Metabolic syndrome (MetS) is a sub-health-risk phenomenon that has been severely aggravated worldwide in recent years. The purpose of this study was to investigate the prevalence and risk factors of MetS among the homeless in Taipei City, Taiwan. In this study, a convenience sampling was conducted at homeless counseling agencies in Taipei City from April 2018 to September 2018. A total of 297 homeless participants were recruited, from whom clinical indicators and questionnaire information were collected. Through statistical verification, analysis of variance (ANOVA), and logistic regression, we found the following main conclusions for homeless adults in Taipei: (1) The prevalence of MetS was estimated to be 53%, with 50% meeting four or more diagnostic conditions. (2) Dyslipidemia (high-density lipoprotein (HDL) deficiency and elevated triglyceride (TG)) showed the strongest association with the prevalence of MetS; more than 83% of people with HDL deficiency or hypertriglyceridemia had MetS. For the patient groups meeting more MetS diagnostic conditions, the values of high-density lipoprotein cholesterol (HDL-C), TG, and total cholesterol (TC) increased significantly. (3) The deterioration of MetS was significantly related to the high prevalence of hyperlipidemia (HL). (4) The homeless who were divorced, separated or widowed were more likely to suffer from MetS.

The Effects of Obesity-Related Anthropometric Factors on Cardiovascular Risks of Homeless Adults in Taiwan.

Homelessness is a pre-existing phenomenon in society and an important public health issue that national policy strives to solve. Cardiovascular disease (CVD) is an important health problem of the homeless. This cross-sectional study explored the effects of four obesity-related anthropometric factors-body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)-on cardiovascular disease risks (expressed by three CVD markers: hypertension, hyperglycemia, and hyperlipidemia) among homeless adults in Taipei and compared the relevant results with ordinary adults in Taiwan. The research team sampled homeless adults over the age of 20 in Taipei City in 2018 and collected 297 participants. Through anthropometric measurements, blood pressure measurements, and blood tests, we calculated the obesity-related indicators of the participants and found those at risks of cardiovascular disease. The results showed that the prevalence of hypertension, hyperglycemia, and hyperlipidemia in homeless adults was significantly higher than that of ordinary adults in Taiwan. Among the four obesity-related indicators, WHtR showed the strongest association with the prevalence of hypertension and hyperlipidemia, followed by WHR, both of which showed stronger association than traditional WC and BMI indicators. It can be inferred that abdominal obesity characterized by WHtR is a key risk factor for hypertension and hyperlipidemia in homeless adults in Taiwan. We hope that the results will provide medical clinical references and effectively warn of cardiovascular disease risks for the homeless in Taiwan.

Frontal skull craniotomy combined with moderate-dose radiotherapy effectively ameliorate a rare case of non-secretory, multiple myeloma with orbital involvement.

BACKGROUND: Orbital infiltration in patients with multiple myeloma is a rare condition, with less than 50 cases reported in the medical literature. Most patients undergo conservative treatment because multiple myeloma is a disseminated systemic disease. CASE PRESENTATION: A 43-year-old male subject with multiple myeloma and long-term survival presented with orbital involvement. The subject lacked the typical features and poor prognostic factors associated with multiple myeloma, such as renal failure, hypercalcemia, and paraprotein in the serum and urine. The orbital computed tomographic scan revealed the tumor encasing the optic nerve, but without prominent bony destruction. Therefore, a frontal skull craniotomy with an epidural entrance to the orbital space was performed, to completely extirpate the orbital mass. The surgical procedure was followed by moderate-dose radiation therapy. After 32 months of follow-up care, the subject is doing well with excellent local control. CONCLUSION: Although the effectiveness and applicability of this approach remains to be determined, this case report demonstrates that accurate and early detection combined with local surgical treatment and appropriate radio/chemotherapy, can be applied to effectively extend an orbital multiple myeloma patient's life.

Detection of infectious human adenoviruses in tertiary-treated and ultraviolet-disinfected wastewater.

A pilot-scale study investigating the use of low-pressure, high-intensity UV radiation for disinfection of urban wastewater was conducted. The inactivation of coliform bacteria, wastewater-indigenous enteric viruses, seeded poliovirus, and seeded F-specific coliphage was studied. During the course of the pilot study, infectious human adenoviruses were isolated from 15 of 16 large-volume samples of UV-disinfected secondary- and tertiary-treated wastewater. Half of the tertiary-treated, UV-disinfected effluent samples from which the adenoviruses were isolated had total coliform concentrations that complied with California's Water Recycling Criteria. To determine the relative UV resistance of the adenovirus isolates, purified viruses were seeded into tertiary-treated waste-water and exposed to low-pressure, high-intensity, collimated UV radiation. A dose of approximately 170 mW-s/cm2 was required to achieve 99.99% inactivation. These findings suggest that UV doses effective at meeting certain wastewater regulations for total coliform bacteria may not provide suitable inactivation of the UV-resistant human adenoviruses.

Bioavailability effect of methylprednisolone by polymeric micelles.

PURPOSE: To investigate the effect of PEO-PPO-PEO polymeric micelles (PM) formulation on the bioavailability of methylprednisolone (MP), a treatment of spinal cord injury (SCI), to the blood and spinal cord (SC) of rabbits. METHODS: The characteristic of MP formulated with PM (MP/PM) was evaluated by critical micelles concentration (CMC), dynamic light scattering (DLS), atomic force microscopy (AFM) and in vitro kinetic release measurements. HPLC was used to analyze the MP disposition in plasma and SC of rabbits receiving single dose intravenous administration. After MP/PM delivery, the mRNA and protein levels of anti-apoptotic marker, Bcl-x(L), were monitored by Reverse Transcription -Real-Time -Polymerase Chain Reaction (RT-qPCR) and Western blotting analysis, respectively. RESULTS: At a concentration of 0.1% and at 25 degrees C, PEO-PPO-PEO copolymers formed micelles shown by fluorescence probe, DLS and solubility test. The size of the MP/PM was in an average of 60 nm with a single, rounded shape detected under AFM. Being formulated with 6% PM, MP had higher solubility (219.6 +/- 3.6 microg/ml) and release rate (11.1 +/- 0.4 ng min(1/2)) at 37 degrees C. After intravenously administrated with single dose of 1 mg/kg of MP/PM to rabbits, higher levels of MP in plasma and SC were detected compared to animals receiving an equal dose of MP, analyzed by HPLC. PM formulation markedly increased (7-fold) the plasma half-lives (t (1/2)) of MP (from 76.1 +/- 8.0 to 514.3 +/- 70.0 min). In addition, the SC t (1/2) of MP/PM also increased from 278 to 528 min. In SC, the mRNA level of Bcl-x(L) increased 4-fold in animals receiving MP/PM compared to that with MP alone at 7 h post-administration. Similar elevated Bcl-x(L) protein was also detected upon MP/PM administration compared to MP. CONCLUSIONS: PM vehicle was able to deliver MP to improve its pharmacokinetic profile in plasma and SC with higher expression of anti-apoptotic Bcl-x(L) at both mRNA and protein levels.