The efficacy of electroacupuncture for cervical nerve edema and movement disorder caused by the brachial plexus injury: a case report.

The brachial plexus injury (BPI) is one of the most severe types of peripheral nerve injuries, often caused by upper limb traction injury. In clinic, the surgery is widely used to treat the BPI. However, surgery may need to be performed multiple times at different stages, which carries risks and brings heavy economic burden. In non-surgical treatment, splinting, local injection of corticosteroids, and oral corticosteroids can achieve significant short-term benefits, but they are prone to recurrence and may cause complications of mechanical or chemical nerve damage. In this report, we present a case of a 46-year-old female patient with BPI. The patient had difficulty in raising, flexing and extending of the left upper limb, and accompanied with the soreness and pain of neck and shoulder. After 3 months of EA treatment, a significant reduction in the inner diameter of the left C5 to C7 root at the outlet of brachial plexus nerve was detected by musculoskeletal ultrasound, and the soreness and pain in the left neck and shoulder were significantly reduced. The soreness and pain in the left neck and shoulder did not recur for 2 years. Case summary: The patient is a 46-year-old female with BPI. She experienced difficult in lifting, flexing and extending of the left upper limb, which accompanied by soreness and pain in the left neck and shoulder. After 3 months of EA treatment, the patient's pain and limb's movement disorder was improved. After 2 years of follow-up, the patient's left neck and shoulder showed no further pain. Conclusion: EA has shown satisfied efficacy in BPI, improving limb restrictions and relieving pain in patients for at least 2 years.

Association and predictive value of contrast­enhanced ultrasound features with axillary lymph node metastasis in primary breast cancer.

Primary breast cancer is the most common malignant tumor in women worldwide, and axillary lymph node metastasis (ALNM) is an important marker of disease progression in patients with breast cancer. The objective of the present study was to analyze the association between contrast-enhanced ultrasound (CEUS) features and ALNM in primary breast cancer and its predictive value. A total of 120 patients with breast cancer were assigned to the non-metastatic group (n=70) and metastatic group (n=50). The factors influencing ALNM were explored by multivariate logistic regression analysis. The consistency of CEUS, ordinary ultrasonography and pathological examination in the diagnosis of the ALNM of breast cancer was evaluated by consistency testing. The sensitivity, specificity and consistency rate of CEUS features and ordinary ultrasonography were analyzed by receiver operating characteristic curve and four-fold table analyses. High enhancement amplitude, centripetal enhancement sequence, increased maximum cortical thickness, high peak intensity and a larger area under the curve of lymph nodes were more commonly found in the metastatic group than in the non-metastatic group. The lymph node aspect ratio and time to peak were lower in the metastatic group than the non-metastatic group. The time to peak was a protective factor for ALNM in patients with breast cancer. The sensitivity, specificity and coincidence rate with pathological examination of CEUS in the diagnosis of ALNM were 92.00, 90.00 and 90.83%, while these of ordinary ultrasonography were 76.00, 80.00 and 78.33%, respectively. The consistency test indicated that CEUS and pathological examination were consistent in the diagnosis of ALNM in patients with breast cancer, with a κ value of 0.816, indicating a good consistency. The κ value of ordinary ultrasonography and pathological examination was 0.763, also indicating a good consistency. However, these results indicate that CEUS is more valuable than ordinary ultrasonography in the diagnosis of ALNM in cases of breast cancer. In conclusion, the present study indicates that CEUS features were influencing factors associated with ALNM in patients with breast cancer and may serve as an important reference for the preoperative prediction of ALNM in breast cancer.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition).

With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.

Ultra-high-performance liquid chromatography-tandem mass spectrometry-based metabolomics unveils the metabolic alterations in colon cancer mice during CT-guided radiofrequency ablation.

Colon cancer (CC) is a malignancy of the digestive tract, and computed tomography (CT)-guided radiofrequency ablation (RFA) has been extensively adopted in cancer treatment. We aimed to explore the changes in fecal metabolism after CT-guided RFA in CC mice. The orthotopic CC mice received CT-guided RFA upon modeling. Subsequently, we quantified tumor volumes and weights to assess treatment efficacy. Next, because metabolomics is useful for evaluating therapeutic validity, feces were collected for metabolomics analysis. CT-guided RFA inhibited tumor growth effectively. Additionally, metabolomics results showed that the contents of bile acids and fatty acids were downregulated in CC mouse feces. Moreover, the levels of amino acids and carbohydrates were decreased while the levels of fatty acids, organic acids, phenols, pyridines and short-chain fatty acids were elevated in feces after CC mice received CT-guided RFA. Pathway enrichment analysis revealed that those differential metabolites were closely related to fatty acids degradation and synthesis. CT-guided RFA possesses a strong ability to suppress CC development in mice, accompanied by a significant increase of fatty acid content in feces. This study proposes a novel approach and target for CC treatment, which provides hope for CC patients and establishes a solid basis for future in-depth studies.

A prospective observation of PICC related anaphylactoid reactions.

PURPOSE: To explore the incidence, signs and symptoms, causes and prognosis of anaphylactoid reactions in PICC catheterization. METHODS: Prospectively observe the occurrence of anaphylactoid reactions in coated and uncoated PICC during insertion from November 2018 to April 2020. A diagnosis of anaphylactoid reactions was based on the signs and symptoms and laboratory results, and then collect data for analysis. RESULTS: A total of 1439 coated catheters were inserted, of which 30 resulted in anaphylactoid reactions (2.08%). The signs and symptoms were mainly skin system symptoms, combined with respiratory, cardiovascular, and digestive system symptoms. The anaphylactoid reaction rates of coated catheters were higher than those of uncoated catheters (χ2 = 38.417, 19.352, p < .01). A 29 of 30 patients completed catheterization after symptoms were resolved, these catheters were removed after treatment completion. Catheterization was terminated in one patient. There were no anaphylactoid reactions in 2850 uncoated catheters. CONCLUSION: Anaphylactoid reactions may occur during catheterization when using the coated PICC, which should be paid attention to in clinical application.

Focused ultrasound restrains the growth of orthotopic colon cancer via promoting pyroptosis.

INTRODUCTION: Focused ultrasound (FUS) is a non-invasive tumor therapy technology emerging in recent years, which can treat various solid tumors. However, it is unclear whether FUS can affect the pyroptosis of colon cancer (CC) cells. Here, we analyzed the effect of FUS on pyroptosis in the orthotopic CC model. MATERIAL AND METHODS: After an orthotopic CC mouse model was constructed by injecting CT26-Luc cells, BABL/C mice were allocated to the normal, tumor, FUS, and FUS + BAY11-7082 (pyroptosis inhibitor) groups. We monitored the tumor status of the mice through in vivo fluorescence image analysis. The histopathological injury of the intestinal tissue and the expression of IL-1ß, IL-18, caspase-recruitment domain (ASC), cleaved caspase-1, gasdermin D (GSDMD), and NLRP3 of the CC tumors were examined utilizing hematoxylin and eosin staining, immunohistochemical assay, and Western blot. RESULTS: FUS restrained the fluorescence intensity of the tumors in orthotopic CC mice, while FUS-mediated suppression of the bioluminescent signal of the tumors was alleviated by BAY11-7082. FUS was found to relieve the injury of the intestinal tissues in CC mice as revealed by morphology. Furthermore, the expressions of IL-1ß, IL-18, GSDMD, ASC, cleaved caspase-1, and NLRP3 of the CC tumors in the FUS group were higher than those in the tumor group, while BAY11-7082 addition partly reversed the FUS's effects on orthotopic CC model mice. CONCLUSIONS: Our results pointed out that FUS presented anti-tumor activity in experimental CC, and its mechanism was correlated with the promotion of pyroptosis.

Midline catheter tip position and catheter-related complications in antimicrobial therapy: A multi-center randomized controlled trial.

BACKGROUND: The use of midline catheters (MCs) in intravenous therapy has increased over the last few years; however, scientific evidence is scarce. The recommendations for its specific tip position and safe use in antimicrobial therapy are not well established, which increases the risk of catheter-related complications. OBJECTIVE: This study aimed to provide evidence for selecting MC tip positions for safe use in antimicrobial therapy. DESIGN: This prospective, randomized controlled trial compared catheter-related complications with different tip positions. Participants were assigned to three different catheter tip groups, and the relationship between the tip position and catheter-related complications was observed during antimicrobial therapy. SETTING: Multicenter trial based in intravenous therapy centers at six Chinese hospitals. PARTICIPANTS: A fixed-point continuous convenience sampling method was used to enroll 330 participants. Three different study groups with equal numbers of participants (n = 110) were established using a randomization technique. METHODS: The incidence of catheter-related complications and catheter retention time was compared among the three groups. The catheter measurement data between the three groups were compared using one-way ANOVA or the Kruskal-Wallis tests. Counting data were compared using chi-square tests, Fisher's exact tests, and Kruskal-Wallis tests. Post-hoc tests were conducted to compare the incidence of complications among the three groups. We followed a time-to-event analysis approach and used Kaplan-Meier curves and log-rank tests to analyze the relationship between catheter-related complications and different tip positions. RESULTS: The total incidence of catheter-related complications in Experimental Groups 1 and 2 as well as the control group were 10.09%, 17.98%, and 33.73%, respectively. Statistically significant differences existed between the groups (p < 0.0001). In pairwise comparisons of the three groups, significant differences were evident in the incidence of complications between Experimental Group 1 and the control group (RD 19.40%, confidence interval 7.71-31.09). No statistical significance in the incidence of complications between Experimental Group 1 and Experiment Group 2 (RD -4.93%, confidence interval -14.80-4.95) and in the incidence of complications between Experimental Group 2 and the control group (RD 14.47%, confidence interval 1.82-27.12) were noted. CONCLUSION: Catheter-related complications were reduced when the tip of the Midline Catheter was located in the subclavian or axillary vein of the chest wall. TRIAL REGISTRATION: NCT04601597(https://clinicaltrials.gov/ct2/show/NCT04601597). Registration date: September 1, 2020.

Venipuncture-related traumatic neuroma of the ulnar nerve on the dorsal of a hand: A case report.

A large number of venipunctures are placed on the dorsal of the hand, and it is suitable for the majority of patients with the advantage of few complications. Here, the ulnar nerve on the dorsal was injured during peripheral intravenous catheter insertion, and a painful traumatic neuroma was discovered a week later. Through oral medication and topical lidocaine medicated plaster, the patient's pain is greatly reduced, and allowed to engage in nearly all activities. Knowledge of this complication may help with its recognition and early treatment.

Effectiveness and safety of acupuncture for treating trigeminal neuralgia associated anxiety and depression: A protocol for systematic review and meta-analysis.

BACKGROUND: Patients with trigeminal neuralgia (TN) often develop a terrible fear of triggering pain, which may lead to anxiety and depression, exerting a negative effect on their quality of life. This protocol is carried out to comprehensively explore the effectiveness and safety of acupuncture for treating anxiety and depression induced by TN. METHODS: Randomized control trials involving acupuncture for treating patients with anxiety and depression caused by TN will be searched in eight electric databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database and Technology Periodical Database (VIP). In addition, studies that were reported in Chinese or English will be considered. Studies selection, data extraction and risk of bias assessment of the included studies will be conducted independently by two reviewers. Quality of the included studies will be performed according to the Cochrane Risk of Bias tool. Meanwhile, the level of evidence for results will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation method. The primary outcomes will be the Hamilton Anxiety/Depression Scale or Zung Self-Rating Anxiety/Depression Scale, secondary outcomes will be the visual analog score, numerical rating score, SF-36, and adverse events. All analyses will be conducted by using the RevMan software V5.3. RESULTS: A high-quality synthesis of current evidence of acupuncture for TN patients associated with anxiety and depression will be provided in this study. CONCLUSION: This systematic review will offer comprehensive evidence of acupuncture on specific outcomes induced by TN and TN-related anxiety and depression. TRIAL REGISTRATION: PROSPERO registration number: CRD42020219775.

Diagnosis and management of secondary malposition of PICC into the azygos vein.

BACKGROUND: Peripherally inserted central catheter (PICC) has been widely used. The catheter-related complications might occur and the reports of secondary malposition into azygos veins were rare. METHODS: This retrospective review summarized the experience in diagnosis and management of secondary malposition of PICC into azygos veins in 25 cases. RESULTS: When the catheter dysfunction occurred in the PICC on the left limb, it was necessary to consider whether there would be malposition into azygos veins after other reasons were excluded. The malposition could be diagnosed by chest lateral radiograph or chest computed tomography. The secondary malposition into azygos veins was resolved by repositioning or withdrawing the PICC. After re-inserting the catheter, it should be closely monitored whether the malposition occurred again. Intracavitary electrocardiogram positioning technology was used to confirm the catheter tip position before using corrosive drug. After the catheters withdrawn from the azygos veins, close attention should be paid to the property and concentration of the infusion drug strictly and the complications such as blockage and re-malposition. No serious complications such as infection, thrombosis and extravasation occurred in this group of patients after treatment. CONCLUSIONS: The results of our study suggested that the right limb is recommended for PICC catheterization in order to avoid secondary malposition into azygos veins and the malposition into azygos veins should be dealt with in time.

Ventriculoatrial shunt as a feasible regimen for certain patients of hydrocephalus: clinical features and surgical management.

Ventriculoatrial (VA) shunt is one of the most commonly used solutions for hydrocephalus. In recent years, the number of VA shunt has decreased worldwide, given the perceived technical challenges and the potentially serious complications associated with VA shunt. However, VA shunt remains as a viable treatment option for hydrocephalus in selected patients. Novel placement strategies and monitoring methods have been developed to reduce complications following VA shunt. In this article, we reported that seven consecutive cases who received a VA shunt. VA shunts were applied in seven hydrocephalic patients who experienced previous ventriculoperitoneal (VP) shunt failures or had contraindications to abdominal catheter placement. The insertion of VA shunt catheters was guided with the aid of intraoperative electromagnetic neuronavigation and electrocardiographic technique. There were three female and four male patients with a mean age of 46 years (range 22-68 years) received VA shunts under the guidance of electromagnetic neuronavigation and electrocardiographic method intraoperatively. In all cases, postoperative cranial CT scans and chest radiography demonstrated appropriate positioning of the catheter tips. And no postoperative complications occurred during the follow-up period of 3-26 months. VA shunts are potential favorable alternatives for patients who cannot tolerate VP shunts. It is noteworthy that VA is not free of complications. Intraoperative application of electromagnetic neuronavigation and electrocardiographic technique contributes to safe and optimal catheter placement of VA shunts.

Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated.

PURPOSE: Patients needing medium- to long-term infusion therapy with limited catheterization via the superior vena cava system is a challenging condition. The conventional catheterization via the femoral vein in the groin has a high complication rate, discomfort, and short indwelling time. Since changing the insertion site can avoid the disadvantage of conventional catheterization via the femoral vein in the groin, the present study aimed to investigate the effects of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh to resolve the issue of limited superior vena cava system catheterization. METHODS: Based on the symptoms and signs, enhanced computed tomography findings, and insertion history, in 121 patients, limited catheterization via the superior vena cava system was identified. Subsequently, the femoral inserted central catheters were inserted via the superficial femoral vein at the mid-thigh under the guidance of ultrasound, and the tip of femoral inserted central catheters was in the inferior vena cava. RESULTS: A total of 121 patients underwent femoral inserted central catheters insertion via a superficial femoral vein at the mid-thigh from August 2017 to December 2018. The success rate of insertion was 100%, and the indwelling time was 3-472 days. The complications of femoral inserted central catheters in the thigh were similar to that of peripherally inserted central catheters in the arm. The incidence of primary malposition was 1.65%, the incidence of catheter-related thrombosis was 0.83%, and the central line associated bloodstream infection rate was 0.83%. Subsequently, 116 lines (95.87%) were removed at the end of the treatment, one line (0.83%) was accidentally removed by the patient, and four lines (3.31%) were unplanned removed due to complications. CONCLUSION: The technique of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh has a high success rate, low complication rate, and less impact on activities, and is easy to maintain. This phenomenon resolves the patient's needs of medium- to long-term infusion therapy with limited catheterization of superior vena cava system.

Image noise reduction via geometric multiscale ridgelet support vector transform and dictionary learning.

Advances in machine learning technology have made efficient image denoising possible. In this paper, we propose a new ridgelet support vector machine (RSVM) for image noise reduction. Multiscale ridgelet support vector filter (MRSVF) is first deduced from RSVM, to produce a multiscale, multidirection, undecimated, dyadic, aliasing, and shift-invariant geometric multiscale ridgelet support vector transform (GMRSVT). Then, multiscale dictionaries are learned from examples to reduce noises existed in GMRSVT coefficients. Compared with the available approaches, the proposed method has the following characteristics. The proposed MRSVF can extract the salient features associated with the linear singularities of images. Consequently, GMRSVT can well approximate edges, contours and textures in images, and avoid ringing effects suffered from sampling in the multiscale decomposition of images. Sparse coding is explored for noise reduction via the learned multiscale and overcomplete dictionaries. Some experiments are taken on natural images, and the results show the efficiency of the proposed method.