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Cureus May 2024This case report describes a rare presentation of a bicornuate bicollis uterus with a longitudinal vaginal septum in a 25-year-old woman presenting with a ruptured...
This case report describes a rare presentation of a bicornuate bicollis uterus with a longitudinal vaginal septum in a 25-year-old woman presenting with a ruptured ectopic pregnancy. The patient's obstetric history revealed a previous cesarean section due to oligohydramnios. The diagnosis was confirmed through intraoperative assessment and MRI findings. Despite successful management of the ectopic pregnancy, the case underscores the importance of early detection and tailored management of Mullerian anomalies to optimize pregnancy outcomes. This report highlights the need for continued research to improve diagnostic accuracy and therapeutic approaches for such complex anatomical variations.
PubMed: 38903298
DOI: 10.7759/cureus.60645 -
Cureus May 2024Persistent trigeminal artery (PTA) is the most common remnant of the primitive carotid-vertebrobasilar anastomoses, which typically form and obliterate during the early...
Persistent trigeminal artery (PTA) is the most common remnant of the primitive carotid-vertebrobasilar anastomoses, which typically form and obliterate during the early stages of human embryonic development. While PTA can be non-pathologic and is usually an incidental finding, it is also associated with various other vascular abnormalities, such as arteriovenous malformations and fistulae, but most commonly cerebral aneurysms. In these cases, aneurysms are usually reported in the anterior cerebral circulation or in the PTA trunk itself; to date, only one report exists of an associated aneurysm in the posterior circulation (basilar artery). These associated vascular pathologies are not only a source of morbidity and mortality but can also complicate subsequent endovascular treatment due to different flow patterns and increased vessel tortuosity. In this case report, we present the first reported case of PTA-associated aneurysm in the anterior inferior cerebellar artery and its resulting impact on the endovascular treatment of this aneurysm.
PubMed: 38903290
DOI: 10.7759/cureus.60648 -
BioRxiv : the Preprint Server For... Apr 2024Lysosomes are dynamic cellular structures that adaptively remodel their membrane in response to stimuli, including membrane damage. We previously uncovered a process we...
Lysosomes are dynamic cellular structures that adaptively remodel their membrane in response to stimuli, including membrane damage. We previously uncovered a process we term LYTL (LYsosomal Tubulation/sorting driven by Leucine-Rich Repeat Kinase 2 [LRRK2]), wherein damaged lysosomes generate tubules sorted into mobile vesicles. LYTL is orchestrated by the Parkinson's disease-associated kinase LRRK2 that recruits the motor adaptor protein and RHD family member JIP4 to lysosomes via phosphorylated RAB proteins. To identify new players involved in LYTL, we performed unbiased proteomics on isolated lysosomes after LRRK2 kinase inhibition. Our results demonstrate that there is recruitment of RILPL1 to ruptured lysosomes via LRRK2 activity to promote phosphorylation of RAB proteins at the lysosomal surface. RILPL1, which is also a member of the RHD family, enhances the clustering of LRRK2-positive lysosomes in the perinuclear area and causes retraction of LYTL tubules, in contrast to JIP4 which promotes LYTL tubule extension. Mechanistically, RILPL1 binds to p150, a dynactin subunit, facilitating the transport of lysosomes and tubules to the minus end of microtubules. Further characterization of the tubulation process revealed that LYTL tubules move along tyrosinated microtubules, with tubulin tyrosination proving essential for tubule elongation. In summary, our findings emphasize the dynamic regulation of LYTL tubules by two distinct RHD proteins and pRAB effectors, serving as opposing motor adaptor proteins: JIP4, promoting tubulation via kinesin, and RILPL1, facilitating tubule retraction through dynein/dynactin. We infer that the two opposing processes generate a metastable lysosomal membrane deformation that facilitates dynamic tubulation events.
PubMed: 38903076
DOI: 10.1101/2024.04.02.587808 -
Danish Medical Journal Jun 2024In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the hamstring tendon (HT) or patella tendon (PT). The purpose of this meta-analysis was to compare these two methods when returning to sports.
METHODS
Eleven studies were included based on a literature search conducted in PubMed. The primary outcome was return to preinjury sport level in athletes. Post-operative results such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score, the Tegner Activity Score and KT-1000 arthrometry and autograft re-rupture rates were analysed as secondary outcomes.
RESULTS
The analysis showed no significant difference in return to preinjury sports level at a two-year follow-up between patients operated with hamstring or patella autograft. Considering the secondary outcomes, no significant differences were recorded in Lysholm score, IKDC score or re-rupture rate. The Tegner Activity Scale demonstrated a significantly higher activity level in the PT group than in the HT group (OR 0.79, p = 0.003). At the two-year follow-up, the KT-1000 arthrometer analysis also showed a significant difference in laxity, which was higher for the HT autografts (OR -0.31, p = 0.02).
CONCLUSION
This study showed no significant differences between hamstring and patella autografts. Even so, the choice of method when operated for ACL rupture remains crucial for the individual and should be a weighted decision made jointly by the patient and the physician.
Topics: Humans; Return to Sport; Anterior Cruciate Ligament Reconstruction; Hamstring Tendons; Patellar Ligament; Anterior Cruciate Ligament Injuries; Autografts; Transplantation, Autologous; Treatment Outcome
PubMed: 38903025
DOI: 10.61409/A09230599 -
Journal of Medical Case Reports Jun 2024An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be...
BACKGROUND
An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair.
CASE PRESENTATION
A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation.
CONCLUSION
Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Topics: Humans; Female; Esophageal Fistula; Aged; Endovascular Procedures; Aortic Aneurysm, Thoracic; Aortic Rupture; Esophageal Perforation; Vascular Fistula; Blood Vessel Prosthesis Implantation; Salvage Therapy; Animals; Hematemesis; Aortic Diseases; Aorta, Thoracic; Treatment Outcome; Fishes; Endovascular Aneurysm Repair
PubMed: 38902817
DOI: 10.1186/s13256-024-04605-0 -
Journal of Orthopaedic Surgery and... Jun 2024The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare... (Comparative Study)
Comparative Study
BACKGROUND
The effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points.
METHODS
The study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness.
RESULTS
Among the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively.
CONCLUSION
Early repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI.
Topics: Humans; Rotator Cuff Injuries; Arthroscopy; Male; Middle Aged; Female; Treatment Outcome; Range of Motion, Articular; Adult; Time Factors; Aged; Follow-Up Studies; Recovery of Function; Rotator Cuff; Time-to-Treatment
PubMed: 38902793
DOI: 10.1186/s13018-024-04858-x -
Npj Aging Jun 2024Aortic aneurysms are dilatations of the aorta that can rupture when left untreated. We used the aneurysmal Fibulin-4 mouse model to further unravel the underlying...
Aortic aneurysms are dilatations of the aorta that can rupture when left untreated. We used the aneurysmal Fibulin-4 mouse model to further unravel the underlying mechanisms of aneurysm formation. RNA sequencing of 3-month-old Fibulin-4 aortas revealed significant upregulation of senescence-associated secretory phenotype (SASP) factors and key senescence factors, indicating the involvement of senescence. Analysis of aorta histology and of vascular smooth muscle cells (VSMCs) in vitro confirmed the senescent phenotype of Fibulin-4 VSMCs by revealing increased SA-β-gal, p21, and p16 staining, increased IL-6 secretion, increased presence of DNA damage foci and increased nuclei size. Additionally, we found that p21 luminescence was increased in the dilated aorta of Fibulin-4|p21-luciferase mice. Our studies identify a cellular aging cascade in Fibulin-4 aneurysmal disease, by revealing that Fibulin-4 aortic VSMCs have a pronounced SASP and a senescent phenotype that may underlie aortic wall degeneration. Additionally, we demonstrated the therapeutic effect of JAK/STAT and TGF-β pathway inhibition, as well as senolytic treatment on Fibulin-4 VSMCs in vitro. These findings can contribute to improved therapeutic options for aneurysmal disease aimed at reducing senescent cells.
PubMed: 38902222
DOI: 10.1038/s41514-024-00154-4 -
Journal of Reproductive Immunology Jun 2024The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal...
The objective of this study was to investigate the immune mechanisms involved in preterm labor (PTL), preterm prelabor rupture of the membranes (PPROM), and normal pregnancies. The second objective was to explore immune profiles in PTL for association with early ( < 34 gestational weeks (gw)) or instant ( < 48 h) delivery. This prospective observational multi-center study included women with singleton pregnancies with PTL (n = 80) or PPROM (n = 40) before 34 gw, women with normal pregnancies scheduled for antenatal visits (n = 44), and women with normal pregnancies in active labor at term (n = 40). Plasma samples obtained at admission were analyzed for cytokine and chemokine quantification using a multiplex bead assay in order to compare the immune profiles between PTL, PPROM, and normal pregnancies. In PTL, CXCL1 and CCL17 were significantly higher compared to gestational age-matched women at antenatal visits, whereas for PPROM, CXCL1 and IL-6 were increased. Women in term labor had a more pronounced inflammatory pattern with higher levels of CXCL1, CXCL8, and IL-6 compared with PTL (p = 0.007, 0.003, and 0.013, respectively), as well as higher levels of CCL17, CXCL1 and IL-6 (all p < 0.001) compared with the women at antenatal visits. In PTL, CXCL8 was higher in women with delivery before 34 gw, whereas CXCL8, GM-CSF, and IL-6 were significantly higher in women with delivery within 48 h. To conclude, PTL and PPROM were associated with a complex pattern of inflammation, both involving Th17 (CXCL1) responses. Although further studies are needed, CXCL8, GM-CSF, and IL-6 may be potential candidates for predicting preterm birth in PTL.
PubMed: 38901109
DOI: 10.1016/j.jri.2024.104278 -
World Journal of Clinical Cases Jun 2024Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a...
BACKGROUND
Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA).
CASE SUMMARY
A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI.
CONCLUSION
The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.
PubMed: 38899288
DOI: 10.12998/wjcc.v12.i16.2822 -
RSC Advances Jun 2024The mechanical strength of magnesium implants undergoes a rapid decline after implantation due to bioabsorption, which can lead to the risk of rupture. To ensure...
The mechanical strength of magnesium implants undergoes a rapid decline after implantation due to bioabsorption, which can lead to the risk of rupture. To ensure sustained mechanical strength and initiate bioabsorption selectively upon specific external stimuli until the bone regains sufficient support, we developed a biosafe near-infrared light (NIR)-sensitive polymer coating using polycaprolactone (PCL) and TiC (MXenes). The synthetic MXene powders were characterized using SEM, EDS, and XRD, and the amount of MXenes had a proliferation-promoting effect on MC3T3-E1, as observed through cell assays. The PCL-MXene coating was successfully prepared on the magnesium surface using the casting coating method, and it can protect the magnesium surface for up to 28 days by decreasing the corrosion ratio. However, the coating can be easily degraded after exposure to NIR light for 20 minutes to expose the magnesium substrate, especially in a liquid environment. Meanwhile, the magnesium implant with the PCL-MXene coating has no cytotoxicity toward MC3T3-E1. These findings can provide a new solution for the development of controlled degradation implants.
PubMed: 38899034
DOI: 10.1039/d4ra00799a