Background: Military underwater operations personnel are repeatedly exposed to hyperbaric environments and increased respiratory workload, which may influence pulmonary function over time. However, the association between years of diving service and detailed pulmonary function parameters remains unclear in military diving populations. Aim: To investigate the association between years of diving service and pulmonary function among military underwater operations personnel. Methods: This cross-sectional study enrolled personnel of the Underwater Operations Unit who underwent comprehensive pulmonary function testing, including spirometry and body plethysmography. Participants were categorized as either shorter-service (<10 years of diving service) or longer-service (≥10 years of diving service) divers. Pulmonary function parameters included static lung volumes and flow–volume loop-derived indices. Between-group comparisons were performed using the Mann–Whitney U test, and correlations between years of diving service and pulmonary function parameters were assessed using Spearman’s rank correlation analysis. Results: Most of the lung volumes and conventional spirometric indices did not differ significantly between shorter-service and longer-service divers. However, longer-service divers exhibited significantly lower functional residual capacity and reduced residual volume/total lung capacity expressed as a percentage of measured/predicted values. The forced expiratory volume in 1s/forced vital capacity ratio was also significantly lower in longer-service divers. Conclusion: Among military underwater operations personnel, longer diving service duration is associated with specific alterations in lung volume distribution and expiratory flow ratios, whereas overall ventilatory capacity remains preserved. These findings are consistent with functional respiratory adaptations rather than pulmonary impairment.
Background: Long-term real-world evidence regarding the efficacy and safety of micropulse transscleral cyclophotocoagulation (MPCPC) remains limited. Aim: To evaluate the 5-year efficacy and safety of MPCPC in refractory glaucoma. Methods: This single-center retrospective study evaluated 42 eyes of 30 patients who underwent MPCPC between January 1, 2019, and May 31, 2020. All procedures followed a standardized protocol using a 2.0 W power setting for 180 s. The primary outcome was surgical success, defined as an intraocular pressure (IOP) reduction of ≥20% from baseline. Secondary outcomes included changes in visual acuity, antiglaucoma medication burden, and the incidence of ocular adverse events. Results: Mean IOP significantly decreased from 28.9 ± 11.6 mm Hg at baseline to 24.4 ± 10.4 mm Hg at 12 months and 21.5 ± 11.5 mm Hg at 60 months (all P < 0.05). Success rates were 54.3% at 1 year and 51.7% at 5 years. In the multivariable Firth regression model, each 1 mm Hg increase in baseline IOP was associated with a 16% increase in the probability of 1-year success (odds ratio: 1.16; 95% confidence interval: 1.05–1.29; P = 0.0048). While the topical medication burden remained unchanged, oral acetazolamide use significantly decreased at 1 month ( P = 0.039). Visual acuity declined in 58.1% of eyes at 5 years, largely attributable to disease progression in this refractory cohort. No severe complications, such as hypotony or phthisis bulbi, were observed. Conclusion: MPCPC provides a sustained, long-term IOP-lowering effect with a favorable safety profile in a real-world refractory population. This study addresses a critical evidence gap by demonstrating treatment durability up to 5 years and identifying preoperative IOP as a key predictor of success in an ethnically Chinese cohort.
We report a rare case of delayed methicillin-resistant Staphylococcus aureus (MRSA) infection following elective mini-open trigger finger release in a 55-year-old male with asthma receiving anti-interleukin (IL)-5 therapy. The patient initially recovered uneventfully but developed signs of infectious flexor tenosynovitis on postoperative day 36. Culture confirmed MRSA, and surgical debridement was required. The patient continued anti-IL-5 therapy throughout the perioperative period. Although a causal relationship cannot be established, this case raises awareness of a potential association between biologic therapy and delayed postoperative infection.
Background: Diabetes-related gastrointestinal dysfunction may predispose to anorectal disorders, yet sex-specific associations between glycemic abnormalities and hemorrhoids remain unexplored. Aim: To investigate associations between glycemic dysregulation (prediabetes, diabetes, metabolic syndrome [MetS]) and hemorrhoids using reciprocal regression analyses and identify potential sex-specific patterns. Methods: This cross-sectional study analyzed 4620 participants from a Taiwanese health examination database (2010–2017). Hemorrhoids were diagnosed via colonoscopy (39.6%) or clinical assessment, including medical history and digital rectal examination when indicated. Prediabetes and diabetes were defined per American Diabetes Association criteria; MetS per modified National Cholesterol Education Program Adult Treatment Panel III criteria with Asian-specific cutoffs. Multivariable logistic regression assessed associations, adjusting for metabolic and lifestyle factors, with false discovery rate correction for multiple comparisons. Results: Among 4620 participants (16.5% hemorrhoid prevalence), those with hemorrhoids were older and had higher prediabetes prevalence. In fully adjusted models, diabetes showed an association with hemorrhoids (odds ratio [OR] = 2.00, 95% confidence interval [CI]: 1.08–3.70, P = 0.027). Gender-stratified analyses showed stronger point estimates in males (prediabetes: OR = 1.89; diabetes mellitus [DM]: OR = 2.27) compared to females (prediabetes: OR = 0.92; DM: OR = 1.11), although formal interaction testing did not reach statistical significance (sex × DM, P = 0.218), possibly due to limited statistical power in the female subgroup. Conclusion: This study provides preliminary evidence for male-specific associations between glycemic dysregulation and hemorrhoids (OR: 1.89–2.27), although findings did not withstand multiple comparison correction. While these hypothesis-generating results warrant validation in independent cohorts with a comprehensive assessment of bowel habits and menopausal status, they highlight the importance of considering biological sex in metabolic-anorectal disease research.
Background: Head and neck squamous cell carcinoma (HNSCC) is characterized by pronounced molecular heterogeneity, immune microenvironment dysregulation, and limited therapeutic options in advanced human papillomavirus (HPV)-negative diseases. System-level approaches may facilitate the identification of core pathogenic mechanisms and clinically applicable therapeutic strategies. Aim: This study aimed to elucidate system-level mechanisms underlying HNSCC and to identify potential drug repurposing candidates using an integrative systems biology and pharmacology approach. Methods: Transcriptomic data from the Gene Expression Omnibus dataset GSE148944 (61 HNSCC tumors and 6 normal tissues) were analyzed. Differentially expressed genes (DEGs) were identified using |fold change| ≥ 2 and an adjusted P value ≤ 0.05. Hierarchical systems biology networks (HiSBiNs) quantify perturbations across genes, pathways, subsystems, and system levels using the Kyoto Encyclopedia of Genes and Genomes and meta-z scores. Drug–gene networks integrated DEGs with DrugBank/BindingDB data. Pharmacophore-guided virtual screening of FDA-approved drugs was conducted using Homopharma/SiMMap and iGEMDOCK. Results: We found 271 upregulated and 36 downregulated DEGs, including SPP1 , ARG1 , MS4A1 , CXCL13 , and SPINK5 , linked to immune regulation and tumor microenvironment. HiSBiN highlighted the immune system (meta-z = highest), and the signaling pathways were the most perturbed. The top candidates were rituximab, tocilizumab, and dasatinib. Conclusion: This integrative hierarchical systems biology and pharmacology framework elucidated the system-level mechanisms underlying HNSCC and identified hypothesis-generating drug repurposing candidates that warrant further experimental validation, providing a computational foundation, rather than definitive recommendations, for precision therapeutic development, especially in betel nut–prevalent regions, such as Taiwan, where HPV-negative HNSCC predominates.
A 63-year-old obese male with severe ankylosing spondylitis (AS) underwent general anesthesia for total hip replacement. Despite apparently successful video-assisted intubation, the patient developed acute ventilation failure characterized by significant air leakage, elevated peak inspiratory pressure (PIP), and an abnormal end-tidal carbon dioxide (E t CO 2 ) waveform. Suction catheter insertion met resistance at approximately 30 cm, suggesting distal endotracheal tube (ETT) malposition, likely due to tracheal wall impingement caused by altered airway anatomy from severe kyphotic deformity. Prompt recognition, aggressive secretion management, and emergency reintubation using a video-assisted technique successfully restored ventilation. There was no desaturation during the event, but PIP increased to 44 cm H 2 O, and continuous air leakage was noted. This case report highlights the importance of early recognition of ETT malposition, the challenges of airway management in patients with combined AS and obesity, and the value of a structured, team-based approach using multimodal airway strategies.
Background: Depressive symptoms following acute myocardial infarction (MI) are associated with adverse cardiovascular outcomes. Although numerous studies have examined nonpharmacological interventions to alleviate post-MI depression, their results remain inconclusive. Aim: This systematic review and meta-analysis evaluated the effects of nonpharmacological interventions on depressive symptoms in patients after acute MI. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and six electronic databases were systematically searched to identify randomized controlled trials (RCTs) comparing nonpharmacological interventions with usual care in patients with post-MI depression. Data were extracted on intervention content, format, delivery setting, frequency, and duration. Meta-analyses were conducted using both random-effects and fixed-effects models, and subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity. Results: Thirteen RCTs involving 3267 patients were included. Compared with usual care, nonpharmacological interventions exerted significant immediate and intermediate effects on post-MI depression, with standardized mean differences of −0.29 (95% CI: −0.45 to −0.13, P < 0.001) and −0.28 (95% CI: −0.42 to −0.14, P < 0.001), respectively. Subgroup analyses indicated that psychological interventions, relaxation training (RT), weekly intervention frequency, session durations of ≤30 min, total durations of ≤3 months, and delivery by nurses or psychologists were associated with greater effectiveness. Conclusion: Nonpharmacological interventions, particularly RT and psychological therapies, significantly reduced depressive symptoms in patients with MI at the end of the intervention period. Additional RCTs are determined to clarify how differences in intervention type, intensity, and delivery format contribute to variability in treatment outcomes.
Background: The rapid emergence of healthcare-associated infections is rising, driven by diverse etiologic agents whose evolving antimicrobial resistance poses a growing threat to global healthcare. Therefore, combination strategies integrating antibiotics with silver nanoparticles (AgNPs) have attracted increasing attention as a potential means of restoring antibacterial efficacy. Aim: This study aimed to synthesize and validate polyelectrolyte-coated AgNPs and evaluate their synergistic antibacterial effects with aminoglycosides against healthcare-associated pathogens. Methods: Alginate- and chondroitin sulfate-coated AgNPs were synthesized using glucose as a green reducing agent. NP formation was confirmed by physicochemical characterization, followed by cell-based cytotoxicity assessment. The antibacterial activity of AgNPs, alone or in combination with amikacin or tobramycin, was evaluated against six healthcare-associated infection (HAI)-related pathogenic bacterial species. Results: Physicochemical analyses confirmed the formation of spherical metallic AgNPs. Both AgNP formulations showed minimal cytotoxicity at silver concentrations ≤40 ppm but exhibited limited antibacterial activity when used alone. In contrast, combinations of aminoglycosides with AgNPs exhibited species-dependent synergistic effects, with tobramycin–AgNP combinations consistently demonstrating synergistic effects against all six HAI-related pathogenic bacterial species. Conclusion: AgNP–aminoglycoside combinations represent a promising therapeutic strategy for HAI bacterial infections and may help reduce the reliance on the development of novel antibiotics.
Background: Long COVID commonly features cognitive “brain fog,” and vascular involvement has been implicated. Enhanced external counterpulsation (EECP), approved for angina and heart failure, may improve cerebral perfusion, but evidence for post-COVID symptoms remains limited. Aim: To evaluate the physiological and psychological effects of EECP in patients with long COVID–related brain fog, focusing on cerebral blood flow (CBF) and symptom severity. Methods: Five adults (≥18 years) with persistent post-COVID brain fog received 15 h of EECP over 8 weeks. Prefrontal cerebral perfusion was assessed using near-infrared spectroscopy (NIRS), and symptoms were measured using the Brain Fog Scale (BFS) at baseline, midpoint, and post-intervention. Correlation analyses and generalized estimating equations (GEE) were performed. Results: All participants completed the protocol. Prefrontal cerebral blood flow increased from baseline to post-intervention, while BFS total scores decreased. EECP exposure correlated positively with cerebral blood flow ( r = 0.342; P = 0.002) and negatively with BFS severity ( r = −0.418; P = 0.001); cerebral blood flow was also inversely correlated with BFS scores ( r = −0.354; P = 0.017). GEE showed significant perfusion increases at the third, fifth, and ninth treatment hours ( P < 0.01), with a borderline BFS-perfusion association ( B = −0.09; P = 0.051). Conclusion: EECP was associated with increased NIRS-derived cerebral perfusion and improved brain fog symptoms in long COVID. Given the small, uncontrolled design, causal inference is limited; larger controlled studies are needed to confirm these preliminary findings.
Background: Facemask ventilation (FMV) is a critical skill in airway management. Although the two-handed triple airway maneuver is often regarded as the gold standard, its complexity may limit consistent application in clinical practice. Aim: This study aimed to compare the ventilation efficacy of the one-handed E–C technique, two-handed jaw-thrust, and two-handed triple airway maneuver performed with a thenar eminence (E–V) grip in anesthetized adults. Methods: In this prospective, randomized, crossover study, 14 adult patients (American Society of Anesthesiologists I–III) undergoing elective surgery were enrolled in this study. After induction of general anesthesia and neuromuscular blockade, each patient underwent three FMV techniques in randomized order: one-handed E–C (Vt1), two-handed jaw-thrust (Vt2), and two-handed triple airway maneuver (Vt3). Tidal volumes (TVs) were recorded for each technique. Because the data were non-normally distributed, the Friedman test and the Wilcoxon signed-rank test with Bonferroni correction were applied. Results: The Friedman test showed a significant difference in TVs among techniques ( χ 2 = 16.57, P < 0.001). Both two-handed maneuvers produced significantly higher median TVs than the one-handed E–C technique (Vt1: 421.0 [347.0–468.5] mL vs. Vt2: 569.0 [496.3–628.5] mL; Vt3: 563.0 [489.3–626.3] mL; both P = 0.001). No significant difference was observed between Vt2 and Vt3 ( P = 0.57). Conclusion: Two-handed FMV techniques are markedly superior to the traditional one-handed E–C technique. A two-handed jaw-thrust using an E–V grip is as effective as the full triple airway maneuver and represents a simplified, equally efficacious option, particularly valuable in patients with cervical spine limitations.
Background: Inguinal hernia repair is one of the most performed surgical procedures worldwide. Despite advances in technique, recurrence remains a significant clinical concern. While factors such as smoking and chronic pulmonary disease have been implicated, the prognostic value of objective pulmonary function parameters remains unclear. Aim: This study evaluated whether preoperative forced expiratory volume in one second (FEV 1 ) is associated with recurrence after inguinal hernia repair. Methods: A retrospective cohort study was conducted on patients who underwent hernia repair at a regional teaching hospital in northern Taiwan between 2011 and 2017. Preoperative pulmonary function test results and long-term recurrence outcomes were analyzed. Cox proportional hazards models were used to evaluate the association between FEV 1 and recurrence. Receiver operating characteristic (ROC) analysis and Kaplan–Meier survival analysis were performed for risk stratification. Results: Among the 89 eligible patients (mean age: 74.18 ± 12.68 years), 18 (20.2%) developed recurrence during a median follow-up of 50 months. In multivariable Cox analysis, FEV 1 (% predicted) was independently associated with recurrence (hazard ratio: 0.965 per 1% increase; 95% confidence interval: 0.937–0.994, P = 0.018). ROC analysis identified an optimal cutoff of 74.21%, and Kaplan–Meier analysis demonstrated significant recurrence-free survival stratification based on this threshold (log-rank P = 0.002). Conclusion: Reduced preoperative FEV 1 was significantly associated with an increased hazard of recurrence following inguinal hernia repair. These findings suggest that objective pulmonary function assessment may provide incremental prognostic information, although larger prospective studies are needed to confirm these results.
Background: Dermatologic diseases constitute a major yet often underestimated global health challenge. Skin disorders rank as the fourth leading cause of nonfatal disease worldwide, measured by disability-adjusted life years, with disproportionate impact in resource-limited regions. In geographically isolated areas, such as the Matsu Islands, restricted healthcare access and a shortage of dermatology specialists may exacerbate disease severity and outcomes. Public health efforts in Matsu have been hampered by a lack of population-based epidemiologic data. Aim: This study aimed to describe the demographic characteristics and prevalence of dermatologic diseases in the Matsu Islands. Methods: A 1-year cross-sectional study was conducted, including all patients who attended dermatology services at Lienchiang County Hospital, Matsu, between January 1, 2024, and December 31, 2024. Results: A total of 970 patients were enrolled, comprising 492 males and 478 females, with ages between 1 and 96 years (mean age, 42.3 ± 20.4 years). The highest proportion of cases occurred among individuals aged 40–59 years (32.6%), followed by those aged 20–39 years (29.7%). Eczema was the most prevalent diagnosis (37.2%), followed by fungal skin diseases (18.7%), miscellaneous skin and subcutaneous disorders (12.3%), and pruritus (8.9%). Scabies—a neglected tropical disease—was identified in three patients. Dermatologic conditions were most frequently observed during autumn (29.3%). Conclusion: This study provides the first primary epidemiologic data on dermatologic disease prevalence in the Matsu Islands. The substantial burden of skin diseases highlights the need for sustained dermatologic services and targeted resource allocation to improve health equity in this under-resourced region.
Among the various congenital heart defects, a history of atrial septal defect (ASD) with ventricular septal defect (VSD) closures combined with pacemaker implantation necessitates a tailored approach to ensure maternal and fetal well-being. Here, in this case report, the patient presented with 35 weeks of pregnancy with congenital heart disease (CHD) of VSD with ASD and left-to-right shunt who had a pacemaker in situ from the year 2017. All the baseline investigations, electrocardiography, and echocardiography were done. Obstetric sonography with Doppler was done for the patient, which suggested fetal growth restriction and severe oligoamnios. The patient and the husband, with other relatives, were jointly counseled by the senior gynecologist, cardiologist, anesthetist, and neonatologist regarding all the risk factors. The patient was delivered by cesarean operation under combined spinal and epidural anesthesia. The patient had arrhythmia in the postoperative period and was managed by intravenous isoprenaline infusion and Orciprenaline tablet doses. With appropriate management, women with a history of CHD having ASD and VSD closures and pacemaker implantation can have successful pregnancies and healthy outcomes.
Primary malignant cardiac neoplasms are very uncommon, with sarcomas being the most common. Primary tumors of the Ewing sarcoma family of the heart are exceptionally uncommon in children and carry a poor prognosis. Here, we report a case of a 10-year-old girl who presented with breathlessness, chest pain, and generalized swelling. Imaging revealed a large right atrial mass prolapsing into the right ventricle with pleuro-pericardial effusions. Positron emission tomography-computed tomography showed heterogeneous uptake confined to the cardiac lesion and did not reveal an extracardiac uptake. The excised mass showed sheets of small, round, blue cells with rosettes, brisk mitoses, necrosis, and myocardial invasion. Tumor cells demonstrated positivity for a diffuse membranous cluster of differentiation (CD99), nuclear Friend Leukemia Integration 1 fusion, and strong diffuse nuclear NKX2.2, whereas CD45, desmin, and myogenin showed negativity. In the absence of molecular confirmation, the tumor is best classified as a primary right atrial small round cell sarcoma, favoring Ewing sarcoma based on the morphology and immunohistochemistry. This pediatric presentation is exceedingly rare. Management relies on surgical resection with adjuvant chemotherapy due to the lack of standardized guidelines. Given its aggressive behavior and high recurrence risk, long-term follow-up is essential, and greater awareness is needed to guide future management strategies.
Background: Following global population aging, a growing trend of malnutrition among older adults has been observed. This not only places a greater burden on health care but also increases the risks of disability, falls, and death. Malnutrition has also been associated with a higher risk of dementia and depression. Aim: This study explored the association between nutritional status and the mental state of older adults. Methods: A cross-sectional study was conducted, including demographic information, nutritional status, physical function assessment, medical history, cognitive function status, and geriatric depressive tendencies. Results: A total of 299 older outpatients were enrolled, with a mean age of 73.82 ± 5.35 years. Compared with participants who were at risk of malnutrition or malnourished, the normal nutritional status group showed lower proportions of cognitive impairment (9.58%) and depressive tendencies (3.75%), whereas participants who were at risk of malnutrition or malnourished had higher rates of cognitive impairment (25.42%) and depressive tendencies (20.34%). Adjusted logistic regression analysis showed that normal nutritional status was associated with lower odds of cognitive impairment and depressive tendencies. Conclusion: Significant associations were observed among nutritional status, physical function, cognitive function, and geriatric depressive tendencies.
Background: Hepatocellular carcinoma (HCC) is one of the leading lethal cancers. Varieties of treatment methods have been developed without promising results to reduce mortality in patients with advanced HCC. KDM4 genes ( KDM4s ) are associated with multiple malignancies. Aim: This study aimed to investigate the role of KDM4s in the prognostic prediction and treatment of HCC. Methods: Multi-omics analyses were used to explore differential expression, prognostic value, genetic alteration, associated signaling pathways, microRNA (miRNA) targets, and immune cell infiltration of KDM4s in patients with HCC. Results: KDM4s messenger ribonucleic acid (mRNA) levels in various common cancer cell lines were obtained. KDM4A-C in liver cancer cell lines ranked 20, 15, and 29, respectively, within 34 cancer cell lines. KDM4 upregulation was demonstrated in HCC compared to adjacent normal tissue by The U niversity of AL abama at Birmingham CAN cer data analysis Portal (UALCAN) and confirmed by the hepatocellular cell carcinoma database (HCCDB). High KDM4A and KDM4C expression indicated poor overall survival (OS), whereas high KDM4B expression was significantly associated with good OS. High KDM4C expression indicated poor recurrence-free survival. Genetic alteration and biological interaction network of KDM4s showed that KDM4s play vital roles in metabolic pathways, molecular signaling, and many diseases. The miRNA targets and immune cell infiltration associated with KDM4s were explored and may provide value as therapeutic targets in HCC. Conclusion: KDM4s are promising prognostic biomarkers for survival and could be potential molecules for targeted therapy or immunotherapy in patients with HCC.
Background: Vitamin D is a critical factor in immune regulation and epithelial regeneration. Vitamin D deficiency is commonly observed in diabetic patients and is associated with impaired wound healing. Circulating exosomes transport bioactive molecules and influence cellular behavior relevant to tissue repair. Aim: This study aimed to investigate the capacity of serum exosomes derived from individuals with/without diabetes and with different vitamin D statuses to enhance keratinocyte-mediated wound healing. Methods: Serum samples were collected from diabetic patients and healthy nondiabetic controls [22 participants in total: eight healthy volunteers and 14 patients with type 2 diabetes, of whom six were vitamin D-sufficient (>20 ng/mL) and eight were vitamin D-deficient (<20 ng/mL)]. Exosomes were isolated using ExoQuick™ and quantified using the ExoView R200 platform. HaCaT keratinocytes (HaCaT cells—human immortalized keratinocytes) were subjected to a wound healing assay and treated with serum-derived exosomes or with different concentrations of 1α,25(OH)₂D₃. Expressions of cytokeratin 14, E-cadherin, and vitamin D receptor were measured using immunofluorescence. Results: Exosomes from vitamin D-sufficient donors enhanced keratinocyte healing, while those from deficient diabetics were ineffective. 1α,25(OH)₂D₃ promoted proliferation up to a concentration of 100 nM, with inhibition at 200 nM. This biphasic response aligns with those of previous studies and suggests a threshold beyond which calcitriol may exert feedback-inhibitory or cytostatic effects. Regenerative efficacy aligned more with vitamin D status than glycemic metrics. Conclusion: Vitamin D status influences the regenerative efficacy of circulating exosomes. Stratifying diabetic patients by vitamin D levels may improve the outcomes of exosome-based therapies.
Sacroiliac joint (SIJ) pain is a frequent problem, occurring in 20%–40% of patients with low back pain. SIJ pain has various presentations, including pain in the lower back, buttocks, and lower extremities. The treatment of SIJ pain involves conservative management and more invasive modalities. Percutaneous peripheral nerve stimulation (PNS) has recently gained attention as an effective modality in treating pain disorders. Applying PNS in our patients revealed promising results in all three cases during the 60-day trial. The positive impact of PNS continued during the 6 weeks following the lead explanation in at least 2 of these three patients. In conclusion, PNS represents a safe, effective, and well-tolerated modality for treating patients suffering from this chronic and potentially disabling pain. To our knowledge, this is the first case series for patients with SIJ pain treated with a 60-day temporary percutaneous PNS.
Severe acute respiratory syndrome coronavirus 2-induced encephalitis in children poses significant challenges due to neurological sequelae and mortality. We present two pediatric cases of coronavirus disease 2019 (COVID-19) encephalitis treated with integrated Western and traditional Chinese medicine (TCM). The two patients, aged 8 and 10, diagnosed with COVID-19 encephalitis, received immediate integrated care with Western and TCM upon admission to our hospital. Both patients exhibited marked clinical improvement within 4 days of integrative treatment and were discharged after 8 days. Upon discharge and follow-up visits, both patients were alert, with normal electroencephalography examinations, and exhibited normal liver and kidney function without significant adverse effects. This suggests the potential clinical benefit of integrating Western and TCM in treating COVID-19 encephalitis and suggests its potential effectiveness for other viral or bacterial encephalitis.
Background: Postoperative pain management is crucial after surgery. Poorly controlled postoperative pain can lead to prolonged hospital stays and patient dissatisfaction. Wound infiltration is one of the modalities of multimodal analgesia. Aim: The present randomized, controlled, double-blinded study aimed to compare the analgesic efficacy of dexamethasone and dexmedetomidine as adjuvants to ropivacaine following their infiltration at the surgical port site in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: Participants were allocated into three groups (20 in each group): Group RS received ropivacaine and normal saline, Group RDx received ropivacaine with dexamethasone (8 mg), and Group RDm received ropivacaine with dexmedetomidine (50 μg) before surgical port closure. Postoperative pain was assessed using the Numerical Rating Scale (NRS) at 1, 3, 6, 9, 12, and 24 h postinfiltration. Results: Patients in Groups RDx and RDm experienced significantly lower pain scores at 1, 3, 6, and 9 h compared to Group RS (P < 0.05). The mean duration of analgesia was significantly prolonged in Group RDm (567.75 ± 125.81 min) compared to Group RDx (476.25 ± 116.76 min) and Group RS (360 ± 88.79 min) (P < 0.0001). Conclusion: It is concluded that both dexamethasone 8 mg and dexmedetomidine 50 μg may be used as an adjuvant to 0.5% ropivacaine for port site infiltration to prolong postoperative analgesia in patients undergoing laparoscopic cholecystectomy safely and effectively. However, dexmedetomidine (50 μg) provided significantly more prolonged analgesia than dexamethasone (8 mg).
