Rejected

Patients with migraine are interested in integrative therapies and overall wellness. They also suffer from social isolation as they try to manage a chronic medical condition. We implemented a three-part workshop structured as a group visit that teaches multiple integrative therapies from specialists and offers a chance for shared support and learning.

We present the case of a woman with a severe clinical history of antiphospholipid syndrome and persistent positivity for lupus anticoagulant, IgG anticardiolipin and IgG anti-β2Glycoprotein I antibodies. An acute clinical onset characterized by severe abdominal pain immediately followed by circulatory shock and histological colonic small vessel thrombosis pattern pointed to a diagnosis of ischemic colitis. The subsequent rapid onset of pulmonary alveolitis and heart failure associated to subendocardial hypoperfusion led to a diagnosis of definite catastrophic antiphospholipid syndrome (CAPS). Conventional triple therapy together with a broad-spectrum preventive antibiotic therapy were quickly initiated, and the outcome was favorable. We evaluated the patients with ischemic colitis in CAPS described in the literature between 1992 and May 2019 and our CAPS case. In accordance with the "two-hit" hypothesis and on the basis of the patients' data, we would like to speculate that the colonic wall necrosis related to ischemic colitis damaged the intestinal barrier causing loss of resistance to bacteria and leading to endotoxemia and bacteremia with bacteria translocation through the circulatory stream to the lungs and heart. The bacteria acted as the priming factor which favored the binding of β2Glycoprotein I to the endothelium vessels in the colon, lungs, and heart following activation of anti-β2Glycoprotein I antibodies which attached to the domain I of β2Glycoprotein I. This was followed by complement activation which triggered the thrombotic and cytokine storm. If further clinical studies confirm this hypothesis, the treatment of CAPS could be more targeted and effective.

A 40-year old female patient from the Chinese Han population presented colorectal cancer (CRC) related symptoms including abdominal discomfort, tenesmus and severe back pain, and was admitted to the First Affiliated Anhui Medical University in October, 2008. The size of her tumor was 3 cm × 3 cm, and the carcinoma had invaded the serosa layer, covering 3/4 of the intestine tube. She was diagnosed with stage III CRC after examination. The patient presented a good prognosis with over 8-year survival after curative surgery and adjuvant therapy with Oxaliplatin and Huaier granules, a traditional Chinese medicine. Using the whole-genome sequencing (WGS) data, we profiled the germline and somatic mutations and obtained an all-inclusive data of the genomic alterations. The genomic alterations were compared with those of stage III CRC patients in The Cancer Genome Atlas Network (TCGA). Mutations in and defined as drivers in TCGA patients were not recorded in our study. However, mutations in and rarely reported in TCGA patients were predominant in our patient. Additionally, we observed loss of heterozygosity (LOH) in and 30 other genes in contrast to deletion and amplification events recorded in TCGA patients. Overall, we produced a genomic mutation profile of a long-term surviving CRC patient and identified recurrent and rare mutations that could provide a valuable resource for further study into the alterations that characterize advanced CRC which may be useful to design clinical therapy for personalized medicine.

To analyze the epidemiological characteristics and clinical features of the patients with coronavirus disease 2019 (COVID-19), so as to provide basis for clinical diagnosis.

Targeted muscle reinnervation (TMR) is an evolving technique with promising results for prevention and treatment of neuropathic pain, as well as modulation of control for myoelectric prostheses. The previously described and most commonly used technique for transhumeral TMR combines both an anterior and posterior approach to access the major peripheral nerves of the upper extremity. In this article, we review the literature for transhumeral TMR and describe a more expeditious and efficient anterior-only approach that offers safe access through a single incision.

The aim of this research was to explore the hypothesis that acupuncture at the sphenopalatine ganglion (SPG), a new a new method of acupuncture, would be more efficacious and safe than traditional acupuncture in the treatment of persistent allergic rhinitis (PAR). For this study, 120 patients with PAR were randomly assigned to SPG acupuncture, traditional acupuncture ( [LI 20], [LI 4], and [Ex-HN 3]), or drug treatment (budesonide nasal spray). Efficacy was assessed by using single symptoms, including sneezing, rhinorrhea, nasal obstruction and nasal itch, a total nasal symptoms score (TNSS), and a Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) before treatment, the day treatment ended, and 4-, 8-, 12-weeks later, respectively. Four weeks after treatment ended, the effectiveness rate in the SPG-acupuncture group was superior to that of the traditional-acupuncture group ( = 0.033) but was still lower than that of the drug-treatment group ( = 0.039), with mean effectiveness rates of 69.70%, 44.44%, and 71.43%, respectively. However, these rates gradually decreased in each group during weeks 8 through 16. Moreover, statistically significant improvements in TNSS', and reductions in nasal congestion and sneezing symptoms were observed in the SPG-acupuncture group, compared with those in the traditional-acupuncture group as early as the day treatment ended and this continued throughout the observation period ( < 0.05). However, the improvement did not continue for sneezing, during weeks 8 through weeks 12 after treatment ended. The RQLQ of the SPG-acupuncture group was lower than that of the traditional-acupuncture group at week 12; however, there were no differences at weeks 8 and 16. The data generated by this study confirmed that acupuncture at the SPG alleviated the symptoms of PAR rapidly and safely, especially nasal obstruction, and improved the patients' life quality. These results were worthy of clinical promotion.

Schizophrenia is a serious, chronic mental illness that manifests a variety of symptoms: hallucinations, delusion of grandiose, disorganized behaviors, and neurocognitive decline after each episode. Among the patients with schizophrenia, obsessive- compulsive symptoms (OCS) or obsessive- compulsive disorder (OCD) are two relatively common comorbidities (25% and 12.5%, respectively). The appearance of these comorbidities complicates patient management: selecting the suitable pharmacological treatment may be challenging as delusion and obsession have similar presentation in this population. We would like to present a case which we suggest that differentiation between obsession and delusion will result in a positive impact on disease management.Patient was a middle- aged male with history of Schizophrenia and status post skin grafting. He presented with delusions, auditory hallucinations and disorganized behavior. During his hospitalization, he spent much portion of a day slapping or hitting his wound. He would not follow staffs' recommendations regarding wound care as he believed that his behavior would lead to diminishing his pain from skin grafting and shorten the recovery time. He was treated with psychotropic medications, anti-depressants aided with medication for pain. Despite adequate pain management, appropriate dosage of anti-depressants and psychotherapy his self- injurious behavior persisted throughout the course of his hospitalization.In this report, we presented the challenges in managing compulsive behavior in a patient with Schizophrenia. To date, OCD and OCS are diagnosed based on clinical presentations, which results in difficulty in patient management especially when the illness is complicated by Schizophrenia. Patient was accessed with Yale- Brown Obsessive- Compulsive Scale on multiple occasions which the results indicated that he had subclinical OCD. However, the validity of the test is questionable as it is a test for severity of OCD; If his compulsive behavior was due to delusion rather than obsession, YBOCS should not be applied since it is limited to the patients with OCD.We propose that there is a necessity of developing a diagnostic intervention that may aid the differentiation between delusion and obsession in Schizophrenic patients. Genetic testing, for example, may be one of the potential diagnostic interventions to utilize clinically: A recent study, "Serotonin system genes and obsessive- compulsive trait dimensions in a population- based, pediatric sample: a genetic association study" by Sinopoli et al, has demonstrated a possible correlation between obsessive- compulsive spectrum disorders and serotonin gene variants. Although genetic testing of OCD is at its early stages and many aspects are yet to be discovered, it is optimistic to believe that potential benefits of the genetic test is tremendous as it will provide physicians a clearer picture in designing a treatment plan for this patient population.

Intracranial chondroma is a rare benign tumor comprising only 0.2% of all intracranial tumors. A 27-year-old woman presented with visual dysfunction and headache. Brain computed tomography and magnetic resonance imaging revealed a suprasellar mass lesion with a calcified component. Gross total removal was achieved via a basal interhemispheric approach. Postoperatively, visual function improved to the normal range, and no recurrence was evident 4 years later. Histopathological examination confirmed the diagnosis of benign chondroma. Preoperative differentiation of chondromas from chordomas is clinically important, because of the different treatment and prognostic implications. The only effective treatment for chondroma is total surgical removal. We present a case of gross total resection of a suprasellar chondroma with reference to the literature.

Migraine and obesity are comorbid particularly in women of reproductive age. Obesity treatment involves reducing energy intake and improving dietary quality but the effect of these changes on migraine is largely unknown.

Chronic pruritus affects up to 20% of the population; about 8% of patients suffer from neurogenic pruritus, including notalgia paresthetica (NP). This is a syndrome of benign, chronic itch of the unilateral medial border of the scapula of unknown etiology and limited treatment efficacy. Here we report the background on NP, followed by a classic case presentation of a 63-year-old woman. We report on difficulty in her diagnosis and numerous failed lines of treatment, until initiation of treatment with duloxetine, which provided her with long-lasting benefit for the first time. Delay in diagnosis is common for NP, and though there are many options for treatment, evidence is lacking to support their efficacy. Finding an effective, well-tolerated regimen to alleviate long-term suffering brought on by this syndrome is heavily dependent on early identification. Our case provides anecdotal evidence for both treatment efficacy as well as the etiology of this poorly understood phenomenon.