Medicine
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The objective was to clarify the feasibility and clinical effect of 3D-printed external cranial protection devices (ECPD) in preventing complications following unilateral supratentorial decompressive craniectomy (DC). A retrospective cohort study was conducted on post-DC patients meeting inclusion and exclusion criteria. In the experimental group, head computed tomography data were collected after DC, and the ECPD were 3D-printed with photosensitive resin materials, and fixed to the bone window defect for continuous wear. ⋯ The 2 groups had no significant differences in modified Rankin Scale scores after cranioplasty. The clinical use of the 3D-printed ECPD is safe and reliable, effectively reducing the incidence of complications following DC, particularly in the prevention and treatment of subdural effusion. However, it does not significantly improve the prognosis of patients after DC, warranting further research.
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Case Reports
Hypertrophic pachymeningitis with cranial nerve palsy as the initial symptom: A case report.
Hypertrophic pachymeningitis (HP) is a rare and complex condition marked by inflammation and thickening of the dura mater. It can occur either on its own or as a result of various underlying medical issues. This type of granulomatous meningitis is extremely rare and poorly understood, making diagnosis and treatment particularly challenging. Patients with HP may experience severe headaches and cranial nerve defects, but in some cases, the condition can occur without any symptoms, making it undetected. We detail the case of patient who was diagnosed with HP after presenting with abducens nerve palsy, a condition that significantly affected her vision and quality of life. Remarkably, she showed substantial recovery following a course of methylprednisolone pulse therapy, coupled with careful radiographic diagnosis and follow-up assessments. The decision to report this case stems from its rarity and the diverse clinical manifestations associated with this condition, which can vary widely among patients. ⋯ This case underscores the critical importance of imaging examinations in the clinical diagnosis of patients presenting with diplopia, as they play a vital role in both diagnosing and differentiating between various diseases. Furthermore, it is essential to rule out any infection-related factors in patients diagnosed with HP before commencing treatment with glucocorticoids, ensuring a comprehensive approach to patient care.
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This study aimed to evaluate the association between family structure and healthy life expectancy among older Japanese adults, hypothesizing that social participation increases healthy life expectancy more in older men without a spouse than in older women. This study collected data on Healthy Life Expectancy from 541 older adults between 2003 and 2021 from the Healthy Life Expectancy Study, a cohort study of older adults in Yamanashi Prefecture, Japan. The Japanese long-term care insurance system serves as an indicator of a healthy life expectancy. ⋯ The risk of loss of healthy life expectancy was higher among older men who lived alone or lived with non-spouse cohabitants than older living with a spouse (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01-3.75; hazard ratio: 1.66, 95% confidence interval: 1.05-2.64, respectively). However, older men living without a spouse and engaging in high social activity participation had a lower risk of loss of healthy life expectancy than did those with low social activity participation (hazard ratio: 0.35, 95% confidence interval: 0.17-0.71). In conclusion, older men living without a spouse with high social activity participation had longer healthy life expectancies than those living alone with low social activity participation did.
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Observational Study
Clinical manifestations and misdiagnosis factors of pulmonary embolism patients seeking treatment in cardiology.
To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. ⋯ PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE.
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Observational Study
Evaluation of retinal microvascular changes with OCT-A in Parkinson disease and essential tremor.
This study aimed to evaluate the presence and comparison of microvascular abnormalities in essential tremor (ET) and Parkinson disease (PD) using optical coherence tomography angiography (OCT-A) and to show the relationship between retinal microvascular changes and disease stage in the patient group. A total of 176 eyes, including 26 PD diagnosed according to the United Kingdom PD Society Brain Bank criteria, 31 ET diagnosed according to the Washington heights-inwood genetic study of ET (WHIGET) criteria and 31 healthy controls, were included in the study. Unified PD assessment scale (UPDRS) motor scores, non-motor symptom scale (NMS), modified Hoehn&Yahr stages (mH&Y) and Fahn-Toloso-Marin grading scale were recorded. ⋯ In both eyes, OD radial peripapillary capillarity inside the disc small values of PD were significantly lower than those of ET and controls (P < .05). In our study, deep macular vascular density, RNFL and radial peripapillary capillarity were significantly lower in PD compared with ET and control groups, and radial peripapillary capillarity was lower in ET compared with control group. This study provides valuable information regarding the potential of OCT-A as a diagnostic tool for PD and ET.