Asploro Journal of Biomedical and Clinical Case Reports | ISSN: 2582-0370

Recently, the medical term for nonalcoholic fatty liver disease (NAFLD) has been changed to a novel nomenclature: metabolic dysfunction-associated steatotic liver disease (MASLD). The latest report shows analyses of the National Health and Nutrition Examination Survey (NHANES III) using the fibrosis-4 index (FIB-4) and enhanced liver fibrosis (ELF). Among 6429 NAFLD cases, 99% met MASLD criteria. In another study with 4286 cases, 99% of steatosis cases met the MASLD definition, and 95.4% met the metabolic dysfunction-associated fatty liver disease (MAFLD) definition. Several biomarkers show a relationship with MASLD/MAFLD, such as BMI, T2D, HOMA-IR, central obesity, waist circumference, and CKD.

Recently, actual changes in blood glucose can be measured by continuous glucose monitoring (CGM) using FreeStyle Libre. The case involves a 67-year-old male patient with type 2 diabetes (T2D) treated with Multiple Daily Insulin (MDI) therapy, who underwent CGM. Analysis of the CGM data revealed that hyperglycemia resulted from increased carbohydrate intake and irregular meal timings and quantities. The estimated HbA1c from CGM was 6.6%, whereas the HbA1c value recorded at the outpatient clinic during the same period was 7.3%. The use of CGM applications encourages diabetic patients to be mindful of their carbohydrate intake in daily life, leading to an increased ratio of time spent in the target range (TIR).

The case involves a 74-year-old female with type 2 diabetes (T2D). HbA1c remained stable at 6% until summer 2019, but suddenly worsened to 8.4% in autumn 2019 without a certain reason. An abdominal CT scan detected a probable pancreatic tumor, which required further evaluation. Contrast-enhanced images of the arterial, portal vein, and equilibrium phase showed no staining, slight staining, and strong staining, respectively. The application of Curved Planar Reconstruction (CPR) has revealed an apparent pancreatic tumor image with three different stainings, associated with a dilated main pancreatic duct (MPD) in the pancreas body and tail and a normal MPD in the pancreas head. Consequently, CPR would be useful for diagnosis.

Purpose of Review: Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. The methods of monitoring sedation and assessing the depth of anesthesia for benzodiazepine sedative drugs have been fraught with controversy in clinical work. As a newly released short-acting anesthetic sedative drug that can be continuously pumped, appropriate anesthetic monitoring and sedation depth assessment tools can better help anesthesiologists make clinical decisions and reduce the emergence of perioperative complications in patients.
Recent Findings: Clinical trials of remimazolam have been completed at home and abroad in various phases, and much progress has been made, but the effective sedation monitoring means of remimazolam are still not conclusive.
Summary: Remimazolam has a rapid onset of action and a high rate of metabolism in the body; tissue accumulation and delayed awakening are rare. At the same time, it can be safely applied to elderly patients with a low cardiopulmonary function inhibition rate, accurate anesthesia effect, and satisfactory quality of awakening. By comparing various methods of sedation depth monitoring, the data correlation is high, which can be of significant importance for remimazolam sedation depth monitoring.

Objectives: This study aimed to investigate the follow-up outcomes and risk factors associated with pain recurrence after percutaneous radiofrequency thermocoagulation (PRT) among patients with primary trigeminal neuralgia (PTN) and to establish a clinical prediction model based on these risk factors.
Methods: The data of PTN patients who underwent PRT were collected in our study. All subjects were randomly divided at a 7:3 ratio into a training group (T Group) and a test group (C Group) to select risk factors. According to the follow-up results, the patients were divided into a recurrence group (F Group) and a nonrecurrence group (NF Group). Predictive factors were selected through LASSO regression analysis based on T Group. The identified variables were subjected to multivariate logistic regression analysis to construct a nomogram. Receiver operating characteristic (ROC) curves and calibration curves were uesd to evaluate discrimination and calibration ability separately.
Results: A total of 884 patients were initially included, 857 patients achieved satisfactory results, and the pain relief rate at discharge was 96.95%. A total of 529 subjects were included after screening, and the recurrence rate was 27.22% after 1 year. Six non-zero variables were selected through LASSO regression analysis: the disease course, atypical pain, previous surgery, facial numbness before PRT, neurovascular contact (NVC), and operation duration. Six variables were included in the multivariate logistic regression analysis, and the results showed that they were independent risk factors (P<0.05). The predictive model is represented by a nomogram. The area under the curves (AUC) of the ROC curves were 0.868 (0.826~0.909) and 0.874 (0.802~0.950) for T Group and C Group, respectively. The prediction curves for T Group (P=0.784) and C Group (P=0.293) fit the ideal prediction curve, and the Brier scores were 0.120 and 0.099 for T Group and C Group, which indicates that the probability predicted by the model is consistent with the actual occurrence.
Conclusion: The Pain relief rate at discharge was 96.95% for PTN patients after PRT, and the recurrence rate was 27.22% after 1 year. The disease course, atypical pain, previous surgery, facial numbness before PRT, NVC, and operation duration are independent risk factors for the recurrence of pain. A nomogram model for pain recurrence was established, which has good predictive ability.

This case report describes a 36-year-old woman who presented with a giant sebaceous nevus affecting her right periauricular area, right facial region, and neck. Excision of all lesions was performed. The remaining defect was reconstructed using local tissue flaps and full-thickness skin grafting, resulting in a favorable aesthetic outcome.

An 11-month-old male infant was diagnosed with bronchogenic cysts and required a right lung cystectomy. The surgical approach involved one-lung ventilation (OLV) using lung isolation techniques. During the procedure, oxygenation could not be adequately maintained using conventional methods. Ultimately, a successful outcome was achieved by administering low-dose epinephrine via a microinjection pump. This case report discusses the methods for achieving OLV during thoracic surgery in infants and the feasibility of using small doses of epinephrine during OLV in pediatric thoracic surgery when encountering intraoperative hypoxia.

The patient is a 73-year-old male with type 2 diabetes (T2D) and hypertension, treated for years with various oral hypoglycemic agents (OHAs) and an anti-hypertensive agent (AHA). His HbA1c levels were unstable during 2020-2022, during which time he was prescribed linagliptin, voglibose, and metformin. In 2023, his HbA1c increased to 8.4%, and imeglimin (Twymeeg) was initiated. This resulted in an acute reduction of HbA1c to 6.5% over 5 months. A pulse wave velocity (PWV) examination, using a sphygmograph, showed stable values for the cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) over 4 years. Consequently, this patient has maintained a low level of arteriosclerosis, associated with the effective treatment using imeglimin.

Background: Remimazolam mesylate for injection (RM) is a new benzodiazepine sedative drug. The aim of this trial was to evaluate the effects of drug metabolism on patients’ hepatic and renal functions by comparing liver and renal function laboratory tests 24 hours before and 24 hours after surgery when using Remimazolam mesylate for injection (RM) for intraoperative sedation.
Methods: 40 surgical patients who underwent prostate electrocision under elective intrathecal anesthesia were included in this trial. Changes in the patients’ perioperative hepatic and renal function indexes were analyzed using paired t-tests to assess the safety of Remimazolam mesylate for injection (RM) used for sedation in elderly patients under intrathecal anesthesia.
Results: The patients’ preoperative 24-hour ALT (u/L) was 18.10 ± 4.97; the postoperative 24-hour ALT (u/L) was 18.08 ± 5.72; P = 0.975.
The preoperative 24-hour AST (u/L) was 18.83 ± 4.89; the postoperative 24-hour AST (u/L) was 19.73 ± 4.91; P = 0.358.
The preoperative 24-hour TBil (μmol/L) was 10.34 ± 6.16; the postoperative 24-hour TBil (μmol/L) was 12.03 ± 5.25; P = 0.008.
The preoperative 24-hour sCr (μmol/L) was 79.43 ± 26.31; the postoperative 24-hour sCr (μmol/L) was 71.80 ± 22.93; P = 0.001.
The preoperative 24-hour BUN (mmol/L) was 5.85 ± 1.75; the postoperative 24-hour BUN (mmol/L) was 4.83 ± 1.71; P < 0.001.
The preoperative 24-hour GFR (ml/min) was 82.73 ± 29.88; the postoperative 24-hour GFR (ml/min) was 125.23 ± 60.02; P < 0.001.
Important vital signs of the patients during the trial were stable, and laboratory tests of liver and renal function showed no abnormal changes of clinical significance.
Conclusion: The intraoperative vital signs of the patients were stable, and no significant adverse reactions were observed in liver and kidney functions when Remimazolam mesylate for injection (RM) was used for intrathecal anesthesia-assisted sedation in elderly patients.

A 4-year-old child was diagnosed with intestinal obstruction and was scheduled to undergo exploratory laparotomy. Anesthesia evaluation, preparation, airway management, and intraoperative circulation maintenance were thoroughly addressed. This case report discusses the key points of anesthesia management in children with intestinal obstruction and provides a reference for the anesthesia management of children with abdominal distension.

Background: The 1-year mortality rate after liver transplantation is approximately 8%-20%. It is important to explore risk factors associated with postoperative outcomes in liver transplantation recipients (LTRs). Red cell distribution width (RDW) is an indicator that assesses the variability in the volume of red blood cells in circulation. RDW is not only related to inflammatory levels and nutritional status but also associated with postoperative outcomes in surgical patients. However, the relationship between preoperative RDW and postoperative outcomes in LTRs remains unclear. Therefore, we designed a retrospective observational study to investigate the impact of preoperative RDW levels on postoperative outcomes in LTRs.
Methods: We retrospectively collected clinical data of patients who underwent allogeneic liver transplantation at West China Hospital, Sichuan University, from January 2016 to December 2020. The primary outcome was 1-year mortality. Secondary outcomes included 30-day mortality, long-term survival, early postoperative graft dysfunction, acute kidney injury, renal replacement therapy, pulmonary complications, duration of postoperative mechanical ventilation, length of ICU stay, and length of hospital stay. Patients were divided into two groups: RDW ≤ 14.5% and RDW > 14.5%. We selected 14 covariates and used propensity score matching (PSM) to adjust for baseline characteristics. Postoperative outcomes and long-term survival were analyzed after PSM. Receiver operating characteristics (ROC) curves and subgroup analyses were also performed.
Results: A total of 661 patients who underwent liver transplantation surgery were screened for this study. Finally, 438 patients were included in the statistical analysis. After PSM, there were no statistically significant differences in postoperative mortality and complications between the RDW ≤ 14.5% group and the RDW > 14.5% group (P > 0.05). The comparison of long-term survival between the two groups also showed no statistical difference (hazard ratio = 0.67, 95% confidence interval: 0.28-1.61, P = 0.358). Subgroup analyses showed consistent results. The ROC curve indicated that the predictive ability of preoperative RDW levels for 1-year mortality is moderate (area under the ROC curve 0.661).
Conclusion: Preoperative RDW levels do not affect postoperative mortality and the incidence of complications in LTRs. However, these results still need further research for verification.

Background: Ciprofol is a new anaesthetic sedative drug independently developed in China, and its chemical structure is derived from the classical sedative drug Propofol. The aim of this trial was to compare the incidence of anaesthetic PONV in patients undergoing painless gastroscopy with that of Propofol, and to analyze and evaluate the antiemetic effect, one of the non-sedative effects of cyclobenzaprine, in comparison with that of Propofol.
Methods: In this trial, 112 patients undergoing elective painless gastroscopy were included and divided into two groups: Group C for Ciprofol (0.4 mg/kg of Ciprofol) and Group P for Propofol (1.5 mg/kg of Propofol). The patients were also given 7 μg/kg alfentanil. At the end of the examination and after complete awakening, the patients were discharged after observing no special conditions. The assistant physician made a telephone follow-up after 24 hours. The PONV impact scale was used as a reference, and the patients were asked whether they had developed PONV. A chi-square test was used to count the occurrence of PONV in Group C and Group P and to compare the incidence rates of the two. Statistical significance was defined by a Pearson’s chi-squared P value < 0.05.
Results: The incidence of PONV in Ciprofol (Group C) was 26%; the incidence of PONV in Propofol (Group P) was 11.3%. The Pearson’s chi-square test results of Group C and Group P = 0.042, indicating that both Ciprofol and Propofol could prevent the occurrence of PONV.
Conclusion: Both Ciprofol and Propofol can prevent PONV when used for anaesthesia in patients undergoing painless gastroscopy, with Propofol’s antiemetic effect being superior to that of Ciprofol. Propofol has a better antiemetic effect than Ciprofol, and both can be safely used for anaesthesia in patients undergoing gastroscopy.

Diaphragmatic hernia is usually congenital or follows thoracoabdominal injury. Diaphragmatic hernia combined with pneumothorax is a rare combination in the clinical setting, where pneumothorax is usually secondary to hollow viscera perforation in the long-term complications of diaphragmatic herniation or rupture of ectopic endometrium over the diaphragm during menstruation. Unlike the aforementioned conditions, we describe a 67-year-old man with chronic diaphragmatic hernia who suffered from pneumothorax and pneumoperitoneum secondary to pulmonary bulla by barotrauma during mechanical ventilation. Computed tomography showed scattered free gas in the thoracic and abdominal cavities, while there was no tenderness and rebound tenderness. The patient was managed conservatively with low PEEP and a lung-protective mechanical ventilation strategy. Finally, the oxygenation index gradually rose from 58 to 107. Unfortunately, in light of the patient’s poor clinical status and significant comorbidities, the patient passed away peacefully 3 weeks after hospital admission. Diaphragmatic hernia combined with pneumothorax should be differentiated from tension pneumothorax. Whether to intubate chest drainage depends on the cause of pneumothorax and pneumoperitoneum, as well as the risks and benefits of chest drainage. Additionally, mechanical ventilation should be applied cautiously, and respiratory parameters should be adjusted reasonably in patients at high risk of pneumothorax.

Congenital melanocytic nevus (CMN) is a benign skin condition that affects the epidermis and dermis. Large to giant CMNs are associated with a higher risk of malignancy over a lifetime, underscoring the importance of assessing and monitoring their potential for malignant transformation. We present a case of a large to giant CMN on an infant’s scalp, emphasizing its potential risk for malignancy. The infant underwent a successful two-stage surgical procedure, resulting in excellent aesthetic outcomes.

Background: Gemella haemolysans is a gram-positive coccus that colonizes the genitourinary system, gastrointestinal system, and upper respiratory tract as an opportunistic pathogen. Berge et al. found that the frequency of Gemella species bacteremia was 4.5 and infective endocarditis was 0.31 per 1,000,000 inhabitants yearly. We report the first case of G. haemolysans bacteremia presenting as new-onset atrial fibrillation with rapid ventricular response (RVR) and acute respiratory failure and present a case series on G. haemolysans bacteremia and infective endocarditis.
Case Presentation: A 58-year-old male with a past medical history including aortic valve bioprosthetic replacement, type 2 diabetes, hypertension, and coronary artery stenting and bypass surgery presented with shortness of breath and confusion. Examination and testing revealed a 40.4°C fever, acute respiratory failure, atrial fibrillation with RVR, congestive heart failure, lactic acidosis, and acute renal failure, with no drug use, dental wounds, or pneumonia. Diltiazem, metoprolol, aspirin, atorvastatin, insulin, heparin, and ceftriaxone were started. TTE and TEE revealed no clear vegetations. Blood cultures revealed Gemella haemolysans. He became stable after 4 days, was electrically cardioverted to sinus rhythm with first-degree AV block, progressed to complete heart block, then had a temporary pacer placed. A repeat TEE demonstrated an aortic root abscess. He underwent redo sternotomy and homograft placement with no complications and was discharged with instructions to complete a six-week course of ceftriaxone.
Discussion: Our patient presented with multiple comorbidities at a younger age compared to the mean (66) and median (70) age of the 4 bacteremia cases in our 8-case series. Preemptive antibiotic treatment may be warranted for prosthetic heart valve patients, with the possibility of urgent valve replacement surgery. Several antibiotics were previously reported in case studies with varying results. The shortest course was 16 days, with most courses lasting 4 to 7 weeks. With no standard treatment, this case series suggests G. haemolysans tends to be susceptible to beta-lactam agents.
Conclusion: Our case highlights the importance of a multidisciplinary approach in the diagnosis and management of Gemella haemolysans bacteremia, particularly in patients with complex medical histories and prosthetic heart valves.

The authors focused on nutritional therapy, including low carbohydrate diets (LCD), calorie restriction (CR), lipids, olive oil, and other dietary studies. Recent topics on cognitive impairment related to olive oil, fruits, vegetables, and other factors were described with perspectives. A reverse relationship was observed between total fruit/vegetable intake and dementia risk in the elderly. In a study of 92,383 cases, an intake of more than 7g/day of olive oil showed a 28% decreased risk of dementia-related death. Dietary patterns may influence cognitive mechanisms. Among 8,692 elderly participants, lower odds ratios (OR) for cognitive impairment were found for a protein-enriched diet (PED) at 0.910 and an anti-inflammatory diet (AID) at 0.789.

Background: Cognitive impairment (CI) is a common complication in chronic low back pain (CLBP) patients, and its progression increases the risk of dementia. However, there is currently a lack of predictive indicators for CLBP-CI. Previous studies have shown that routine blood indexes have predictive value for Alzheimer’s disease, but their relationship with CLBP-CI remains unclear. This study aims to explore the correlation between routine blood indexes and provide evidence of disparities in chronic pain and cognitive impairment between two groups of individuals with low back pain, as well as establish the foundation for longitudinal experimental studies aimed at developing effective interventions for cognitive impairment in individuals with chronic low back pain.
Methods: This cross-sectional study was conducted at West China Hospital, Sichuan University. The Montreal Cognitive Assessment (MoCA) was conducted to divide patients into the CLBP-CI or CLBP-nCI group. Statistical analysis was performed to examine the differences between chronic low back pain patients with cognitive impairment and those without cognitive impairment. All statistical tests were conducted at a significance level of α=0.05 for two-sided testing.
Results: The prevalence of chronic low back pain with cognitive impairment in this study demonstrates age-related disparities, with a higher prevalence observed among older individuals (P=0.009). A statistically significant difference in white blood cell count was observed between individuals with chronic low back pain and cognitive impairment (P=0.004).
Conclusion: Age and white blood cell count may serve as influential factors in the development of chronic low back pain with cognitive impairment. This finding can aid healthcare professionals in implementing early intervention and treatment for individuals experiencing this condition.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that primarily affects the spine and eventually causes its malformation. Surgery is a common treatment for AS patients. Patients with severe AS usually have difficulty with ventilation or intubation. Therefore, airway management should be carefully evaluated, especially in patients with severe cervical deformities. Anesthesiologists must fully and carefully evaluate the airway in these patients.
Case Presentation: A 49-year-old woman with AS suffered from a severe spinal deformity that required surgical treatment under general anesthesia. The patient was monitored for vital signs and adequately oxygenated. Lidocaine was used for cricothyroid puncture and throat anesthesia. The feasibility of tracheal intubation was assessed using a visual laryngoscope to expose the glottis under full surface anesthesia. Finally, a #7 enhanced tracheal catheter was successfully inserted after conventional sequential induction. The surgery was successfully completed, and the patient was discharged 10 days after surgery.
Conclusions: Anesthesiologists should fully and carefully assess the presence of a difficult airway in patients with AS, whether it is difficult to ventilate or intubate. Adequate preparation plans are essential.