Medicine
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To evaluate disparities in the National Institute of Health (NIH) trauma research funding. Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. ⋯ Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer. In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.
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Case Reports
Laser acupuncture for refractory coccydynia after traumatic coccyx fracture: A case report.
Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture. ⋯ Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.
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KIAA0586 variants have been associated to short-rib thoracic dysplasia, an autosomal recessive skeletal ciliopathy characterized by a narrow thorax, short limbs, and radiological skeletal abnormalities. ⋯ We report two patients affected by short-rib polydactyly syndrome and overlapping phenotype with oral-facial-digital syndrome associated with the c.1815G>A variant in KIAA0586, suggesting a quite peculiar genotype-phenotype correlation.
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Observational Study
The impact of pain and opioids use on survival in cancer patients: Results from a population-based cohort study and a meta-analysis.
The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association. A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. ⋯ Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival. We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.
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To evaluate the utility of echocardiography (echo) in the diagnosis of persistent fifth aortic arch (PFAA), a very rare congenital aortic arch anomaly, and to compare echo and computed tomography angiography (CTA) imaging findings to improve our understanding of this anomaly. Data on the clinical diagnosis, imaging findings, and clinical management of PFAA were retrospectively analyzed in 10 suspected cases of PFAA admitted to our hospital between January 2012 and February 2017. We compared echo as a first line examination modality, and CTA and surgery results as the gold standard. ⋯ The diagnostic conformance rate of echo was 62.5% after comparisons with CTA and surgery results. The clinical manifestation of PFAA was atypical, and its diagnosis depended primarily on medical imaging. Echo has a relatively high diagnostic accuracy for PFAA, which is very valuable for its early detection.