Background/Objectives: Particle beam therapy (PBT) was approved in April 2018 for head and neck malignancies and has since been introduced as a radical therapy for parotid malignancies. However, its prevalence and effectiveness in relation to surgical treatment have not been investigated. Methods: In this study, we evaluated 36 patients with parotid malignancy who underwent surgery (n = 26) or PBT (n = 10) and then analyzed the annual changes in the number of patients, survival rates, and clinical factors affecting prognosis. Results: Of the ten patients who opted for PBT, two and eight patients underwent PBT before and after 2018, respectively. There was a significant difference between these two groups of patients (p = 0.04). Of the ten patients who underwent PBT, five patients were recurrent cases; meanwhile, all twenty-six patients who underwent surgery were receiving initial treatment. Only one patient in each group had local recurrence after the treatment. Conclusions: The use of PBT as a radical therapy for parotid malignancies has been increasing since 2018, and patients with recurrent tumors tended to choose PBT. The outcome of the patients who underwent PBT did not seem to be inferior compared with those of the patients who underwent surgery. The histopathological type was a crucial issue in the outcomes of patients who underwent radical therapy for parotid malignancies.

This case report illustrates the successful treatment of an iatrogenic furcal perforation using mineral trioxide aggregate (MTA) and its reinforcement with fiber-reinforced composites (FRCs). Endodontic perforations, particularly in the furcal area, present unique challenges that demand effective management strategies. MTA, known for its multifaceted properties including osteoinductive activity and sealing capabilities, has emerged as the gold standard material for perforation repair. This case report demonstrates the application of MTA in repairing the perforation site following thorough cleaning and shaping of the root canals. Furthermore, the use of FRCs, specifically glass fiber-reinforced composite (GFRC), is introduced to reinforce the repaired site, enhancing its mechanical properties and long-term stability. The discussion emphasizes the importance of selecting appropriate materials for endodontic perforation repair and highlights the advantages of FRCs in preventing structural failures. Future directions suggest further research to refine FRC formulations and standardize clinical protocols to maximize treatment outcomes. This case report contributes valuable insights to the advancement of endodontic therapy, showcasing the combined benefits of MTA and FRCs in achieving favorable treatment outcomes for iatrogenic furcal perforations.

Treating advanced thyroid cancer presents challenges due to its resistance to various treatment modalities, thereby limiting therapeutic options. To our knowledge, this study is the first to report the efficacy of temsirolimus in conjunction with dual immunotherapy of nivolumab/ipilimumab to treat heavily treated advanced PDTC. A 50-year-old female initially presented with a rapidly enlarging mass on her right neck. Subsequent diagnosis revealed poorly differentiated thyroid carcinoma, leading to a total thyroidectomy followed by post-operative radioablation therapy. After four years, an examination for persistent cough revealed a recurrence of the disease within multiple mediastinal nodes. Genetic analysis of blood samples uncovered somatic mutations in the tumor, specifically involving PTEN and TP53. The disease progressed despite palliative radiation, lenvatinib, and nivolumab/ipilimumab therapy. Consequently, temsirolimus, functioning as an mTOR inhibitor, was introduced as an adjunct to the nivolumab/ipilimumab regimen. This combination approach yielded remarkable clinical improvement and disease control for a duration of approximately six months. Temsirolimus likely suppressed the aberrantly activated PI3K/AKT/mTOR signaling pathway, facilitated by the PTEN genetic alteration, thus engendering an effective treatment response. This synergy between targeted agents and immunotherapy presents a promising therapeutic strategy for advanced PDTC patients with limited treatment alternatives. In previous clinical trials, mTOR inhibitors have demonstrated the ability to maintain stable disease (SD) in 65% to 74% for advanced thyroid cancer patients, including those with PDTC. When combined with other targeted therapies, the observed SD or partial response rates range from 80% to 97%. Many of these trials primarily involved differentiated thyroid carcinoma, with diverse genetic mutations. Thyroid cancer patients with alterations in the PI3K/mTOR/Akt appeared to benefit most from mTOR inhibitors. However, no clear association between the efficacy of mTOR inhibitors and specific histologies or genetic mutations has been established. Future studies are warranted to elucidate these associations.

UNASSIGNED: Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated, we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery.
UNASSIGNED: We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15, 2020 to April 29, 2022. Demographics, epidemiological, clinical symptoms, radiological and laboratory data, treatment medicines and outcomes, and follow up were analyzed, and findings of a systematic review were demonstrated.
UNASSIGNED: A total of four COVID-19 with brucellosis patients were included. One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis. The median age was 54.5 years, and all were males (100.0%). Two cases (50.0%) were moderate, and one was mild and asymptomatic, respectively. Three cases (75.0%) had at least one comorbidity (brucellosis excluded). All 4 patients were found in COVID-19 nucleic acid screening. Case C and D had only headache and fever on admission, respectively. Four cases were treated with Traditional Chinese medicine, western medicines for three cases, no adverse reaction occurred during hospitalization. All patients were cured and discharged. Moreover, one case (25.0%) had still active brucellosis without re-positive COVID-19, and other three cases (75.0%) have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery. Conducting the literature review, two similar cases have been reported in two case reports, and were both recovered, whereas, no data of follow up after recovery.
UNASSIGNED: These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery. More clinical studies should be conducted to confirm our findings.

UNASSIGNED: and importance: Herein we present a rare case of multiple second to fifth carpometacarpal joint fracture-dislocations. It is important in such cases to be aware of a high-velocity impact etiology of the fractures, which will ensure proper imaging, diagnosis and treatment.
UNASSIGNED: A 34-year-old male presented with severe pain in his left hand following a motorcycle accident. He was diagnosed as multiple second to fifth carpometacarpal joint fracture-dislocations. He was successfully treated with closed reduction with multiple Kirshner wires fixation under general anesthesia. A one-year follow up confirmed excellent clinical results.
UNASSIGNED: There are various surgical options including casting, closed reduction and percutaneous pinning (CRPP), and open reduction internal fixation, however, the optimal treatment is still controversial. The closed reduction is recommended in all CMC joint dislocations. Adding a K-wire fixation can create a secure fixation and achieve an excellent outcome.
UNASSIGNED: Multiple carpometacarpal joint fracture-dislocations is a very rare injury. Careful clinical examination is important for an accurate diagnosis and plain radiographic studies are necessary. Standard fracture dislocation treatment can be used. Simple closed reduction with the K-wires fixation technique is easy to perform and in our case achieved successful treatment in terms of clinical and radiographic outcomes.

BACKGROUND: The COVID-19 lockdown may have negatively impacted the treatment of obesity. This study aimed to assess the effect of COVID-19 lockdown in patients with obesity treated with intensive residential cognitive behavioral therapy (CBT-OB).
METHODS: This retrospective case-control study analyzed 129 patients with severe obesity who experienced COVID-19 lockdown in the 6 months after discharge from intensive residential CBT-OB, comparing their outcomes on weight loss, binge-eating episodes, and general health status with those in a sample of patients matched by gender, age, and body mass index given the same treatment before the COVID-19 outbreak as control. Patients were assessed at baseline and by phone interview 6-month follow-up.
RESULTS: Both groups had lost more than 9% of their baseline bodyweight and reported a significant decrease in binge-eating episodes and similar general health status at 6-month follow-up. However, control patients achieved a significantly greater weight loss than those who experienced lockdown, although half of lockdown patients reported persisting with CBT-OB procedures after their discharge.
CONCLUSIONS: Patients with obesity treated with CBT-OB and exposed to COVID-19 lockdown, despite achieving lower weight loss than non-exposed patients, had a healthy weight loss at 6-month follow-up and comparable reduction in binge-eating behaviors.

The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting.
Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers.
Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen\'s f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups.
CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.

BACKGROUND: Colonoscopy is a routine procedure in diagnosis and treatment of colonic disease. While generally regarded as a safe procedure, potentially fatal complications can occur. Gas gangrene is one such complication, with very high mortality. There are few cases of gas gangrene occurring after colonoscopy, making it one of the rarer complications of this procedure. There have been no previously reported cases of a patient surviving such an infection and the optimal treatment strategy is contentious. This report describes a case of intramural gas gangrene of the colon, treated conservatively with antibiotic therapy in which the patient survived with full recovery.
METHODS: A 71-year-old, previously healthy male presented 6 h post apparently uncomplicated colonoscopic polypectomy with rigors, nausea, vomiting and right upper quadrant pain. At presentation he was febrile at 40.1 °C but hemodynamically stable. Abdominal computed tomography revealed substantial colonic thickening and several focal intramural gas bubbles (pneumatosis intestinalis) surrounding the polypectomy site. Within 24 h post procedure he became hypotensive and was admitted to ICU in frank septic shock requiring inotropes, and with demonstrable septic myocardial depression. Bloods showed multi-organ derangement with leukocytosis, lactic acidosis, haemolytic anaemia and hyperbilirubinemia. A diagnosis of presumed Clostridial gas gangrene was made, and treatment was initiated with benzylpenicillin, clindamycin, metronidazole and vancomycin. After 4 days in ICU he was stepped down, and discharged after a further 10 days with no surgical or endoscopic interventions. At three-month review he reported being back to full health.
CONCLUSIONS: This case demonstrates that gas gangrene infection is a possible complication of colonoscopic polypectomy. This is a cause of rapid deterioration in post-colonoscopy patients and has been misdiagnosed as colonic perforation in previously reported cases of retroperitoneal gas gangrene. Such misdiagnosis delays antibiotic therapy, which likely plays a role in the high mortality of this condition. Early diagnosis and initiation of antibiotic therapy with benzylpenicillin and clindamycin as seen in this case is essential for patient survival. While surgery is typically performed, non-operative management of pneumatosis intestinalis, and potentially gas gangrene is becoming more common and was utilized effectively in this patient.

BACKGROUND: Tuberculosis (TB) remains a petrified condition with a huge economic and health impact on families and health systems in Ghana. Monitoring of TB programme performance indicators can provide reliable data for direct measurement of TB incidence and mortality. This study reflects on the trends of TB case notification and treatment outcomes and makes comparison among 10 districts of the Volta region of Ghana.
METHODS: This was a retrospective analysis of surveillance data of a cohort of TB cases from 2013 to 2017. Trends of case notification and treatment outcomes were examined and compared. Logistic regression was used to determine the independent relationship between patients and disease characteristics and unsuccessful treatment outcomes. Odds ratios, 95% confidence intervals and p-values were estimated.
RESULTS: A gradual declining trend of case notification of all forms of TB was noticed, with an overall case notification rate (CNR) of 65 cases per 100,000 population during the period. A wide variation of case notification of TB was observed among the districts, ranging from 32 to 124 cases per 100,000 population. Similarly, treatment success rate decreased slightly from 83.1% during the first year to 80.2% in 2017, with an overall treatment success rate of 82.5% (95% CI: 81.3-83.8%). Treatment failure, death, and lost to follow up rates were 0.8% (range 0.5-1.2%), 13.5% (range 12.4-14.7%), and 3.1% (range 2.6-3.8%) respectively. The treatment success rate among districts ranged from 70.5% in South Tongu to 90.8% in Krachi West district. Returned after treatment interruption (Adjusted odds ratio [AOR]: 3.62; 95% CI: 1.66-7.91; P < 0.001) and TB/HIV co-infection (AOR: 1.94; 95% CI: 1.57-2.40; P < 0.001) predicts poor treatment outcomes.
CONCLUSIONS: Over the past five years, TB case notification and successful treatment outcomes did not significantly improve. Wide district variations in CNR was observed. The overall treatment success rate observed in this study is below the target of > 90% set by the World Health Organization\'s (WHO) end TB strategy. Additionally, patients who returned to continue treatment after interruption and those who were co-infected with HIV strongly predict unsuccessful treatment outcomes. Sustained interventions to prevent treatment interruptions and improved management of co-morbidities can enhance treatment outcomes, as required to achieve the elimination goal.

Purpose: The purpose of this case report is to provide an alternative treatment approach to pushing behavior (PB), adapting widely used equipment for persons with stroke demonstrating such behaviour. The aim is to change their graviceptive experience during interventions while performing repeated stepping and righting practice to resolve PB more quickly. Client Description: The subject is a man aged 56 years who sustained a right middle-cerebral-artery ischemic stroke. He entered in-patient rehabilitation from an acute care hospital 7 days post-stroke. Intervention: Lateral stepping with body weight-supported treadmill training (LS-BWSTT) was used such that the subject stepped laterally toward the uninvolved side. Measures and Outcome: Scores on the Scale for Contraversive Pushing and the FIM were recorded at regular intervals. After intervention, the subject demonstrated decreased PB and improved function. Implications: The individual\'s PB improved after LS-BWSTT. LS-BWSTT is a novel treatment intervention that could be considered in future clinical decision making using evidence-based principles.
Objectif : le présent rapport de cas vise à proposer une autre approche thérapeutique qui consiste à adapter du matériel largement utilisé pour les personnes qui ont subi un accident vasculaire cérébral et démontrent un comportement de poussée (CP–pushing). On cherche ainsi à modifier leur expérience de graviception pendant les interventions, tout en exécutant des pas et des redressements répétés afin de régler le CP plus rapidement. Description du client : le patient est un homme de 56 ans qui a souffert d\'un accident ischémique de l\'artère cérébrale moyenne droite. Il a été hospitalisé en réadaptation à sa sortie d\'un hôpital de soins aigus sept jours après son accident ischémique. Intervention : les pas latéraux avec entraînement sur tapis roulant soutenu par le poids corporel (LS-BWSTT) ont été utilisés de manière que le sujet fasse des pas latéraux vers le côté non touché. Mesures et résultats : à intervalles réguliers, les chercheurs ont enregistré les résultats de l\'échelle de poussée de contraversion et de la mesure d\'autonomie fonctionnelle. Après l\'intervention, le sujet a démontré une diminution du CP et une meilleure fonction. Implications : le patient a réduit son CP après la LS-BWSTT. Cette nouvelle intervention thérapeutique pourrait être envisagée dans le cadre des prochaines décisions cliniques faisant appel à des principes fondés sur des données probantes.