Rare Bilateral Radius and Ulna Fractures: A Case Report

Introduction: Forearm fractures involving both the radius and ulna, present distinctive challenges in orthopedic trauma management. This case report explores the complexities of a rare case of bilateral fractures, emphasizing the importance of a comprehensive approach for optimal outcomes. Case Presentation: This report presents the case of a 40-year-old motorcyclist who was involved in a road accident and arrived at the emergency department shortly after the incident. Clinical examination revealed closed fractures in both forearms with mild swelling and severe tenderness. Fortunately, no neurovascular issues or compartment syndrome were detected. The patient was administered intravenous fluids and effective pain relief. Forearm splints were applied and the arms were elevated using pillows. Radiographs showed fractures in the right distal radius and ulna, as well as the left mid-shaft radius and ulna. Under general anesthesia, open reduction and internal fixation were per-formed using plates and screws for all four fractures. Postoperatively, the patient’s arms were immobilized and elevated, with gradual recovery during follow-up appointments over six months, eventually achieving full function without complaints. Conclusion: This article highlights the possibility, although infrequent, of bilateral shaft fractures of the ulna and radius. With thorough clinical assessment and radiological investigation, such fractures can be well-defined. The required definitive treatment, which usually involves open reduction and internal fixation, can be performed.

Bilateral adrenal histoplasmosis in a Malaysian tertiary hospital:Report of four cases

Rationale:Adrenal histoplasmosis can present as bilateral adrenal enlargement with constitutional symptoms and/or adrenal insufficiency.Often these patients are initially investigated as secondary adrenal metastases before eventually their diagnosis established by histopathological examination of the adrenal tissues.Patients concerns:We report 4 cases of patients aged 55-78 who presented with hypocortisolism and bilateral adrenal masses.Diagnoses:Bilateral adrenal histoplasmosis.Interventions:Three patients received antifungal treatment for at least one year while 1 patient passed away before the initiation of antifungal treatment.Outcomes:Two patients’adrenal function recovered not requiring any steroid replacement,while 1 patient still requires long-term steroid replacement.Lessons:Adrenal histoplasmosis should be excluded in patients from endemic areas presenting with bilateral adrenal masses and adrenal insufficiency.Usually patients have an exposure to bird droppings,bat guano or soil contaminated with histoplasmosis fungi.Histopathological examination of biopsied adrenal tissues is still the gold standard investigation as serology and molecular diagnostic methods are still not widely available in most centers in Malaysia.

Cross-Domain Bilateral Access Control on Blockchain-Cloud Based Data Trading System

Data trading enables data owners and data requesters to sell and purchase data.With the emergence of blockchain technology,research on blockchain-based data trading systems is receiving a lot of attention.Particularly,to reduce the on-chain storage cost,a novel paradigm of blockchain and cloud fusion has been widely considered as a promising data trading platform.Moreover,the fact that data can be used for commercial purposes will encourage users and organizations from various fields to participate in the data marketplace.In the data marketplace,it is a challenge how to trade the data securely outsourced to the external cloud in a way that restricts access to the data only to authorized users across multiple domains.In this paper,we propose a cross-domain bilateral access control protocol for blockchain-cloud based data trading systems.We consider a system model that consists of domain authorities,data senders,data receivers,a blockchain layer,and a cloud provider.The proposed protocol enables access control and source identification of the outsourced data by leveraging identity-based cryptographic techniques.In the proposed protocol,the outsourced data of the sender is encrypted under the target receiver’s identity,and the cloud provider performs policy-match verification on the authorization tags of the sender and receiver generated by the identity-based signature scheme.Therefore,data trading can be achieved only if the identities of the data sender and receiver simultaneously meet the policies specified by each other.To demonstrate efficiency,we evaluate the performance of the proposed protocol and compare it with existing studies.

Morphological and functional observations of a novel model of retinal ischemia injury induced by bilateral carotid artery stenosis in mice

AIM:To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis(BCAS).METHODS:BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice.Cerebral blood flow was monitored at 2,7,and 28d postoperatively.Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining.Fluorescein fundus angiography(FFA)was performed to detect retinal vascular changes and circulation.The levels of apoptosis,activation of neurogliosis,and expression of hypoxiainducible factor(HIF)-1αin the retina were assessed by Western blotting and immunofluorescence staining,followed by retinal ganglion cell(RGC)density detection.Additionally,electrophysiological examinations including photopic negative response(PhNR)was also performed.RESULTS:The mice demonstrated an initial rapid decrease in cerebral blood flow,followed by a 4-week recovery period after BCAS.The ratio of retinal artery and vein was decreased under fundus photography and FFA.Compared with the sham mice,BCAS mice showed thinner retinal thickness on day 28.Additionally,apoptosis was increased and RGC density was decreased mainly in peripheral retinal region.Neurogliosis was mainly located in the inner retinal layers,with a stable increase in HIF-1αexpression.The dark-adapted electroretinogram showed a notable reduction in the a-,b-,and oscillatory potential(OP)wave amplitudes between days 2 and 7;this gradually recovered over the following 4wk.However,the b-and OPwave amplitudes were still significantly decreased on PhNR examination on day 28.CONCLUSION:BCAS can result in relatively mild retinal ischemia injuries in mice,mainly in the inner layer and peripheral region.Our study provides a novel animal model for investigating retinal ischemic diseases.

Klippel Trenaunay Syndrome with Angiokeratoma Circumscriptum Naeviforme and Bilateral Congenital Anorchia: A Rare Association

Klippel-Trenaunay syndrome (KTS) is not a common congenital vascular abnormality. A trio of capillary malformation, venous varicosities, and bony or soft-tissue hypertrophy define this syndrome. Significant morbidities associated with this illness include bleeding, deep vein thrombosis, and embolic consequences. Angiokeratoma circumscriptum naeviforme (ACN) is indeed a congenital variant of angiokeratoma that appears as a hyperkeratotic plaque on the lower extremity. Bilateral congenital anorchia (BCA) is the total lack of testicular tissue in a male with a normal phenotype and karyotype. KTS has been linked to ACN. Here we presented an 8-year-old male child who came with a swollen left thigh and the right side of his face with overlying blackish nodules on his left thigh and scrotum. The patient was diagnosed as KTS with angiokeratoma circumscriptum naeviforme and bilateral congenital anorchia based on his history, imaging studies and the typical clinical features of the disease.

Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions:A case report

BACKGROUND In addition to the non-specific symptomatology of ocular rosacea,currently,there are no reliable diagnostic tests for the disease,which may lead to its misdiagnosis.Here,we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids.CASE SUMMARY A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes,with no facial erythema.Initial management done were application of steroid eye ointment on both eyelids,hot compresses,and eyelid margin cleaning;noting that there was no relief of symptoms.Surgical excision of the chalazion was done on both eyes,however,bilateral recurrence occurred post-operatively.The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells.Immunohistochemistry studies were positive for LL-37.Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin.CONCLUSION Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

Bilateral meibomian gland morphological alterations in unilateral herpes simplex keratitis based on artificial intelligence analysis

AIM:To explore whether unilateral herpes simplex keratitis(HSK)can cause morphological changes of bilateral meibomian glands(MGs)based on artificial intelligence(AI)analytical system.METHODS:In the retrospective study,29 patients with unilateral HSK and 29 participants matched in terms of age and sex were included as control group.Meibographic images of the upper eyelid using Keratograph 5M and assessed ocular surface parameters including tear meniscus height and tear break-up time.MG density and vagueness values were automatically analyzed and calculated using an AI analytical system.We compared the differences between the affected and the contralateral unaffected eyes in HSK patients,and the normal control eyes.We employed either the paired t-test or the Wilcoxon signed-rank test to compare significant difference between the affected and unaffected eyes in HSK patients or between the HSK group and control group.RESULTS:The MG density was 0.19±0.09 in the HSKaffected eye and 0.18±0.07 in contralateral unaffected eye,which had no significant difference(P=0.616).The MG density between the affected eye with HSK and the normal control group was statistically significant(P=0.028).There was a significant difference in MG density between the contralateral unaffected eye and the normal control group(P=0.012).However,no significant difference in vagueness value was observed between the eye with HSK and the control group or between HSK eye and contralateral eye.CONCLUSION:The MG density between the HSKaffected eye and the contralateral unaffected eye don’t significantly differ,whereas there is a significant decrease in the HSK group compared to that of the normal participants.Unilateral HSV keratitis may suffer from bilateral changes of MG morphology indicating bilateral dry eye.Therefore,the fellow eye of patients with unilateral HSK should be considered a potential case of MG dysfunction,necessitating early treatment for bilateral dry eye in the clinic.

Next-Level Relations China-Laos Economic and Trade Cooperation Exchange Conference fortifies bilateral economic ties

On September 5,the ChinaLaos Economic and Trade Cooperation Exchange Conference,themed"Highlevel Opening-up and Building a China-Laos Community with a Shared Future,"took place in Vientiane,capital of Laos.The purpose of the conference was to review the achievements of bilateral economic and trade cooperation and work together to develop the roadmap to high-quality development of China-Laos economic and trade cooperation by focusing on shared goals,pooling strength,and adhering to results-oriented collaboration.

The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Effectiveness of Low-Temperature Plasma Adenoidectomy Combined with Bilateral Tonsillectomy in the Treatment of Snoring in Children and Its Effect on Sleep Quality

Objective:To evaluate the therapeutic effect of low-temperature plasma adenoidectomy(abbreviation:adenoid low-temperature plasma excision)coupled with tonsillectomy(bilateral)on snoring in children.Methods:Seventy-six cases of snoring children treated in the hospital between November 2020 and November 2023 were selected.38 cases of children in Group A agreed to surgery and were admitted to the hospital for surgical treatment and were treated with adenoid cryo-plasma excision combined with tonsillectomy(bilaterally),and 38 cases of children in Group B did not agree to outpatient conservative treatment for surgery,and the results of the treatment were compared.Results:Before treatment,there was no difference between the ventilation function indexes,sleep quality scores,and quality of life scores of the two groups compared with each other(P>0.05).After treatment,the ventilation function indexes of Group A were better than Group B,and the sleep quality score and quality of life score were higher than that of Group B.The total effective rate of Group A was higher than that of Group B(P<0.05).Conclusion:Adenoid cryo-plasma excision combined with tonsillectomy(bilateral)can improve the quality of life,ventilation function,and sleep quality of children with snoring,and can enhance the efficacy.

Rare uterine serosal pregnancy after in vitro fertilization in a woman with bilateral salpingectomy

Objective:To improve the understanding of ectopic pregnancy after bilateral salpingectomy through case analysis and literature review.Method:A case of uterine serosal pregnancy after in vitro fertilization and embryo transfer(IVF-ET)in a woman with bilateral salpingectomy was reported in detail and summarized,and relevant literatures searched in Pubmed were analyzed.Results:The patient had a sudden abdominal pain 18 days after transplantation.Ultrasound showed no pregnancy sac in the intrauterine cavity and bilateral adnexal areas,but there was a large amount of fluid in the Pouch of Douglas,which was an indication for surgical exploration.During the operation,the pregnancy tissue was found on the uterine serosal and cleared in time.And the patient recovered well after surgery.Review of the literatures showed that most of ectopic pregnancies after bilateral salpingectomy were treated surgically and had a good prognosis.Conclusion:Ectopic pregnancy after bilateral salpingectomy is extremely rare and should be early judged by the patients’signs.Surgical treatment timely can achieve good outcome.

Blockchain-Based Secure and Fair IoT Data Trading System with Bilateral Authorization

These days,data is regarded as a valuable asset in the era of the data economy,which demands a trading platform for buying and selling data.However,online data trading poses challenges in terms of security and fairness because the seller and the buyer may not fully trust each other.Therefore,in this paper,a blockchain-based secure and fair data trading system is proposed by taking advantage of the smart contract and matchmaking encryption.The proposed system enables bilateral authorization,where data trading between a seller and a buyer is accomplished only if their policies,required by each other,are satisfied simultaneously.This can be achieved by exploiting the security features of the matchmaking encryption.To guarantee non-repudiation and fairness between trading parties,the proposed system leverages a smart contract to ensure that the parties honestly carry out the data trading protocol.However,the smart contract in the proposed system does not include complex cryptographic operations for the efficiency of onchain processes.Instead,these operations are carried out by off-chain parties and their results are used as input for the on-chain procedure.The system also uses an arbitration protocol to resolve disputes based on the trading proof recorded on the blockchain.The performance of the protocol is evaluated in terms of off-chain computation overhead and on-chain gas consumption.The results of the experiments demonstrate that the proposed protocols can enable the implementation of a cost-effective data trading system.

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block(TAPB)in gastric cancer patients undergoing laparoscopic radical gastrectomy.METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group(n=45)and epidural anesthesia group(n=40)according to the different anesthesia and analgesia programs used.The TAPB group received general anesthesia combined with TAPB,and the epidural anesthesia group received general anesthesia combined with epidural anesthesia.The pain status,cognitive status,intestinal barrier indicators,recovery quality,and incidence of complications were compared between the two groups.RESULTS Compared with the epidural anesthesia group,the TAPB group’s visual analog scale scores were significantly lower 6 h,12 h,24 h and 48 h after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)in the TAPB group was significantly lower than that in the epidural anesthesia group,and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group(P<0.05).The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery(P<0.05).The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group(P<0.05).The total incidence of postoperative complications in the TAPB group was 4.44%,significantly lower than the 20.00%in the epidural anesthesia group(P<0.05).CONCLUSION Compared with epidural anesthesia combined with general anesthesia,TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications,improve the levels of intestinal barrier indicators,and improve postoperative recovery quality.

Ponseti Treatment of Bilateral Idiopathic Clubfoot: Does the Hand Dominance of the Provider Make a Difference?

Introduction: Congenital talipes equinovarus (CTEV) is the commonest musculoskeletal deformity worldwide. The Ponseti technique is the goal standard for clubfoot treatment. During the correction phase, the provider’s right hand manipulates the right foot and the left hand, left foot. Often, one foot is ready for Achilles tenotomy before the other in bilateral clubfoot. Objective: To determine the effect of the provider’s hand dominance would have on bilateral clubfoot treated with the Ponseti technique. Method: This was a prospective cross-sectional study that analyzed idiopathic bilateral clubfoot patients aged 0 - 5 years and treated using the Ponseti technique at FMC Umuahia from October 2019 to September 2020. Informed consent and ethical clearance were obtained. The Pirani scores were obtained and compared at presentation and at each clinic visit. All trained manipulators were right-handed. Two-tailed t-test was used and a p-value less than 0.05 was deemed significant. Results: Forty-seven patients participated in the study with an M:F of 2.6:1 and mean age of 13.79 ± 13.39 months. Thirty-six patients (76.6%) had the same Pirani score on both feet at presentation, while the right and left feet were more severely affected in 8 and 3 cases respectively. The mean number of casts before readiness for tenotomy was 4.95 on the right and 5.28 on the left with p-value of 0.042. Conclusion: Though the right foot had a worse mean Pirani score on presentation, however, it required fewer casts before readiness for tenotomy than the left.

Spontaneous Bilateral Pneumothorax in a Healthy Young Adult: A Comprehensive Case Report

Background: Spontaneous bilateral pneumothorax in healthy young adults is a rare and challenging condition that defies conventional diagnostic and etiological paradigms. This case report explores the presentation, diagnostic evaluation, management, and potential contributing factors in a 29-year-old male with no prior medical history who experienced bilateral spontaneous pneumothoraces. Aim: This case report aims to shed light on the complexities of managing spontaneous bilateral pneumothorax, particularly in the absence of common risk factors. It underscores the need for a thorough assessment and ongoing research to unravel the enigma surrounding this condition. Case Presentation: A healthy 29-year-old male presented with acute chest pain and shortness of breath, ultimately diagnosed with bilateral spontaneous pneumothoraces. Despite the absence of typical risk factors, advanced imaging techniques revealed valuable insights into the diagnosis and management of this unique presentation. Conclusion: Spontaneous bilateral pneumothorax in healthy individuals presents diagnostic challenges and raises questions about potential genetic predisposition, connective tissue disorders, and lifestyle-related triggers. While the acute phase was effectively managed, this case underscores the importance of interdisciplinary collaboration and ongoing research to comprehensively understand this condition.

Screening for Transthyretin Cardiac Amyloidosis in Patients with Bilateral Carpal Tunnel Syndrome: Identifying Missed Opportunities for Early Detection and Treatment

Purpose: Transthyretin cardiac amyloidosis (ATTR-CA) has been linked to many extra-cardiac manifestations including bilateral carpal tunnel syndrome (CTS). The aim of this study is to analyze patients with bilateral CTS to identify patients with high-risk features or “red flags” for ATTR-CA, identify if systematic screening was done for ATTR-CA and define opportunities for improved detection. Methods: Out of >5000 patients with bilateral CTS evaluated in a single tertiary care center in Southeast Michigan (2010-2016), we retrospectively studied a focused population of patients: men > 50 years and women > 60 years old with bilateral CTS and atrial fibrillation (n = 295). Baseline demographic, comorbidities, and electrocardiographic and echocardiographic findings were analyzed. A high-risk group suspicious for ATTR-CA was identified as patients with bilateral CTS, atrial fibrillation, and concomitant “red flags” including heart failure and left ventricular hypertrophy. Results: Out of 295 patients, 51.2% were female, 75.6% were White, and 22.4% were African American. Upon comparing the high-risk group (n = 67) with the remaining study population (n = 228), both diagnosis of ATTR-CA and mortality were higher among the high-risk group (7.5% vs 0.4% and 43.3% vs 24.6%, respectively, P = 0.003). Conclusions: A substantial number of bilateral CTS patients had additional “red flags” warranting formal evaluation for ATTR-CA;however, systematic evaluation for cardiac amyloidosis was not performed in many patients. This emphasizes that Multidisciplinary collaboration is needed to create a systematic workflow and to raise awareness amongst cardiologists and other physicians for suspecting ATTR-CA in bilateral CTS patients who have additional “red flags”.

Ochronotic arthropathy of bilateral hip joints:A case report

BACKGROUND Ochronosis,also known as alkaptonuria,is a rare autosomal recessive selfmetabolic disease arising from deficiency of homogentisate 1,2 dioxygenase enzyme.It affects several organs and muscoskeletal structures.We herein report a case of a patient who presented with severe hip arthropathy complicated with late stage ochronosis.CASE SUMMARY A 56-year-old male patient was admitted in our department in 2019 with complaints of chronic low backache and left hip pain.After the required investigations were done,lumbar disc herniation and severe hip arthritis were the initial diagnosis.A total left hip arthroplasty was performed.Ochronotic osteoarthritis was only obtained post-surgery as confirmatory diagnosis.He was again admitted mid 2022 with the same complaints on the right hip.Subsequently,he underwent a total right hip arthroplasty.Post-operative recovery and follow-ups were deemed very satisfactory.CONCLUSION Ochronosis is an unusual diagnosis for a patient who presents with typical hip arthritis.Thus,unless meticulous history taking and advanced laboratory tests,the diagnosis can easily be missed by surgeons.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Robust fault detection for delta operator switched fuzzy systems with bilateral packet losses

Considering packet losses, time-varying delay, and parameter uncertainty in the switched fuzzy system, this paper designs a robust fault detection filter at any switching rate and analyzes the H∞ performance of the system. Firstly, the Takagi-Sugeno(T-S) fuzzy model is used to establish a global fuzzy model for the uncertain nonlinear time-delay switched system,and the packet loss process is modeled as a mathematical model satisfying Bernoulli distribution. Secondly, through the average dwell time method and multiple Lyapunov functions, the exponentially stable condition of the nonlinear network switched system is given. Finally, specific parameters of the robust fault detection filter can be obtained by solving linear matrix inequalities(LMIs). The effectiveness of the method is verified by simulation results.

Even Closer China-Philippines Relations China and the Philippines have shown commitment to managing differences and expanding cooperation,which fosters more confidence in the ongoing stability of bilateral relations over the next six years

On January 3,2023,China welcomed the first visit in the new year by a foreign head of state,Philippine President Ferdinand Marcos Jr.The visit was also the president’s first official state visit to a country outside ASEAN since he took office in June 2022,which demonstrated the great importance the two countries attach to their bilateral relations.The three-day visit was fruitful despite a tight schedule.