Efficacy and Safety of Extracorporeal shock wave therapy in Treatment of Hypertrophic Scars and Keloids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Review question / Objective: The objective of this systematic review and meta-analysis of randomized controlled trials is to evaluate quantitatively the efficacy and safety of extracorporeal shockwave therapies (ESWT) combined comprehensive treatments on hypertrophic scars and keloids compared with comprehensive treatments alone and provide clinicians with an evidence base for their clinical decision making. Information sources: We will search all English and Chinese language articles indexed in PubMed, Medline, the Excerpta Medica database (Embase), Cochrane Central Register of Controlled Trials, the Cochrane Library, Physiotherapy Evidence Database(PEDro), Chinese biomedical literature service system(sinomed) before October 2021. In addition to these databases, Google Scholar and the lists of references will be used to carry out citation tracking of the selected studies for identifying any other eligible studies that could have been missed.

Evolution of a refractory prolactin-secreting pituitary adenoma into a pituitary carcinoma: report of a challenging case and literature review

Background Pituitary carcinomas (PCs), defined as distant metastases of pituitary neoplasms, are very rare malignancies. Because the clinical presentation of PCs is variable, early diagnosis and management remain challenging. PCs are always refractory to comprehensive treatments, and patients with PCs have extremely poor prognoses. Case presentation We describe one case of a prolactin-secreting pituitary adenoma (PA) refractory to conventional therapy that evolved into a PC with intraspinal metastasis. A 34-year-old female was diagnosed with an invasive prolactin-secreting PA in 2009 and was unresponsive to medical treatment with bromocriptine. The tumor was gross totally removed via transsphenoidal surgery (TSS). However, the patient experienced multiple tumor recurrences or regrowth despite comprehensive treatments, including medical therapy, two gamma knife radiosurgeries (GKSs), and four frontal craniotomies. In 2016, she was found to have an intradural extramedullary mass at the level of the fourth lumbar vertebra. The intraspinal lesion was completely resected and was confirmed as a metastatic PC based on histomorphology and immunohistochemical staining. The literature on the diagnosis, molecular pathogenesis, treatment, and prognosis of patients with prolactin-secreting PCs was reviewed. Conclusion PCs are very rare neoplasms with variable clinical features and poor prognosis. Most PCs usually arise from aggressive PAs refractory to conventional therapy. There is no reliable marker to identify aggressive PAs with a risk for progression to PCs; thus, it is difficult to diagnose these PCs early until the presence of metastatic lesions. It is still very challenging to manage patients with PCs due to a lack of standardized protocols for diagnosis and treatment. Establishing molecular biomarkers and the pathobiology of PCs could help in the early identification of aggressive PAs most likely to evolve into PCs.

Comprehensive Treatment of Single Finger Frostbite: A Case Study

Third- and fourth-degree frostbites usually result in loss of skin and tissue requiring amputation, and scarring. The 3- to 6-week waiting period is often necessary to determine the severity of the lesion. This period is also a critical time for the rescue of frostbitten tissue. This patient was a 30-year-old man who developed frostbite of his right index finger. He presented to our hospital 4 hours after injury with loss of sensation on the whole index finger and early signs of necrosis. The patient received a series of comprehensive treatments, including fasciotomy, injection of papaverine hydrochloride, baking lamp irradiation, and negative pressure treatment. At the time of discharge, he had re-epithelialization of the index finger by 21 days after injury. The conclusion of this paper is that the comprehensive treatments combined with negative pressure wound treatment has certain clinical application value for the rescue of deep frostbite tissues.

Rare Multiple Organ Failure Caused by Tumor Lysis and Subsequent Fatal Sepsis After Novel Salvaged Chemotherapy of Rituximab in a Diffuse Large B-cell Lymphoma Patient: A Case Report

Background: Tumor lysis syndrome (TLS) ranges from mild asymptomatic electrolyte derangement to severe organ dysfunction, is rarely associated with diffuse large B-cell Lymphoma (DLBCL). Standard chemotherapy of DLBCL is usually for clinical stable patients, however, it is still unclear for those in critical care situation with organ dysfunction. Case presentation: Here, we presented a rare case of aggressive bcl-2 and -myc double-positive DLBCL patient, 59-year-old, male, who rapidly progressed to severe multiple organ failure because of spontaneous TLS, and especially hepatic failure is very uncommon. Although the comprehensive treatments inclusive of early glucocorticoid usage, a stent implantation in superior vena cava, pleural and pericardial puncture drainage, anti-shock, non-invasive ventilator support, continuous renal replacement treatment (CRRT), plasma exchange and antibiotics alleviated or inverted the multiple organ failure, the patient was worsened to septic shock and died on the 12th day after new salvage chemotherapy regime with rituximab and cyclophosphamide under CRRT protection. Conclusions: The current case demonstrated a useful treatment framework to this kind of patient. We should cautiously give glucocorticoid to the patient suspected of lymphoma with high tumor burden. The comprehensive treatments for organ function supporting, especially CRRT, play a crucial role in the recovery of multiple organ failure. In addition, the optimal time and regimen choosing of rescue chemotherapy in severe DLBCL patients still remains a long way to define.

Cancer immunotherapy and toxic epidermal necrolysis

ObjectivesImmunotherapy has come to play an increasingly important role in cancer treatment. Accordingly, immune-related adverse events (irAEs) have drawn considerable attention. In this case, a young female patient developed immune-related toxic epidermal necrolysis (TEN). The same irAEs have been rarely reported in previous studies. In this study, we describe the treatment and care methods used in this case in detail in order to provide a reference for clinical practice.MethodsAfter being diagnosed with TEN, the patient accepted systemic glucocorticoid therapy, timely care of skin and mucous membranes, nutrition support, antiacid therapy, anti-inflammatory, analgesics and other supportive measures.ResultsThe patient’s skin recovered completely, and no serious adverse outcomes, such as secondary infection or multiple organ failure, occurred during treatment.ConclusionMedical staff should be able to identify the performance of rare irAEs such as TENs and actively explore comprehensive treatments to ensure patient safety and avoid adverse outcomes.