Algoritmo para la selección de colgajos perforantes perimamarios en reconstrucción inmediata poscirugía conservadora / Algorithm to select chest wall perforator flaps in immediate conservative breast surgery reconstruction

RESUMEN Antecedentes: los colgajos perforantes perimamarios son de gran utilidad en la reconstrucción mamaria inmediata en cirugía conservadora. Objetivo: describir los resultados del empleo de un algoritmo sobre colgajos perforantes perimamarios en la reconstrucción mamaria inmediata después de cirugía conservadora por cáncer de mama. Material y métodos: se llevó a cabo un estudio retrospectivo descriptivo. Se revisaron las historias clínicas de las pacientes operadas entre enero de 2020 y diciembre de 2022 por carcinoma de mama con cirugía conservadora y que requirieron reconstrucción con colgajos perimamarios. Las indicaciones incluyeron déficit de volumen, defecto de contorno y asimetría. Se evaluó el pedículo vascular del colgajo mediante Doppler color en todos los casos, lo que permitió seguir un algoritmo para la selección de la mejor opción de colgajo. Resultados: se realizaron 20 colgajos en 19 pacientes. Promedio de edad: 52 años ± 11 (rango 30-76). No existieron complicaciones intraoperatorias. Una paciente requirió reoperación por compresión del pedículo vascular del colgajo por hematoma, con la pérdida parcial, y otro colgajo sufrió epidermólisis superficial. No hubo pérdidas totales de ningún colgajo. Todas recibieron radioterapia posoperatoria y no experimentaron pérdida de volumen ni retracciones. Con un promedio de seguimiento de 15 meses, las pacientes valoraron los resultados a 6 meses como excelente en 7, bueno en 11 y regular en 2. Conclusión: la selección de colgajos perforantes locales para corregir defectos mamarios después de cirugía conservadora, mediante el examen con Doppler color preoperatorio para la identificación del pedículo vascular y un algoritmo específico, permitió obtener resultados estéticos satisfactorios sin requerir elementos aloplásticos ni revisiones posteriores.

ABSTRACT Background: Chest wall perforator flaps are a good option for immediate breast reconstruction after conservative surgery. Objective: The aim of this study was to describe the clinical results of an algorithm for using chest wall perforator flaps for breast reconstruction after breast-conserving surgery for breast cancer. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from the medical records of the patients diagnosed with breast cancer who underwent breast-conserving surgery and required reconstruction using chest wall perforator flaps between January 2020 and March 2022. The indications included volume deficit, contour defect and asymmetry. The vascular pedicle of the flap was evaluated by color Doppler ultrasound in all cases, which allowed us to follow an algorithm for selecting the best flap option. Results: Twenty flaps were made in 19 patients. Mean age: 52 years ± 11 (range 30-76). There were no intraoperative complications. One patient required reoperation due to a hematoma with compression of the vascular pedicle of the flap with partial flap loss, and another flap presented superficial epidermolysis. There were no cases of complete flap loss. All the patients underwent postoperative radiation therapy without loss of volume or retractions. Mean follow-up was 15 months. At 6 months, patients rated the results as excellent, good, and fair in 7, 11, and 2 cases, respectively. Conclusion: The selection of local perforator flaps to correct breast defects after conservative surgery, using preoperative color Doppler ultrasound to identify the vascular pedicle and a specific algorithm, allowed us to obtain satisfactory aesthetic results without the need for alloplastic elements or subsequent revisions.

Atypical evolution of collapsing FSGS in extreme elderly: case report / Evolução atípica de GESF Colapsante na velhice extrema: relato de caso

Introduction: Segmental and Focal Glomerulosclerosis (FSGS) is an entity characterized by glomerular damage involving the podocyte as the main target. A variant with a worse prognosis, poor response to corticosteroid therapy, and rapid progression to end-stage renal disease is recognized as collapsing FSGS. Case Report: A 102-year-old man with nephrotic syndrome and acute kidney injury underwent renal biopsy, revealing collapsing FSGS. He achieved an excellent response to immunosuppressive treatment, presenting renal recovery, and was discharged from dialysis treatment. Discussion: Diagnosis and definition of treatment in the elderly are challenging, and each case must be individualized and have functionality and risk assessed in a naturally immunosuppressed population.

Introdução: Glomeruloesclerose Segmentar e Focal (GESF) é uma entidade caracterizada por lesão glomerular que envolve o podócito como principal alvo. Uma variante de pior prognóstico, baixa resposta à corticoterapia, e rápida evolução para doença renal terminal é reconhecida como GESF colapsante. Relato de Caso: Um homem de 102 anos com síndrome nefrótica e lesão renal aguda foi submetido a biópsia renal, revelando GESF colapsante. Ele obteve excelente resposta ao tratamento imunossupressor, apresentando recuperação renal e recebendo alta de terapia renal substitutiva. Discussão: Diagnóstico e definição de tratamento nos idosos são desafiadores, devendo-se individualizar cada caso, avaliar funcionalidade e risco em uma população naturalmente imunossupressa.

Contrast-Enhanced Ultrasound in Assessing the Blood Perfusion of Kidney in Type 2 Diabetic Nephropathy / 中国医学影像学杂志

Purpose To explore the clinical value of quantitative assessment of renal perfusion using ultrasound contrast imaging for the auxiliary diagnosis of type 2 diabetic nephropathy.Materials and Methods This prospective study was conducted from May 2017 to December 2019 at the First Medical Center of Chinese PLA General Hospital.A total of 41 patients with type 2 diabetes and renal function abnormalities,who were scheduled for renal biopsy,underwent contrast-enhanced ultrasound.Differences in contrast imaging parameters,including time to peak in the renal cortex,peak enhancement,mean transit time local,and area under the curve between diabetic nephropathy and focal segmental glomerulosclerosis were compared,and the correlation between imaging parameters and pathological results was analyzed.Results Among 41 patients,30 cases were diagnosed as diabetic nephropathy,and 11 cases were diagnosed as focal segmental glomerulosclerosis.The peak enhancement and area under the curve in the diabetic nephropathy group were significantly lower than those in the focal segmental glomerulosclerosis group[peak enhancement:3 837.16(2 449.16,5 929.16)vs.8 508.00(4 334.88,21 201.00),Z=-2.766,P=0.006;area under the curve:0.14±0.05 vs.0.19±0.05,t=-3.135,P=0.003].In the diabetic nephropathy group,peak enhancement showed a negative correlation with the global glomerulosclerosis rate(r=-0.489,P=0.006).Conclusion Contrast-enhanced ultrasound can quantitatively evaluate renal perfusion and has certain clinical value in assisting the diagnosis of type 2 diabetic nephropathy.

Curative effects of 3D printed microporous titanium (tantalum) prosthesis in reconstruction of large segmental bone defects caused by lower extremity osteomyelitis / 中华创伤骨科杂志

Objective:To evaluate the curative effects of 3D printed microporous titanium (tantalum) prosthesis in reconstruction of large segmental bone defects caused by lower extremity osteomyelitis.Methods:A retrospective study was conducted to analyze the clinical data of 18 patients who had been treated for large segmental bone defects caused by lower extremity osteomyelitis between January 2020 to May 2022 at Department of Orthopaedics, The 920th Hospital of Joint Logistics Support Force. There were 10 males and 8 females with an age of (45.3±14.1) years. The defects were at the left side in 13 cases and at the right side in 5 cases, at the femur in 11 cases and at the tibia in 7 cases. The duration of osteomyelitis was 1.0 (1.0, 3.5) years. The length of bone defects was 8.35 (6.50, 9.84) cm. Their bone defects were repaired by an individually 3D printed microporous titanium (tantalum) prosthesis after operative removal of osteomyelitis lesions. The wound healing was observed after surgery. The clinical efficacy was comprehensively evaluated by the Paley grading for bone defect healing, visual analog scale (VAS), lower extremity functional scale (LEFS), and imaging examination.Results:The postoperative follow-up period for the 18 patients was (12.2±0.3) months. Wound infection occurred 2 months after surgery in one patient who was treated with Ilizarov bone transfer after removal of the microporous titanium prosthesis. The remaining 17 patients had good postoperative wound healing. At the last follow-up, the 18 patients had a VAS pain score of 2.0(1.0, 4.0) points, significantly lower than the preoperative one [(6.1±2.3) points], and a LEFS score of 54.00(34.50, 69.25) points, significantly higher than the preoperative one [18.50(9.00, 26.50) points] ( P<0.05). At the last follow-up, according to the Paley grading, the bone union was rated as excellent in 16 patients, as good in 1 patient and as poor in 1 patient. The integration of femoral fractures with 3D printed microporous titanium prostheses was fine. Conclusion:In reconstruction of large segmental bone defects caused by lower extremity osteomyelitis, implantation of a 3D printed microporous titanium (tantalum) prosthesis is feasible and effective, not only reducing pain but also restoring the limb function.

Clinical analysis of laparoscopic anatomical hepatectomy of segment VII for hepatocellular carcinoma with dorsal-ventral combined approach / 中华肝胆外科杂志

Objective:To study the feasibility of laparoscopic anatomical hepatectomy of segment VII for hepatocellular carcinoma (HCC) with dorsal-ventral combined approach.Methods:Clinical data of 23 patients with HCC undergoing laparoscopic anatomical hepatectomy of segment VII with dorsal-ventral combined approach in Jiangnan University Affiliated Hospital from December 2020 to April 2023 were retrospectively collected, including 11 males and 12 females, aged (58.5±7.9) years old. The patient's perio-perative data, postoperative complications, and follow-ups were analyzed.Results:All patients underwent the surgery successfully without conversion to laparotomy. The operation time was (286.7±63.4) min, the amount of intraoperative blood loss [ M( Q1, Q3)] was 200(150, 400) ml without blood transfusion. There were no major complications such as abdominal bleeding, bile leakage, liver failure or abdominal infection. Two cases had right pleural effusion and were managed with thoracic drainage. The patients could ambulate on postoperative day 2, and the postoperative hospital stay was (9.36±1.72) d. The diameter of the lesion was (4.38±1.42) cm. The serum level of alpha fetoprotein (AFP) three months after surgery was (3.26±0.93) ng/ml, lower than the preoperative baseline (46.75±9.43) ng/ml ( t=38.24, P=0.008). All patients showed normal serum levels of AFP and there were no tumor recurrence or metastasis during postoperative follow-ups. Conclusion:Laparoscopic anatomical hepatectomy of segment VII for HCC with dorsal-ventral combined approach is feasible and worth spreading.

The guiding value of ultrasound-guided selective nerve root block in the surgical treatment of multilevel lumbar degeneration / 国际外科学杂志

Objective:To evaluate the guiding value of ultrasound-guided selective nerve root block in the surgical treatment of multilevel lumbar degeneration.Methods:Retrospective case-control study was used. Clinical data of 47 patients with multi-level lumbar degeneration who underwent decompression surgery in Honghui Hospital, Xi′an Jiaotong University from January 2019 to December 2021 were retrospectively analyzed. They were divided into nerve root block group ( n=22)and non-nerve root block group( n=25) according to whether ultrasound-guided selective nerve root block was performed before decompression surgery. The operation time, intraoperative blood loss, number of decompression laminae, postoperative drainage volume and length of stay of the two groups were recorded and compared. The visual analogue scale of low back pain, the visual analogue scale (VAS) of leg pain, the Japanese orthopaedic association (JOA) score and Oswestry disability index (ODI) score were all compared before surgery and during follow-up between the two groups. Measurement data with normal distribution were represented as mean±standard deviation( ± s), and the comparison between groups was conducted using the paired t-test. Chi-square test was used for counting data. Results:All 47 patients successfully completed the operation without any serious complications such as neurovascular injury. All patients were followed up for (27.6±7.5)months. In the nerve root block group, the operation time, intraoperative blood loss, number of decompression laminae, postoperative drainage volume and hospital stay were (90.5±12.6) min, (110.5±15.8) mL, 1.2±0.8, (85.6±15.8) mL, (6.2±2.8) d, respectively. In the non-root block group, they were (190.6±25.5) min, (450.5±24.8) mL, 3.8±1.6, (210.5±16.8) mL, (9.5±2.2) d, respectively. The above indexes in the nerve root closure group were less than those in the non-root closure group, and the difference was significant between the two groups ( P< 0.05). The scores of VAS of low back pain and leg pain, JOA and ODI in both groups were significantly improved after surgery and during the follow-up period when compared with those of pre-operation ( P< 0.05). The VAS scores of low back pain on the 3rd day, 6 months after operation and at the last follow-up in the nerve block group were 3.2±1.4, 1.4±0.8, 0.5±0.2, the JOA scores were 15.8±4.3, 21.3±5.6, 25.6±1.4, and the ODI scores were 50.6±10.3, 22.8±7.8, 16.8±4.2, respectively. The VAS scores of low back pain on the 3rd day, 6 months after operation and at the last follow-up in the non-nerve block group were 5.1±1.8, 3.4±1.2, 1.8±0.5, the JOA scores were 14.1±4.8, 20.5±3.2, 24.2±1.8, and the ODI scores were 60.5±9.8, 31.6±8.2 and 21.3±5.5, respectively. The difference between the two groups was statistically significant ( P<0.05). However, there was no statistical difference in the VAS scores of leg pain between the two groups after surgery and during follow-up ( P>0.05). At the last follow-up, the internal fixation position of the two groups was good, no loosening and displacement, and bone graft fusion was good. Conclusion:For patients with multi-level lumbar degeneration, ultrasound-guided selective nerve root block before surgery can identify the responsible segment, and selective decompression and fusion based on this can effectively reduce surgical trauma, while improving patients′ back and leg pain and physical function, which has important surgical guidance value.

Application and accuracy assessment of a novel 3D-printed osteotomy guide in anterior maxillary segmental distraction osteogenesis / 上海交通大学学报（医学版）

Objective·To evaluate the effects of anterior maxillary segmental distraction osteogenesis(AMSDO)in treating sagittal maxillary hypoplasia in cleft lip and palate(CLP)patients and to report a 3D-printed surgical guide to facilitate the osteotomy.Methods·Twelve patients with CLP who underwent AMSDO were included in this study.Virtual osteotomy was performed in a 3-dimensional model and the osteotomy line were fabricated into a tooth-borne surgical guide by using 3D-printing technique.Lateral cephalograms taken before surgery(T0),at the end of consolidation(T1)and six months after consolidation(T2)were used to evaluate the effects of AMSDO.The accuracy of the osteotomy guide was measured by superimposing the postoperative CT data to virtual planning.Results·All the patients went through surgery without serious complications.SNA and overjet changed significantly both from T0 to T1 and from T0 to T2.ANB,facial convexity,and palatal length changed without significance from T0 to T1 and from T0 to T2.SNB remained stable.All the variables remained relatively stable from T1 to T2.The anteroposterior linear root-mean-square deviation(RMSD)between planning and actual results was 0.90 mm,while the angular RMSD in the sagittal plane was 5.07°.Conclusion·AMSDO is an effective treatment for maxillary hypoplasia secondary to CLP.The accuracy of this 3D-printed osteotomy guide is clinically acceptable,and this can simplify the surgery with fewer complications.

Clinical analysis of 10 neonates with primary segmental volvulus / 中国新生儿科杂志

Objective:To summarize the clinical features of primary segmental volvulus (PSV) in neonates.Methods:A retrospective analysis was conducted on the clinical data of neonates with PSV who were admitted to the Department of Neonatal Surgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2014 to May 2023. The clinical manifestations, auxiliary examinations, treatment and prognosis of the neonates were summarized, and descriptive statistical analysis was performed on the collected data.Results:A total of 10 neonates with PSV were included, with a mean gestational age of (34.1±3.0) weeks and birth weight of (2 291±646) g. Eight cases had an onset age of 3 d or less, and 2 cases had an onset age of more than 3 d. Abdominal distension was observed as the main manifestation in all cases, while bilious vomiting occurred in seven cases and hematochezia in five cases. Imaging examinations mainly revealed low intestinal obstruction without specific manifestations. Laboratory tests showed metabolic acidosis and varing degrees of anaemia. Nine cases underwent diagnostic abdominal puncture, of which five had bloody ascites, two had clear ascites, one had bloody mixed with fecal-like ascites, and one had chylous ascites. All the cases underwent emergency exploratory laparotomy and segmental small bowel resections with either primary intestinal anastomosis or enterostomy. All cases were successfully cured and had been followed up to the age of 4 months to 9 years with good growth and development as normal children of the same age.Conclusions:Neonatal PSV is an independent abdominal emergency characterized by non-specific clinical manifestations and difficult preoperative diagnosis, but the overall prognosis is favorable after active surgical treatment.

Digital repair for a patient with limited mouth opening: a case report and literature review / 口腔疾病防治

Objective@#To explore an accurate method to obtain an intraoral model of patients with specific limited mouth opening (microstomia) due to systemic scleroderma.@*Methods@#This study followed medical ethics, and informed consent has been obtained from patients. A case of Ken's Type I mandibular dentition defect scleroderma with limited mouth opening was addressed with digital technology as the leading method combined with the traditional impression method of segmental impression. Individual trays were made based on the patient's left and right mandibular dentition, and segmented molds were obtained. Simultaneously, intraoral scanning was performed to obtain the morphological data of both the soft and hard tissues of the upper and lower mandibles. After each part of the model was obtained, the mandibular model was scanned and digitally aligned to form the final denture model, and the final removable partial denture was designed and made by computer aided design/computer aided manufacturing (CAD/CAM) technology. At the same time, combined with the literature, the diagnosis and treatment of removable partial denture in patients with limited mouth opening were retrospectively analyzed.@*Results@#The denture was well retained and achieved a good repair effect. The patients expressed satisfaction with the mastication efficiency and other functions of the denture. The findings of the literature review show that the integration of digital technology with the traditional impression method, along with computer fitting, can accurately obtain the patient's oral model and facilitate successful follow-up repairs. However, when the anterior mandibular dentition of the patient is absent, the margin of error is increased in this procedure, which deserves further exploration.@*Conclusion@#Utilizing digital technology as the leading method, combined with the traditional impression method of segmental impression, for the repair of dental defects in patients with limited mouth opening, has proven to be effective. Thus, patients report a positive medical experience with high satisfaction, indicating that this approach is worthy of clinical promotion.

Aggressive treatment may be needed for idiopathic membranous nephropathy with focal segmental glomerulosclerosis lesions

SUMMARY OBJECTIVE: The purpose of this study was to analyze the clinical, pathological, prognostic features and treatment response of the coexistence of focal segmental glomerulosclerosis lesions with idiopathic membranous nephropathy. METHODS: This is a two-center retrospective cohort study. Patients of idiopathic membranous nephropathy were enrolled and divided into two groups with or without focal segmental glomerulosclerosis lesions according to the renal biopsy. Laboratory data and pathological manifestation were compared. Renal phospholipase A2 receptor was detected by immunofluorescence. During the follow-up, the effects of different therapies and renal function were estimated. RESULTS: A total of 236 patients were finally enrolled in this study, of which 60 and 176 idiopathic membranous nephropathy patients were enrolled in the FSGS+ and FSGS- groups, respectively. The FSGS+ group showed a higher percentage of hypertension history (38.3 vs. 20.0%, p=0.004), with a significantly higher level of systolic pressure [137 (120, 160) mmHg vs. 130 (120, 140) mmHg, p=0.009]. Main laboratory findings, including serial albumin (20.4±7.8 g/L vs. 24.5±6.7 g/L, p<0.001), 24-h proteinuria [5.61 (3.10, 7.87) g/day vs. 3.82 (2.31, 5.79) g/day, p=0.002], serial creatinine [80.8 (65.8, 97.9) μmol/L vs. 72.0 (58.7, 84.9) μmol/L, p=0.003], and estimated glomerular filtration rate [86 (66, 101) mL/min/1.73 m2 vs. 95 (81, 108) mL/min/1.73 m2, p=0.007] showed significant differences between the two groups. Pathologically, patients with focal segmental glomerulosclerosis lesions appeared with a higher percentage of crescents, a more severe degree of interstitial fibrosis, and a higher level of membranous nephropathy stage. Renal phospholipase A2 receptor showed a relatively lower positive rate of only 75.0% in the FSGS+ group in comparison with the positive rate of 90.3% in the FSGS- group (p=0.031). The prognosis was generally similar between the two groups. Among patients who were given non-immunosuppression treatment, those with focal segmental glomerulosclerosis lesions took a relatively longer period of time to achieve complete remission (29.3±7.0 m vs. 15.4±8.9 m, p=0.025) and experienced a higher rate of renal function deterioration (37.5 vs. 5.4%, p=0.033) compared with the other ones. While among those receiving immunosuppression treatment, both groups received similar remission rates. CONCLUSION: Compared with FSGS- group, idiopathic membranous nephropathy with focal segmental glomerulosclerosis lesions represented more severe nephrotic syndrome and worse renal function. In view of the renal function decline during the follow-up, more aggressive treatment with the use of immunosuppressants should be considered for idiopathic membranous nephropathy patients with focal segmental glomerulosclerosis lesions.

Training in oncoplastic surgery for mastologists

SUMMARY OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.

Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study

Introduction: Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims: To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods: Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results: Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions: CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.

Hemangioma segmentario de la barba / Segmental Beard Hemangioma

Los hemangiomas infantiles son el resultado de la proliferación de células del endotelio vascular y representan los tumores benignos más frecuentes en la infancia, con una incidencia estimada del 4-10% en bebés caucásicos. Se clasifican según el número, la profundidad y la distribución. Dentro de esta última clasificación se encuentran aquellos denominados segmentarios, que se caracterizan por su distribución extensa en áreas de prolongaciones mesodérmicas embrionarias. Se comunica el caso de una paciente evaluada al mes y medio de vida, con un hemangioma extenso del área mandibular y cuello anterior (hemangioma segmentario de la barba). Se describe la importancia de los estudios complementarios para evaluar el compromiso de órganos subyacentes, para detectar síndromes asociados y definir el tratamiento sobre la base de estos resultados. (AU)

Infantile hemangiomas arise from the proliferation of vascular endothelial cells and represent the most common benign tumors in infancy, with an estimated incidence of 4-10% in Caucasian infants. They vary according to their number, depth, and distribution. Within the latter classification are the so-called segmental ones, which feature an extensive distribution in areas of embryonic mesodermal extensions. We report the case of a patient evaluated at one and a half months of life with an extensive hemangioma of the mandibular area and anterior neck (segmental hemangioma of the beard). We describe the importance of complementary studies for evaluating the involvement of underlying organs, detecting associated syndromes, and defining the treatment based on these findings. (AU)

Reconstruction Plate Fracture: Mechanism and Recent Advances

Reconstruction plates with or without bone grafts are used to restore mandibular continuity, form and function following segmental resection of mandible. Fracture of reconstruction plate is observed in 2.9 % to 10% of cases reported in the literature excluding other complications. In this case, we report the fracture of stainless steel reconstruction plate used without bone graft and its management using locking reconstruction plate with non vascularised iliac crest graft following removal of the fractured plate. Review of literature describing incidence, pattern and causes of reconstruction plate fracture and its management is discussed.

Glomerulopatía colapsante en un paciente con Covid-19. Reporte de caso / Collapsing glomerulonephritis in a COVID-19 patient. Case report

La injuria renal aguda por glomerulopatía colapsante, presenta alta morbimortalidad, incluso con requerimiento de diálisis crónica; la Covid-19 es una de sus causas. Se presenta el caso de un paciente con Covid-19 y glomerulopatía colapsante. Varón de 17 años, sin antecedentes patológicos; con historia de cuatro meses de edema, orina espumosa y disminución del flujo urinario. Al examen: anasarca. Exámenes: creatinina 4,2 mg/dl, albumina 1,9 gr/dl, colesterol y triglicéridos aumentados; orina: proteinuria 6,7 gr/24h, leucocituria y hematuria con urocultivo negativo. Serología para VIH, sífilis y hepatitis negativos. Inmunología para lupus negativa, prueba rápida para la Covid-19 IgG (+). La biopsia renal mostró Glomeruloesclerosis Focal y Segmentaria, variante Colapsante. Recibió corticoides y ciclosporina. La creatinina mejoró, la proteinuria se mantiene >3 gr/24horas.

SUMMARY Acute renal injury due to collapsing glomerulonephritis is associated with high morbidity and mortality, requiring chronic dialysis, COVID-19 is one of its causes. A 17-year-old male patient presented with a four-month history of edema, foamy urine and reduction in the urine flow; anasarca was observed at physical examination. Laboratory values showed creatinine 4,2 mg/dl; albumin 1,9 gr/dl; cholesterol and triglycerides were high; proteinuria 6,7 gr/24h: leucocyturia and hematuria with negative urine culture. Serologies for HIV, syphilis and hepatitis were negative. Studies for systemic lupus were negative. An antigenic test for SARS-CoV-2 was positive as well as an IgG. Renal Biopsy showed Focal and Segmental Glomerulosclerosis, Collapsing variant. He received corticosteroids and cyclosporine. Creatinine improved; proteinuria remained >3 gr/24 hours.

Efficacy of thoracoscopic segmentectomy of the dominant lung segment versus thoracoscopic segmentectomy of the complex lung segment for the treatment of stage I non-small cell lung cancer / 中国基层医药

Objective:To investigate the efficacy of thoracoscopic segmentectomy of the dominant lung segment versus thoracoscopic segmentectomy of the complex lung segment for the treatment of stage I non-small cell lung cancer (NSCLC). Methods:This is a case-control study. The clinical data of 110 patients with stage I NSCLC who received treatment in Jinhua Municipal Central Hospital from August 2019 to August 2021 were retrospectively analyzed. These patients were assigned to a control group (thoracoscopic segmentectomy of dominant lung segment, n = 58) and an observation group (thoracoscopic segmentectomy of complex lung segment n = 52) according to the surgical method. Tumor location and resection scope in each group were recorded. Perioperative indexes, lung function indexes, complications, and short-term recurrence rates were compared between the two groups. Results:The operative time in the observation group was (175.45 ± 30.72) minutes, which was significantly longer than (152.41 ± 29.83) minutes in the control group ( t = 3.99, P < 0.05). The number of nail bins in the observation group was (4.55 ± 1.23), which was significantly greater than (3.77 ± 1.16) in the control group ( t = 3.42, P < 0.05). There were no significant differences in intraoperative bleeding volume, the number of dissected lymph nodes, postoperative drainage volume, postoperative extubation time, and postoperative hospital stay between the two groups (all P > 0.05). Forced vital capacity, forced expiratory volume in the first second (FEV 1), and FEV l/FVC ratio in the observation group were (3.89 ± 0.47) L, (2.92 ± 0.36) L, and (75.06 ± 2.47)%, which were significantly higher than (3.64 ± 0.49) L, (2.68 ± 0.35) L, and (73.63 ± 2.38)% in the control group (all P < 0.05). There was a significant difference in the incidence of complications between the observation and control groups [32.69% (17/52) vs. 20.69% (12/58), P > 0.05]. There was no significant difference in recurrence of stage I NSCLC between the observation and control groups [3.85% (2/52) vs. 1.72% (1/58), P = 0.495]. Conclusion:The overall effect and safety of thoracoscopic segmentectomy of complex lung segment in the treatment of stage I NSCLC are comparable to those of thoracoscopic segmentectomy of the dominant lung segment. However, thoracoscopic segmentectomy of complex lung segments can reduce the impact on lung function and protect lung function to the maximum extent.

Observation on the Curative Effect of"Tiaodu Tongmai Zhengji"on Cervical Cardiac Syndrome / 世界科学技术-中医药现代化

Objective To study the safety and effectiveness of Tiaodu Tongmai Zhengji method in the treatment of cervical cardiac syndrome,and to provide a choice for the clinical treatment of cervical cardiac syndrome.Methods From January 2020 to January 2022,45 patients with cervical cardiac syndrome diagnosed clinically in the outpatient department of geriatrics of our hospital were randomly divided into"Tiaodu Tongmai Zhengji"group,routine massage group and routine acupuncture group,with 15 patients in each group.Three methods were used in the"Tiaodu Tongmai Zhengji"group:acupuncture,massage and chiropractic therapy.The routine massage group adopted the massage treatment scheme of sympathetic cervical spondylosis,while the routine acupuncture group adopted the treatment scheme of cervical spondylosis and palpitation.Three times a week for four weeks.One month later,the treatment effect was evaluated from the main symptoms,secondary symptoms,follow-up symptoms and TCM syndrome score.Results In alleviating the main symptoms of patients with cervical cardiac syndrome,including palpitation,chest tightness and chest pain,the treatment of regulating Du,Tongmai and Zhengji was superior to the conventional massage treatment(P<0.05),while the conventional massage treatment was superior to the conventional acupuncture treatment(P<0.05).Acupuncture,Tuina and Tiaodu Tongmai Zhengji treatment can improve the secondary symptom of cervical heart syndrome,that is,neck and scapular pain.However,in terms of alleviating neck and scapular pain,Tiaodu Tongmai Zhengji treatment is significantly better than conventional acupuncture and Tuina treatment(P<0.01),while there is no difference between acupuncture and Tuina treatment(P>0.05).In improving the anxiety of cervical heart syndrome,acupuncture is better than regulating Du Tongmai Zhengji,while regulating Du Tongmai Zhengji is better than massage(P<0.05).The total effective rate of acupuncture and massage treatment was the same,but the total effective rate of Tiaodu Tongmai Zhengji treatment was better than that of acupuncture and massage treatment(P<0.05).Conclusion Tiaodu Tongmai Zhengji method is a feasible method obtained by summing up experience in clinical practice.It focuses on the manipulation of the spine and its small joints,meridians and acupoints,in order to balance yin and yang,dredge the meridians and dredge the collaterals,regulate the tendons and repair,regulate the qi and blood,restore the muscle mechanical balance,and restore the balance of visceral functions.while Tiaodu Tongmai Zhengji method has obvious advantages in relieving palpitation,chest tightness,chest pain and neck shoulder pain of patients with cervical heart syndrome.The total effective rate is also better than massage method and acupuncture method.Tiaodu Tongmai Zhengji method is a therapeutic method worthy of clinical promotion.

Long-term prognostic analysis of IgA nephropathy with focal segmental glomerulosclerosis in children / 中华肾脏病杂志

Objective:To analyze the long-term prognosis of IgA nephropathy (IgAN) with focal segmental glomerulosclerosis (FSGS) and the risk factors related to renal prognosis in children with IgAN-FSGS.Methods:A retrospective study was concluded in IgAN-FSGS children who were followed up for more than 5 years and diagnosed by renal biopsy for the first time in the Eastern Theater General Hospital from January, 2004 to December, 2018. The end-point events of the study were entering end-stage kidney disease (ESKD) or estimated glomerular filtration rate (eGFR) decreased by ≥50% from baseline, which were defined as poor renal prognosis. Baseline clinicopathologic data of IgAN-FSGS children were compared between the end-point event group and the non-end-point event group. The cumulative renal survival rate of IgAN-FSGS children was calculated by Kaplan-Meier survival analysis. The influencing factors of poor renal prognosis in IgAN-FSGS children were analyzed by Cox proportional hazards model, and the diagnostic value was evaluated by the receiver operating characteristic curve (ROC curve) and area under the curve (AUC). The diagnostic value was verified by time dependent-ROC and time dependent-AUC.Results:A total of 204 IgAN-FSGS children were enrolled in this study, of whom 132 cases were males (64.7%). The median age of renal biopsy was 16 (14, 17) years old. During a median follow-up time of 90.7 (71.7, 114.8) months, 57 cases (27.9%) reached the end-point events. Compared with the non-end-point event group ( n=147), the end-point event group ( n=57) had higher proportions of males and hypertension, higher levels of 24-hour urinary protein, serum creatinine, serum uric acid, urinary N-acetyl-β- D-glucosaminidase, urinary retinol binding protein, higher proportions of glomerular segmental sclerosis (S1) ≥25% and tubular atrophy/interstitial fibrosis (T1/T2), and lower levels of serum albumin, serum IgA, and serum IgG (all P<0.05). There was no statistical difference between the two groups in treatment (all P>0.05). Kaplan-Meier survival analysis showed that with entry of ESKD or eGFR decreased by ≥50% from baseline as the end-point events, the 5-year, 10-year, and 15-year cumulative renal survival rates in IgAN-FSGS children were 88.7%, 67.6%, and 50.7%, respectively. Multivariate Cox regression analysis showed that proteinuria >1 g/24 h ( HR=3.702, 95% CI 1.657-8.272, P=0.001), hyperuricemia ( HR=3.066, 95% CI 1.793-5.245, P<0.001), S1≥25% ( HR=2.017, 95% CI 1.050-3.874, P=0.035), T1/T2 ( HR=1.863, 95% CI 1.021-3.158, P=0.016) were the independent related factors for poor renal prognosis. ROC curve analysis showed that S1≥25% ( AUC=0.605, P=0.021, sensitivity 26.3%, specificity 94.6%), T1/T2 ( AUC=0.624, P=0.006, sensitivity 43.9%, specificity 81.0%), hyperuricemia ( AUC=0.658, P<0.001, sensitivity 52.6%, specificity 78.9%), proteinuria>1 g/24 h ( AUC=0.670, P<0.001, sensitivity 87.7%, specificity 46.3%) could accurately predict the renal outcome of IgAN-FSGS. Time dependent-ROC curve validation showed that the combined diagnosis of S1≥25%, T1/T2, hyperuricemia and proteinuria>1 g/24 h had a good predictive value for renal prognosis (3-year AUC=0.846 and 5-year AUC=0.777, respectively). Conclusions:During a median follow-up of 90.7 months, 27.9% of IgAN-FSGS children have poor renal prognosis, and the 5-year, 10-year, and 15-year cumulative renal survival rates are 88.7%, 67.6%, and 50.7%, respectively. Urinary protein >1 g/24 h, hyperuricemia, T1/T2, and S1 ≥25% are the risk factors for renal prognosis in IgAN-FSGS children.

Significance of target volume delineation of tumor bed according to metal clips or seroma in determing tumor bed position during radiotherapy after breast-conserving surgery for breast cancer / 肿瘤研究与临床

Objective:To investigate the differences between the mental clips placed intraoperatively and the tumor bed's target volume delineation of seroma based on CT scanning during radiotherapy for breast cancer patients who received breast-conserving surgery in the persuit of a better solution to determine the tumor bed position.Methods:The clinical data of 13 patients with early breast cancer who received postoperative radiotherapy after breast-conserving surgery at Beijing Shijingshan Hospital and Beijing Shijitan Hospital of Capital Medical University from December 2020 to January 2022 were retrospectively analyzed. They all had surgical clips implanted during the surgery. The following methods were used to delineate the target volume of tumor bed, including gross target volume delineation of tumor bed based on the mental clips (GTVtb-Clip), the tumor bed's gross target volume delineation of seroma based on CT scanning (GTVtb-Seroma), and the combination of both (GTVtb-C+S). The volume, diameter on three coordinate axis, neutral point displacement and conformability of these delineation methods were compared.Results:The volume of GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S was (25±10) cm 3, (38±17) cm 3, (49±20) cm 3, and the differences were statistically significant (all P<0.05). The diameter on X axis was (4.7±1.2) cm, (5.3±1.4) cm, (5.7±1.6) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Y axis was (4.6±1.7) cm, (5.0±1.6) cm, (5.7±1.7) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Z axis was (4.4±1.5) cm, (5.2±1.4) cm, (5.6±1.4) cm in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S. The differences in the diameter of GTVtb-Clip and GTVtb-C+S on X,Y, Z axis were statistically significant (all P<0.05); the differences in the diameter of GTVtb-Seroma and GTVtb-C+S on X, Z axis were statistically significant (all P<0.05); the difference in the diameter of GTVtb-Clip and GTVtb-Seroma on X axis was statistically significant ( P<0.05) .Neutral point displacement was (5.8±1.6) cm, (5.5±1.9) cm, (6.0±1.7) cm, respectively of GTVtb-Clip, GTVtb-Seroma, GTVtb-C+S, and the difference was not statistically significant ( P>0.05). Conformability of GTVtb-Clip and GTVtb-Seroma, GTVtb-Clip and GTVtb-C+S, GTVtb-Seroma and GTVtb-C+S was 0.412±0.112, 0.525±0.095, 0.774±0.112,respectively, and the differences were statistically significant (all P<0.05). Conclusions:During radiotherapy after breast-conserving surgery for breast cancer, compared with the single method, the combination of GTVtb-Clip and GTVtb-Seroma can better cover the real tumor bed, thus reducing the omission of tumor bed and recurrence rate. CT position should better take place at 4 to 8 weeks for patients receiving radiotherapy after breast-conserving surgery, and target volume of tumor bed will be delineated based on the postoperative changes of both mental clips and seroma.

De Novo Focal Segmental Glomerulosclerosis (FSGS) Post Covid 19 Vaccination: Case Series in A Single Centre in Malaysia

@#Introduction: Mass COVID-19 vaccination has been pivotal in the fight against this pandemic. The occurrence of glomerular disease following COVID-19 vaccinations particularly mRNA vaccine has been reported. The reported cases in the region are limited and number of cases reported are low in contrast to the total number of vaccine doses given worldwide, the healthcare providers should be alerted about such issues to provide swift and proper management. Case Series: Here, we report 3 cases of Focal segmental glomerulosclerosis (FSGS) following COVID-19 vaccination and their outcomes. Two of the patients received BNT162b2 vaccination and one received CoronaVac vaccination. The mean age of the patients was 33+/-7 years old. The mean duration onset of FSGS was 23+/-19 days post vaccinations. Two of the patients (BNT162b2 vaccination and CoronaVac vaccination) achieved complete remission after corticosteroid therapy. This is the first reported case of De Novo FSGS following CoronaVac vaccination in the literature. The third patient, who received BNT162b2 vaccination and presented late (42 days post vaccination) was not in remission despite three months of immunosuppressive treatment. Conclusion: The treating physician needs to be aware of the possibility of the development of FSGS associated with COVID-19 vaccination and how to proceed with vaccination schedule in these populations. Overall, the advantage of COVID-19 vaccination far outweighs the possibility of COVID-19 vaccine-associated glomerular disease.