Pediatric Crohn's disease diagnosis aid via genomic analysis and machine learning.

Introduction: Determination of pediatric Crohn's disease (CD) remains a major diagnostic challenge. However, the rapidly emerging field of artificial intelligence has demonstrated promise in developing diagnostic models for intractable diseases. Methods: We propose an artificial neural network model of 8 gene markers identified by 4 classification algorithms based on Gene Expression Omnibus database for diagnostic of pediatric CD. Results: The model achieved over 85% accuracy and area under ROC curve value in both training set and testing set for diagnosing pediatric CD. Additionally, immune infiltration analysis was performed to address why these markers can be integrated to develop a diagnostic model. Conclusion: This study supports further clinical facilitation of precise disease diagnosis by integrating genomics and machine learning algorithms in open-access database.

Modified Adipofascial Internal Mammary Artery Perforator Flap for Secondary Esophagoplasty.

Papillary thyroid carcinoma with esophageal invasion often requires simultaneous reconstruction after radical tumor resection. However, in a recurrent case, with the upper aerodigestive tract previously reconstructed by a free flap, the alternative option for secondary reconstruction still presents a great challenge for surgeons. Here, we describe a novel secondary cervical esophagoplasty technique using a modified adipofascial internal mammary artery perforator flap. The 2-month follow-up postoperatively showed satisfactory patency of the cervical esophagus. The modified adipofascial internal mammary artery perforator flap is a reliable and convenient technique, with better aesthetic results for secondary cervical esophageal reconstruction.

Concealed Tracheal Angiosarcoma Beneath a Large Thyroid Mass-An Unexpected Cause of Intractable Hemoptysis.

Angiosarcoma is a rare primary tracheal-bronchus origin tumor which was only reported in a few cases. The diagnosis and treatment for such a rare tumor has long been a challenge. In this case, a male hemoptysis patient who was initially misdiagnosed with thyroid carcinoma with tracheal invasion was finally diagnosed with tracheal angiosarcoma. A thick-walled cystic nodular mass was found preoperatively in the right thyroid lobe overlying the tracheal angiosarcoma, which contributed to our initial misdiagnosis. Flap bleeding and necrosis occured after the surgery and patient continued to cough blood even when we excised the whole flap, which suggested the intramural growth and local invasion of the angiosarcoma. This study also reviewed previous literactures on airway angiosarcoma and discussed the treatment strategy.

Adipofascial anterolateral thigh free flap in hypopharyngeal and oropharyngeal reconstruction.

BACKGROUND: The anterolateral thigh (ALT) flap is a popular choice for head and neck reconstruction surgery, but its ungainly thickness makes it of limited value in some intracavitary reconstructions. The ALT adipofascial flap is an improved flap without skin or muscle. Here, we seek to further illustrate the ALT adipofascial flap as an alternate method of hypopharyngeal and oropharyngeal reconstruction in head and neck. METHODS: A retrospective review of 9 patients (7 men, 2 women) ranging from 28 to 67 years (mean age, 53.1 years) who underwent reconstruction with the ALT adipofascial flap after hypopharyngeal carcinoma (4 patients) or oropharyngeal carcinoma (5 patients) resections from August 2018 to December 2019 was performed. Surgical outcomes and functional resoration were assessed. RESULTS: The size of the flaps ranged from 6 × 4 cm2 to 6 × 12 cm2 . The average flap thickness was 0.14 cm (range, 0.1-0.2 cm) and the average pedicle length was 9.8 cm (range, 7-12 cm). The postoperative course was uneventful in eight patients. Reconstruction was successful in all cases during 7-23 months of follow-up (mean time, 14.3 months). All patients resumed oral feeding for 2-8 weeks (mean time, 4.9 weeks) and the tracheal cannula was successfully removed 0.5-4 months postsurgery (mean time, 2.4 months). CONCLUSION: The ALT adipofascial flap is a viable choice for hypopharyngeal and oropharyngeal reconstructions and is thinner than the ALT flap. It could be harvested as a single-pedicled double-island flap for complex defect reconstruction.

Successful cervicothoracic esophageal stricture treatment with partial sternectomy and a pedicled TAAP flap: A case report.

Postoperative benign esophageal anastomotic leakage and stenosis are common complications after esophagectomy. Treatment options for anastomosis stenosis include endoscopic mechanical dilation, dilation-combined steroid injection, incisional therapy, stent placement, and self-bougienage. However, long-segmental cervicothoracic esophageal stenosis and cutaneous fistula are always refractory to conservative treatments and are clinically challenging. When lesions extend well below the thoracic inlet, transthoracic esophagectomy and alimentary canal reconstruction seem to be the common choice but are susceptible to perioperative mortality and donor-site sequelae, especially for patients with poor health conditions. In this report, we present a novel surgical approach for cervicothoracic esophageal stenosis and fistula via partial sternectomy and reconstruction with a pedicled thoracoacromial artery perforator flap. No recurrence or complications occurred throughout 3 months of follow-up. This case study adds new perspectives to the treatment of anastomotic stenosis.