Nursing of forearm hematoma after transradial coronary intervention.

Background: Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. Material and methods: By observing, describing, and analyzing the pictures taken during clinical diagnosis and consultation, we summarize the prevention, treatment, and nursing of forearm hematoma after percutaneous coronary intervention, to provide reference for the nursing of patients with forearm hematoma. Results: We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma. Conclusion: Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma, providing reference for the prevention and management of forearm hematoma in clinical practice. For patients undergoing transradial coronary intervention, the three key time points for preventing hematoma and symptomatic management based the risk classification of forearm hematoma are crucial.

Two assumptions of the prior event rate ratio approach for controlling confounding can be evaluated by self-controlled case series and dynamic random intercept modelling.

OBJECTIVES: The prior event rate ratio is a recently developed approach for controlling confounding by measured and unmeasured covariates in real-world evidence research and observational studies. Despite its rising popularity in studies of safety and effectiveness of biopharmaceutical products, there is no guidance on how to empirically evaluate its model assumptions. We propose two methods to evaluate two of the assumptions required by the prior event rate ratio, specifically, the assumptions that occurrence of outcome events does not alter the likelihood of receiving treatment, and that earlier event rate does not affect later event rate. STUDY DESIGN AND SETTING: We propose using self-controlled case series (SCCS) and dynamic random intercept modelling (DRIM) respectively, to evaluate the two aforementioned assumptions. A non-mathematical introduction of the methods and their application to evaluate the assumptions are provided. We illustrate the evaluation with secondary analysis of de-identified data on pneumococcal vaccination and clinical pneumonia in The Gambia, West Africa. RESULTS: SCCS analysis of data on 12,901 vaccinated Gambian infants did not reject the assumption of clinical pneumonia episodes had no influence on the likelihood of pneumococcal vaccination. DRIM analysis of 14,325 infants with a total of 1,719 episodes of clinical pneumonia did not reject the assumption of earlier episodes of clinical pneumonia had no influence on later incidence of the disease. CONCLUSION: The SCCS and DRIM methods can facilitate appropriate use of the prior event rate ratio approach to control confounding.

Effectiveness and safety of tildrakizumab in individuals with HIV and psoriasis: A case series.

Psoriasis, a chronic inflammatory skin disease, presents unique challenges when co-occurring with HIV. Tildrakizumab, an IL-23p19 inhibitor, has demonstrated efficacy in treating moderate-to-severe psoriasis. This retrospective case series reports three individuals living with HIV and psoriasis treated with tildrakizumab. Clinical outcomes, including Psoriasis Area and Severity Index (PASI) and HIV viral load, were recorded over a year. All three patients achieved significant clinical improvements with tildrakizumab, with PASI scores improving by over 95%. No adverse effects were reported, and HIV viral loads remained undetectable. Tildrakizumab appears to be a safe and effective treatment option for psoriasis in individuals living with HIV, providing significant benefits without compromising HIV control.

Dengue encephalitis - An unusual case series.

Dengue infection can take on many different forms, ranging from no symptoms to a mild fever, all the way to a severe condition known as dengue shock syndrome. Although the typical symptoms of dengue are well known, the virus can also cause rare neurological complications. Dengue encephalitis is a severe form of neuroinvasive dengue that can be fatal as the virus directly affects the central nervous system. This case series provides a comprehensive overview of dengue, its clinical spectrum, and the potential for severe neurological complications such as dengue encephalitis. It highlights the importance of considering dengue as a possible diagnosis in patients with encephalitis, particularly during a dengue epidemic.

Association Between Influenza Vaccination and Acute Kidney Injury Among the Elderly: A Self-Controlled Case Series.

BACKGROUND: Several cases of renal complications, including acute kidney injury (AKI), after influenza vaccination have been reported, but the association remains unproven. We evaluated the association between influenza vaccination and AKI occurrence among the Korean elderly in the 2018-2019 and 2019-2020 seasons. METHODS: We used a large database combining vaccination registration data from the Korea Disease Control and Prevention Agency and claims data from the National Health Insurance Service. The study subjects were patients hospitalized with AKI for the first-time following vaccination among those who received one influenza vaccine in the 2018-2019 or 2019-2020 season. Only those aged 65 or older at the date of vaccination were included. We performed a self-controlled case series study, designating the risk period as 1 to 28 days post-vaccination and the observation period as each influenza season. The adjusted incidence rate ratio (aIRR) was calculated by adjusting for nephrotoxic drug use and influenza infection that may influence AKI occurrence using a conditional Poisson regression model. RESULTS: A total of 16 713 and 16 272 AKI events were identified during the 2018-2019 and 2019-2020 seasons, respectively. The aIRR for AKI was 0.83 (95% confidence interval [CI] = 0.79-0.87) in the 2018-2019 season. The aIRR for the 2019-2020 influenza season was similar to the 2018-2019 season (aIRR = 0.86; 95% CI = 0.82-0.90). CONCLUSIONS: Influenza vaccination is associated with a lower risk of AKI in the elderly over 65. This evidence supports the recommendation of annual influenza vaccination for the elderly. Further studies are needed to determine the biological mechanisms linking the influenza vaccine and AKI.

Role of Autologous Platelet-Rich Fibrin in Chronic Non-healing Ulcers With Various Etiologies in a Tertiary Care Rehabilitation Centre: A Case Series.

Introduction Chronic non-healing ulcers are defined as a discontinuity or break in the integrity of skin that is not healing in a reasonable period of time due to an underlying systemic etiology. Despite using conventional initial treatment and many other available dressing options, such wounds are difficult to completely heal, thus affecting the progress of rehabilitation measures and compromising functional improvement and quality of life. Materials and methods In this case series, platelet-rich fibrin (PRF) was applied to eight wounds from six patients. The patients included had various etiologies (including spinal cord injury, peripheral vascular disease, Guillain-Barré syndrome, and diabetic foot ulcer) with chronic non-healing wounds over different anatomical locations on the body. Pressure ulcer scale for healing (PUSH) score, surface area, and volume of the wounds were evaluated and monitored weekly after PRF dressing. We have applied PRF every week. On average, two PRF dressings were applied, the maximum being three applications. Results The maximum healing rate in terms of PUSH score was observed to be 3.84% per day, and the minimum was 1.19% per day. The maximum healing rate in terms of surface area was observed to be 5.89% per day, and the minimum was 1.78% per day. Three of the wounds showed complete closure. The maximum follow-up period was 10 weeks. The percentage mean Functional Independence Measure (FIM) improvement was calculated to be 15.87% ± 14.04 during the course of hospitalization after PRF application. Conclusion Based on the results, we can conclude that PRF showed accelerated improvement in the healing of chronic non-healing ulcers of various etiologies at different anatomical locations. It has proven to be a safe and effective method, thereby improving their quality of life and functional independence in performing activities of daily living. To our knowledge till date, no other study in a rehabilitation setting has been done on patients having non-healing ulcers due to various etiologies and at different anatomical locations.

Addressing complexities in ß-thalassemia care: a case series from a resource-limited setting.

Introduction and importance: ß-thalassemia is a hereditary blood disorder with a global prevalence, presenting diagnostic and management challenges, particularly in regions with high consanguinity rates. Diagnostic methods include clinical assessments, genetic testing, and hemoglobin electrophoresis. Treatment typically involves transfusions and chelation therapy, with gene therapy showing promise. This case series emphasizes the need for tailored care strategies and global health initiatives to improve outcomes for ß-thalassemia patients worldwide. Methods: This case series involves five patients from rural Nepal presenting various ß-thalassemia manifestations. The cases highlight the challenges in diagnosis and management in resource-limited settings. Data were collected through clinical assessments, laboratory investigations, and follow-ups. Each patient's medical history, presentation, and treatment regimen were documented. Outcomes: The cases underscore the importance of regular follow-ups, community engagement, and personalized treatment strategies tailored to genetic profiles. Key findings include the necessity for consistent transfusion schedules, iron overload monitoring, and managing complications associated with ß-thalassemia. Enhanced education and healthcare collaboration were noted as critical for optimizing care and outcomes in resource-limited settings. Conclusions: Managing ß-thalassemia in resource-limited settings demands timely intervention, regular monitoring, and community involvement. Enhanced healthcare collaboration, access to advanced diagnostic tools, and tailored treatment strategies are paramount in addressing the unique challenges of ß-thalassemia. These measures are essential for ensuring an improved quality of life for affected individuals in such regions.

The Effectiveness of Hyperbaric Oxygen Treatment in Patients with Complex Regional Pain Syndrome: A Retrospective Case series.

Background: Complex regional pain syndrome (CRPS) presents as persistent regional pain, both spontaneous and triggered. The demand persists for innovative treatments that patients can endure with minimal adverse effects. Hyperbaric oxygen therapy (HBOT) emerges as a possible intervention in this regard. Methods: The main objective of this work is to retrospectively analyse a case series of patients diagnosed with CRPS treated in the Centre of Hyperbaric Medicine Ostrava over two years (period 2018-2019). The HBOT was applied at 2.0-2.4 absolute atmosphere (ATA) once a day. Results: A total of 83 patients with CRPS were treated with HBOT. 98% of cases reported pain, 92% reported limitation of movement of the affected limb, 87% had swelling of the limb, 41% had lividity and 70% had sensory problems. The mean number of HBOT exposures was 22.0 ± 7.1. At the end of HBOT treatment, 86% of cases had symptoms relief. The mean VAS value of pain at rest before the start of HBOT was 3.2±3.0, after treatment it was 1.6±1.9 (p<0.001). In a pain at activity it was 6.1±2.4 and 3.7±2.4 (p<0.001), respectively, at the end of HBOT. The value of the functional assessment of the limb was 7.0±2.0 and 4.3±2.4 (p<0.001), respectively, at the end of treatment. 79 cases were included in the end-of-treatment assessment. 23 cases (29%) were evaluated as large clinically significant response, 48 cases (61%) were evaluated as partial response with minimally important difference. The results showed larger clinical HBOT effect in cases of disease duration up to 3 and 6 months (p=0.029). Conclusions: The majority of patients improved pain and functional state of the affected limb. Our data also suggests the sooner after diagnosis of CRPS is HBOT started, the treatment has larger clinical effect. There was no serious HBOT-related complication or injury.

SYNGAP-1 Mutation And Catatonia: A Case Series And Systematic Review.

Introduction: Hyperactive catatonia is often unrecognized in pediatric patients due to its clinical heterogeneity, though it is often seen in children with neurodevelopmental disabilities, especially autism spectrum disorder (ASD). Emerging evidence implicates hyperactive catatonia in more cases of self-injury and aggression in ASD than previously thought. Objectives: The study seeks to describe cases of hyperactive catatonia in SYNGAP-1 mutation and examine existing literature for symptomatic overlap between previously-described clinical and behavioral phenotypes of individuals with SYNGAP-1 mutations and catatonia. Methods: The study describes two cases of an adolescent and a young adult with SYNGAP-1 mutation and ASD presenting with hyperactive catatonia, which are the first reports of catatonia in individuals known to have a pathogenic variant in SYNGAP-1. A systematic review was undertaken during which 101 articles were screened. 13 articles were then examined for neurological and behavioral features present in participants with SYNGAP-1 mutations which are seen in catatonia. Results: The systematic review demonstrates that clinical features suggestive of catatonia are frequently seen among individuals with SYNGAP-1 mutations, including verbal impairment, psychomotor symptoms, aggression, oral aversion, and incontinence. These features were also present in the cases of catatonia in SYNGAP-1 mutations presented here. Both patients showed clinical improvement with use of a long-acting benzodiazepine, and one patient showed benefit from electroconvulsive therapy. Conclusions: This symptomatic overlap revealed in the systematic review, including symptoms seen in the reported cases, raises the possibility that diagnoses of catatonia may have been missed in the past in individuals with SYNGAP-1 mutations. Self-injurious behavior and aggression, which are hallmarks of hyperactive catatonia, are commonly part of the behavioral phenotype of SYNGAP-1-related disorders. Clinicians should consider catatonia as a cause of such symptoms in individuals with SYNGAP-1 mutations, as effective treatment can result in significant improvement in safety and quality of life.

Risk of bowel obstruction in patients with colon cancer responding to immunotherapy: an international case series.

BACKGROUND: Immunotherapy is used routinely for treating deficient mismatch repair (dMMR) colon cancer (CC). This case series highlights an emerging safety issue, where patients develop bowel obstruction associated with immunotherapy response. PATIENTS AND METHODS: Patients with dMMR CC who developed bowel obstruction while responding to immunotherapy were retrospectively identified. Data on patient, disease, treatment, and response-specific factors were explored for potential risk factors. Overall treatment numbers were used to estimate incidence. RESULTS: Nine patients from eight European centres were included. Common features were hepatic flexure location (5/9), T4 radiological staging (6/9), annular shape (8/9), radiological stricturing (5/9), and endoscopic obstruction (6/9). All received pembrolizumab and obstructed between 45 and 652 days after starting treatment. Seven patients underwent surgical resection; one was managed with a defunctioning stoma; and one was managed conservatively. One patient died from obstruction. Radiological response was seen in eight patients, including two complete responses. Pathological response was seen in all seven who underwent resection, including four complete responses. The overall incidence of immunotherapy response-related obstruction in these centres was 1.51%. CONCLUSIONS: Bowel obstruction associated with immunotherapy response may represent a rare treatment-related complication in dMMR CC. Clinicians must recognise this safety signal and share experience to maintain patient safety.

Peritoneal baclofen pump migration: a rare complication of subfascial placement. Illustrative cases.

BACKGROUND: The intrathecal baclofen pump is an effective treatment option for patients with severe spasticity. In children, subfascial pump placement is often preferred given concerns for infection and wound healing. However, this approach is not without risk, and rare complications, such as peritoneal pump migration, can occur. OBSERVATIONS: The authors describe three pediatric cases of peritoneal pump migration at their institution over the past 14 years (3/545, 0.5%). All three patients had low body weight (below the 39th percentile), and two had scoliosis requiring surgery. All pumps had been placed using the subfascial technique. The first case occurred 6 months postplacement, and the pump was not replaced. Cases 2 and 3 occurred at 2 and 3 years postplacement, respectively, and both pumps were replaced. LESSONS: The authors conclude that peritoneal pump migration, although uncommon, can occur in patients with subfascial pump placement, and providers should have a low threshold of suspicion for repeat imaging prior to refilling if the pump's location has migrated. Potential contributing factors to pump migration include a patient's small size, a larger pump size (40-mL pump), and scoliosis. All these factors should be considered during pump placement, and surgeons can consider using a 20-ml pump for smaller patients. https://thejns.org/doi/abs/10.3171/CASE24290.

Description of the etiological factors behind acute moderate and severe malnutrition in children under 5 years hospitalized at two high-complexity referral centers: Case series.

BACKGROUND: Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. METHODS: This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. RESULTS: Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. CONCLUSIONS: The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

Grace periods and exposure misclassification in self-controlled case-series studies of drug-drug interactions.

The self-controlled case-series (SCCS) research design is increasingly used in pharmacoepidemiologic studies of drug-drug interactions (DDIs), with the target of inference being the incidence rate ratio (IRR) associated with concomitant exposure to the object plus precipitant drug versus the object drug alone. While day-level drug exposure can be inferred from dispensing claims, these inferences may be inaccurate, leading to biased IRRs. Grace periods (periods assuming continued treatment impact after days' supply exhaustion) are frequently used by researchers, but the impact of grace period decisions on bias from exposure misclassification remains unclear. Motivated by an SCCS study examining the potential DDI between clopidogrel (object) and warfarin (precipitant), we investigated bias due to precipitant or object exposure misclassification using simulations. We show that misclassified precipitant treatment always biases the estimated IRR toward the null, whereas misclassified object treatment may lead to bias in either direction or no bias, depending on the scenario. Further, including a grace period for each object dispensing may unintentionally increase the risk of misclassification bias. To minimize such bias, we recommend 1) avoiding the use of grace periods when specifying object drug exposure episodes; and 2) including a washout period following each precipitant exposed period.

Is Anterior Cervical Discectomy and Fusion Sufficient for Neglected Unstable Hangman's Fracture? A Retrospective Case Series of Five Patients.

Introduction: This study investigates the outcomes of treating neglected unstable Hangman's fractures through a single-stage Anterior Cervical Discectomy and Fusion (ACDF) procedure with tricortical iliac crest bone grafts. Methods: Five patients with neglected unstable Hangman's fractures, treated at our institution between March 2012 and March 2017, underwent C2-C3 ACDF. Functional outcomes were assessed using the Visual Analog Scale (VAS) score and Neck Disability Index (NDI), and neurological evaluation was done using the American Spinal Injury Association (ASIA) grading system. The radiological assessment included serial plain radiographs and a computed tomography scan at a 12-month follow-up. Results: Postoperatively, C2-C3 angulation improved significantly, decreasing from 15° to 4.4°, and sagittal translation improved from 4.2 mm to 2 mm. The VAS score improved from 6.4 to 1.4 at 24 months postsurgery. Concurrently, NDI decreased from 70.4% to 14.8%. Fusion occurred in an average of 5.6 months. Neurologically, one patient improved from ASIA grade D to grade E, while the other four retained their grade E status. Conclusions: A single-stage ACDF with autologous iliac crest bone grafts is an effective surgical option for neglected type II/IIA Hangman's fractures, yielding satisfactory functional and radiological outcomes. This technique significantly corrects anterior translation and angulation, even in neglected cases, with the aid of intraoperative skull traction and plate reduction.

Misconception of 'malignant' and 'scissor-like compression' of interarterial course in anomalous aortic origin of a coronary artery: a case series.

Background: The notion that the 'interarterial' segment of anomalous aortic origin of a coronary artery (AAOCA) is 'malignant' and 'scissor-like' compressed between the aorta and pulmonary artery (PA) is debated, owing to the lower pressure in the pulmonary system compared with that in the coronary system. However, data supporting or refuting this belief under stress conditions are lacking. Case summary: Three cases of right AAOCA with interarterial/intramural courses (52, 66, and 51 years old) were assessed. Invasively measured fractional flow reserve (FFR) under dobutamine was 0.85, 0.82, and 0.81, respectively. Intravascular ultrasound illustrated lateral vessel compression of the intramural course with a decrease of minimal lumen area (MLA) (i.e. 5.71-3.47 mm2, 5.88-4.00 mm2, and 5.85-4.06 mm2) under stress conditions with heart rates of 130, 140, and 150 b.p.m., respectively. Pulmonary artery pressure (PAP) increased from rest {s/d (m) [systolic/diastolic (mean)] 22/11 (15), 15/2 (5), and 24/6 (14) mmHg} to stress [s/d (m) 47/24 (36), 30/3 (11), and 36/22 (24) mmHg] and remained below aortic peak pressure (blood pressure, BP) rest [s/d (m) 116/64 (91), 94/48 (71), 99/53 and (62) mmHg]; BP stress [s/d (m) 142/63 (80), 123/63 (88), and 86/46 (62) mmHg]; coronary pressure (CoP) rest [s/d (m) 100/59 (80), 80/45 (62), and 83/47 (63) mmHg]; and CoP stress [s/d (m) 95/60 (69),101/54 (72), and 70/32 (50) mmHg]. Conclusion: This case series challenges the assumption that the interarterial segment of AAOCA is scissor-like compressed by both the aorta and PA. The decrease in MLA and FFR under stress is due to the aorta's unidirectional lateral compression on the intramural segment. Additionally, the term 'malignant' should not be universally applied to all AAOCA cases with an interarterial course, as not all result in haemodynamic significance.

Two case reports of coronary spastic angina accompanied by the menstrual cycle.

Background: Coronary spastic angina (CSA) in premenopausal women is not frequent but has also been suggested to be associated with oestrogen decline during the menstrual cycle and sometimes becomes refractory and difficult to control. We experienced two premenopausal women with CSA that showed the involvement of the menstrual cycle. Case summary: Case 1: 41-year-old-woman had ST-segment elevation and chest pain during urosepsis, just 2 days after the onset of menstruation. The acetylcholine stress test was performed according to the menstrual cycle, and multiple coronary spasms were induced. Case 2: 40-year-old-woman had refractory chest pain as a symptom of premenstrual syndrome (PMS). Coronary angiography on drugs at the maximum dose revealed spontaneous multiple coronary spasms. Blood levels of oestrogen were normal, suggesting that hormonal change may be involved, and the introduction of low-dose pills made free from angina and the reduction of drug dose. Discussion: In premenopausal female angina pectoris, oestrogen may play a role; it is important to ask about the menstrual cycle and history of PMS. Besides, the timing of catheterization in premenopausal women with suspected CSA should be considered. Low-dose pills may be effective in some cases, and active medical collaboration with other departments such as gynaecology is desirable.　.

Sternal fixation and autologous bone grafting for post sternotomy non-union: a case series.

Background: Sternal non-union is a rare but serious complication post cardiac surgery. It is defined as sternal pain with clicking, instability or both, lasting for more than 6 months in the absence of infection. It usually presents in an outpatient setting and is confirmed on computed tomography (CT) scanning. Despite many corrective methods described in the literature, there is a lack of consensus amongst cardiac surgeons as to the ideal surgical management of sternal non-union post cardiac surgery. We describe our experience of sternal plating combined with autologous iliac crest bone grafting (AICBG) for sternal fixation and explore its safety and feasibility in patients with non-union post cardiac surgery. Case Description: Patients who underwent sternal non-union surgery between 2015 and 2020 were included. Their primary cardiac surgical interventions occurred between 2011-2018. Demographic, clinical and outcome data obtained from a local database was analyzed retrospectively. Surgical procedure: sternal edge debridement, plate fixation with screws, filling with AICBG. Due to variable pathoanatomy of non-union, residual wires and multiple fragments of poor bone quality were cut and the sternal halves were stabilised by titanium plates and screws. These were reinforced with AICBG applied in the residual sternal gap created after debridement. Seven patients were included in the study. Median age was 65 years (54-75 years). Four patients (57.1%) were male. Demographic risk factors for sternal non-union prior to their initial cardiac surgery included diabetes (N=6), smoking history (N=3), and a median body mass index (BMI) of 31.2 kg/m2. The median interval between primary surgery and sternal fixation was 2.2 years. There were no perioperative deaths. Complications post sternal plating such as iliac crest pain (n=3) and acute tubular necrosis (n=1) were managed conservatively with long-term resolution. None of the patients required further intervention post sternal fixation after a mean follow-up of 18.0 months. Conclusions: The use of AICBG in addition to sternal plating is a viable and innovative method of treating sternal non-union post-cardiac surgery with lasting effects and without any serious long-term complications. However, further larger studies are required to validate our results.

One-stop hybrid operation versus microsurgery for treating brain arteriovenous malformation in children-a retrospective case series.

Background: Brain arteriovenous malformation (BAVM) is one of the most common causes of cerebral hemorrhage in children. The effectiveness of one-stop hybrid operation in the treatment of BAVM in adults has been widely confirmed, but there are few study for the case in children. The aim of this study was to retrospectively analyze of the role and significance of one-stop hybrid surgery versus microsurgery in the treatment of BAVM in children. Methods: A total of 57 children (≤18 years old) with BAVM who were admitted to The 900th Hospital and Fujian Children's Hospital between September 2018 and August 2022 were retrospectively analyzed. According to the inclusion and exclusion criteria, 38 patients were included, and they were divided into a microsurgical group (25 patients) and a hybrid operation group (13 patients) according to the treatment modality. The following clinical characteristics were observed: sex, age, initial symptoms, presence or absence of signs, Glasgow Coma Scale (GCS) score, Hunt-Hess grade, imaging characteristics such as the location of the BAVM, Spetzler-Martin (S-M) grade, presence of intraventricular hemorrhage, treatment and prognostic indicators such as intraoperative blood loss, operation time, imaging cure, postoperative complications, length of hospital stay, and 3- and 6-month modified Rankin score (mRS) after the operation. Results: The proportions of female patients (P=0.042), patients whose BAVM were located in the supratentorial region (P=0.034) and patients whose S-M grade was above grade III (P=0.003) were greater in the hybrid operation group than those in the microsurgical group. The intraoperative blood loss (P<0.001), operation time (P<0.001) and postoperative hospital stay (P=0.024) of patients in the microsurgical group were greater than those in the hybrid operation group. The presence of signs and the S-M grade may be relevant factors in predicting the surgical approach, and the probability of selecting a hybrid operation for each step of increasing the S-M grade was 3.046 times that of microsurgery. Conclusions: A one-stop hybrid operation is effective and safe for the treatment of BAVM in children. High S-M grades of BAVM are more suitable for hybrid operation.

Modified SMILE (mSMILE) is active in the treatment of pediatric Epstein-Barr virus-associated natural killer/T-cell lymphoma: a single center experience, case series.

Background: The Epstein-Barr virus-associated natural killer (NK) and T-cell lymphoma (EBV + NK/T cell lymphoma) is a severe illness mainly affecting children and young adults, often resulting in a poor prognosis. To date, there is no consensus on an established treatment strategy. This study aims to evaluate the efficacy and safety of the mSMILE (modified steroid, methotrexate, ifosfamide, L-asparaginase, and etoposide) chemotherapy regimen in treating EBV+ NK/T-cell lymphoma and to provide insights into potential treatment outcomes. Methods: In this study, we conducted a retrospective analysis of the clinical data and treatment outcomes for patients with EBV + NK/T cell lymphoma treated at Children's Hospital of Nanjing Medical University between July 2017 and January 2022. These patients received at least two cycles of the mSMILE chemotherapy, in which a single dose of pegaspargase was substituted for 7 doses of L-asparaginase per cycle. Results: Eight patients were included in the study: one with extranodal NK/T-cell lymphoma, one with primary nodal NK/T-cell lymphoma, and six with Systemic EBV+ NK/T cell lymphoma of childhood. The results showed that five patients achieved complete remission, two achieved partial remission, and one showed progressive disease, resulting in a complete remission rate of 62.5% and an overall response rate of 87.5%. The 3-year overall survival (OS) and event-free survival (EFS) rates were 87.5% and 75%, respectively. The most common adverse reactions associated with chemotherapy were hematologic toxicities of stages III to IV. Nonhematologic adverse reactions mainly included impaired liver function, infections, and oral mucositis, which were resolved with aggressive anti-infective therapy. Conclusions: Based on our clinical experience, the mSMILE appears to be a safe and effective treatment option for EBV + NK/T-cell lymphoma, meriting further investigation in late-phase clinical trials.