Objective: To summarize the clinical features, endoscopic characteristics, treatment and prognosis of cap polyposis (CP) in children. Methods: In this case series study, clinical data including clinical manifestations, laboratory tests, endoscopic examinations, pathological results, treatment plans and follow-up conditions of 6 CP children diagnosed at Xi'an Children's Hospital from January 2018 to August 2025 were summarized. Results: Among the 6 children, there were 5 males and 1 female, with the age range at diagnosis of 9.2 to 14.3 years. The symptoms included bloody stool in all 6 cases, diarrhea in 4 cases, prolapse of perianal masses in 2 cases, and malnutrition in 2 cases. Among the auxiliary examinations, 3 cases were positive for 13C-urea breath test, and 5 cases were positive for Helicobacter pylori (Hp) in gastric mucosa histopathology. Colonoscopy revealed irregular polyps covered with white mucus, with 3 cases involving the rectum and 3 cases involving both the rectum and sigmoid colon. Histopathology showed inflammatory polyps covered with fibrous purulent exudate. The treatment plan included Hp eradication, mesalazine, hormone enema, thalidomide, and endoscopic polypectomy. The symptoms of all 6 children improved. Five of the children underwent re-examination with colonoscopy. Among them, 3 cases showed small polyp-like protrusions, and 2 cases showed local intestinal mucosa with slight congestion. Conclusions: CP is rare in children, with hematochezia and diarrhea as the main clinical manifestations. Colonoscopy typically reveals polyps with mucus adhering to the surface. Diagnosis requires histopathological examination, and individualized treatment should be formulated based on the specific condition of the child.

Objective: To analyze the clinical diagnosis and treatment strategies for acquired tracheoesophageal fistula (aTEF) and bronchoesophageal fistula (aBEF) in children, and explore the value of interventional bronchoscopy in their management. Methods: A case series study analyzed the clinical data of 9 pediatric patients with aTEF and aBEF admitted to the Department of Respiratory Intervention and Department of Gastroenterology, Children's Hospital Affiliated to Shandong University, from February 2014 to July 2025. The clinical features, diagnostic and therapeutic processes, and treatment outcomes were summarized. Results: Among the 9 patients, 7 were male and 2 were female, the age of onset was 1.7 (1.0, 4.0) years. Etiologies included esophageal corrosive injury due to button battery ingestion (4 cases), and 1 case each of esophageal corrosive injury from caustic alkali ingestion, esophageal perforation by foreign body, fall from height, neck stab wound, and iatrogenic injury.Clinical manifestations: 6 cases of dyspnea, 5 cases of recurrent cough and choking during feeding. There were 6 cases of aTEF and 3 cases of aBEF. Seven patients underwent interventional therapy via bronchoscopy or gastrointestinal endoscopy: 4 cases received covered metallic stent placement via bronchoscopy for fistula occlusion, 1 case underwent titanium clip closure via gastroscopy, 1 case underwent mucosal deepithelialization combined with titanium clip closure via gastroscopy, and 1 case received combined bronchoscopic stent placement, epidermal growth factor injection, and gastroscopic titanium clip closure. Seven patients underwent surgical treatment, including aTEF or aBEF repair in 6 cases, gastric fundoplication with gastrostomy in 2 cases, and jejunostomy in 1 case. Conclusions: The management of aTEF, aBEF in children is challenging. For patients presenting with respiratory symptoms, palliative interventions such as airway-covered stent placement or gastroscopic fistula clip closure can be considered to occlude the fistula. A multidisciplinary collaborative approach is essential for managing children with aTEF, aBEF, improve nutrition and manage complications to enhance the quality of life of the pediatric patients.

Little is known about the outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiopulmonary arrest occurring after major cardiac surgery. This study aimed to evaluate our institutional experience with ECPR in this setting. We retrospectively reviewed all adult patients who underwent extracorporeal membrane oxygenation (ECMO) for cardiopulmonary arrest within 30 days after major cardiac surgery outside the operating room between 2015 and 2023. Baseline characteristics, operative details, and clinical outcomes were analyzed. A total of 21 patients who underwent ECPR were identified. Index operations included valve surgery (n = 5), coronary artery bypass grafting (CABG) (n = 10), and others. The location of arrest was the intensive care unit (ICU) in 8 patients (38.1%) and the step-down unit in 13 patients (61.9%). Nine patients (42.9%) underwent central cannulation with an open chest, and 12 (57.1%) underwent femoral cannulation with chest compressions. Twelve patients (57.4%) were successfully decannulated, whereas nine (42.6%) died while on ECMO. In-hospital mortality was 47.6% (n = 10) and similar between central and femoral cannulation (44.4 vs. 50.0%; p = NS). Of the 11 in-hospital survivors, 7 (33.3%) were neurologically intact at discharge. Kaplan-Meier analysis showed a 1 year survival rate of 41.2%.

Foreign body aspiration, though uncommon, remains a potentially fatal condition associated with significant morbidity and mortality. While children constitute majority of cases, a few occur in adults-particularly in the elderly. However, chronic retained foreign bodies in the young adult population are exceedingly rare, and when encountered, pose unique challenges due to chronic inflammatory changes, excessive granulation tissue, and resultant bronchial stenosis. These factors often complicate retrieval and may necessitate surgical intervention, including lobectomy. In this case series, we present two young patients with chronic retained bronchial foreign bodies (retained for 13 years and 15 years respectively) and associated bronchial stenosis, both of whom were successfully removed with balloon bronchoplasty to dilate the stenotic segment, enabling removal of the foreign body. Notably, both patients were spared lobectomy and its associated morbidity. Both the patients showed clinical and radiological improvement post procedure and are doing well on follow-up. Foreign bodies aspirated during childhood might present in the adulthood after being undetected for years due to neglected symptoms with associated chronic changes making foreign body removal complex. This case series highlights the importance of a complete trial of bronchoscopy guided foreign body removal strategy, including balloon bronchoplasty, in patients with chronic retained foreign bodies and associated bronchial stenosis before proceeding to surgical resection especially in young patients.

To assess clinical, radiographic and functional outcomes of digital splinting in acute closed bony mallet finger injuries. This Level IV case series included 19 patients with acute bony mallet finger. Patients with loss to follow-up, chronic injuries, open lesions, or unstable, irreducible, or clearly displaced distal interphalangeal (DIP) joint subluxations not corrected by splint positioning at presentation were excluded. All patients were treated with volar splint immobilisation of the DIP joint in extension for six weeks and followed for a minimum of 12 months. Extension deficit, range of motion, radiographic consolidation and classification (Wehbe and Schneider), and functional outcomes using the DASH score were assessed. The average age of the patients was 33.6 years. The little finger was the most affected (52.6%). Most patients (84.2%) presented a fracture with an articular fragment greater than one-third of the articular surface. Overall satisfaction had a mean rating of 9.5 on a 0-10 scale (0=lowest, 10=highest). The mean DASH score was 4.3±2.8. All fractures achieved bone consolidation, and no treatment-related complications were observed. Conservative digital splinting is a reasonable nonoperative option for acute bony mallet finger treated within four weeks of injury. Satisfactory consolidation and functional outcomes were observed in fractures with larger articular fragments and in selected cases of mild, splint-reducible distal interphalangeal joint subluxation. These findings do not extend to unstable or irreducible subluxations and should be interpreted within the constraints of a descriptive case series.

Esophageal button battery impactions are pediatric emergencies with clear guidelines for pre-extraction management, but post-extraction care remains highly variable. Common practices include ICU admission, prolonged NPO, antibiotics, and extensive imaging, though the supporting evidence is unclear. We performed a scoping review, searching PubMed, Embase, and Scopus for pediatric esophageal button battery injuries reporting post-extraction management. Variables included imaging strategy and impact, ICU admission, feeding practices, and complications. Case reports, case series, and retrospective cohorts were included. Variables included imaging strategy and impact, ICU admission, feeding practices, and complications. Case reports, case series, and retrospective cohorts were included. Of 37 studies with 713 patients, complications included 47 esophageal perforations, 37 tracheoesophageal fistulas, 28 esophageal strictures, 26 mediastinitis, 23 esophageal stenoses, 11 vocal cord injuries, 4 aortoesophageal fistulas, and 3 deaths. Post-extraction imaging was reported in 83.8 % of studies with 610 patients; esophagram was most common. In studies that reported imaging details, imaging influenced postoperative management in 12/23 studies using esophagram, 5/12 studies using CXR, 4/6 studies using CT, and 2/3 studies using MRI/MRA. (These were study-level proportions as patient-level counts could not be consistently extracted and modalities overlapped).Time to feeding ranged from 1 h to 233 days via multiple routes. Among 24 studies with known timing, 12/18 resuming <7 days and 2/6 resuming ≥7 days reported morbidity or mortality. Antibiotics were explicitly given in 24 studies. Routine ICU admission, prolonged NPO, universal antibiotics, and multi-modality imaging are not standard after esophageal button battery removal. We propose a risk-stratified framework for imaging, ICU use, and feeding that reserves advanced imaging, ICU level care, and delayed feedings for patients at highest risk for complications based on their presentation and injury severity.

Rheumatic heart disease is not over: Cardiac cirrhosis and multivalvular sequelae in an endemic setting - A case series and review.

Subdermal contraceptive implants (SCIs) are a widely used form of long-acting reversible contraception (LARC) with high efficacy (Pearl Index 0.00, 95% CI: 0.00-0.14). However, upper limb neurovascular injuries related to SCI insertion and removal are increasingly reported. The true incidence of these complications cannot be reliably estimated from the current literature, which is largely limited to case reports and small case series, although sporadic cases are being described with increasing frequency. These injuries may result in significant morbidity, including chronic neuropathic pain, sensorimotor deficits, and functional impairment, yet standardized management guidelines remain lacking. This study aims to systematically review the literature on SCI-associated upper limb peripheral nerve injuries and present a case series of affected patients treated by the senior authors. The findings are intended to inform evidence-based recommendations for the prevention and management of these injuries. Following PRISMA guidelines, a systematic review of the literature was conducted to identify and characterize SCI-associated PNIs. Data extraction included demographics, injury-related factors (incidence, clinical presentation, implant type, timing of injury (insertion/removal), nerve injury classification and functional deficits at presentation, and treatment-related factors (management strategies and patient outcomes at latest follow-up). A prospectively collated bi-institutional case series of patients presenting with PNI's following SCI procedures is also presented. This systematic review identified 24 patients (mean age 28.5y, range: 19 to 51) with 26 PNIs linked to subdermal contraceptive implants. Most injuries occurred during removal (67%), with the ulnar nerve most frequently affected (52% n=14), followed by the median (26% n=7) and medial antebrachial cutaneous nerves (22% n=6). Injury severity included neuropraxia (33%, n=9), axonotmesis (26%, n=7), axonotmesis with neuroma-in-continuity (33%, n=9), and partial nerve transection (7%, n=2). Surgical intervention was required in 56% (n=13) of cases. At the latest follow-up, 39% (n=9) achieved full recovery, 43% (n=10) had partial recovery, and 9% (n=2) had no recovery. Our case series of 6 patients mirrored these findings, with injuries ranging from transient neuropraxia to persistent deficits. SCI-associated PNIs can cause significant morbidity. The ulnar nerve is particularly at risk, especially during removal, with implant impalpability contributing to injury severity. This study underscores the need for enhanced practitioner training, improved insertion and removal techniques, and consideration of alternative insertion sites to mitigate nerve injury risks. Image-guided removal should be standard practice for impalpable implants.

The aim of this study was to present three adult cases of obstructed hemivagina, and ipsilateral renal anomaly (OHVIRA) syndrome diagnosed in different gynecological centers in Poland. The clinical presentations, diagnostic imaging, surgical treatment, and outcomes were analyzed to highlight the diagnostic challenges and variability in clinical course. This retrospective case series included three female patients aged 19,20 and 30 diagnosed in adulthood with OHVIRA syndrome. All three patients were diagnosed with uterus didelphys. Two had confirmed congenital right renal agenesis, while one had undergone nephrectomy in infancy. One patient presented with severe dysmenorrhea and purulent content in the right hemivagina, initially suspected to be hematocolpos. Another patient, with a history of adolescent hematocolpos, was diagnosed postpartum during assessment following cesarean section. The third case was identified incidentally during nephrological imaging. The patient had undergone the right nephrectomy in infancy. All patients underwent resection of the vaginal septum and drainage of hematocolpos. These cases show the variable clinical presentation of OHVIRA syndrome and emphasize the importance of a detailed history and imaging evaluation. Early diagnosis remains essential to prevent complications and provide treatment.

Generative modeling of clinical time series via latent stochastic differential equations.

Asenapine (ASE) is a second-generation antipsychotic with potential efficacy against insomnia due to its pharmacological profile. This study aimed to evaluate the effects of ASE add-on therapy on sleep in schizophrenia patients. Participants in this observational study comprised four schizophrenia patients with complaints of insomnia who planned to receive ASE as add-on therapy. ASE was added to the existing pharmacological regimens and administered according to the approved dosage and administration guidelines. Pre-existing treatments were continued throughout the 28-day observation period. Psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale and subjective insomnia severity was assessed using the Insomnia Severity Index. Objective sleep parameters were evaluated using a portable sleep electroencephalogram device. Three of the four patients completed the 28-day observational period. In all three cases, ASE was effective for improving positive symptoms and subjective insomnia symptoms. However, no consistent trends in objective sleep parameters were observed. These preliminary findings suggest that ASE may be a viable adjunctive treatment option for patients with schizophrenia experiencing insomnia and positive symptoms. Further studies with larger, controlled samples are needed to validate these effects.

Immediate breast reconstruction with perforator flaps after breast-conserving surgery: A case series

As breast cancer incidence rises, aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) has become increasingly prevalent, yet treatment remains diverse and lack clearly defined therapeutic targets. We report 3 postmenopausal breast cancer patients (mean age: 64.7y) who developed AIMSS after more than 6 months of AIs therapy. After receiving denosumab and participating in slow-jogging aerobic exercise aimed at improving bone mineral density and reducing the android-to-gynoid fat ratio, all 3 patients demonstrated marked improvements in pain scores (Visual Analog Scale, VAS), grip strength, and joint imaging after one year of follow-up. Beyond traditional anti-inflammatory medications and symptom-focused management, we propose viewing AIMSS as a metabolic condition induced by hormone suppression that leads to arthritis. The combination of denosumab and slow-jogging aerobic exercise may help alleviate symptoms and improve adherence to AIs therapy in patients with AIMSS.

Cystic fibrosis (CF) is a monogenic disorder leading to pulmonary disease, pancreatic insufficiency and cystic fibrosis-related diabetes (CFRD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are now being investigated in people with cystic fibrosis (pwCF) and CFRD. To date, their therapeutic potential has been almost exclusively studied in case reports or case series. These agents improved glycated haemoglobin (HbA1c) and continuous glucose monitoring (CGM) parameters. Benefits were also observed in weight reduction, particularly for subjects on cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy elexacaftor/tezacaftor/ivacaftor (ETI). However, discordant results have also been reported. Moreover, GLP-1RAs have improved pulmonary function, even following lung transplantation. Importantly, the dual glucagon-like peptide1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide has also yielded favourable outcomes. Finally, preliminary evidence suggests potential inhibition of bone resorption, pointing to a therapeutic perspective in cystic fibrosis-related bone disease (CFBD). However, potential adverse events should not be ignored. These include risk of acute pancreatitis, nausea/vomiting, nutritional depletion, bowel dysmotility and distal intestinal obstruction syndrome, as well as others. Adverse events should be addressed with caution, and dose adjustments may be useful. Large prospective multicentre studies are now required to validate these outcomes and to suggest implications for clinical practice.

Technique of performing an epidural blood patch in spontaneous intracranial hypotension due to cerebrospinal fluid leakage from the nerve root sheath: Case series.

Effect of GLP1-Receptor Agonist Therapies for Patients with a LVAD and Obesity: A Case Series

Reported rates of return to the preinjury level of play (RTPL) after superior labrum anterior and posterior (SLAP) repair in overhead athletes are relatively low (22%-64%). Current fixation techniques that rigidly fix the posterosuperior labrum may lead to overconstraint and persistent pain. The purpose of this study was to retrospectively evaluate the clinical outcomes and RTPL rates of our surgical strategy in competitive baseball throwers with SLAP lesions. This strategy includes debridement of the posterosuperior labrum without fixation, with selective anterosuperior fixation when anterior extension and instability of the labral detachment are present. The authors hypothesized that posterosuperior and posterior debridement with or without anterosuperior repair would yield high return to play rates in baseball throwers with SLAP lesions. Case series; Level of evidence, 4. A total of 80 shoulders in 80 baseball players (mean age, 20 years [range, 15-38 years]) underwent arthroscopic surgery for SLAP lesions (Type II or Type VIII with posterior extension). The cohort included 16 professional, 31 collegiate, 23 high school, and 10 recreational players. Based on intraoperative findings, isolated debridement of the posterosuperior and/or posterior labrum was performed for stable lesions, defined as posterosuperior detachment without gross instability or lift-off of the superior labrum (n = 33), while anterosuperior repair, defined as suture anchor fixation of the unstable anterior labrum, was added only if the detachment extended anteriorly and demonstrated instability of the labrum in this region (n = 47). The primary outcome was the RTPL rate, defined as return to the preinjury level of play. Secondary outcomes included the time to RTPL and subgroup comparisons according to procedure, player position, and competition level. Of the 80 players, 79 (99%) returned to competitive baseball play; 1 player failed to return secondary to persistent shoulder pain. Overall RTPL was 79% (63/80). The RTPL rate was 73% (24/33) in the debridement-alone group and 83% (39/47) in the anterosuperior repair group (P = .27). Pitchers achieved an RTPL rate of 81% (38/47), and professional players achieved an RTPL rate of 75% (12/16). The mean time to RTPL was 9 months overall. There were no significant differences in RTPL rates or time to return between procedure types, player position, or competition level. This surgical strategy involving debridement of the posterosuperior labrum yielded high RTPL rates regardless of whether anterosuperior repair was performed. Avoiding rigid fixation of the posterosuperior labrum may be a key to successful outcomes in competitive throwing athletes.

Microaxial Left Ventricular Assist Device as a Bridge to Delayed Surgical Repair of Post-Infarct Ventricular Septal Defect: A Case Series

Methicillin-resistant Staphylococcus aureus (MRSA) endovascular infections are associated with high mortality. The increasing reports of clinical failure and toxicities associated with first-line vancomycin provide a medical need for alternative therapies. In this narrative review, we analyze studies published from 2017 to 2025 on the efficacy and tolerability of ceftaroline, a β-lactam antibiotic with anti-MRSA activity, for off-label treatment of endovascular infections. Identified publications included 1 randomized controlled trial (RCT), 17 retrospective cohort studies, four case series, and one meta-analysis. Failure rates were similar between ceftaroline, vancomycin, and daptomycin when used as monotherapies. Ceftaroline, used in combination with vancomycin or daptomycin, showed efficacy and tolerability in high-risk MRSA bacteremia cases. Although higher-level evidence is needed to definitively establish ceftaroline as a mainstay treatment of MRSA endovascular infections, the current evidence positions ceftaroline as one of several antibiotic strategies in serious cases of MRSA endovascular infections.

Inferiorly-hinged transnasal advancement flap with back-cut for medial canthal reconstruction: A case series.