Clinical Experience In Treatment Research Articles

Glottic Kaposi's sarcoma.

Kaposi's sarcoma was first described by the Hungarian dermatologist Moritz Kaposi in 1872. This mysterious vascular tumor has since received increasing attention, especially after its association with AIDS was discovered in 1981. Kaposi's sarcoma is an indicative disease of AIDS, which is clinically divided into four forms: the classic (Mediterranean), endemic (African), epidemic (HIV/AIDS-associated), and iatrogenic (transplant-related). All four types share the same causative virus but have distinct epidemiological and clinical presentations [1,2]. Kaposi's sarcoma is now considered as a low-grade vascular tumor and is caused by Kaposi's sarcoma herpesvirus/human herpesvirus-8 (KSHV/HHV-8) infection [3,4]. It usually involves the skin, lymphatic system and viscera, most notably the respiratory and gastrointestinal tracts [5–7], whereas involvement of the glottis alone is rare. In particular, acute laryngeal obstruction occurs when Kaposi's sarcoma completely obstructs the glottis, which is life-threatening. This report summarized the clinical diagnosis and treatment of a case of AIDS complicated with glottic Kaposi's sarcoma. A 31-year-old man with HIV infection, had a history of homosexual sex. Antiviral drugs were stopped 2 years ago after antiretroviral therapy (ART) failure. Hoarseness and dyspnea occurred 3 months before admission without obvious inducement and became significantly worse after exercise. Since then, the symptoms gradually aggravated, and the patient were transferred to the infection department of our hospital for hospitalization. Fiberoptic bronchoscopy: under the microscope, purplish red nodules with different sizes of 0.3–0.8 cm are fused into clusters (Fig. 1a). Laboratory studies showed that antibody testing for HIV type 1 was positive. The viral load was 237 000 copies per milliliter (reference range, <40), and the CD4+ cell count was 2 per cubic millimeter (reference range, 500–1200). Glottic biopsy specimen staining with hematoxylin–eosin (HE) showed that spindle cell tumor (Fig. 1c) and immunohistochemical (IHC) testing for HHV-8 was positive (Fig. 1d). These findings were consistent with Glottic Kaposi's sarcoma. Highly active antiretroviral therapy regimen was treated with Albuvirtide+Twinaqt, and tracheotomy was performed. Two weeks after operation, the metal endotracheal tube was replaced. The patient breathed with tube, and was given liposomal doxorubicin 20 mg/m2 ivgtt D1 q3w chemotherapy for one course of treatment. After 3 months, laryngoscope was rechecked, and the glottic mucosa completely returned to normal (Fig. 1b). The patient's voice returned to normal without dyspnea. The metal endotracheal tube was successfully removed. After the tracheotomy fistula was closed, the patient continued to complete four chemotherapy courses, and then the rechecked viral load was less than 40 copies per milliliter, and the CD4+ cell count was 246 per cubic millimeter.Fig. 1: Fiberoptic bronchoscopy showed that there were multiple purplish red nodules of different sizes of 0.3–0.8 cm.Clinically, Kaposi's sarcoma mainly involves the skin and gastrointestinal mucosa, and only involving the glottis leading to acute respiratory obstruction is extremely rare. There is little clinical diagnosis and treatment experience. At present, there is no unified standard for the treatment of Kaposi's sarcoma. Radiotherapy, chemotherapy, local freezing, laser, surgical resection, and other methods can be selected, and HAART treatment needs to be restarted. For this rare case of AIDS complicated by glottis Kaposi's sarcoma with serious acute laryngeal obstruction and dyspnea, if not treated in time, it will lead to airway obstruction, even life-threatening. The patient had severe immune deficiency and extremely low CD4+ cells. If tracheotomy or thyrocricocentesis is performed according to the treatment principle of conventional patients to relieve airway obstruction, it may lead to incision infection, fistula nonunion, tracheal stenosis, and even sepsis and MODS. Therefore, in this case, we innovated the treatment mode, focusing on minimally invasive treatment, and selected the tracheal tube matching with the narrow airway through nasal tracheal intubation to open the airway to relieve airway obstruction, save lives, and win time for the next treatment; Then the oral cavity was chosen as the treatment path, with a wider field of vision exposure, and the glottis tumor was removed by high-frequency electrosection. To sum up, our treatment method can avoid trachea stenosis, intubation breathing and long-term inability to speak caused by incision infection, which will seriously affect the quality of life. Nasal intubation and oral treatment do not interfere with each other and have no impact on the operation. Furthermore, minimally invasive treatment eliminates new microorganisms, immediately relieves airway obstruction, is more conducive to retaining tissue samples, and is not easy to relapse after extubation. There are also few complications, a short hospitalization time, and a low cost. In conclusion, we summarized the diagnosis and treatment experience of this rare case, hoping to provide reference for the diagnosis and treatment of similar patient. Acknowledgements Conflicts of interest There are no conflicts of interest.

Clinical management and prognosis for descending necrotizing mediastinitis

Objective: To investigate the clinical characteristics, treatment experiences and prognostic factors for descending necrotizing mediastinitis (DNM). Methods: A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People's Hospital from January 2016 to August 2022, including 16 males and 6 females, aged 29-79 years. After admission, all patients underwent CT scanning of the maxillofacial, cervical, and thoracic regions to confirm their diagnoses. Emergency incision and drainage were performed. The neck incision was treated with continuous vacuum sealing drainage. According to the prognoses, the patients were divided into cure group and death group, and the prognostic factors were analyzed. SPSS 25.0 software was used to analyze the clinical data. Rusults: The main complaints were dysphagia (45.5%, 10/22) and dyspnea (50.0%, 11/22). Odontogenic infection accounted for 45.5% (10/22) and oropharyngeal infection accounted for 54.5% (12/22). There were 16 cases in the cured group and 6 cases in the death group, with a total mortality rate of 27.3%. The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7% and 40%. Compared with the cured group, the death group had higher incidences for diabetes, coronary heart disease and septic shock (all P<0.05). There were statistically significant differences between the cure group and the death group in procalcitonin level (50.43 (137.64) ng/ml vs 2.92 (6.33) ng/ml, M(IQR), Z=3.023, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score (16.10±2.40 vs 6.75±3.19, t=6.524, P<0.05). Conclution: DNM is rare, with high mortality, high incidence of septic shock, and the increased procalcitonin level and APACHE Ⅱ score combined diabetes and coronary heart disease are the poor prognostic factors for DNM. Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center.

Growth hormone (GH)/thyroid stimulating hormone (TSH) cosecreting pituitary adenoma (PA) is an exceedingly rare kind of bihormonal pituitary neuroendocrine tumors (PitNETs). Its clinical characteristics have rarely been reported. This study aimed to summarize the clinical characteristics and experience of diagnosis and treatment among patients with mixed GH/TSH PAs from a single center. We retrospectively reviewed GH/TSH cosecreting PAs from 2063 patients diagnosed with GH-secreting PAs admitted to Peking Union Medical College Hospital between January 1st, 2010, and August 30th, 2022, to investigate the clinical characteristics, hormone detection, imaging findings, treatment patterns and outcomes of follow-up. We further compared these mixed adenomas with age- and sex-matched cases of GH mono-secreting PAs (GHPAs). The data of the included subjects were collected using electronic records from the hospital's information system. Based on the inclusion and exclusion criteria, 21 GH/TSH cosecreting PAs were included. The average age of symptom onset was 41.6 ± 14.9 years old, and delayed diagnosis occurred in 57.1% (12/21) of patients. Thyrotoxicosis was the most common complaint (10/21, 47.6%). The median inhibition rates of GH and TSH in octreotide suppression tests were 79.1% [68.8%, 82.0%] and 94.7% [88.2%, 97.0%], respectively. All these mixed PAs were macroadenomas, and 23.8% (5/21) of them were giant adenomas. Comprehensive treatment strategies comprised of two or more therapy methods were applied in 66.7% (14/21) of patients. Complete remission of both GH and TSH was accomplished in one-third of cases. In the comparison with the matched GHPA subjects, the mixed GH/TSH group presented with a higher maximum diameter of the tumor (24.0 [15.0, 36.0] mm vs. 14.7 [10.8, 23.0] mm, P = 0.005), a greater incidence of cavernous sinus invasion (57.1% vs. 23.8%, P = 0.009) and a greater difficulty of long-term remission (28.6% vs. 71.4%, P <0.001). In addition, higher occurrence rates of arrhythmia (28.6% vs. 2.4%, P = 0.004), heart enlargement (33.3% vs. 4.8%, P = 0.005) and osteopenia/osteoporosis (33.3% vs. 2.4%, P = 0.001) were observed in the mixed PA group. There are great challenges in the treatment and management of GH/TSH cosecreting PA. Early diagnosis, multidisciplinary therapy and careful follow-up are required to improve the prognosis of this bihormonal PA.

Conversion therapy for advanced hepatocellular carcinoma with vascular invasion: a comprehensive review.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and has a high mortality rate worldwide. The percentage of HCC patients with vascular invasion at the time of initial HCC diagnosis is 10%-40%. According to most guidelines, HCC with vascular invasion is classified as advanced stage, and resection is only suggested for a minority of such patients. Recently, advances in systemic and locoregional treatments for such patients have resulted in amazing response rates. Therefore, a "conversion therapy" strategy including systemic and locoregional treatments is proposed to select patients from an initially unresectable state to eventually undergo R0 resection. Recently, many studies have proven that conversion therapy followed by subsequent surgery is achievable in well-selected advanced HCC patients and can provide prolonged long-term outcomes. Based on published research, this review has summarized the clinical experience and evidence of conversion treatment in HCC patients with vascular invasion.

Clinical Efficacy Analysis of Different Surgical Methods for Giant Adrenal Tumors (≥10 cm): A Single-Center Study of 44 Cases.

Objective: The objective of this study was to compare the efficacy and safety of open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) by summarizing the clinical features and treatment experience of giant adrenal tumors. Methods: The clinical data of 44 patients with adrenal tumors ≥10 cm admitted to the Second Hospital of Lanzhou University from January 2006 to August 2022 were retrospectively analyzed. The mean tumor diameter was 11.6 ± 1.8 cm. Regular follow-up was performed to observe the outcome of symptoms and the recurrence after operation. Results: All the 44 patients successfully completed the operation and were divided into the OA group (21 cases) and the LA group (11 cases of transabdominal laparoscopic adrenalectomy [TLA] and 12 cases of retroperitoneal laparoscopic adrenalectomy [RLA]) according to different operation methods. The analysis results showed that the proportion of estimated blood loss (EBL) >100 mL and the postoperative length of stay (PLOS) in the LA group were superior to those in the OA group, and there were no significant differences in other surgical indicators (P > .05); subgroup analysis was conducted for patients in the LA group according to different surgical pathways, and the results showed that there were no significant differences in each surgical indicator between TLA and RLA (P > .05). Among the 44 patients, 15 (34.1%) had intraoperative complications, 19 (43.2%) had postoperative complications, and 5 (21.7%) were converted from LA to OA. The median follow-up time was 68 (5-162) months. Conclusions: For adrenal tumors with diameter ≥10 cm, both LA and OA have relatively large damage to the patients, and the incidence of conversion to open surgery is also high. However, LA is superior to OA in EBL and PLOS. Given the fact that giant adrenal tumors are mainly pheochromocytoma and paraganglioma and have an increased possibility of malignancy, we suggest that the relationship between tumors and peripheral important blood vessels and organs should be carefully evaluated before operation, and the operative methods should be selected according to the experience of the surgeon.

Analysis of clinical diagnosis and treatment of intestinal volvulus

BackgroundThe aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and related risk factors of intestinal volvulus.MethodsThirty patients with intestinal volvulus admitted to the Digestive Emergency Department of Xijing Hospital from January 2015 to December 2020 were selected. The clinical manifestations, laboratory tests, treatment and prognosis were retrospectively analyzed.ResultsA total of 30 patients with volvulus were enrolled in this study, including 23 males (76.7%), with a median age of 52 years (33–66 years). The main clinical manifestations were abdominal pain in 30 cases (100%), nausea and vomiting in 20 cases (67.7%), cessation of exhaust and defecation in 24 cases (80%), and fever in 11 cases (36.7%). The positions of intestinal volvulus were jejunum in 11 cases (36.7%), ileum and ileocecal in 10 cases (33.3%), sigmoid colon in 9 cases (30%). All 30 patients received surgical treatment. Among the 30 patients underwent surgery, 11 patients developed intestinal necrosis. We found that the longer the disease duration (> 24 h), the higher the incidence of intestinal necrosis, and the higher the incidence of ascites, white blood cell count and neutrophil ratio in the intestinal necrosis group were significantly higher than those in the non-intestinal necrosis group (p < 0.05). After treatment, 1 patient died of septic shock after operation, and 2 patients with recurrent volvulus were followed up within 1 year. The overall cure rate was 90%, the mortality rate was 3.3%, and the recurrence rate was 6.6%.ConclusionLaboratory examination, abdominal CT and dual-source CT are very important for the diagnosis of volvulus in patients with abdominal pain as the main symptom. Increased white blood cell count, neutrophil ratio, ascites and long course of disease are important for predicting intestinal volvulus accompanied by intestinal necrosis. Early diagnosis and timely intervention can save lives and prevent serious complications.

Actual view on skin scarring and clinical experience of conservative treatment of keloids

Scars are an urgent issue for many areas of practical medicine, especially for dermatovenerologists, cosmetologists and plastic surgeons. Every year, 100 million patients develop new scars and about 11 million of them are keloid. The issue of differential diagnosis of keloid and hypertrophic scars is still the subject of discussion among specialists. Despite the wide variety of available methods of treatment of keloid and hypertrophic – surgical excision, injections of glucocorticosteroids, laser therapy, cryotherapy, compression therapy and silicone bandages are the most effective and pathogenically rationalised methods for the correction of pathological scars. Promising methods of therapy are: injections of interferon, recombinant human TGF-β3 polypeptide, platelet-rich plasma, calcium channel blockers, lipofilling, the use of angiotensin-converting enzyme inhibitors, creams based on imiquimod and resiquimod, growth factors, stem cells. The article presents an up-to-date view on the processes of physiological and pathological scarring, the most important aspects of the differential diagnosis of keloid and hypertrophic scars, the understanding of which is important for choosing the right therapeutic strategy. Particular attention is paid to the pathophysiological mechanisms of action, the advantages and features of the use of silicone dressings. The authors present the clinical experience of successful two-stage correction of keloid scar – post-acne with the use of injection therapy with hyaluronidase and silicone dressings.

Expert consensus on diagnosis and treatment of COVID-19 infection related cough in children

An epidemic outbreak of the corona virus disease 2019(COVID-19) Omicron variant occurred in most regions of China. Children are susceptible to COVID-19 and the vast majority of them suffer from upper respiratory tract infection. Cough is one of the most common symptoms. COVID-19 infection related cough includes acute cough, persistent cough and chronic cough, and children with original chronic cough or chronic lung disease can also induce or aggravate symptom of cough after infection, which has a great impact on children's physical and mental health. The treatment for COVID-19 infection related cough vary with the etiology. Improper treatment would delay the patient's condition and increase adverse drug reaction. Currently, there is no guideline or consensus on the diagnosis and treatment of COVID-19 infection related cough in children in China, therefore this consensus is drafted. Referring to the latest international research and the diagnostic and therapeutic strategy for COVID-19 infection (Tenth Edition For Trial Implementation), and combining with clinical diagnosis and treatment experience,the consensus elaborates the pathogenesis and etiology of COVID-19 infection related cough, the use of cough relievers and expectorants, as well as the key points of diagnosis and treatment of different etiological factors. It is expected to provide specific and feasible guidance scheme for pediatricians, general practitioners and clinical pharmacists.

Sensory integration in a department of child and adolescent psychiatry

IntroductionThe area of Sensory Integration has its origin in the 1960s, developed by the neuroscientist and occupational therapist Jean Ayres. Although the first studies focused on the relationship between learning problems and atypical sensory processing, today there are new applications in clinical practice.Sensory integration is defined as the neurological process responsible for organizing the sensations that one receives from one’s own body and from the environment, in order to respond and function adequately in relation to environmental demands.ObjectivesThis work has several objectives. On the one hand, review the concept of sensory integration, the definition and theoretical basis as well as the scientific evidence of this theory. On the other hand, review the use of sensory integration in psychiatric practice from the 1960s to the present day. Also, explain the experience of a child and adolescent psychiatry unit with the use of sensory integration as part of the treatment. Finally, new challenges, approaches and needs of psychiatry services will be considered for the implementation or improvement of this new work tool in a multidisciplinary team.MethodsA bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed.ResultsIn our clinical experience, the child and adolescent psychiatry device for intensive outpatient treatment where patients between 12 and 17 years of age with severe mental disorders attend, initially passed the sensory profile by occupational therapy to patients who presented behavioral or emotional symptoms. not consistent with the psychopathological examination. In view of the results and magnificent progress, this intervention began to be carried out systematically to the boys who joined the device.We present the case of a 15-year-old patient who attended the device due to emotional dysregulation and suicidal risk. During evolution, possible difficulties were seen in sensory integration that made it difficult for the patient to improve with psychiatric or psychological therapy alone. The patient was evaluated and treated by the team’s occupational therapist, specifically trained in sensory integration. It was evaluated with the sensory profile, with the results having a sensory sensitivity profile and auditory and tactile avoidance. The specific measures that were carried out were: sensory diet and environmental modifications.ConclusionsSensory integration is a therapy with sufficient clinical evidence to implement it in child and adolescent psychiatry services. Therapy should be performed by suitably trained and validated occupational therapists. This therapy must be included in a multidisciplinary approach to the patient and specific modifications that can be developed at home and at school are provided.Disclosure of InterestNone Declared

Eighteen cases of renal aneurysms: Clinical retrospective analysis and experience of endovascular interventional treatment.

Development of endovascular interventional techniques gradually replaced traditional open surgery and has become the preferred treatment for renal aneurysms. This study aimed to analyze the clinical characteristics of renal artery aneurysm (RAA) and the safety and efficacy of intravascular interventional treatment. We retrospectively analyzed the clinical characteristics and imaging data of 23 aneurysms in 18 patients with RAA. The technical success rate, complication rate, mortality rate, reintervention rate, and use of embolization materials were evaluated. In 18 patients with RAA (age, 32-72 years, average age, 52.2 ± 11.2 years), a total of 23 aneurysms were found (diameter 0.5-5.5 cm, average diameter 2.2 ± 1.4 cm). Among them, 11 cases (61.1%) were discovered accidentally, and the remaining patients were diagnosed due to the following major complaints: four cases (22.2%) presented low back pain, two (11.1%) were due to high blood pressure, and one (5.5%) had low back pain with gross hematuria. A total of 14 aneurysms in 13 patients received endovascular interventional therapy. The technical success rate of 13 patients with renal aneurysms was 100%. Three of the 18 patients were lost to follow-up, and the remaining were followed up for 4-89 months. There was no recurrence of the aneurysm or displacement of the stent or coil. Endovascular treatment for RAA has a high success rate, low complication rate, and low reintervention rate. It has the advantage of less trauma and is flexible and more targeted for different types of renal aneurysms.

CLINICAL CASE OF CONGENITAL HYPERINSULINISM

Introduction. Congenital hyperinsulinism (HI) is a hereditary disease characterized by inadequate insulin hypersecretion by pancreatic beta-cells and leading to hypoglycemia. The prevalence of HI in European countries is on average 1:30,000 - 1:50,000 live births. Despite its low prevalence, HI is one of the main causes of persistent hypoglycemia in children of the first year of life.The aim of the study is to demonstrate the current clinical experience of observation and treatment of a child with HI in the conditions of limited experience of work with similar rare pathologies in children.Material and methods of research. The study is based on the analysis of examination and treatment of a child diagnosed with HI. The set of diagnostic measures included: clinical and laboratory studies, ultrasound, magnetic resonance imaging, molecular genetic studies.Results of the research. Seeing the presence of elevated insulin levels (blood insulin more than 2.0 μIU / ml) on the background of hypoglycemia (blood glucose less than 3.0 mmol / l), the child was diagnosed with congenital hyperinsulinism.Considering the possible etiological and pathogenic factors of HI in children, hereditary metabolic diseases (deficiency of fatty acid dehydrogenase, maple leaf disease, etc.), adrenal insufficiency, thyroid disease, panhypopituitarism were excluded.Conservative glucose treatment in a child with HI did not show the desired results. Additional examination included a molecular genetic study of genes and a heterozygous mutation of the ABCC8 gene was detected, which indicates a focal form of HI.The only effective method of treatment of this pathology is partial resection of the pancreas with removal of the pathological locus. The child was operated at the Danish Children's Clinic, where enucleation of the lesion in the pancreas was performed, which was detected by position-emission (PET) and computed tomography (CT).Conclusions. 1. In case of detection of hypoglycemia in a child, timely diagnosis of the disease is necessary, which reduces the risk of neurological complications of HI. 2. Conservative treatment of focal forms of HI in children does not give significant results and is not appropriate. 3. Partial pancreatectomy is a pathogenic method of treatment of focal form of HI.

GAO Wei-bin's clinical experience in treatment of neurogenic bladder with acupuncture

The paper introduces GAO Wei-bin's clinical experience in acupuncture treatment for neurogenic bladder. In association with the etiology, the location and types of neurogenic bladder and in accordance with nerve anatomy and meridian differentiation, the acupoints are selected accurately in treatment. Four acupoint prescriptions are allocated. For frequent urination and urinary incontinence, the foot-motor-sensory area of scalp acupuncture, Shenshu (BL 23) and Huiyang (BL 35) are used. For all kinds of urine retention, especially the patients who are not suitable for acupuncture at the lumbar region, Zhongji (CV 3), Qugu (CV 2), Henggu (KI 11) and Dahe (KI 12) are selected. For all kinds of urine retention, Zhongliao (BL 33) and Ciliao (BL 32) are applicable. For the patients with both dysuria and urinary incontinence, Zhongliao (BL 33), Ciliao (BL 32) and Huiyang (BL 35) are chosen. In treatment of neurogenic bladder, both biao (root causes) and ben (primary symptoms) are considered, as well as the accompanying symptoms; and electroacupuncture is combined accordingly. During the delivery of acupuncture, the sites where the acupoints located are detected and palpated so as to rationally control the depth of needle insertion and the operation of reinforcing and reducing needling techniques.

Unilateral Condylar Hyperplasia in Surgeons’ Perspective—A Narrative Review

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors’ own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth.

Single-port thoracoscopic removal of an azygos vein aneurysm: a case report and literature review

BackgroundAzygos vein aneurysms (AVAs) are extremely rare. The majority of patients have no obvious clinical symptoms, so they are found by physical examination or by chance. There is limited clinical treatment experience that can be referred to, and there are no clear guidelines or research evidence standardizing the surgical and interventional therapy. Here, we report a patient with idiopathic AVA whose three-dimensional reconstruction of the tumor was completed before surgery. On the basis of three-dimensional reconstruction, single-port thoracoscopic resection of the AVA was successfully completed and reported for the first time. The previously reported cases are summarized to provide guidance for the diagnosis and treatment of patients with AVAs.Case presentationA 56-year-old man was transferred to our hospital due to “dysphagia”. The diagnosis of AVA was made after enhanced computed tomography, gastroscopy, fiberoptic bronchoscopy, and three-dimensional reconstruction. Congenital weakness or degenerative changes causes the vein walls to be extremely thin that the AVA had the risk of ruptur. Furthermore, the patient had symptoms of dysphagia, he received single-port thoracoscopic surgery. After the operation, his dysphagia disappeared. The postoperative pathology confirmed hemangioma. The patient was discharged 3 days after surgery without any complications.ConclusionsAVAs are rare. Preoperative three-dimensional reconstruction can greatly help surgeons clarify the disease diagnosis, formulate the surgical plan, avoid damage to the surrounding vital organs, and reduce intraoperative bleeding. Thoracoscopic surgery to remove AVAs is difficult and has a high risk of bleeding, while more minimally invasive single-port thoracoscopic surgery is also safe and effective for the treatment of AVAs.

Випадки ізольованого аспергильозу шкіри і нігтів та вторинного аспергильозного ураження шкіри, зумовлені професійним чинником. Симптом «засушеного листя» за аспергильозу нігтів

Cases of aspergillosis (A.), both isolated lesions of the skin and nails, and secondary skin lesions as a result of complications of invasive aspergillosis of the lungs and intestines, can be considered occupational, since there is a clear connection with the direct professional activities of the patients. it was found. It can be assumed that A. of the skin and nails in dermatological practice occurs more often than is diagnosed, especially since at the present stage the total number of patients with fungal infection is increasing. The goal is to share the experience of clinical and laboratory diagnostics and effective treatment of patients with isolated lesions of the skin and nails due to aspergillosis. Materials and methods. A clinical case of skin damage due to invasive aspergillosis (lungs and intestines) is presented, as both cases are caused by professional factors. Patients were examined in detail with the use of microscopic and mycological (sowing material on a nutrient medium) research. Results and conclusions. When diagnosing, the professional background of the patients should be taken into account. The clinical «symptom of dried leaves» proposed by us is likely to be of significant importance in establishing the clinical diagnosis of onychomycosis caused by A.flavus, and which can serve as a differential sign for other fungal infections of the nails. Our experience confirms the effectiveness of treating A. skin and nails using the «pulse therapy» method with Orungal and confirms its increase under the condition of a combination of systemic action and local antifungal activity of the drug Cidipol.

Knowledge Graph Construction of Chronic Kidney Disease Diagnosis and Treatment with Traditional Chinese Medicine

Background. The purpose of this study is to construct a knowledge graph of chronic kidney disease (CKD) diagnosis and treatment with traditional Chinese medicine (TCM), reorganize its knowledge, and display it. It allows the inheritance, development, and utilization of CKD diagnosis and treatment experiences with TCM in a standard and scientific manner. Methods. First, we constructed a knowledge framework for TCM diagnosis and treatment on the basis of the Chinese Pharmacopoeia, government projected textbook, and the current TCM diagnosis and treatment standards. Then, we collected and sorted the electronic medical records of TCM inpatients, extracting and normalizing the diagnoses, symptoms, syndromes, prescriptions, and other diagnosis and treatment information, creating the knowledge base of TCM diagnosis and treatment for CKD. Finally, we stored TCM diagnosis and treatment CKD knowledge in Neo4j graph database, which refers to the knowledge framework and knowledge base. The frequent patterns and complex network knowledge mining methods are integrated to construct the TCM diagnosis and treatment CKD knowledge graph. Results. The knowledge graph of CKD diagnosis and treatment with TCM was constructed, including 807 nodes and 10476 relationships, which are 273 diagnoses, 130 symptoms, 34 syndromes, 370 Chinese herbal medicine (CHM) nodes, and 5483 diagnosis‐symptom, 1349 diagnosis‐syndrome, 3644 syndrome‐CHM relationships. Conclusion. The knowledge graph provides rich knowledge of TCM diagnosis and treatment of CKD, which is helpful to inherit the clinical experience of TCM diagnosis and treatment of CKD and assist clinical diagnosis and treatment of CKD.

Retracted: Clinical Experience of Diagnosis and Surgical Treatment of 6 Cases of Acute Subhepatic Appendicitis.

[This retracts the article DOI: 10.1155/2022/4969774.].

РОЛЬ КЛАССИФИКАЦИИ В ОПРЕДЕЛЕНИИ ТАКТИКИ ЛЕЧЕНИЯ ВЫСОКОЭНЕРГЕТИЧЕСКИХ ПОВРЕЖДЕНИЙ НИЖНИХ КОНЕЧНОСТЕЙ

The article discusses the classification of highly energetic injuries of the lower extremities, their role and determining importance in choosing the scope of examination, preoperative treatment and the choice of a treatment method, proposed a new classification of these injuries. Based on the study of the clinical experience of surgical treatment of 239 patients with complex segmental and complex irregular diaphysial fractures of tibia, the high effectiveness of this classification in determining the algorithm of pre- and postoperative management, surgical treatment of patients depending on the degree of bone tissue damage, the size and nature of wounds in open fractures, the degree of soft tissue damage in closed fractures is shown.

Clinical experience in laparoscopic treatment of gallbladder perforation.

We herein present our clinical experience in laparoscopic surgery for gallbladder perforation (GBP). Retrospective analysis was performed on the clinical data of 44 patients who diagnosed with GBP from January 2015 to November 2020. The mean age of the 44 patients was 64.0 years and the female-to-male ratio was 20:24. The most common type of GBP was Type II, followed by Type I and Type III (31:9:4). 72.7% of the patients were diagnosed with GBP at the time of surgery. Laparoscopic surgery was performed for 38 (86.4%) patients, with a conversion rate of 13.2%. The mean length of hospital stays was 7.8 days. The mortality and morbidity rates were 2.3% and 11.4%, respectively. Pre-operative diagnosis of GBP is difficult. Laparoscopic surgery is safe, feasible and effective for patients with GBP.

Хирургия опухолевых тромбов нижней полой вены.

Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.