Subcutaneous Hematoma Research Articles

Post-mortem examination on a striped dolphin (Stenella coeruleoalba) reveals a potential fatal interaction with bottlenose dolphins (Tursiops truncatus) in Italian waters

Abstract Despite attacks of bottlenose dolphins towards conspecifics and other species of dolphins being reported worldwide, inside the Mediterranean Sea these behaviours are still considered sporadic and have been, to date, only recorded in Spain and France, mostly directed to striped dolphins. In this work, we reported the necropsy outcomes of a dead striped dolphin that suggest a fatal interaction with bottlenose dolphins inside the Italian side of the Pelagos Sanctuary, Western Ligurian Sea. Results from the post-mortem examination showed multiple, multifocal external rake marks spaced 1–1.2 cm and several internal injuries, consisting of subcutaneous and muscular haematomas and haemorrhages, multiple vertebral and rib fractures, haemothorax and lung laceration. The inter-tooth distance and all the internal findings were consistent with a fatal traumatic interaction with bottlenose dolphins as reported in similar cases in other parts of the world where the same results were found. No other significant gross and microscopic findings and concurrent significant pathogens were detected. This case highlights the existence of negative interspecific interactions in an area where they have never been reported before and adds new important information to the literature for understanding their occurrence, expanding the geographical range of observation in the western Mediterranean Sea.

Extrapolation study for determining the time since injury in a rat subcutaneous hematoma model utilizing ATR-FTIR spectroscopy.

The determination of the time of an injury has been a major problem in forensic science due to the lack of objective, reliable and portable methods. In this study, a subcutaneous hemorrhage model in rats was established over six days, and attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy coupled with chemometrics was used to determine the time since injury. Initial principal component analysis (PCA) showed variance among hematoma sites. Subsequently, spectral data were acquired to establish a dependable partial least square (PLS) regression model with predictive abilities. The root mean square error of cross-validation (RMSECV) and the root mean square error of prediction (RMSEP) values produced by a genetic algorithm (GA) were 0.64 d (R2 = 0.88) and 0.57 d (R2 = 0.90), respectively. Few variables were involved in the model, and significantly better results were obtained in comparison to the conventional full-spectrum PLS model. In combination with the results of variable importance in projection (VIP) scores, all components, including proteins, nucleic acids and phospholipids, provided inferences regarding the samples at different time points; additionally, amide I and II bands represented the secondary structure of proteins and provided the largest contribution. Based on our preliminary study, the combination of swift and nondamaging ATR-FTIR spectroscopy with chemometrics could prove to be an advantageous approach for gauging the age of an injury in the forensic field.

Trypanosomiasis: An emerging disease in Alpine swift (Tachymarptis melba) nestlings in Switzerland?

Alpine swifts (Tachymarptis melba) are sub-Saharan migratory birds, which, in Switzerland, nest in colonies that have been continuously monitored for over 40 years. In the summer of 2022, despite favourable environmental conditions, an unexpectedly high number of sudden mortalities (30–80%) occurred in 20 to 45-day-old nestlings from several nesting sites, of which 3 were monitored in detail. Nestlings submitted for post-mortem analysis (n = 5) were in good body condition but exhibited extensive subcutaneous haematomas (n = 5), myocardial petechiae (n = 2) and stunted growth of primary feathers (n = 1). In all birds, 4–5 μm large, amastigote-like protozoans were identified in skeletal and cardiac muscle sections. These tissues tested positive in a PCR targeting the 18S-rRNA gene of Trypanosoma spp. Amplified sequences showed 99.63% identity with sequences of Trypanosoma corvi (JN006854 and AY461665) and Trypanosoma sp. (AJ620557, JN006841). 72 blood smears of 45-day-old nestlings from two colonies were assessed, of which 20 contained trypomastigote forms, some with high parasitaemia (highest average of 56.4 in 10 high power fields, 400x magnification). Trypomastigote morphometrics (n = 36; mean total length = 30.0 μm; length of free flagellum = 5.8 μm) were consistent with those of T. bouffardi. These findings suggest that an avian trypanosomiasis causing mass nestling mortality could be an emerging disease in Swiss Alpine swift populations.

Complete Arthroscopic Posterior Knee Capsulotomy in Patients With Knee Extension Deficit: Preliminary Results of a Clinical Trial.

Guided physiotherapy and surgical arthrolysis are effective in most patients with knee extension deficit. However, in refractory cases, posterior knee capsulotomy may be needed. To assess extension restoration, pain reduction, and functional improvement after arthroscopic complete posterior knee capsulotomy in patients with extension deficit refractory to guided physiotherapy and surgical arthrolysis. Case series; Level of evidence, 4. Included were patients with symptomatic asymmetric extension deficit >3° refractory to at least 6 months of guided physiotherapy and initial arthrolysis (15 patients with 12-month follow-up and 8 patients with 24-month follow-up). The mean duration of extension deficit was 24.6 months. An arthroscopic complete posterior knee capsulotomy was performed with transection of the posteromedial, posterolateral and central capsule, and the posterior septum. The primary outcome measure was knee extension, with hyperextension denoted as negative knee extension values. Secondary outcome measures included visual analog scale (VAS) for pain during maximum effort and exercise, International Knee Documentation Committee (IKDC) score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The mean patient age was 40.0 years (range, 26-70 years); 6 out of 15 patients had developed knee contracture after isolated anterior cruciate ligament reconstruction. The mean knee extension deficit decreased from 16.9° (range, 7° to 45°) preoperatively to -0.2° (range, -5° to 5°) at 12-month follow-up (P = .003) and to -0.3° (range, -5° to 5°) at 24-month follow-up (P = .035). The mean VAS pain score decreased from 3.5 (range, 1-6) preoperatively to 1.1 (range, 0-2) at 12-month follow-up (P = .004) and to 1.5 (range, 0-4) at 24-month follow-up (P = .005). The mean IKDC increased from 37.9 (range, 21-62) preoperatively to 63.9 (range, 46-87) at 12-month follow-up (P < .001) and to 60.9 (range, 39-80) at 24-month follow-up (P = .003). The mean KOOS increased from 45.0 (range, 30-62) preoperatively to 75.3 (range, 49-94) at 12-month follow-up (P < .001) and to 72.3 (range, 49-92) at 24-month follow-up (P = .003). There were no significant differences between 12- and 24-month follow-up in extension deficit or functional outcomes. One patient had a midcalf subcutaneous hematoma 5 weeks postoperatively, requiring evacuation. Arthroscopic complete posterior knee capsulotomy was able to restore knee extension, reduce pain, and improve function, with 12-month follow-up results sustained at 24-month follow-up. NCT05385393 (ClinicalTrials.gov identifier).

Artificial dermis combined with skin grafting for the treatment of hand skin and soft tissue defects and exposure of bone and tendon

BACKGROUND The recovery time of hand wounds is long, which can easily result in chronic and refractory wounds, making the wounds unable to be properly repaired. The treatment cycle is long, the cost is high, and it is prone to recurrence and disability. Double layer artificial dermis combined with autologous skin transplantation has been used to repair hypertrophic scars, deep burn wounds, exposed bone and tendon wounds, and post tumor wounds. AIM To investigate the therapeutic efficacy of autologous skin graft transplantation in conjunction with double-layer artificial dermis in treating finger skin wounds that are chronically refractory and soft tissue defects that expose bone and tendon METHODS Sixty-eight chronic refractory patients with finger skin and soft tissue defects accompanied by bone and tendon exposure who were admitted from July 2021 to June 2022 were included in this study. The observation group was treated with double layer artificial dermis combined with autologous skin graft transplantation (n = 49), while the control group was treated with pedicle skin flap transplantation (n = 17). The treatment status of the two groups of patients was compared, including the time between surgeries and hospital stay. The survival rate of skin grafts/flaps and postoperative wound infections were evaluated using the Vancouver Scar Scale (VSS) for scar scoring at 6 mo after surgery, as well as the sensory injury grading method and two-point resolution test to assess the recovery of skin sensation at 6 mo. The satisfaction of the two groups of patients was also compared. RESULTS Wound healing time in the observation group was significantly longer than that in the control group (P &lt; 0.05, 27.92 ± 3.25 d vs 19.68 ± 6.91 d); there was no significant difference in the survival rate of skin grafts/flaps between the two patient groups (P &gt; 0.05, 95.1 ± 5.0 vs 96.3 ± 5.6). The interval between two surgeries (20.0 ± 4.3 d) and hospital stay (21.0 ± 10.1 d) in the observation group were both significantly shorter than those in the control group (27.5 ± 9.3 d) and (28.4 ± 17.7 d), respectively (P &lt; 0.05). In comparison to postoperative infection (23.5%) and subcutaneous hematoma (11.8%) in the control group, these were considerably lower at (10.2%) and (6.1%) in the observation group. When comparing the two patient groups at six months post-surgery, the excellent and good rate of sensory recovery (91.8%) was significantly higher in the observation group than in the control group (76.5%) (P &lt; 0.05). There was also no statistically significant difference in two point resolution (P &gt; 0.05). The VSS score in the observation group (2.91 ± 1.36) was significantly lower than that in the control group (5.96 ± 1.51), and group satisfaction was significantly higher (P &lt; 0.05, 90.1 ± 6.3 vs 76.3 ± 5.2). CONCLUSION The combination of artificial dermis and autologous skin grafting for the treatment of hand tendon exposure wounds has a satisfactory therapeutic effect. It is a safe, effective, and easy to operate treatment method, which is worthy of clinical promotion.

Application of transradial and transfemoral accesses during hepatic artery chemoembolization in the treatment of patients with malignant liver neoplasms

Introduction Malignant neoplasms of the liver are one of the most common pathologies in oncology. Chemoembolization of the hepatic artery is currently widely used in the treatment of unresectable liver tumors. Transradial vascular access is actively used in interventional cardiology due to fewer local vascular complications. At the same time, until recently, chemoembolization of the hepatic artery was more often performed via transfemoral vascular access.The aim of the work is a comparative analysis of the results of transradial and transfemoral vascular accesses for the purpose of hepatic artery chemoembolization.Material and methods The data of 69 patients who underwent 212 hepatic artery chemoembolization procedures for malignant neoplasms in the liver were analyzed. The group of transradial access included 107 (50.5 %) interventions, the group of transfemoral access – 105 (49.5 %). The groups were comparable in terms of the main initial clinical and anamnestic data.Results Chemoembolization of the hepatic artery was successfully performed in 98.1 % in the transradial access group and 99 % in the transfemoral access group (p = 1.0). The total duration of intervention, time spent on catheterization of the target artery and radiation exposure were significantly shorter in the transradial access group than in the opposite group. The incidence of local vascular complications was not significantly different between the groups: 11 (10.3 %) and 12 (11.4 %) cases, respectively (p = 0.79). According to the results of patient interviews, the use of transradial access was accompanied by significantly less discomfort associated with the procedure.Discussion Traditionally, embolization of peripheral arteries is performed via transfemoral access, and the total incidence of local vascular complications (large subcutaneous hematomas, false aneurysms, arterovenous fistulas, etc.) is relatively high. According to the results of studies, it is possible to reduce the incidence of local vascular complications without increasing the cost of the procedure by performing the same interventions using transradial access.Conclusion Transradial vascular access has a number of significant advantages over transfemoral access, and therefore can be recommended as a priority for performing hepatic artery chemoembolization.

Giant Subcutaneous Hematoma Associated with Subcutaneous Insulin Injection in a Patient with Diabetes: a Case Report

The complications of insulin self-injection include subcutaneous bleeding, nerve damage, and subcutaneous induration due to repeated injection at the same site. However, considering the short length and thinness of the needle, it is unlikely that these complications will ever become serious. Here, we report a case of a 50-year-old man with abdominal giant hematoma due to insulin self-injection, which requires surgical treatment. The patient had obesity and took anticoagulants and steroids for 12 years. These drugs seemed to have affected the vessel wall and led to its compromise or destruction and subsequent hemorrhagic events.

Acupuncture as an adjunctive therapy for gastric ulcer: A modified Delphi consensus study

BackgroundAcupuncture is often used as an adjunctive therapy for gastric ulcer (GU). However, there is still a lack of evidence on the appropriate and optimal interventions for acupuncture. This study aimed to optimize the acupuncture treatment of gastric ulcers based on expert consensus for guiding acupuncturists in clinical practice. MethodsTo conduct this study, research evidence was gathered from databases in both Chinese and English. After discussion, preliminary clinical questions were developed. Following three rounds of multidisciplinary clinical expert consultation, the initial consensus questionnaire was formed after testing and modification by team members. A Delphi consensus was ultimately reached to answer the questionnaire and develop guidance for acupuncture treatment. A 9-point Likert-type scale was used to measure the agreement of expert consensus, where a score of 80% between 7 and 9 was defined as “agreement.” ResultsAfter two rounds of Delphi voting, a total of 35 items reached an agreement. These items can be roughly divided into 6 domains. According to expert consensus, the application of acupuncture for gastric ulcer should follow a semistandardized approach. Based on the syndrome differentiation, the main acupoints recommended are Zusanli (ST36), Zhongwan (CV12), Neiguan (PC6), and Sanyinjiao (SP6), while the adjunct acupoints include Taichong (LR3), Guanyuan (CV4), Xuehai (SP10), and Taixi (KI3). In the experience of experts, adverse events associated with acupuncture are typically mild and often manifest as subcutaneous hematomas. ConclusionThere is a lack of definitive acupuncture guidelines that can effectively determine the optimal therapeutic approach for the treatment of gastric ulcer. This expert consensus provides recommendations for clinical research and practice of acupuncture, with a particular focus on the selection of acupoints. However, further exploration through rigorous studies is necessary due to the limited availability of clinical evidence.

Review of Topical Sodium Heparin 1000 IU/g Gel in Symptomatic Uncomplicated Superficial Thrombophlebitis.

Heparin, a mixture of sulfated polymorphic polysaccharides (glycosaminoglycan) chains of variable lengths and weights and a natural anticoagulant, is widely used in medical practice to prevent intravascular blood coagulation. Heparin has demonstrated antithrombotic and anti-inflammatory activity, and it is mostly administered systemically (intravenously or subcutaneously) for primary or secondary prevention of venous thromboembolism after surgical interventions, or immobilized patients, or on short-term antithrombotic therapy of patients with atrial fibrillation who must undergo treatment. However, since systemic administration of heparin could be, in certain cases, linked to an increased risk of bleeding, topical heparin is widely used for the prevention and treatment of local symptoms of peripheral vascular disorders, such as venous insufficiency, varicose veins, or superficial thrombophlebitis. This review summarizes the main safety and efficacy characteristics of the topical formulation of Heparin in Gel form (1000 International Units of Heparin/g Gel) currently in use, which has demonstrated an excellent efficacy and tolerability profile in reducing signs and symptoms of peripheral vascular disease, e.g., varicose syndromes and their complications, phlebothrombosis, thrombophlebitis, superficial periphlebitis, varicose ulcers, for post-operative varicophlebitis, sequelae of saphenectomy, for traumas and contusions, local edemas and infiltrates, subcutaneous hematoma and for traumatic affections of musculotendinous and capsuloligamentous apparatuses.

The efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula

BackgroundTo access the efficacy of percutaneous transluminal angioplasty and arteriovenous fistula reconstruction for immature arteriovenous fistula, compare the long-term patency and post-operative complications between them.Materials and methodsThe medical records and Hemodialysis record sheets from 44 patients between May 2020 and January 2022 who underwent percutaneous transluminal angioplasty or arteriovenous fistula reconstruction treatment for immature autogenous arteriovenous fistula (AVF) were retrospectively reviewed. The patients were divided into two groups according to the type of surgery they received, including 25 patients in the PTA group and 19 patients in the AVF reconstruction group. Clinical outcomes were included, such as the primary and secondary patency rates following the procedure, maturation time, peak systolic velocity (PSV) of brachial artery, maximum pump-controlled blood flow at initial dialysis, and post-operative complications rates in the two groups.ResultsTechnical and clinical success was achieved in 100% of the 44 cases. For patients who underwent percutaneous transluminal angioplasty, the primary patency rate at 3, 6, and 9 months was 84.0%, 68.0%, 60.0%, and the secondary patency rate was 92.0%, 84.0%, 80.0%, respectively. And for patients who underwent arteriovenous fistula reconstruction, the primary patency rate at 3, 6, and 9 months was 89.5%, 73.7%, 68.4%, and the secondary patency rate was 100.0%, 94.7%, 94.7%, respectively. There were no significant differences between the two groups in terms of patency rates (p > .050). In patients whose maturation was successful, the average maturation time of fistula after the PTA procedure was 19.36 ± 13.94 days, and 58.63 ± 18.95 days for the reconstruction procedure (p < .010). The PSV of brachial artery before and after the procedure was 87.64 ± 23.87 cm/s and 153.20 ± 21.69 cm/s in PTA group, for reconstruction group, the number was 86.26 ± 20.59 cm/s and 151.26 ± 29.94 cm/s, respectively. No statistically significant differences (p > .050). The maximum pump-controlled blood flow at initial dialysis was 232.60 ± 16.72 ml/min in PTA group, which was significantly higher than 197.11 ± 10.45 ml/min in reconstruction group (p < .010). Subcutaneous hematoma, restenosis, thrombus formation, and pseudoaneurysm were major complications in PTA group. Restenosis, thrombus formation, and pseudoaneurysm were major complications in reconstruction group, with no statistically significant differences between the two groups (p > .050).ConclusionWhen immature AVFs require reconstruction surgery, the patency outcomes are comparable to AVFs that undergo successful management by PTA. While, when AVFs are successfully managed by PTA, they have significantly less maturation times and higher maximum pump-controlled blood flow rates at initial dialysis AVF use.

Dermatosparaxis type of Ehlers-Danlos syndrome: case report

Background. The dermatosparaxial type of Ehlers-Danlos syndrome (EDSDERMS, VIIC, dEDS) is an extremely rare disorder. To date, 15 patients with this type of Ehlers-Danlos syndrome are known worldwide. The purpose was to improve knowledge and spread data about the orphan connective tissue di­sease — dEDS — on the example of a patient from a family in which the father and two sons have the same type of lesions. Materials and methods. We report a 6-year-old patient as well as his father and sibling with clinical symptoms of the dEDS, which we diagnosed based on the main diagnostic criteria: extreme skin fragi­lity, craniofacial features, superficial skin trauma, wrinkling of the palms, especially when they are exposed to water for a long time, and a tendency to ecchymosis with a risk of subcutaneous hematomas and bleeding. Secondary diagnostic criteria were represen­ted by atrophic scars, refractive errors (myopia), gingival margi­nal dysplasia, hypermobility of the finger and knee joints. The informed consent of the patient’s parents was obtained for the exa­mination and publication of information, and the parents agreed to the publication of clinical photographs. Results. After laboratory and instrumental studies and consultations with related specialists (hematologist, geneticist, cardiologist, pediatrician, orthopedist, dermatologist), we excluded such diseases as Marfan syndrome, MASS-phenotype, congenital coagulopathies and thrombocytopathies, hemophilia, isolated vascular pathologies, as well as other types of Ehlers-Danlos syndrome and identified dEDS in the patient only clinically. Genetic testing did not reveal any pathological mutations or exonic deletions/duplications. The negative result of genetic testing in dEDS is due to the fact that certain types of mutations (e.g., deep intronic mutations) cannot always be detec­ted by standard diagnostic genetic methods. Conclusions. It is possible to establish a diagnosis based on clinical symptoms, but an extended mutation search is mandatory for the entire family.

A retrospective comparative study on the diagnostic efficacy and the complications: between CassiII rotational core biopsy and core needle biopsy.

Accurate pathologic diagnosis and molecular classification of breast mass biopsy tissue is important for determining individualized therapy for (neo)adjuvant systemic therapies for invasive breast cancer. The CassiII rotational core biopsy system is a novel biopsy technique with a guide needle and a "stick-freeze" technology. The comprehensive assessments including the concordance rates of diagnosis and biomarker status between CassiII and core needle biopsy were evaluated in this study. Estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), and Ki67 were analyzed through immunohistochemistry. In total, 655 patients with breast cancer who underwent surgery after biopsy at Sir Run Run Shaw Hospital between January 2019 to December 2021 were evaluated. The concordance rates (CRs) of malignant surgical specimens with CassiII needle biopsy was significantly high compared with core needle biopsy. Moreover, CassiII needle biopsy had about 20% improvement in sensitivity and about 5% improvement in positive predictive value compared to Core needle biopsy. The characteristics including age and tumor size were identified the risk factors for pathological inconsistencies with core needle biopsies. However, CassiII needle biopsy was associated with tumor diameter only. The CRs of ER, PgR, HER2, and Ki67 using Cassi needle were 98.08% (kappa, 0.941; p<.001), 90.77% (kappa, 0.812; p<.001), 69.62% (kappa, 0.482; p<.001), and 86.92% (kappa, 0.552; p<.001), respectively. Post-biopsy complications with CassiII needle biopsy were also collected. The complications of CassiII needle biopsy including chest stuffiness, pain and subcutaneous ecchymosis are not rare. The underlying mechanism of subcutaneous congestion or hematoma after CassiII needle biopsy might be the larger needle diameter and the effect of temperature on coagulation function. In summary, CassiII needle biopsy is age-independent and has a better accuracy than CNB for distinguishing carcinoma in situ and invasive carcinoma.

Microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle

To explore method and clinical effect of microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle. From March 2017 to January 2022, totally 20 patients with soft tissue defects of ankle joint were treated with micro-thinning anterolateral perforator flap for free transplantation, included 13 males and 7 females, aged from 22 to 58 years old with an average of (36.45±12.36) years old. The size of flap ranged from 8.0 cm×5.0 cm to 20.0 cm×12.0 cm. Before operation, perforating vessels on the anterolateral thigh region were detected and marked with a portable Doppler detector. For the defect width less than 8 cm, 11 patients were repaired with a single flap. For the defect width more than 8 cm, the wound could not be sutured directly, and the lobulated flap technique was used in 9 patients, the width was converted to length, and the donor site was closed directly. Under the microscope, all flaps were thinened in a stepwise manner from the center of the pedicle to the periphery. After operation, survival of the flap, the shape, texture, sensory function recovery were observes, and recovery of foot function was evaluated by Maryland foot function evaluation standard. All 20 patients with microsurgical thinned anterolateral thigh perforator flaps were survived. Venous crisis occurred in 1 patient due to subcutaneous hematoma, after removal of the hematoma, the crisis was relieved and the flap survived successfully. The wounds in the donor and recipient sites healed well, and only linear scars left in the donor sites. Twenty patients were followed up for 3 to 26 months after operation, good shape of flaps without bloated, and good texture. The two-point discrimination of free flaps ranged from 9.0 to 16.0 mm, and the protective sensation was restored. The ankle flexion and extension function recovered well and patients could walk normally. According to Maryland foot function evaluation standard, 8 patients got excellent result, 10 patients good and 2 middle. Microsurgical thinned anterolateral thigh perforator flap is an ideal method to repair soft tissue defects in functional area of foot and ankle, with good appearance and texture of the flap, no need for re-plastic surgery, reduced hospitalization costs, and less donor site damage.

Acupuncture therapy for post-stroke depression: A scoping review of randomized controlled trials

The prevalence of post-stroke depression (PSD), a common complication following a stroke, is rising yearly. Due to the success in treating PSD, acupuncture therapy has gained in popularity in recent years. To provide clinicians with more referable recommendations, we undertook a scoping study to examine the clinical evidence and status of acupuncture for the treatment of PSD. This scoping review followed Arksey and O'Malley's framework. Six databases were systematically searched to identify randomized controlled trials (RCTs) published in English or Chinese language that evaluated any type of acupuncture, with or without co-interventions, for treating PSD. Data were analyzed using descriptive statistics and organized in response to review questions. Findings were presented in a visual and aggregate form as well as in a descriptive format aligning with the objectives and scope of this protocol. A total of 231 RCTs were included, of which 230 were conducted in China. The applied acupuncture-related therapies included manual acupuncture, electroacupuncture, head acupuncture, auricular acupuncture, abdominal acupuncture, press needle, pestle acupuncture, eye acupuncture, and wrist and ankle acupuncture. The most commonly used form of acupuncture was manual acupuncture (n=73, 31.60%), and DU20 (n=121, 52.38%) was the most frequently used acupuncture point. Only a small number of studies reported adverse events (n=30, 12.99%), with the main symptoms including subcutaneous bleeding, headache, and hematoma. Ninety-six of 149 studies reported an effectiveness rate of over 90%. A more standardized trial process is recommended to strengthen the clinical evidence and avoid irregularities in clinical trial methodology. Future studies should include populations from a wider range of countries to improve the generalisability of the evidence.

Clinical analysis of gasless transoral vestibular robotic resection of thyroglossal duct cysts

Objective:This study aimed to explore the safety and feasibility of gasless transoral vestibular robotic resection of thyroglossal duct cysts. Methods:The clinical data of patients who underwent gasless transoral vestibular robotic resection of thyroglossal duct cysts at the Department of otolaryngology, Sun Yat-sen Memorial Hospital, Sun yat-sen university from September 2020 to May 2022 were analyzed. The operative time, blood loss, postoperative complications, postoperative pain score, postoperative aesthetic score, and recurrence were prospectively evaluated. Results:All patients completed the operation successfully and no case conversed to an open operation. The operation time was 104.00（95.00, 131.25） minutes, and the surgical blood loss was 15.00（10.00, 16.25） mL. The drainage volume was（59.71±9.20） mL. Postoperative pathology was consistent with thyroglossal duct cysts. There was no local reswelling, subcutaneous hematoma, emphysema, skin flap necrosis, infection and other complications. The postoperative hospital stay was 3.00（2.00, 3.00） days. Six patients had mild sensory abnormalities of the lower lip 3 months after surgery, and all patients were satisfied with the cosmetic outcomes. No recurrence was found during the 5-26 months follow-up. Conclusion:gasless transoral vestibular robotic resection of thyroglossal duct cysts is safe and feasible, with hidden postoperative scars and good cosmetic outcomes. It can provide a new choice for patients with thyroglossal duct cysts.

Automated wound segmentation and classification of seven common injuries in forensic medicine

In forensic medical investigations, physical injuries are documented with photographs accompanied by written reports. Automatic segmentation and classification of wounds on these photographs could provide forensic pathologists with a tool to improve the assessment of injuries and accelerate the reporting process. In this pilot study, we trained and compared several preexisting deep learning architectures for image segmentation and wound classification on forensically relevant photographs in our database. The best scores were a mean pixel accuracy of 69.4% and a mean intersection over union (IoU) of 48.6% when evaluating the trained models on our test set. The models had difficulty distinguishing the background from wounded areas. As an example, image pixels showing subcutaneous hematomas or skin abrasions were assigned to the background class in 31% of cases. Stab wounds, on the other hand, were reliably classified with a pixel accuracy of 93%. These results can be partially attributed to undefined wound boundaries for some types of injuries, such as subcutaneous hematoma. However, despite the large class imbalance, we demonstrate that the best trained models could reliably distinguish among seven of the most common wounds encountered in forensic medical investigations.

Comparison of distal transradial approach versus conventional transradial approach for coronary angiography and percutaneous coronary intervention: A prospective observational study

BackgroundCompared with the conventional transradial approach (TRA), there are limited data on the efficacy and safety of the novel distal transradial approach (DTRA). This study aimed to verify the effectiveness and safety of the DTRA for percutaneous coronary angiography and intervention. Besides, we also try to highlight the potential of the DTRA in reducing radial artery occlusion (RAO), shorter time to hemostasis, and improved patient comfort. MethodsThis single-center prospective observational study enrolled patients treated with DTRA (n = 527) in the first 9 months and with TRA (n = 586) in the next 8 months from May 2020 to December 2021. The primary endpoint was the proximal RAO rate at 30 days. ResultsBaseline data were similar between the two groups. The proximal radial artery occlusion rate at 30 days [2.3% vs. 7.0%], the success rate of puncture [86.4% vs. 96.7%], the Numeric Rating Scale score [1.97 ± 1.89 vs. 4.61 ± 2.68], and the incidence of postoperative subcutaneous hematoma and finger numbness [3.4% vs. 8.2%, 2.7% vs. 4.4%] were lower. The puncture time [6.93 ± 7.25 min vs. 3.18 ± 3.52 min] was longer, and the time until radial compression device removal was shorter [CAG: 138.61 ± 38.73 min vs. 191.6 ± 61.22 min, PCI:221.46 ± 62.45 min vs. 276.28 ± 76.39 min] in the DTRA group than TRA group (all P < 0.05). Multivariate logistic regression analysis revealed that the DTRA (OR 0.231, 95% confidence interval [CI] 0.088–0.769, P = 0.001),BMI<18.5 kg/m2 (OR 2.627, 95% CI 1.142–4.216, P = 0.004), Diabetes mellitus (OR 2.15, 95%CI1.212–3.475, P = 0.014), RCD removal time (CAG,min) (OR 1.091, 95% CI 1.013–1.441, P = 0.035) and RCD removal time (PCI,min) (OR 1.067, 95% CI 1.024–1.675, P = 0.022) were the independent risk factors of RAO 1 month after intervention procedure. ConclusionDTRA was found to a lower incidence of postoperative RAO and bleeding-related complications, shorter time to achieve hemostasis, and greater patient comfort.

The influence of the water-salt extract of the medicinal leech Hirudo verbana Carena, 1820 on the general course of embryogenesis in rats after intraperitoneal administration

Background. The increase in infectious and non-infectious diseases occurrence during pregnancy prompts scientists to search for substances that can fight these ailments. This especially applies to natural substances that have virtually no side effects. These include substances obtained from medicinal leeches. These substances have a wide range of therapeutic effects; as to their practical use, all preclinical studies must be completed. This particularly refers to the presence of an embryotoxic effect. The aim of this work was to investigate the effect of the water-salt extract of the medicinal leech Hirudo verbana Carena, 1820 on the general course of embryogenesis in rats when administered intraperitoneally. Materials and Methods. The work was performed on female non-linear white rats. Two experimental groups of animals were injected intraperitoneally with a water-salt extract of the medicinal leech at a concentration of 5 μg/g of the animal, in a volume of 0.5 mL, three times before mating and three times during pregnancy every 3 days. Two control groups were injected intraperitoneally with physiological saline according to the same scheme as the experimental groups. Subsequently, one of the control and experimental groups underwent euthanasia, dissection of the abdominal cavity and uterine horns on the 20th day of pregnancy. We analyzed the total number of corpora lutea of pregnancy, the number of live and dead fetuses. Fetuses were weighed, examined for the presence of skin hematomas, mutilations, and external abnormalities in the develop­ment of internal organs. The other two groups of control and experimental animals were left until the offspring were born. Then the females of both groups were weighed, and their general condition was assessed. Newborn rats were examined, weight and body length were determined, mortality was recorded from the beginning of birth to 15 days, the presence of skin hematomas, mutilations, and external anomalies of the development of internal organs were checked. Results and discussion. The study established that the intraperitoneal injection of a water-salt extract of a medicinal leech before and during pregnancy in female rats does not cause any toxic effect during embryogenesis and at the early stages of post-embryonic ontogenesis. During the external examination of fetuses and offspring in both groups, no developmental anomalies were noted, all organs in both groups were of normal topography and size. The number of subcutaneous hematomas in the experimental group of fetuses compared to the control group decreased by an average of 50%, postnatal mortality decreased by an average of more than 3 times, as well as an increase in body weight in females, an increase in body weight and body length in the fetus and offspring in the early post-embryonic period ontogenesis (p &lt;0.05). Conclusion. Intraperitoneal administration of a therapeutic dose of a water-salt extract of the medicinal leech to female rats before and during pregnancy, after every three days, does not have any toxic effect on the course of embryogenesis and later in early post-embryonic ontogenesis.

Incision caring for thyroid nodules surgery without drainage at Hanoi Medical University Hospital

Thyroid nodules are the most common among endocrine gland tumors, including benign thyroid nodules and thyroid cancer. Surgery is the mainstay of treatment in thyroid nodules. Drainage making patients more painful after surgery, and at the same time prolonging hospital stay. WE conducted a randomized controlled trial. Study subjects were randomly divided into 2 groups: placement of drainage and no drainage by random selection before surgery. Total of 84 study subjects include patients with thyroid nodules who underwent surgery at the Department of Oncology and Palliative Care, Hanoi Medical University Hospital from May 2018 to November 2018. Average age was 47.12 ± 11.2 (17 - 76) years old; tumor palpable sign was 58.3%; 58.3% of nodules are in two lobes and nodules ≤ 10mm was 39.3%, TIRADS 4: 76.2%; and 58.3% thyroid cancer and 41.7% benign thyroid nodule. Univariate analysis of clinical characteristics between the two study groups: Similarities in age group, tumor size, number of tumors, histological diagnosis between the two intervention groups. Group without drainage had VAS0: 3.8 ± 0.2, VAS1: 2.3 ± 0.8, complications of fluid collection accumulation 9.5%, subcutaneous hematoma accumulation 4.8%, hypoparathyroidism 4.8%, hoarseness 7.1%, no cases of bleeding requiring reoperation and postoperative infection, hospital stay 4.7 ± 0.5 days, satisfaction level 4.6 ± 0.5, higher than drainage group. No drainage in several thyroid surgery cases is safe, with shortened surgery period, hospitalized period, and brings comfort and convenience to patients in the postoperative period.

Retroperitoneoscopic access in organ-preserving treatment of renal cell carcinoma

Background. Renal cell carcinoma is one of the most common urologic cancers. Due to development of modern diagnostic methods, kidney tumors are often diagnosed at early stages (cT1a-T1b). The golden standard of treatment of localized renal cell carcinoma is tumor resection. In retroperitoneoscopic access, the time to artery access is decreased, the risk of intra- and postoperative complications is reduced. Retroperitoneal access is preferable for tumors located on the lateral or posterior kidney surface.Aim. To analyze the results of treatment of patients after retroperitoneoscopic kidney resection.Materials and methods. Between 2018 and 2021, at the A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Radiological Center 47 retroperitoneoscopic kidney resections were performed (29 (61.7 %) in men, 18 (38.3 %) in women) due to stage cT1aN0M0 renal cell carcinoma. Retrospective analysis of demographic data, comorbid status, tumor characteristics, operative time, blood loss volume, frequency and severity of complications per the Clavien-Dindo classification was performed. Complexity of resection was evaluated using the R.E.N.A.L. scale.Results. Mean patient age was 63 (38-79) years, body mass index was 29.9 (22-39) kg/m2. Tumor of the left kidney was diagnosed in 24 (51.0 %) cases, of the right kidney - in 22 (46.8 %) cases, bilateral lesions - in 1 (2.2 %) case. Mean tumor size was 22.4 (11-39) mm. Resection had low complexity in 35 (74.5 %) cases, intermediate complexity in 12 (25.5 %) cases. Mean operative time was 156 (80-280) minutes, mean warm ischemia time was 19 (7-32) minutes, number of resections with zero ischemia was 15 (31.9 %), mean blood loss volume was 53 (10-300) mL, number of resections without renal parenchyma suturing was 10 (21.3 %). Mean hospitalization time after surgery was 5 days. Postoperative complications were observed in 4 (8.5 %) cases: bleeding (severity grade II per the Clavien-Dindo classification) in 1 (2.1 %) case, postoperative infectious complications (severity grade II) - in 2 (4.2 %) cases, subcutaneous hematoma (severity grade I) - in 1 (2.1 %) case.Conclusion. Retroperitoneoscopic access is effective and safe. This is confirmed by low frequency and severity of postoperative complications. This access allows to reduce hospitalization time and pain management medication which accelerates patient mobilization and recovery. Comparative analysis shows that retroperitoneoscopic kidney resection has the same effectiveness as laparoscopic resection.