UNASSIGNED: Doege-Potter syndrome, characterized by solitary fibrous tumors and non-islet cell tumor hypoglycemia, is rare. Here, we report a case of Doege-Potter syndrome in which retroperitoneal tumor resection was performed with continuous intraoperative blood glucose monitoring.
UNASSIGNED: A 37-year-old man presented with hypoglycemia-related symptoms, and a 10 × 12 × 9 cm tumor was found in his right kidney. Following tumor resection, insulin secretory abnormalities improved, and intraoperative blood glucose monitoring showed no hypoglycemic events. High levels of insulin-like growth factor-II confirmed the diagnosis of an insulin-like growth factor-II-producing tumor with non-islet cell tumor hypoglycemia. Postoperative serum insulin-like growth factor-II levels normalized, with no recurrence observed over 3 years.
UNASSIGNED: This case highlights the rarity of primary retroperitoneal Doege-Potter syndrome, emphasizes the safety of intraoperative blood glucose levels during surgery, and suggests rapid recovery of insulin secretion postoperatively.

BACKGROUND: Aortic dissection with malperfusion necessitates emergency surgery and is associated with poor outcomes. Therefore, in this study, we analyzed patients\' treatment courses from the initial management to hospital discharge in cases of acute aortic dissection (AAD) with malperfusion and investigated the risk factors associated with mortality.
METHODS: We evaluated cases of AAD with malperfusion treated at our institution over a 16-year period from 2007 to 2022. The primary endpoint was in-hospital mortality. The study\'s primary outcome measure was mortality during hospitalization. We collected and analyzed data encompassing preoperative patient characteristics, Stanford classification, sites of preoperative malperfusion, surgical techniques employed, and postoperative complications. These variables were examined to identify factors associated with in-hospital mortality.
RESULTS: During the study period, 366 patients were admitted with AAD, 102 of whom had malperfusion. There were 62 men (61%) and 40 women (39%), with a mean age of 64 ± 13 years (range: 28-87 years). According to the Stanford classification, 75 (74%) and 27 (26%) patients had type A and B aortic dissection, respectively, and 29 patients (28%) presented with shock. Preoperative malperfusion sites included the brain, coronary arteries, abdominal viscera, limbs, and spinal cord in 40 (39%), 10 (10%), 34 (33%), 52 (51%), and six (6%) patients, respectively. Eleven (11%) patients required immediate intervention in the emergency department. The treatments administered to the patients were as follows: ascending aortic replacement, 30 (29%) patients; aortic arch replacement, 34 (33%) patients; root replacement, three (3%) patients; thoracic endovascular aortic repair (TEVAR), 12 (12%) patients; non-anatomic bypass, five (5%) patients; and conservative management, five (5%) patients. In-hospital mortality occurred in 23 (23%) patients. Multivariate logistic regression analysis identified preoperative coronary malperfusion as an independent risk factor of mortality.
CONCLUSIONS: Preoperative coronary malperfusion is an independent risk factor for in-hospital mortality in patients with AAD presenting with malperfusion.

Perianal embryonal rhabdomyosarcoma (ERMS) is a rare disease with a poor prognosis. There are few reported cases of this disease, and specific clinical manifestations are lacking; therefore, making an early diagnosis before surgery is challenging. In November 2014, a 30-year-old man was admitted to Xiaoshan Affiliated Hospital of Wenzhou Medical University due to severe left perianal pain. Ultrasonography revealed a multilocular perianal abscess, and an emergency perianal abscess incision and drainage were performed. However, pathology combined with immunohistochemistry confirmed an ERMS. The patient did not receive postoperative radiotherapy or chemotherapy and died of multiple metastases and multiple organ failure 6 months later. Perianal ERMS is highly malignant and rare, and can easily be misdiagnosed as a perianal abscess. Clinicians must enhance their knowledge and improve preoperative diagnostic tests to prevent misdiagnoses.

BACKGROUND: Whether operation is superior to non-operation for humeral shaft fracture remains debatable. We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.
OBJECTIVE: To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.
METHODS: We searched the PubMed, Web of Science, ScienceDirect, and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures. Two investigators independently extracted data from the eligible studies, and the other two assessed the methodological quality of each study. The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale. The nonunion, reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software (version 5.3).
RESULTS: A total of four randomized control trials and 13 cohort studies were included, with 1285 and 1346 patients in the operative and nonoperative groups, respectively. Patients in the operative group were treated with a plate or nail, whereas those in the conservative group were managed with splint or functional bracing. Four studies were assessed as having a high risk of bias, and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool. The operative group had a significantly decreased rate of nonunion [odds ratio (OR) 0.30; 95%CI: 0.23 to 0.40), reintervention (OR: 0.33; 95%CI: 0.24 to 0.47), and overall complications (OR: 0.62; 95%CI: 0.49 to 0.78)]. The pooled effect of the Disabilities of Arm, Shoulder, and Hand score showed a significant difference at 3 [mean difference (MD) -8.26; 95%CI: -13.60 to -2.92], 6 (MD: -6.72; 95%CI: -11.34 to -2.10), and 12 months (MD: -2.55; 95%CI: -4.36 to -0.74). The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.
CONCLUSIONS: This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.

暂无摘要。

UNASSIGNED: Kontrollierte Nachsorge bei Patienten nach vollständiger Resektion von Hochrisikotumoren der Haut führt zur Entdeckung von Metastasen in sehr frühen Stadien, allerdings ist die operative Entfernung nicht tastbarer Läsionen häufig problematisch.
UNASSIGNED: In dieser monozentrischen retrospektiven Studie wurden 39 Patienten mit malignen Hauttumoren mit verdächtigen nicht tastbaren Läsionen in Lymphknoten (90%) oder subkutan/intramuskulär (10%) eingeschlossen. Bei 21 Patienten wurden die Läsionen unter Ultraschallkontrolle exzidiert, 18 Patienten erhielten vor der Operation eine Drahtmarkierung. Die beiden Patientengruppen wurden hinsichtlich des erfolgreichen intraoperativen Auffindens der Läsion, der Dauer des Eingriffs und der Komplikationsrate verglichen.
UNASSIGNED: Drahtmarkierung führte zu einer signifikant höheren intraoperativen Detektionsrate von 100% gegenüber 76% (p < 0,05). Die durchschnittlich benötigte Zeit für den gesamten Eingriff (p = 0,91) und die Komplikationsrate (p = 0,70) unterschieden sich nicht signifikant zwischen beiden Gruppen. Die mit Hilfe der Drahtmarkierung erfolgreich entfernten bösartigen Läsionen waren signifikant kleiner (p < 0,05). Von allen 34 operativ entfernten auffälligen Läsionen wurden nur 20 (59%) histologisch als bösartig bestätigt.
UNASSIGNED: Die Drahtmarkierung erhöhte die Detektionsrate nicht tastbarer verdächtiger subkutaner, intramuskulärer oder lymphatischer Läsionen. Sie führte zu früherer Diagnose der Metastasierung und auch zur Vermeidung unnötiger vollständiger Lymphknotendissektion.

A Closed Aquatic Ecosystem (CAES) housed an aquatic plant Ceratophyllum demersum, zebrafish (Danio rerio), and microbes that were simultaneously obtained with the zebrafish, and it was used to study the operation of the ecosystem. The results indicated that the CAES can operate steadily for about 4 weeks. The dissolved oxygen (DO), pH, and conductivity values of the ecosystem regularly oscillated, while the total nitrogen of the water decreased and the total phosphate slightly increased. Additionally, the chemical oxygen demand (COD, a measure of organic compounds) of the water after the experiment increased to 39 times more than that of the water before the experiment. The meta-genomic data showed that the number of genera decreased by 38 % and the top 10 most abundant genera were almost completely different before and after the experiment, which demonstrated a great shift in the microbes during the operation process. These results suggested that although the CAES operated steadily during the 28-day experiment, there were more organic materials and less nitrogen in the water by the end of the experiment, which may have influenced the structure and operation of the ecosystem. Thus, it is necessary to remove superfluous plant biomass from the CAES and supply nitrogen to keep the ecosystem stable.

Background: Granulicatella adiacens inhabits the oral cavity, urogenital, and gastrointestinal tracts and is a typical commensal of human mucosal surfaces. It rarely causes disease. Identification of these gram-positive cocci can be challenging. Case Report: In a 58-year-old male in an oncology center, we report the first occurrence of bacterial infection caused by G. adiacens. After a precise diagnosis of the infection, the patient received effective treatment. Conclusion: Owing to a lack of sufficient diagnostic tools, G. adiacens may be a more notable pathogen than has been previously identified. Sensitivity testing standards are desperately needed.

BACKGROUND: Cholesterol stones affect a certain subpopulation of children. Concerns have been raised on the impact of gallbladder surgery on the growth of children and adolescents.
OBJECTIVE: To study the population characteristics, clinical features, treatment, and prognosis of gallstones in children.
METHODS: The clinical data of 44 children with gallstones admitted to The First Affiliated Hospital of Naval Medical University from August 2009 to August 2021 were collected, the children were followed up by telephone to monitor their prognoses. The follow-up ended in August 2023. The shortest follow-up time was 2 years and 6 months, whereas the longest was 13 years and 11 months. The population characteristics, general clinical characteristics, and treatments were retrospectively analyzed. The children were divided according to whether they underwent surgical gallbladder removal into an operation group (n = 28) and a non-operation group (n = 16), The effects of surgical gallbladder resection on the growth and development of children were analyzed.
RESULTS: The male-female ratio in the population was 6:5 and 84.09% of the children had onset in adolescence. Furthermore, 29.55% of the children were overweight or obese. The study identified 26 cases with metabolic abnormalities, 9 with hemolytic anemia, and 4 with choledochal cyst. Of the population, 68.18% had recurrent symptomatic cholecystolithiasis. Surgical treatment accounted for 63.64%, with laparoscopic cholecystectomy accounting for 71.43% of surgical treatment. No significant differences were observed in symptoms and complications between the surgery and non-surgery groups. Furthermore, no significant differences were found between the two groups in the attainment of genetic height target and the rightward shift of height curve during follow-up.
CONCLUSIONS: The sex characteristics of gallstones in children were not observed. Most gallstones occurred in adolescents and rarely in young children. A considerable proportion of children have inborn causes, which are often concurrent with metabolic abnormalities and hemolytic anemia. Most children had recurrent symptomatic gallstones. Surgical treatment, especially laparoscopic cholecystectomy, is still the main treatment for gallstones in children. Surgical treatment did not affect the growth and development of children who underwent gallstone removal.

This study investigated the association of preoperative 25-hydroxy (25 (OH)) vitamin D levels with postoperative complications in osteoporotic hip fracture patients following surgery. We hypothesized that patients with low concentrations of 25 (OH) vitamin D might have an increased risk of developing adverse outcomes. Between January 2019 and December 2020, a retrospective observational study was conducted, including low-energy fragility fractures at the proximal femur. Regarding preoperative 25 (OH) vitamin D levels, patients were divided into two groups (<30 ng/mL and ≥30 ng/mL). Early and late postoperative complications were assessed and graded according to the Clavien-Dindo classification system. Logistic regression analysis was performed to demonstrate the association between preoperative 25 (OH) vitamin D levels (<30 ng/mL, ≥30 ng/mL) and postoperative complications after adjusting for age and sex. Of 314 patients, 222 patients (70.7%) had a 25 (OH) vitamin D level of <30 ng/mL. The mean serum 25 (OH) vitamin D level was 22.6 ng/mL (SD 13.2). In 116 patients (36.9%), postoperative complications were observed, with the most occurring in the short term (95 patients, 30.2%). Late postoperative complications were present in 21 patients (6.7%), most graded as Clavien I (57.1%). Logistic regression analysis identified a low vitamin D level (<30 ng/mL) as an independent risk factor for early postoperative complications (OR 2.06, 95% CI 1.14-3.73, p = 0.016), while no significant correlation was found in late complications (OR 1.08, 95% CI 0.40-2.95, p = 0.879). In conclusion, preoperative 25 (OH) vitamin D serum level might be an independent predictor for early postoperative complications. However, future studies are warranted to determine risk factors for long-term complications and establish appropriate intervention strategies.