Outcome analysis of surgical interventions for osteoporotic vertebral compression fractures

Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this clinical study.They

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Clear cell sarcoma metastasizing to the pancreas

In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis

AIM:To evaluate the effect of lens surgery on health-related quality of life(HRQoL)of preschool children with congenital ectopia lentis(CEL).METHODS:A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center.Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study.All of them completed the child and proxy(parental)PedsQL™4.0 before and after the surgery.Their preoperative scores were compared to their postoperative ones.Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children.RESULTS:Thirty-two children with CEL successfully underwent surgery without any complications,among whom 8 had monocular surgery and 24 had binocular surgery.Preoperative and postoperative questionnaires were completed by 32 child-parent pairs.Surgical intervention could significantly improve the vision of affected children(P<0.001).The medians of physical,psychosocial and total health scores self-reported by the children were 68.75(62.50,81.25),65.00(60.00,80.00)and 67.39(60.87,78.26)preoperatively and were 93.75(87.50,100.00),90.00(83.33,96.67)and 89.13(85.32,95.65)postoperatively.The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children(P<0.001).All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents(P<0.001).In the physical functioning evaluation,the preoperative score reported by parents of girls was higher than parents of boys(P=0.041),and the postoperative score of girls was higher than that of boys(P=0.036).CONCLUSION:CEL is associated with significantly worse quality of life in preschool children.Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

Giant vascular malformations invading the skull:A case report

BACKGROUND Vascular malformations(VMs)arise as a result of errors in the process of angiogenesis and are usually present at birth,but may not become apparent until after birth.However,giant VMs of the head and face are uncommon,with few reported cases,and the prognosis for their surgical intervention is unclear.CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp.After admission,computed tomography(CT)angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation.Furthermore,cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood.The patient underwent surgery to remove the malformed vessels and the eroded skull.Two hours after the surgery,the patient's right pupil was dilated,and an urgent CT scan of the skull showed a right subdural haematoma under the incision,which was urgently removed by a second operation.After surgery,we gave continuous antibiotic anti-infection treatment,and the patient recovered well and was discharged two weeks later.CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative(including interventional embolisation)and intraoperative preparations should be made.

Pierre Robin sequence from orthodontic and surgical perspective

Pierre Robin sequence(PRS)is a triad of micrognathia,glossoptosis,and cleft palate that results in an obstruction of the airway on inspiration and impeding feeding.The tongue of infants with PRS fall back toward the posterior pharyngeal wall(glossoptosis)due to receding chin produced by mandibular micrognathia(small jaw)or retrognathia.This causes a serious condition with potentially severe,life-threatening airway obstruction.If untreated,this problem can lead to exhaustion,cardiac failure,and ultimately death,especially during the early months of life.Actually,in the majority of PRS infants,these symptoms can be managed by placing the infant in the prone position until adequate growth of the jaw occurs.If this type of treatment fails,the infant then should be considered for other conservative therapies or surgical interventions.This paper reviews surgical interventions such as tongue-lip adhesion,mandibular traction,mandibular distraction,tracheotomy and conservative orthodontic approaches,and presents a baby treated successfully with an orthodontic appliance.

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury:a prospective self-controlled study

Although a large number of trials in the SCI field have been conducted,few proven gains have been realized for patients.In the present study,we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury(SCI)subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale(AIS)Class A(AIS-A).A total of 320 clinically complete SCI subjects(271 male and 49 female),aged 16–60 years,received early(≤7 days,n=201)or delayed(8–30 days,n=119)surgical interventions to reduce intraspinal or intramedullary pressure.Fifteen days post-surgery,all subjects received a weight-bearing walking training with the“Kunming Locomotion Training Program(KLTP)”for a duration of 6 months.The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale(KLS).We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores.Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days,3 or 6 months indicating continued improvement in walking scores during the 6-month period.In conclusion,combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI,which generally shows little clinical recovery within the first year after injury and most are permanently disabled.This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital,China and registered at ClinicalTrials.gov(Identifier:NCT04034108)on July 26,2019.

Timing of individualized surgical intervention in Crohn’s disease

Crohn’s disease(CD)is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide.Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications.Surgical intervention plays a vital role in comprehensive therapy.However,deciding the optimal timing for surgical intervention has long been a focus of controversy.This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.

Associations between SARS-CoV-2 infections and thrombotic complications necessitating surgical intervention:A systematic review

BACKGROUND Several unique clinical features of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the cause of coronavirus disease 2019(COVID-19)infection,have been identified and characterized.One such feature,mostly among patients with severe COVID-19 infection,has become known as COVID-19-induced coagulopathy.Surgical patients with a history of or active COVID-19 infection bear a significantly higher risk for postoperative thrombotic complications.These patients may require surgical intervention to treat severe thrombotic complications.Few studies have been carried out to better characterize this association.The purpose of this study was to perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention.We hypothesized that patients with recent or active COVID-19 infection would have high rates of thromboembolic complications both arterial and venous in origin.AIM To perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention.METHODS The current systematic review implemented an algorithmic approach to review all the currently available English medical literature on surgical interventions necessitated by COVID-19 thrombotic complications using the preferred reporting items for systematic reviews and metaanalysis principles.A comprehensive search of the medical literature in the“PubMed”,“Scopus”,“Google Scholar”top 100 results,and archives of Plastic and Reconstructive Surgery was performed using the key words“COVID-19”AND“surgery”AND“thromboembolism”AND“complication”.The search string was generated and the records which were not specific about surgical interventions or thrombotic complications due to COVID-19 infection were excluded.Titles and abstracts were screened by two authors and full-text articles were assessed for eligibility and inclusion.Finally,results were further refined to focus on articles that focused on surgical interventions that were necessitated by COVID-19 thrombotic complications.RESULTS The database search resulted in the final inclusion of 22 retrospective studies,after application of the inclusion/exclusion criteria.Of the included studies,17 were single case reports,3 were case series and 2 were cross sectional cohort studies.All studies were retrospective in nature.Twelve of the reported studies were conducted in the United States of America,with the remaining studies originating from Italy,Turkey,Pakistan,France,Serbia,and Germany.All cases reported in our study were laboratory confirmed SARS-CoV-2 positive.A total of 70 cases involving surgical intervention were isolated from the 22 studies included in this review.CONCLUSION There is paucity of data describing the relationship between COVID-19 infection and thrombotic complications necessitating the need for surgical intervention.Intestinal ischemia and acute limb ischemia are amongst the most common thrombotic events due to COVID-19 that required operative management.An overall postoperative mortality of 30%was found in those who underwent operative procedures for thrombotic complications,with most deaths occurring in those with bowel ischemia.Physicians should be aware that despite thromboprophylaxis,severe thrombotic complications can still occur in this patient population,however,surgical intervention results in relatively low mortality apart from cases of ischemic bowel resection.

Case Report: Intracardiac Mass, the Importance of Early Diagnosis and Surgical Intervention

Background: Cardiac masses are not rare findings;they can be primary or secondary. The differential diagnosis may need surgical intervention in most cases. Case summary: A 42-year female presented with complaints of dyspnea, palpitations, ventricular premature beats, attacks of non-sustained ventricular tachycardia. Echocardiography revealed a myocardial septal mass on both sides in the right and left ventricles. The decision to operate was taken and the masses were removed. It was proved by histopathologic examination to be metastatic from her skin melanoma. Clinically, arrhythmias subsided. Conclusion: The decision of surgery proved unavoidable. Early diagnosis by surgical intervention is important for effective treatment.

Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors

Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A single-center,retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021.The study involved a review of electronic medical records and radiographs and the collection of clinical data.The differences in clinical manifestations between patients with constipation and those without constipation were analyzed.Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled,including 131 patients with constipation and 96 without constipation.The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery(83.2%vs.17.7%,χ~2=99.035,P 0.001).Constipation(OR=9.522,95%CI:4.150±21.849,P 0.001)and urinary retention(OR=14.490,95%CI:4.543±46.213,P 0.001)were independent risk factors for muscle strength decline in the lower limbs.Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness.Moreover,the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM：To assess the outcomes of various interventions for malignant glaucoma（MG）.·M ETHODS：A retrospective,comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan.2009and Dec.2012.Numerous treatments were administered including medical therapy,neodymium：yttriumaluminium-garnet（Nd：YAG）laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options.The characteristic,treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo.·RESULTS：Four eyes of 3 patients achieved complete resolution with medical therapy.Nd：YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes,both of which achieved resolution after initial intervention.Thirty-two eyes were given surgical treatments with anterior vitrectomy-reformation of anterior chamber in13 eyes,phacoemulsification-intraocular lens implantation in 10 eyes and phacoemulsification-intraocular lens implantation-anterior vitrectomy in 9 eyes.Resolution of MG was seen in almost all patients.The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit.The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm.Twenty eyes with preoperative visual acuity better than counting figure/50 cm had various visual improvements.Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity,corneal endothelial decompensation and allergic to atropine respectively.·CONCLUSION：MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment,laser therapy is beneficial in pseudophakic eyes,and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management.MG can be managed successfully by appropriate and timely interventions with good visual outcome.

Childhood constipation:Current status,challenges,and future perspectives

Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.

Imatinib as preoperative therapy in Chinese patients with recurrent or metastatic GISTs

Objective： Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal turnouts. However, it has become clear that secondary resistance to the drug develops during long- term therapy. The purpose of our study was to retrospectively analyze safety and long-term outcomes in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. Methods： Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. Results： Complete resection was accomplished in 8 of the 10 responsive disease （RD） patients （80%）, and in 3 of the 12 patients （25%） who had progression disease （PD）. The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS between patients with RD and those with PD was significant （24.8 vs. 2.81 months, P〈0.001）. The difference in 2-year OS rate between patients with RE） and those with PD was not significant （100% vs. 87.5%, P〉0.05）. Conclusions： Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib.

Clinical features and outcomes of patients with severe acute pancreatitis complicated with gangrenous cholecystitis

BACKGROUND: The effects of gangrenous cholecystitis (GC) and consequent surgical interventions on the clinical outcomes and prognosis of patients with severe acute pancreatitis are not clear. The present study was to characterize the clinical outcomes of patients with severe acute pancreatitis complicated with GC. METHODS: We retrospectively analyzed 253 consecutive patients hospitalized for acute pancreatitis in intensive care unit. Among them, 68 were diagnosed as having severe acute pancreatitis; 10 out of the 68 patients had GC. We compared these 10 patients with GC and 58 patients without GC. The indices analyzed included sepsis/septic shock, pancreatic encephalopathy, acute respiratory distress syndrome, acute renal failure, multiple organ dysfunction syndrome, and death. RESULTS: Specific CT images of GC in patients with severe acute pancreatitis included enlarged and high-tensioned gallbladder, wall thickening, lumenal emphysema, discontinuous and/or irregular enhancement of mucosa, and pericholecystic effusion. The rates of severe sepsis/septic shock (70.0% vs 24.1%, P【0.01), pancreatic encephalopathy (50.0% vs 17.2%, P【0.05), acute respiratory distress syndrome (90.0% vs 41.4%, P【0.01), multiple organ dysfunction syndrome (70.0% vs 24.1%, P【0.01), acute renal failure (40.0% vs 27.6%, P【0.05), and death (40.0% vs 13.8%, P【0.05) were significantly higher in patients with GC than in those without GC.CONCLUSION: CT scans can help to identify early GC in patients with severe acute pancreatitis; early diagnosis and intervention for patients with GC can reduce morbidity and mortality.

Urolithiasis in Pregnancy: Survey in Clinical Epidemiology

This study examined the association of pregnancy with urolithiasis and provided new insights into urolithiasis in pregnancy. A total of 462 subjects were studied from January 2004 to December 2009 in Foshan Maternal and Child Health Hospital, China. Among the 462 subjects, 162 cases of urolithiasis during pregnancy （UPG） were selected as the observation group, 150 cases of no urolithiasis during pregnancy （NUPG） served as pregnancy control group, and 150 cases of no pregnancy （NPG） at reproductive age who took part in physical examination were randomly assigned into non-pregnant control group. At the same time, the patients in observation group were divided into the following sub-groups： no symptomatic urinary calculus （NSUC） and symptomatic urinary calculus （SUC） groups; SUC group was further divided into surgical intervention （SI） and conservative management （CM） groups. The general information and the data of blood and urine were collected and compared among the groups. The results showed that the incidence of urinary calculi in pregnant women was lower than that in non-pregnant women, the formation of urinary stone was associated with the change of metabolism of protein and sugar in pregnant women, and the surgical intervention was a practicable alternative to treat the clinical intractable symptomatic urinary calculi in pregnancy.

Analysis of opto-thermal interaction of porcine stomach tissue with 808-nm laser for endoscopic submucosal dissection

In endoscopic submucosal dissection(ESD),the narrow gastrointestinal space can cause difficulty in surgical interventions.Tissue ablation apparatuses with high-power CO_(2) lasers or Nd:YAG lasers have been developed to facilitate endoscopic surgical procedures.We studied the interaction of 808-nm laser light with a porcine stomach tissue,with the aim of developing a therapeutic medical device that can remove lesions at the gastrointestinal wall by irradiating a near-infrared laser light incorporated in an endoscopic system.The perforation depths at the porcine fillet and the stomach tissues linearly increased in the range of 2–8mm in proportion to the laser energy density of 63.7–382 kJ/cm^(2).Despite the distinct structural and compositional di®erence,the variation of the perforation depth between the stomach and the fillet was not found at 808-nm wavelength in our measurement.We further studied the laser–tissue interaction by changing the concentration of the methyl blue solution used conventionally as a submucosal fluidic cushion(SFC)in ESD procedures.The temperature of the mucosal layer increased more rapidly at higher concentration of the methyl blue solution,because of enhanced light absorption at the SFC layer.The insertion of the SFC would protect the muscle layer from thermal damage.We confirmed that more effective laser treatment should be enabled by tuning the opto-thermal properties of the SFC.This study can contribute to the optimization of the driving parameters for laser incision techniques as an alternative to conventional surgical interventions.

Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease

Background:The purpose of this study was to investigate whether patients with adult congenital heart disease(ACHD)benefit from exercise-based cardiac rehabilitation(CR)short-and long-term with regard to improvement of cardiorespiratory fitness.Methods:Cardiopulmonary exercise tests(CPET)completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively.Linear mixed models were performed for peak oxygen consumption(VO_(2))with patients as random effect and age,sex,disease classification,preceding surgery(≤3 months)and preceding CR(≤4 weeks for short term and>4 weeks for long term)as fixed effects.Results:1056 CPETs of 311 ACHD patients with simple(7),moderate(188)or great(116)complexity heart defects were analysed.The 59 patients who completed a CR(median age 27 yrs,38%females)increased peak VO_(2)from before to after CR by a median of 2.7(IQR–0.6 to 5.5)ml/kg/min.However,in the multivariate mixed model,peak VO_(2)was non-significantly increased short-term after CR(β0.8,95%CI–0.7 to 2.4),not maintained long-term after CR(β0.0,95%CI–1.7 to 1.6)but significantly reduced after surgery(β–5.1,95%CI–7.1 to–3.1).The 20 CR patients after surgery increased their peak VO_(2)by 6.2(IQR 3.6–9.5)ml/kg/min,while the 39 CR patients without preceding surgery increased it by 0.9(IQR–1.5 to 3.1)ml/kg/min.Conclusions:The increase in peak VO_(2)with CR was mainly due to recovery from surgical intervention.The small independent benefit from CR was not maintained long-term,highlighting the potential to improve current CR concepts in ACHD populations.

Tumor-like disorder of the brachial plexus region in a patient with hemophilia:A case report

BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.CASE SUMMARY The case reported here was a 30-year-old man with hemophilia,as well as both sensory and motor dysfunction of the left upper extremity.A presumptive diagnosis of brachial plexus tumor was initially made,which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm.The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints.The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.