Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective:To analyze the differences in pediatric CT radiation dose and scanning parameter Settings between children's specialized hospitals and general hospitals, and to provide reference for the optimization strategy of pediatric CT radiation dose.Methods:From July to August 2022, a stratified sampling method was used to select 7 comprehensive hospitals and 2 children's hospitals in Tianjin, and on-site survey was conducted to collect the dose data of children's head, chest, and abdomen and pelvic CT examinations in these hospitals. The Wilcoxon rank sum test was used to analyze the differences in CTDI vol and DLP of the same age group and examination site among different types of hospitals, and the stepwise regression analysis method was used to analyze the effects of age, examination site, and scanning parameters on radiation dose CTDI vol and DLP. Results:The CTDI vol and DLP of head (1-<5, 5-<10, 10-<15 years old group), chest (5-<10, 10-<15 years old group) and abdomen (1-<5, 5-<10, 10-<15 years old group) in children's specialized hospitals were lower than those in general hospitals (head, 1-<5, 5-<10, 10-<15 years old group, CTDI vol: Z=-9.32, -6.17, -9.86, P<0.001, DLP, Z=-4.41, -4.14, -5.76, P<0.001; chest, 5-<10, 10-<15 years old group, CTDI vol: Z=-3.84, -5.35, P<0.001, DLP, Z=-3.59, -4.63, P<0.001; abdomen, 1-<5、5-<10 and 10-<15 years old group, CTDI vol: Z=-7.88, -7.78, -8.53, P<0.001, DLP, Z=-7.24, -5.92, -3.44, P<0.001). The CT radiation dose in children was positively correlated with age, tube voltage, tube current time product and scan length, and negatively correlated with pitch and hospital type (general hospital and children's hospital) . Conclusion:There are some differences in the CT radiation dose and scanning parameters between children's hospitals and general hospitals. The results indicate that there is still much room for improvement in the optimization of radiation dose in pediatric CT examination.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective:To analyze the differences in pediatric CT radiation dose and scanning parameter Settings between children's specialized hospitals and general hospitals, and to provide reference for the optimization strategy of pediatric CT radiation dose.Methods:From July to August 2022, a stratified sampling method was used to select 7 comprehensive hospitals and 2 children's hospitals in Tianjin, and on-site survey was conducted to collect the dose data of children's head, chest, and abdomen and pelvic CT examinations in these hospitals. The Wilcoxon rank sum test was used to analyze the differences in CTDI vol and DLP of the same age group and examination site among different types of hospitals, and the stepwise regression analysis method was used to analyze the effects of age, examination site, and scanning parameters on radiation dose CTDI vol and DLP. Results:The CTDI vol and DLP of head (1-<5, 5-<10, 10-<15 years old group), chest (5-<10, 10-<15 years old group) and abdomen (1-<5, 5-<10, 10-<15 years old group) in children's specialized hospitals were lower than those in general hospitals (head, 1-<5, 5-<10, 10-<15 years old group, CTDI vol: Z=-9.32, -6.17, -9.86, P<0.001, DLP, Z=-4.41, -4.14, -5.76, P<0.001; chest, 5-<10, 10-<15 years old group, CTDI vol: Z=-3.84, -5.35, P<0.001, DLP, Z=-3.59, -4.63, P<0.001; abdomen, 1-<5、5-<10 and 10-<15 years old group, CTDI vol: Z=-7.88, -7.78, -8.53, P<0.001, DLP, Z=-7.24, -5.92, -3.44, P<0.001). The CT radiation dose in children was positively correlated with age, tube voltage, tube current time product and scan length, and negatively correlated with pitch and hospital type (general hospital and children's hospital) . Conclusion:There are some differences in the CT radiation dose and scanning parameters between children's hospitals and general hospitals. The results indicate that there is still much room for improvement in the optimization of radiation dose in pediatric CT examination.

Objective:To observe the clinical effect of comprehensive reconstruction of grades Ⅰ-Ⅱ thumb and finger defects with hallux osteo-onychocutaneous flaps of great toe.Methods:This is a retrospective study. From June 2020 to December 2023, comprehensive reconstruction surgery for Grade Ⅰ-Ⅱ digital defect were performed with hallux osteo-onychocutaneous flaps of great toe for 3 thumbs and 7 fingers in 9 patients in the Department of Hand and Microsurgery of Baoji Third Hospital. Causes of digital injury were: 4 of machine crush, 3 of electric saw cut, 1 of door crush, and 1 of electrical burn. There were 6 grade I digital defects (beyond the nail root) and 4 grade Ⅱ defects (last segment of digit). The defects of the digits were reconstructed by taking references of the shape and structure of the contralateral normal thumbs and fingers. Then the hallux osteo-onychocutaneous flaps of great toe were designed and harvested accordingly from the left and right great toes. Donor sites were covered by skin grafting or local dressing change. One patient was treated in emergency surgery, 6 in sub-emergency surgery and 2 in elective surgery. Integrated perioperative patient management was provided to all of the patients. Postoperative follow-ups were conducted through the visit of outpatient clinic, telephone calls or WeChat interviews. Flap survival, appearance and sensation recovery were evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:Vascular insufficiency of 1 digit occurred in surgery, and relieved by local treatment with lidocaine and warm saline. All 10 digits successfully survived, and all donor sites healed spontaneously. The postoperative follow-up period was 10 to 30 months, with an average of 18 months. One transferred nail was found in poor appearance (not flat), the rest of the reconstructed digits were good in appearance and function. The nail, finger print and fine sensation (TPD 5~8 mm), as well as digital flexion, extension, grasping and opposition of the reconstructed digits were all good. According to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association, at the last follow-up visit, 5 digits were in excellent, 4 in good and 1 in fair.Conclusion:The comprehensive reconstruction of grades Ⅰ-Ⅱ digital defects with hallux osteo-onychocutaneous flap of great toe is an ideal surgical technique that can reconstruct the nail, finger print and sensation of a digit, with good postoperative function as well as an aesthetic and realistic appearance.

Objective:To explore the value of applying multiple genetic testing techniques for the prenatal diagnosis of Turner syndrome fetuses with complex mosaic small supernumerary marker chromosomes (sSMC).Methods:Chromosomal karyotypes of amniotic fluid samples from 5 030 pregnant women who had undergone amniocentesis at the Prenatal Diagnosis Center of the Third Affiliated Hospital of Zhengzhou University from January to December 2022 were retrospectively reviewed. Three fetuses with complex mosaicism fetuses (carrying 2 types of sSMC) were selected as the study subjects. Genetic tests including G-banded chromosomal karyotyping analysis, fluorescence in situ hybridization (FISH), chromosomal microarray analysis (CMA), and copy number variation sequencing (CNV-seq) were used to clarify the origin and mosaic status of the sSMC. This study has been approved by the Medical Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (No. 2023-159-01).Results:G-banded chromosomal analysis of fetus 1 showed a karyotype of 45, X[64]/46, X, + mar1[13]/46, X, + mar2[3]. FISH results showed that 52% of of its cells had contained one X chromosome signal, whilst 48% contained two X chromosome signals. CMA results revealed the fetus had harbored a 32.32 Mb and a 50.93 Mb deletion in Xp22.33p21.1 and Xq22.2q28 regions, respectively, in addition with mosaic deletions of approximately 1.43 copies, 1.78 copies and 1.43 copies in the Xp21.1p11.1, Xq11.1q21.1 and Xq21.2q22.2 regions, respectively. The fetus 2 had a karyotype of 45, X[27]/46, X, + mar1[14]/46, X, + mar2[12]. FISH results indicated that 88% of its cells contained one X chromosomes signal and two Y chromosome signals, and 12% contained signals for one X chromosomes signal and one Y chromosome signal. CNV-seq results revealed a deletion of 7.74 Mb in the Yq11.222q11.23 region and a mosaic duplication of approximately 1.738 copies in the Yp11.31q11.221 region. The fetus 3 had a karyotype of 45, X[60]/46, X, + mar1[11]/46, X, + mar2[6]. FISH results showed that 28% of its cells contained one X chromosome signal, and 72% contained tow X chromosome signals. CNV-seq results revealed deletions of 55.60 Mb and 53.50 Mb in the Xp22.33p11.1 and Xq22.1q28 regions, respectively, along with a mosaic deletion of approximately 1.85 copies in the Xp11.1q13.2 region and a mosaic repeats of approximately 2.66 copies in the Xq13.2q22.1 region. The sSMCs in the 3 fetuses had all originated from sex chromosomes and were of complex mosaic type. After genetic counseling, the three couples had all opted to terminate the pregnancy.Conclusion:The combined use of multiple genetic testing techniques has determined the origin and structure of complex mosaic sSMCs and provided a basis for prenantal diagnosis and genetic counseling.

The incidence of lower extremity varicose veins is higher in the disease of venous system,and surgical treatment is the main treatment method of lower extremity varicose veins.With the advancement of technique and the development of minimally invasive concept,endovenous thermal ablation(EVTA)has become the first choice in the guidance of the treatment of lower extremity varicose veins depended on its series of advantages include small trauma,rapid recovery after surgery,low incidence of complication and high closure rate.At present,EVTA mainly includes intracavitary radiofrequency ablation(RFA),endovenous laser ablation(EVLA)and endovenous microwave ablation(EMA),which takes heat on target vessel through different thermal ablation equipment,and uses thermal energy to destruct the endothelial cells of blood vessel and collagen fibers in the vascular wall.Then,the contracted lumen forms the fibrous strands,thus reaches the aim that closes target vessel.Different EVTA surgical mode has different mechanism of action,therapeutic effect and incidence of complication,as well as the application range.This paper summarized the routinely surgical mode of EVTA and the clinical application of that in the past 5 years,which can provide references for reasonable choosing the mode of thermal ablation and the equipment,and can provide helps for preventing the complication of thermal injury.

Objective:To understand the level of radiation doses from digital mammography in Tianjin and the associated influencing factors.Methods:The stratified quota sampling method was used for analysis of 374 digital mammography-examined individuals by using 12 digital mammography devices in 12 selected medical institutions. The examinations were carried out in terms of exposure positions[(craniocaudal (CC) and mediolateral oblique (MLO)], compressed breast thickness, tube voltage, time product of tube current (mAs) and target/filter.Results:The median age of the examined individuals in this survey was 43 years, the median tube voltage (kV) was 29 kV, the median tube current time product was 60.3 mAs, the median compressed breast thickness was 48 mm, and the median average glandular dose (AGD) was 1.32 mGy. The mean dose to the analyzed glandular tissue in the conditions of different target/filters varies in the descent order of Mo/Mo > Mo/Rh > Rh/Rh > W/Rh > W/Al, with the difference being statistically significant difference ( χ2=885.90, P<0.05). The mean dose to the glandular tissue increased with the increase in compressed breast thickness, and the difference was statistically significant ( χ2=31.58, 8.56, 76.13, 118.47, 24.09, P<0.05). Conclusions:The median average glandular dose in Tianjin was 1.32 mGy. This level is lower than in Guangxi province and Fuzhou city, similar to that in Beijing and Guangdong province, and lower than the national survey result of average breast dose. The efforts should be dedicated to further strengthening the research on the related factors of the average glandular dose in order to protect the health and safety of the examined individuals.

Objective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.