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.

Objective To evaluate the overall implementation of the WS 76-2020 standard in Anhui Province, China and identify and analyze the factors affecting the implementation of the standard, and to provide a basis for the effective implementation and revision of WS 76-2020. Methods According to the requirements of the Notice of the Department of Regulations in National Health Commission on the 2024 assessment of implementation of mandatory standards, an evaluation of radiological health standards was organized and conducted in Anhui Province. The evaluation involved the three dimensions of standard implementation status, technical content of the standards, and effectiveness of standard implementation, with subsequent data analysis. Results The total evaluation score for WS 76-2020 was 87.83 points, indicating that the standard effectively guided the quality control testing of medical X-ray diagnostic equipment. However, stability testing was either underutilized or not performed in practice. The qualified rate of X-ray diagnostic equipment in the province was 94.26%, with equipment performance issues identified as the leading contributor to non-qualified instances. Expert discussions highlighted recommendations particularly concerning the operability, applicability, and scientific rigor of the standard. Conclusion It is recommended to strengthen the dissemination and training for the standard, promote medical institutions to voluntarily conduct stability testing, provide supplementary clarifications or revisions for problematic clauses, and standardize quality control testing techniques for radiological diagnostic equipment.

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 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 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 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.

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 evaluate the efficacy of a calf tissue flap combined with antibiotic-loaded calcium sulfate (artificial bone or mixed iliac bone graft) in the treatment of foot and ankle osteomyelitis.Methods:A retrospective study was conducted to analyze the 11 cases of foot and ankle osteomyelitis which had been treated at Department of Hand and Microsurgery, The Third Hospital of Baoji from October 2018 to October 2021. There were 8 males and 3 females, aged (42.3±23.7) years. The chronic hypotoxic osteomyelitis was repaired and reconstructed after thorough debridement at one stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound. The acute infected trauma was repaired and reconstructed after thorough debridement at the second stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound only after the acute infection was controlled by local dressing, drainage or negative pressure therapy and systemic anti-infection treatment at the primary stage. The flap size ranged from 3.5 cm × 2.0 cm to 12.0 cm × 6.0 cm. Four cases were treated by a peroneal artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a flap with peroneal artery perforator and peroneal nerve trophic vessel combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a posterior tibial artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, and one by a peroneus longus muscle flap combined with antibiotic-loaded calcium sulfate artificial bone. Postoperatively, the flap survival, bone union time, ankle function and complications were observed; the therapeutic efficacy was evaluated by comparing infection control indexes at the final follow-up [clinical manifestations like local redness, swelling, pain, ulceration, and exudation, and white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calcitoninogen (PCT)].Results:All the flaps survived except for one which developed necrosis at the distal 1/3 of the flap but responded to dressing change. All the patients were followed up for (22.6±11.5) months. The 6-month follow-up revealed that all the flaps were fine in shape and texture. Re-examinations showed that WBC, CRP, ESR and PCT were normal or close to normal, the local skin was free of redness, swelling or ulceration, and protective sensation was restored to varying degrees. X-ray at (12.1±2.3) months showed that lesions disappeared, bony union was achieved, the ankle joint regained basic flexion and extension, and the affected limb also regained weight-bearing and walking functions in all the patients but one whose X-ray at 18 months showed poor bony union but no other symptoms or signs.Conclusion:In the treatment of foot and ankle osteomyelitis, a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone can promote bone healing and restore the function of the foot and ankle because it not only fills the cavity and covers the wound but also effectively controls the infection.