Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair.

Background: Urethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery. Methods: This is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators. Results: In the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001). Conclusion: It is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.

Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. STUDY DESIGN: Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. RESULTS: Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = -21.83, 95% CI [-34.76, -8.90]; MD = -23.8, 95% CI [-32.55, -15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = -18.74, 95% CI [-31.93, -5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). CONCLUSION: P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.

Value of MRI Radiomics Based on Enhanced T1WI Images in Prediction of Meningiomas Grade.

OBJECTIVE: Different grades of meningiomas require different treatment strategies and have a different prognosis; thus, the noninvasive classification of meningiomas before surgery is of great importance. The purpose of this study was to explore the application value of magnetic resonance imaging (MRI) radiomics based on enhanced-T1-weighted (T1WI) images in the prediction of meningiomas grade. MATERIALS AND METHODS: A total of 98 patients with meningiomas who were confirmed by surgical pathology and underwent preoperative routine MRI between January 2017 and December 2019 were analyzed. There were 82 cases of low-grade meningiomas (WHO grade I) and 16 cases of high-grade meningiomas (7 cases of WHO grade II and 9 cases of WHO grade III). These patients were randomly divided into a training group and test group according to 7:3 ratio. The lesions were manually delineated using ITK-SNAP software, and radiomics analysis were performed using the Analysis Kit (AK) software. A total of 396 tumor texture features were extracted. Subsequently, the LASSO algorithm was used to reduce the feature dimensions. Next, a prediction model was constructed using the Logistic Regression method and receiver operator characteristic was used to evaluate the prediction performance of the model. RESULTS: A radiomics prediction model was constructed based on the selected nine characteristic parameters, which performed well in predicting the meningiomas grade. The accuracy rates in the training group and the test group were respectively 94.3% and 92.9%, the sensitivities were respectively 94.8%, and 91.7%, the specificities were respectively 91.7% and 100%, and the area under the curve values were respectively 0.958 and 0.948. CONCLUSION: The MRI radiomics method based on enhanced-T1WI images has a good predictive effect on the classification of meningiomas and can provide a basis for planning clinical treatment protocols.

Primary pulmonary plasmacytoma: a case report introduction.

BACKGROUND: Extramedullary plasmacytoma is a rare plasma cell neoplasm within soft tissue and without bone marrow involvement or other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma. CASE PRESENTATION: A 48-year-old male with a tumor in the right middle ear was referred to our hospital. A routine chest X-ray was arranged and showed enlargement of the left lung hilum. His bilateral breathing sounded clear. A chest CT scan revealed a well-circumscribed mass. Pathological biopsy yielded a diagnosis of isolated pulmonary plasmacytoma. CONCLUSIONS: This is the first presentation of primary pulmonary plasmacytoma with a solitary pulmonary nodule and no lymph node involvement.