Objective: To analyze the diagnostic and therapeutic characteristics of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with predominantly nasal symptoms. Methods: Clinical data of 10 patients (4 males and 6 females, aged 24-73 years) with AAV with predominantly nasal symptoms who were treated in the Second Hospital of Shanxi Medical University from January 2019 to January 2025 were collected and retrospectively analyzed with regard to clinical manifestations, endoscopy, imaging, laboratory examination, pathohistology, treatment and prognosis of the patients. Descriptive statistical methods were used for analysis. Results: Nasal symptoms such as nasal congestion, pus and dry crusts and pulmonary manifestations such as cough and pulmonary nodules were present in all 10 patients; most of them were accompanied by multifocal involvement of the head and neck (9/10) and systemic inflammatory prodromal manifestations such as intermittent fever and polyarticular pain (9/10). Nasal endoscopy showed congestion, erosion, and increased secretion of the nasal mucosa, and in severe cases, perforation of the nasal septum was seen (3/10). Sinus CT showed thickening of nasal and sinus mucosa, bone hyperplasia, and even progressive bone destruction and paranasal sinus granuloma formation (2/10). Laboratory tests showed ANCA positivity in 9 cases and negativity in 1. Six patients were treated with nasal surgery and 5 had postoperative outbreaks. Ten patients were treated with systemic glucocorticoid combined with immunosuppressant or monoclonal antibody after diagnosis, and all of them went into remission. During follow-up, 6 cases relapsed and all 10 cases survived. Conclusions: For patients with refractory nasal symptoms and inflammatory precursor manifestations (combined with other extra-nasal systems), who have poor responses to conventional treatment, AAV should be considered. Early ANCA testing, histopathological examination and multidisciplinary team combined diagnosis and treatment should be performed to improve patient prognosis.

To identify independent predictors of postoperative infectious complications following supine percutaneous nephrolithotomy (PCNL) and to develop and internally validate a predictive nomogram for individualized risk stratification. A prospective cohort study was performed including 906 renal units undergoing supine PCNL at a single tertiary referral center between October 2008 and December 2025. Patients were categorized into two groups according to postoperative infectious outcomes: those without infection (n = 804) and those with infection (n = 102), defined by the occurrence of postoperative fever or urosepsis. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of infectious complications. Based on these predictors, a nomogram was developed, and its performance was assessed in terms of discrimination using the area under the receiver operating characteristic curve (AUC) and calibration using calibration plots. Multivariable logistic regression analysis identified five independent predictors of postoperative infectious complications after PCNL: positive preoperative urine culture (OR 7.07; p < 0.001), multiple surgical steps (OR 1.82; p = 0.049), multiple percutaneous accesses (OR 4.25; p = 0.001), standard-caliber percutaneous tracts (OR 1.80; p = 0.019) and prolonged operative time (OR 1.01; p = 0.032). The resulting nomogram demonstrated good discriminatory performance (AUC = 0.805) and adequate calibration. Postoperative infectious complications after supine PCNL appear to result from the interplay between preoperative urinary infection and intraoperative procedural complexity, with positive urine culture emerging as the strongest predictor. The proposed nomogram enables individualized risk stratification and may support perioperative decision-making aimed at reducing infectious morbidity.

Lymphatic cyst with infection is caused by interruption of lymphatic vessels during para-aortic lymphnode dissection in patients with gynecological malignancies. It is generally considered that the infection is caused by bacteria invading through the lower limb and perineal wound, but the pathogenic factors of most lymphatic cysts are not clear. Our literature search revealed no previously reported cases similar to ours, in which a lymphatic cyst infection resulted from a co-infection with Streptococcus mitis/oralis (S. mitis/oralis) and Klebsiella pneumoniae (K. pneumoniae). A woman of 61 years of age, was diagnosed in endometrial cancer, carcinosarcoma FIGO grade 3, stage IIIC of the FIGO system. During the third postoperative pelvic replacement and drainage procedure, the patient developed a fever with a peak temperature of 39.2°C on the second day after the removal of the drainage tube. Empiric broad-spectrum antibiotics were started upon hospital readmission, but the patient showed poor response to therapy, with persistent and recurrent lower abdominal tenderness, raising concern for ongoing intra-abdominal or pelvic infection. As a result, it is important to identify pathogenic bacteria associated with lymphatic cyst infections and determine antimicrobial regimens. We further investigated the pathogenicity and antibiotic resistance of S. mitis/oralis, formulated an appropriate anti-infective treatment strategies. Consequently, the patient recovered and was discharged.

Phyllodes tumors are uncommon fibroepithelial breast neoplasms with variable biologic behavior. Synchronous bilateral phyllodes tumors are exceptionally rare, and the interpretation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT) may be confounded by tumor necrosis and inflammation, leading to false-positive nodal staging.

ObjectiveTo evaluate the demographic characteristics, surgical approaches, and short- and long-term outcomes of patients undergoing craniosynostosis (CS) at a national referral center over a 20-year period.DesignRetrospective cohort study.SettingNational Craniofacial Center, Khawlah Hospital.ParticipantsAll patients who underwent surgical correction for CS between January 2004 and December 2023 were included.InterventionsPatients were managed according to a standardized multidisciplinary institutional protocol involving craniofacial plastic surgery and neurosurgery. Surgical interventions included open cranial remodeling procedures-most commonly fronto-orbital advancement-and suturectomy.Main Outcome Measure(s)Demographic data, suture involvement, syndromic association, operative details, perioperative complications, and long-term outcomes were analyzed.ResultsA total of 124 patients were identified; 58.1% were male, and 56.5% had nonsyndromic CS. Multisuture involvement was the most common presentation (39.5%). Most patients underwent surgery between 4 and 12 months of age. Open cranial remodeling was performed in 56.5% of cases, while 11.3% underwent suturectomy. Intraoperative complications were predominantly dural injuries (41.9%), with sagittal sinus injury occurring in 2.4%. Postoperative complications included fever (48.4%) and subgaleal collection (4.8%). There was no perioperative mortality. Long-term follow-up of up to 6 years demonstrated residual cranial deformity in 28.2% and palpable fixation devices in 22.6% of patients.ConclusionsThis 20-year institutional review represents the largest national series of surgically managed CS in Khawlah Hospital. Surgical management achieved favorable outcomes with low morbidity and no mortality. Ongoing multidisciplinary collaboration remains essential to optimize long-term results.

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia's congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment-disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb-trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration.

Objective: Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a rare but serious complication following cesarean section (CS). Identifying factors associated with its occurrence is critical for early recognition and prevention. This systematic review and meta-analysis aimed to synthesize available evidence on factors associated with ACPO following CS. Methods: We performed a systematic literature search across five databases (PubMed, Embase, CNKI, Wanfang, and CBM) from inception to December 2025. Studies investigating factors associated with ACPO after CS were eligible. Quality of included studies was assessed using the Newcastle-Ottawa Scale. For factors reported in at least two studies, pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. Results: Five case-control studies comprising 484 patients (103 ACPO cases and 381 controls) were included, of which four were rated as good quality. Twenty-five potential associated factors were analyzed. Several pre-/intraoperative factors demonstrated statistically significant associations with ACPO risk, including concomitant anemia (OR = 8.94, 95% CI: 2.59-30.88), previous abdominal surgery (OR = 2.39, 95% CI: 1.28-4.47), surgery duration > 1 h (OR = 4.11, 95% CI: 2.20-7.67), and blood loss > 1000 mL (OR = 5.72, 95% CI: 2.10-15.58). Intraoperative blood loss as a continuous variable (WMD = 1.30, 95% CI: 0.14-2.46) was also significantly associated with ACPO. In contrast, emergency cesarean section, opioid use, and type of anesthesia were not significantly associated. Regarding postoperative features, bed rest > 12 h (OR = 2.66, 95% CI: 1.29-5.49), postoperative fever ≥ 38 °C (OR = 3.82, 95% CI: 1.94-7.54), elevated postoperative white blood cell count (WMD = 1.22, 95% CI: 0.30-2.14), and lower postoperative hemoglobin level (WMD = -0.50, 95% CI: -0.83 to -0.18) were significantly associated with ACPO. However, these factors may represent consequences of perioperative complications or components of the early clinical presentation of ACPO. Conclusions: This systematic review and meta-analysis identified multiple perioperative factors associated with ACPO following CS. However, the use of univariate data from a limited number of studies limits interpretability. Prospective cohort studies are needed to clarify whether these factors play a causal role in the development of ACPO.

Enterobius vermicularis, commonly known as the pinworm, is a prevalent intestinal nematode, particularly affecting children worldwide. Although infection is often asymptomatic, it may occasionally lead to complications, including appendiceal involvement. The role of E. vermicularis in the pathogenesis of acute appendicitis remains controversial and is frequently overlooked. We report a case of a 10-year-old child who presented with intermittent right lower quadrant abdominal pain without fever or systemic symptoms. Initial ultrasound revealed small mesenteric lymph nodes, with no clear evidence of appendiceal pathology. Empirical treatment with antibiotics and anti-inflammatory agents failed to relieve the symptoms. A follow-up ultrasound demonstrated a thickened retrocecal appendix with hypoechoic intraluminal content. Due to persistent pain, a laparoscopic appendectomy was performed, revealing a white, non-segmented roundworm within the appendiceal lumen. Histopathological examination and direct microscopic analysis confirmed follicular appendicitis with intraluminal nematodes morphologically consistent with E. vermicularis. Postoperative parasitological examination further supported the diagnosis, with detection of characteristic eggs using the Scotch tape test, while stool examinations remained negative. These findings suggested E. vermicularis as the most likely etiological agent and supported its pathogenic role in the patient's clinical presentation. The patient was treated with albendazole, followed by a second dose 2 weeks later. Simultaneous treatment was administered to household contacts, and strict hygiene measures were recommended to prevent reinfection. Clinical recovery was complete, with no postoperative complications. This case highlights the importance of considering parasitic infections in the differential diagnosis of acute abdominal pain, even in the absence of systemic inflammatory markers, particularly in endemic or underrecognized settings. Early recognition and targeted therapy are essential to prevent recurrence and intra-familial transmission.