We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

In recent years，the da Vinci robotic-assisted bariatric and metabolic surgery，as an emerging technology，has begun to gain popularity in China，providing a new option for bariatric and metabolic surgeries.This article reports a case of a female patient with obesity，whose BMI was 38.5 kg/m².She underwent a da Vinci robotic-assisted symmetrical three-port sleeve gastrectomy （without an auxiliary port） on January 24，2024，at the Bariatric and Metabolic Surgery Center of the First People's Hospital of Yunnan Province.The article elaborates on the main steps of this surgical procedure and explores its advantages and disadvantages.

The incidence of both obesity and thyroid cancer is rising worldwide，and obesity has become an important risk factor for thyroid cancer.Studies have shown a significant correlation between obesity and thyroid cancer； however，treatment strategies for patients with both conditions are currently under-researched.This case report describes a 31-year-old female patient admitted to the hospital after a routine check-up detected insulin resistance and a thyroid tumor three days prior.The patient had a body weight of 110 kg and a body mass index （BMI） of 38.5 kg/m².Auxiliary examinations revealed elevated antithyroid peroxidase antibody （TPOAb） levels，and thyroid ultrasound showed bilateral thyroid nodules，with a suspicion of thyroid cancer based on fine-needle aspiration results.A multidisciplinary team at the Department of Bariatric and Metabolic Surgery，Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine successfully performed a single-port laparoscopic sleeve gastrectomy combined with a transoral endoscopic thyroidectomy vestibular approach for thyroid cancer in a single-stage procedure.The surgery lasted 205 minutes，and the patient had an uneventful recovery without significant complications.This combined approach effectively reduced the need for multiple anesthesia and hospital admissions while meeting the patient's needs for cosmetic outcomes and rapid recovery，offering a novel treatment option for patients with obesity and thyroid cancer.

Objective

To assess the diagnostic accuracy of ultrasound in detecting fetal cystic malformations of the posterior fossa in order to further enhance their diagnostic recognition and differential diagnosis.

Methods

Data of 281 fetuses (abnormal group) diagnosed with cystic malformations of the posterior fossa via ultrasound at Hubei Maternal and Child Health Hospital from August 2020 to 2023 were retrospectively analyzed.All cases were confirmed by MRI or postpartum pathological examination and compared with 2000 normal pregnant women (normal group) in the same period.The ultrasound diagnostic features of cystic malformations of the posterior fossa were summarized, the diagnostic concordance rate was calculated, the distribution of malformation types was examined, and the imaging features and causes of misdiagnosed cases were analyzed.

Results

Among all fetal posterior fossa malformation cases, ultrasound and MRI diagnoses showed concordant results in 268 cases (95.37%) and discordant results in 13.Most pregnant women in both the abnormal (74.3%, 199/268) and normal (79.9%, 1598/2000) groups were aged 25-34 years, with no significant difference between the two groups (P=0.104).Most ultrasonographic diagnoses of cystic malformations of the posterior fossa were made in late pregnancy (30-34⁺⁶ weeks, 67.5%,181/268).These malformations often coexisted with nervous system malformations or other congenital abnormalities.In contrast, normal pregnant women mainly had check-ups at 20-22 and 30-32 weeks (two systematic checks), with a significant difference in peak timing of check-ups compared to the abnormal group (P＜0.001).The posterior fossa cisterna malformations detected by ultrasound included 255 cases of mega cisterna magna, 8 cases of Dandy-Walker malformation, 3 cases of Blake’s pouch cysts, and 2 cases of cerebellar vermis hypoplasia.Among 13 misdiagnosed cases, 2 arachnoid cysts were misdiagnosed as Blake's pouch cysts, and 1 case each of arachnoid cyst, Blake's pouch cyst, and cerebellar vermis hypoplasia was missed.Approximately 22.8% (61/268) of the cases had malformations in other systems.The abnormality rate was 24.8% (34/137) in the posterior cranial fossa width ≥1.20 cm group, higher than the 13.6% (16/118) in the＜1.20 cm group.

Conclusion

Ultrasound is valuable for prenatal screening of cystic malformations of the posterior fossa but has a misdiagnosis rate for complex malformations like cerebellar vermis hypoplasia and Blake’s pouch cysts.Late pregnancy (30-34⁺⁶ weeks) is the critical time point for confirming these diagnoses.For suspicious cases, a comprehensive neurological assessment, multi-system screening, and multi-modality imaging verification are recommended to enhance diagnostic accuracy.

Craniofacial duplication is a kind of extremely rare birth defect.This congenital deformity demonstrates significantly various phenotypes and must be treated with personalized protocol based on the extent of soft and osseous tissue involvement and affected physiologic functions.Here we report a case of complete unilateral cleft lip complicated with maxillary duplication.Its clinical manifestation and surgical procedures are described.The literature covering its etiology and management is also systematically reviewed.

Objective

To investigate the efficacy of anti-reflux mucosal ablation （ARMA） in treating reflux hypersensitivity （RH）.

Method

A retrospective analysis was conducted on the efficacy of 8 RH patients who received endoscopic ARMA treatment at Department of Gastroesophageal Surgery Department of Rocket Force Characteristic Medical Center from August 2022 to August 2023. The subjective relief of gastroesophageal reflux related symptoms， discontinuation rate of acid suppressant， postoperative complications， recurrence， and re treatment were compared before and after ARMA.

Results

There were 3 males and 5 females in this group of RH patients， with a mean of 53 years. The mean follow-up time after ARMA was 18 months， and the subjective relief rates of acid reflux， heartburn， and chest/back pain symptoms in postoperative patients were 72%（38， 10）%， 70%（50， 95）%， and 70%（25， 97）%， respectively. And the symptom scores were significantly lower than before surgery （all P＜0.05）. The postoperative discontinuation rate of acid suppressing drug was 87.5% （7/8）， and the satisfaction rate of therapeutic effect was 75% （6/8）.There were 2 cases of postoperative swallowing pain discomfort， 1 case of abdominal distension， and 1 case of upper abdominal pain， all of which were mild and relieved within 1 week after conservative treatment.There were no cases of postoperative dysphagia. There was 1 case of partial recurrence of symptoms and no cases of anti-reflux reintervention.

Conclusion

ARMA can alleviate the GERD symptoms in most RH patients， with a high satisfaction rate of efficacy and acid suppressing drug discontinuation rate. Postoperative complications are rare and mild. However， further research is needed to determine the more accurate safety and efficacy of ARMA.