To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

To explore the effect of mind mapping combined with case-based learning (CBL) method in clinical teaching of nephrology.

A total of 50 residents and graduate students who participated in standardized training in the Department of Internal Medicine of the First Medical Center of the Chinese PLA General Hospital from October 2021 to October 2023 were selected as the study subjects and randomly divided into two groups, a test group (mind mapping+ CBL, n=25) and a control group (traditional teaching method, n=25). The test group was taught with mind mapping combined with CBL employing a "symptoms - examination - diagnosis - treatment" closed-loop training approach, while the control group were taught with the traditional teaching method. The theoretical and practical skill scores as well as teaching satisfaction were compared between the two groups.

The test group achieved significantly higher theoretical scores (92.60±3.27 vs 90.08±2.86, P=0.006) and practical skill scores (89.44±2.77 vs 87.12±4.04, P=0.022) than the control group. The teaching satisfaction survey also showed that the test group had higher ratings for clarity of teaching objectives [8.00 (7.00-8.00] vs. 7.00 (6.00-7.00), P=0.005), practicality of teaching methods [8.00 (8.00-9.00] vs. 7.00 (6.00-8.00], P=0.002), and total satisfaction score (30.48±3.00 vs. 27.84±3.84, P=0.009) than the control group.

Compared with traditional teaching method, the mind mapping combined with CBL in clinical teaching of nephrology effectively enhanced the learners′ learning outcomes in both theoretical knowledge and practical skills of nephrology.

To explore clinical characteristics and treatment results of a child with distal renal tubular acidosis (dRTA) accompanied by peripheral nerve injury and suspected medullary sponge kidney, and review related literature.

One girl (patient 1) with dRTA accompanied by peripheral nerve injury and suspected medullary sponge kidney who visited West China Second University Hospital, Sichuan University in July 2024 was selected as research subject. Her clinical data were retrospectively analyzed, including medical history, clinical manifestations, laboratory tests and genetic test results, treatment and follow-up results. Literature of children with a confirmed diagnosis of dRTA caused by SLC4A1 gene mutations with peripheral nerve damage and suspected medullary sponge kidney were retrieved with " renal tubular acidosis" " medullary sponge kidney" " peripheral nerve damage" and " SLC4A1" etc. as keywords in CNKI, Wanfang service platform and PubMed database. The procedure followed in this study was in accordance with the requirements of the revised Helsinki Declaration of the World Medical Association. The guardian provides informed consent for the diagnosis and treatment of Patient 1.

①Patient 1 is a 7-year-old female who visited the case collection hospital due to " weakness in both lower limbs for 3 days". The main clinical manifestation of the patient is weakness in both lower limbs, without cough, sore throat, vomiting, diarrhea, lower back pain, limb pain or sensory abnormalities. The results of relevant auxiliary examinations at admission suggest hypokalemia, normal anion gap hyperchlorination metabolic acidosis, elevated muscle enzymes, neurogenic lesions, and suspected medullary sponge kidney. Genetic analysis showed that the patient had a heterozygous mutation of SLC4A1 c. 1765C>T (p.Arg589Cys). Based on her clinical manifestations, auxiliary examinations, and genetic testing results, she was diagnosed as renal tubular acidosis with peripheral nerve damage and suspected medullary sponge kidney. After one month of treatment with oral potassium citrate, B vitamins, and rat nerve growth factor, the patient′s symptoms significantly improved. Reexamination showed that blood gas analysis, electrolyte and muscle enzyme levels have completely returned to normal.②Literature review results: According to the literature search strategy set in this study, no relevant literature reports on children with renal tubular acidosis accompanied by peripheral nerve injury and suspected medullary sponge kidney were found both domestically and internationally.

There are currently no reports of SLC4A1 gene mutations leading to dRTA combined with peripheral nerve damage and medullary sponge kidney. This case proposes the possibility of peripheral nerve damage and medullary sponge kidney being associated with SCL4A1 mutations, which may be a key area for future research. Early completion of WES is of great significance for the early diagnosis of dRTA. Early diagnosis and treatment of children with this disease can improve their prognosis and quality of life.

To explore the clinical characteristics of congenital long QT syndrome (LQTS) in children.

A 10-year-old male child (proband) diagnosed with type 2 LQTS (LQT2) at Chengdu Women′s and Children′s Central Hospital in July 2021 was enrolled. Clinical data from the proband and his 8 family members (mother, father, younger brother, maternal grandfather, maternal grandmother, paternal grandfather, paternal grandmother, maternal uncle) were collected. A pedigree map for LQTS genetic investigation of families of proband was constructed. Whole exome sequencing (WES) followed by Sanger sequencing validation were performed on the proband and parents to identify pathogenic variants. Sanger sequencing of the identified variant was conducted in selected family members. Based on the clinical data and genetic findings of the proband and his family members, the diagnosis and management of congenital LQTS were analyzed. This study was approved by the Medical Ethics Committee of Chengdu Women′s and Children′s Central Hospital [Approval No. Lun Shen 2021 (118)], and informed consent form was obtained from the child′s guardian.

① Both the proband (male, 10 years old) and the mother (31 years old) had a history of recurrent syncope, their electrocardiogram results showed a corrected QT interval (QTc) >500 ms and notched or biphasic T-waves. The proband′s maternal grandfather died of liver cancer at the age of 49, with no documented history of syncope or available electrocardiogram records. Other family members, except the proband′s mother, had no history of syncope, and their electrocardiogram results revealed normal QTc. ② WES revealed a heterozygous missense mutation of KCNH2: c. 94G>A (p.A32T) in the proband and his mother, confirming maternal inheritance. The variant was absent in the proband′s younger brother, father, maternal uncle, and maternal grandmother. ③ Both the proband and his mother were diagnosed of LQT2 subtype. The proband was treated with oral propranolol hydrochloride, while his mother received combined oral therapy with propranolol hydrochloride and mexiletine hydrochloride, both need taking lifelong medicine. The proband and his mother had been treated and followed up for over 3 years, and no syncope and cardiac events had occurred. The recheck of electrocardiogram showed that the proband′s QTc was shortened and his mother′s QTc returned to normal.

Family investigation facilitates early identification of congenital LQTS patient. Electrocardiogram examination with accurate QTc measurement is critical in syncope evaluation to prevent missed diagnoses of LQTS patient. Beta blockers are effective in the treatment of congenital LQT2 subtype patients.

To explore the clinical manifestations and genetic variation types of cystic fibrosis (CF) children with pulmonary infection as the initial symptom, and to review relevant literature to provide reference for early clinical diagnosis of CF children.

A case of CF child (child 1) with pulmonary infection as the first symptom admitted to the 980th Hospital of the Joint Logistics Support Force in March 2023 was selected as the research subject. Retrospective analysis method was used to analyze the clinical case data of child 1, including medical history, clinical manifestations and laboratory tests, lung CT examination results, genetic testing results, diagnosis and treatment process. The relevant research literature on Chinese children with CF both domestically and internationally was reviewed to summarize the clinical characteristics of CF children. The procedures followed in this study were in accordance with the standards established by the Ethics Committee of the 980th Hospital of the Joint Logistics Support Force and have been approved by the Ethics Committee (Approval No. 2023-KY-201).

①Child 1 was an 11-year-old male who visited our hospital due to " fever, cough for 3-4 days, and diarrhea for 2 days". CT scan of the lungs showed bronchiectasis, wall thickening, and mucus plugs in some bronchial tubes, accompanied by inflammatory lesions in the lungs. The culture results of pathogenic bacteria in sputum and bronchoalveolar lavage fluid both indicated positivity for Pseudomonas aeruginosa. The genetic testing results showed that the CFTR gene of child 1 developed compound heterozygous missense mutations c. 293A>G (p.Gln98Arg) and c. 1409T>A (p.Va1470Glu), which were inherited from his father and mother, respectively. According to the guidelines of the American Society for Medical Genetics and Genomics (ACMG), and they were classified as pathogenic and suspected pathogenic variants, respectively according to the American College of Medical Genetics and Genomics (ACMG) guidelines. According to the results of genetic testing, child 1 was diagnosed with CF. He was treated with clearing airway secretions and controlling infections. On the 29th day after admission, a CT scan of the lungs showed significant improvement in the inflammatory lesions in the lungs, and child 1 was discharged on the 30th day after admission. ②Literature review results: according to the literature retrieval strategy set in this study, 10 relevant studies on Chinese children with CF were retrieved from both domestic and foreign databases, involving 33 Chinese children with CF. Including child 1 in this study, a total of 34 Chinese children with CF were identified. Among these 34 cases, there were 21 male and 13 female patients, with onset ages ranging from 3 months to 16 years old. The main clinical manifestations were bronchiectasis (31 cases, 91.2%), often complicated by diarrhea (28 cases, 82.4%), sinusitis (19 cases, 55.9%), and respiratory tract infection (16 cases, 47.1%). The most common pathogen of lung infection was Pseudomonas aeruginosa (24 cases, 70.6%).

Chinese children with CF have diverse clinical manifestations. For those with bronchiectasis and recurrent respiratory infections, combined or not with other systemic diseases such as digestive and reproductive systems, as well as those with positive results for Pseudomonas aeruginosa in respiratory pathogen testing, it is important to be alert to the possibility of CF and undergo CFTR gene testing as soon as possible for a clear diagnosis.

To evaluate the safety and efficacy of laparoscopic hiatal hernia repair (LHHR) based on infracardiac bursa in the treatment of massive hiatal hernia (MHH), and to provide evidence-based reference for clinical practice.

A retrospective analysis of clinical data from January 2021 to December 2024 of 40 MHH patients in Hernia and Obesity Surgery at the First Hospital, Affiliated with the University of Science and Technology of China, who received surgical treatment based on infracardiac bursa for massive hiatal hernia repair under laparoscopy. The changes of reflux symptoms before and after surgery were assessed by gastroscopy and the gastroesophageal reflux disease questionnaire (GERD-Q). The main study indicators were right-sided pleural rupture and esophageal muscle injury results during surgery, and diverticulation. Secondary indicators included postoperative complications and length of hospital stay.

Of the 40 patients, 2 (5%) were lost to follow-up, and the median follow-up time was 24 (4-48) months. One died of acute cerebral infarction two months after discharge. Twenty-eight patients successfully identified the structure of the infracardiac bursa during surgery, and none suffered rupture of the right pleural membrane or damage to the oesophageal muscles. A further 12 patients failed to identify the infracardiac bursa, including five with a rupture of the right pleural membrane and one with damage to the oesophageal muscle. The median hernia defect diameter was 4.5 (4.5-5.0) cm, the median operative duration was 108 (60-310) min, and the median intraoperative bleeding was 10 (10-50) ml. The median indwelling time was 2 (1-7) days, and the median postoperative hospital stay was 3.5 (2.5-4.5) days. The average score of GERD-Q was (11.38±0.98) points preoperatively and decreased to (7.57±0.73) points postoperatively (P<0.001).

Based on infracardiac bursa, laparoscopic hiatal hernia repair can effectively reduce the rupture of the pleura and damage to the muscles of the esophagus during surgery, and improve surgical safety.

患者女，27岁，因"体检发现腹腔肿瘤2周"于2024年7月就诊并收入院。2周前，患者于当地医院婚前检查时，腹部超声提示：腹盆腔巨大实性团块（上至剑突下，下至盆腔），伴肝脏及双肾多发肿物。进一步行正电子发射体层成像及CT检查示：肝左叶占位（恶性待排）、左侧腹部巨大肿物（脂肪肉瘤待排）、双侧肾脏多发血管平滑肌脂肪瘤（angiomyolipoma，AML）。患者无自觉症状，否认腹痛、头痛、癫痫发作、视力异常及胸闷胸痛等，大小便及体重无显著变化。既往有缺铁性贫血病史，无手术、药物过敏及传染病史。否认家族成员癫痫、皮肤结节或肾脏疾病史。

Since the mid-1980s, Professor Grammont's design and promotion of reverse shoulder arthroplasty (RSA) has initiated a new area in shoulder joint surgery. Following the FDA approval of RSA in the United States in 2003, its adoption has experienced explosive growth, and RSA has now become an indispensable option for treating various shoulder pathologies. Although initially developed for cuff tear arthropathy (CTA) due to the inability of conventional shoulder arthroplasty to effectively restore stability and function in such cases, its clinical success has expanded its applications to other shoulder conditions. These include massive rotator cuff tears (MRCT) , glenohumeral arthritis with intact rotator cuff, acute proximal humeral fractures, sequelae of proximal humeral fractures, proximal humeral tumors, inflammatory arthropathies, and revision surgeries following failed anatomic total shoulder arthroplasty or hemiarthroplasty. With the increasing utilization of RSA, complication rates have concurrently risen, reported to range between 15%-50%. However, given that RSA is frequently employed for clinically challenging conditions—many representing salvage procedures—the relatively high complication rates are not unexpected. Significant variations in reported complication rates exist across studies due to differing definitions of complications and prosthesis heterogeneity. Improvements in RSA concepts, designs, and surgical techniques have led to evolving complication profiles. For instance, early prosthesis designs were associated with higher rates of scapular notching, while contemporary designs have substantially reduced this complication. Consequently, modern prostheses and surgical techniques demonstrate significantly lower revision rates than earlier generations. Therefore, monitoring complication patterns and incidence remains crucial as RSA indications continue to expand and surgical techniques progress. Compared to international experience, RSA adoption in China began later, with limited complication-related research reported. Exceptionally constrained by single-center case volumes, there remains a paucity of domestic studies analyzing complications in cohorts exceeding 100 cases, highlighting the necessity for further investigation in this field.

To analyze and explore the occurrence of single-center reverse shoulder arthroplasty complications in China.

A review was conducted on 164 cases of RSA performed by a single surgeon in our hospital. The average age of the patients was (70.2±7.98) years (ranging from 24 to 85 years) , and the average follow-up period was 18.6 months (ranging from 1 to 96 months) . The incidence of surgery-related complications was evaluated.

There were a total of 25 cases of total complications, with an incidence rate of (15.2%) . Among them, there were 13 cases (7.9%) of significant complications, including 2 cases (1.2%) of glenoid fractures during the operation, 4 cases (2.4%) of proximal humeral fractures, 1 case (0.6%) of humeral shaft fractures, and 6 cases (3.6%) of prosthesis dislocation after the operation. Among them, 3 cases underwent revision surgery. It included 2 cases of secondary periprosthetic joint infection. Secondary complications included numbness in fingers or wrists in 8 cases (4.9%) after the operation, pain around the incision in 2 cases (1.2%) after the operation, and poor incision healing in 2 cases (1.2%) after the operation. Among the 13 major complications, nine occurred during the operations of the first 80 cases.

These results prove that the complications of reverse shoulder joint replacement surgery are controllable in domestic applications. The core of its successful implementation lies in the solid theoretical foundation of the shoulder joint, strict management of the learning curve, and precise control of technical details, providing an important evidence-based basis for the standardized development of this surgical method in China.

To investigate the clinical features, treatment strategies, and prognosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with nasal symptoms as the initial manifestation.

A retrospective analysis was conducted on three AAV patients treated at the Department of Otolaryngology-Head and Neck Surgery, Huai’an Hospital Affiliated to Xuzhou Medical University between January 2019 and December 2024. Clinical data, diagnostic and therapeutic interventions, and follow-up outcomes were systematically reviewed.

All patients initially exhibited chronic sinusitis-like symptoms: recurrent epistaxis (n=1) and nasal obstruction with headache (n=2). Pulmonary manifestations (lung nodules, localized calcification, or interstitial changes) were observed in all cases. Case 1 was hospitalized for recurrent epistaxis and diagnosed with chronic sinusitis via sinus CT, and he underwent endoscopic sinus surgery (ESS). Postoperative persistence of epistaxis, headache, and orbital pain prompted ANCA serology testing, which confirmed AAV. Immunosuppressive therapy initiated after rheumatology referral achieved symptom remission, though nasal symptoms recurred during follow-up. Case 2 presented with sinusitis. His nasal obstruction and headache improved after minimally invasive ESS. Persistent cough led to ANCA detection and subsequent immunosuppressive treatment with resolution of symptoms. Case 3 was initially diagnosed with chronic sinusitis and a nasal mass at an external institution. ESS failed to alleviate nasal obstruction/headache. Anti-inflammatory therapy was ineffective. Rheumatology consultation confirmed AAV. Cyclophosphamide and corticosteroid treatment resulted in clinical improvement.

AAV with initial sinonasal involvement typically manifests as nasal obstruction, headache, epistaxis, nasal ulceration, and/or polyposis. Otolaryngologists may reflexively resort to ESS for symptom management, potentially resulting in delayed diagnosis and inappropriate initial management. While ANCA serology testing provides critical diagnostic support, definitive diagnosis requires integrated assessment of clinical manifestations, histopathological findings (where available), and immunological parameters to facilitate early disease confirmation. Multidisciplinary collaboration is essential to mitigate diagnostic errors.