RESUMEN

Intracellular lipid droplets (LDs), subcellular organelles playing a role in long-term carbon storage, have immense potential in biofuel and dietary lipid production. Monitoring the state of LDs in living cells is of utmost importance for quick biomass harvest and screening promising isolates. Here, a deep-learning-based segmentation model was developed for automatic detection and segmentation of LDs using the model yeast species Lipomyces starkeyi, leading to fast and accurate quantification of lipid contents in liquid cultures. The trained model detected the yeast's cell and LDs in light microscopic images with an accuracy of 98% and 92%, respectively. Lipid content prediction using pixel numbers counted in segmented LDs showed high similarity to lipid quantification results obtained with gas chromatography-mass spectrometry. This automated quantification can highly reduce cost and time in real-time monitoring of lipid production, thereby providing an efficient tool in bio-fermentation.

Asunto(s)

RESUMEN

Background@#Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications. @*Methods@#Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient’s height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay. @*Results@#The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0–6 h, 54/756 (7.1%); 6–24 h, 120/756 (15.9%); 24–48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24–48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6–24 h and 24–48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. @*Conclusions@#Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

RESUMEN

Purpose@#Physician-modified endovascular stent grafts (PMEG) are a good treatment option for complex abdominal aortic aneurysms (AAAs), especially in high-risk patients not amenable to open repair, and when commercial fenestrated devices are not available. We report our single-center experience with PMEG for the treatment of complex AAAs. @*Methods@#We retrospectively reviewed patients who underwent PMEG repair for AAA from November 2016 to September 2020 at our institution. Demographic data, anatomic characteristics, perioperative and postoperative outcomes, major adverse events, and 30-day mortality were analyzed. @*Results@#We identified 12 patients who underwent PMEG for complex AAA. The mean age was 74 years and the mean maximal AAA diameter was 58.1 mm. Indications for treatment included 4 impending or contained ruptures, 2 mycotic aneurysms, and 6 symptomatic cases. The technical success rate was 91.7%. Aneurysm sac regression was observed in 7 patients (58.3%), including 2 cases of complete regression. There was 1 aneurysm-related mortality at 3 months due to mycotic aneurysm. Also, there was 1 postoperative complication case of transient renal failure requiring temporary dialysis. At 1 year, there was 1 branch occlusion from the initial failed cannulation case and 2 type 1A endoleaks, and there was 1 case of open explantation. @*Conclusion@#PMEG showed a low technical failure rate and acceptable midterm stent durability and sac stability, comparable to conventional endovascular aneurysm repair. Despite the small number of cases, there was a tendency for a high sac regression rate, although longer follow-up is needed.

RESUMEN

Purpose@#This study aimed to investigate the incidence of early failure of vascular access for hemodialysis, and determine which factors measured in duplex ultrasound study could predict early failure. @*Methods@#We performed a retrospective review of patients who underwent arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation for hemodialysis between September 2019 and January 2023. Early failure was defined as any event that required surgical or endovascular intervention within 6 months following AVF or AVG creation. @*Results@#A total of 189 patients were included. Early failure occurred in 36 patients (19.0%), which included 22 AVFs and 14 AVGs. In the patients who underwent AVF, the preoperative venous diameter, postoperative venous and arterial diameters, and flow volume of AVF all were significantly smaller in the early failure group compared to the patent group.In AVG, the preoperative venous diameter was the only parameter that differed between the 2 groups. A sonographic score was defined based on these factors. In a multivariable analysis, male sex, a previous history of AVF or AVG creation, and sonographic score were found to be significantly associated with early failure. The postoperative venous diameter in AVF and the preoperative venous diameter in AVG were highly predictive of early failure (areas under the curves 0.92 and 0.82, respectively). @*Conclusion@#Venous diameter measured 6 weeks following AVF operation and preoperative venous diameter in AVG were highly predictive of early failure among the duplex ultrasound parameters. Surveillance strategies in the early phase following vascular access creation can be based on these factors.

RESUMEN

Background@#Fat grafting is a commonly employed aesthetic procedure for contour enhancement. However, outcome prediction is challenging due to the complex regeneration and remodeling processes involved. We investigated whether adenosine improves engraftment and fat graft survival under conditions of obesity. @*Methods@#Fat was harvested from mice fed a high-fat diet. This fat was washed with either Krebs-Ringer bicarbonate HEPES buffer (the vehicle group) or a buffer containing 500 nM adenosine (the adenosine wash group). Subsequently, the fat was transplanted into normal mice at 0.2 mL per mouse. In both groups, 50% of the mice were sacrificed at 1 week and the remainder at 4 weeks post-transplantation. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis was conducted during week 1. In week 4, micro-computed tomography, immunofluorescence staining, and RT-qPCR were performed. A sample of the initially harvested fat was set aside for lipolysis assay. @*Results@#Adenosine washing improved fat graft retention volumes by up to 50%. One week post-transplantation, the expression of adipogenic and angiogenic genes was found to be upregulated in the adenosine wash group. After 4 weeks, immunofluorescence staining revealed greater adipocyte integrity and an increased number of vessels. Furthermore, adenosine appeared to modulate inflammation by stabilizing the lipolysis rate. @*Conclusions@#Adenosine washing increased the fat graft survival rate under conditions of obesity. Clinically, this suggests a simple, cost-effective adjuvant method for improving fat graft survival in individuals with obesity. Further research is warranted to elucidate the underlying mechanisms and explore the applicability of this technique for autologous transplantation.

RESUMEN

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

RESUMEN

Background/Aims@#To determine the association between evolutionary changes in metabolic dysfunction-associated steatotic liver disease (MASLD) status and the risk of hepatocellular carcinoma (HCC) in a nationwide population-based cohort. @*Methods@#Information on study participants was derived from the Korea National Health Insurance Service database. The study population consisted of 5,080,410 participants who underwent two consecutive biennial health screenings between 2009 and 2012. All participants were followed up until HCC, death, or 31 December 2020. The association of evolutionary changes in MASLD status, as assessed by the fatty liver index and cardiometabolic risk factors, including persistent non-MASLD, resolved MASLD, incident MASLD, and persistent MASLD, with HCC risk was evaluated using multivariable-adjusted Cox proportional hazards regression. @*Results@#Among the 5,080,410 participants with 39,910,331 person-years of follow-up, 4,801 participants developed HCC. The incidence of HCC in participants with resolved, incident, and persistent MASLD was approximately 2.2-, 2.3-, and 4.7-fold higher, respectively, than that in those with persistent non-MASLD among the Korean adult population. When stratifying the participants according to the evolutionary change in MASLD status, persistent (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 2.68–3.21; P<0.001), incident (aHR, 1.85; 95% CI, 1.63–2.10; P<0.001), and resolved MASLD (aHR, 1.33; 95% CI, 1.18–1.50; P<0.001) had an increased risk of HCC compared to persistent non-MASLD. @*Conclusions@#The evolutionary changes in MASLD were associated with the differential risk of HCC independent of metabolic risk factors and concomitant medications, providing additional information on the risk of HCC stratification in patients with MASLD.

RESUMEN

Background/Aims@#Chronic hepatitis B (CHB) is related to an increased risk of extrahepatic malignancy (EHM), and antiviral treatment is associated with an incidence of EHM comparable to controls. We compared the risks of EHM and intrahepatic malignancy (IHM) between entecavir (ETV) and tenofovir disoproxil fumarate (TDF) treatment. @*Methods@#Using data from the National Health Insurance Service of Korea, this nationwide cohort study included treatment-naïve CHB patients who initiated ETV (n=24,287) or TDF (n=29,199) therapy between 2012 and 2014. The primary outcome was the development of any primary EHM. Secondary outcomes included overall IHM development. E-value was calculated to assess the robustness of results to unmeasured confounders. @*Results@#The median follow-up duration was 5.9 years, and all baseline characteristics were well balanced after propensity score matching. EHM incidence rate differed significantly between within versus beyond 3 years in both groups (P<0.01, Davies test). During the first 3 years, EHM risk was comparable in the propensity score-matched cohort (5.88 versus 5.84/1,000 person-years; subdistribution hazard ratio [SHR]=1.01, 95% confidence interval [CI]=0.88–1.17, P=0.84). After year 3, however, TDF was associated with a significantly lower EHM incidence compared to ETV (4.92 versus 6.91/1,000 person-years; SHR=0.70, 95% CI=0.60–0.81, P<0.01; E-value for SHR=2.21). Regarding IHM, the superiority of TDF over ETV was maintained both within (17.58 versus 20.19/1,000 person-years; SHR=0.88, 95% CI=0.81–0.95, P<0.01) and after year 3 (11.45 versus 16.20/1,000 person-years; SHR=0.68, 95% CI=0.62–0.75, P<0.01; E-value for SHR=2.30). @*Conclusions@#TDF was associated with approximately 30% lower risks of both EHM and IHM than ETV in CHB patients after 3 years of antiviral therapy.

RESUMEN

Objective@#The nationwide rehabilitation at-home care pilot program aims to provide medical services such as education, counseling, and remote management to patients who require continuous medical management after surgery. This study aims to retrospectively analyze the medical records of patients who participated in the project after knee arthroplasty to investigate the effectiveness of rehabilitation education in home-based care. Method: Data for analysis were collected from the evaluation form which is completed by the physician immediately after surgery and outpatient follow-up. The collected data included the patient’s sex, age, pre-operative functional level, surgical site, and scores on the berg balance scale (BBS) and visual analogue scale (VAS) for evaluating pain. If patients were re-admitted to other medical institutions for rehabilitation, data on the duration of their stay were collected for further analysis. @*Results@#A total of 234 patients were selected and their data were analyzed. The average change in the BBS (ΔBBS) between immediately after surgery and outpatient follow-up was 43.34 ± 5.51, while the average change in the VAS (ΔVAS) was −0.77 ± 2.27. A significant positive correlation (p=0.001) was found between pre-operative functional level and ΔBBS or ΔVAS. However, no significant correlation (p=0.554) was observed between the duration of stay in other medical institutions and ΔBBS or ΔVAS. @*Conclusion@#The home care pilot program is effective in promoting functional recovery and pain relief after knee arthroplasty. It is expected that appropriate rehabilitation education, remote management, and follow-up observation for up to 6 months will sufficiently replace long-term inpatient treatment after knee arthroplasty.

RESUMEN

Background/Aims@#This study aimed to assess whether hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) could have favorable prognoses with proper treatment under selective conditions. @*Methods@#This retrospective, single-center study involved 1,168 patients diagnosed with HCC between January 2005 and December 2006, before the introduction of sorafenib. Overall survival (OS) was estimated using the Kaplan-Meier method, and the Cox proportional hazards model was used to identify and adjust the variables associated with OS. @*Results@#In nodular-type HCC, the OS differed significantly according to the presence of PVTT (log-rank p<0.001), and the level of PVTT, not only its presence, was a major independent factor affecting OS. PVTT at the Vp1-3 branch was associated with significantly longer OS than was PVTT at the Vp4 level (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.04 to 3.21). In multivariate analysis, the OS was further stratified according to the PVTT level and tumor type, representing that nodular HCC without PVTT exhibited the best OS, whereas nodular HCC with Vp4 PVTT (adjusted HR, 2.59; 95% CI, 1.57 to 4.28) showed a poor prognosis similar to that of infiltrative HCC. The PVTT level was consistently correlated with OS in patients treated with transarterial chemoembolization. Nodular HCC without PVTT showed the best prognosis, while nodular HCC with Vp1-3 PVTT also exhibited a favorable OS, although inferior to that without PVTT (adjusted HR, 1.47, 95% CI, 0.92 to 2.36). @*Conclusions@#Active treatment such as transarterial chemoembolization can be considered for selected PVTT cases. The level of PVTT and type of HCC were independent prognostic factors.

RESUMEN

Background/Aims@#This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). @*Methods@#Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. @*Results@#In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke.Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG.Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. @*Conclusions@#This study shows a similar trend to that found in the previous PEG guidelines.However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities.

RESUMEN

Purpose@#This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography. @*Materials and Methods@#In total, 210 joints from 183 patients (144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model (α=0.05). @*Results@#The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (P<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (P<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (P<0.05). @*Conclusion@#Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.

RESUMEN

The lung is a complex organ comprising a branched airway that connects the large airway and millions of terminal gas-exchange units. Traditional pulmonary biomedical research by using cell line model system have limitations such as lack of cellular heterogeneity, animal models also have limitations including ethical concern, race-to-race variations, and physiological differences found in vivo. Organoids and on-a-chip models offer viable solutions for these issues.Organoids are three-dimensional, self-organized construct composed of numerous cells derived from stem cells cultured with growth factors required for the maintenance of stem cells. On-a-chip models are biomimetic microsystems which are able to customize to use microfluidic systems to simulate blood flow in blood channels or vacuum to simulate human breathing. This review summarizes the key components and previous biomedical studies conducted on lung organoids and lung-on-a-chip models, and introduces potential future applications. Considering the importance and benefits of these model systems, we believe that the system will offer better platform to biomedical researchers on pulmonary diseases, such as emerging viral infection, progressive fibrotic pulmonary diseases, or primary or metastatic lung cancer.

RESUMEN

Background@#The coronavirus disease 2019 (COVID-19) pandemic and the consequent social distancing period are thought to have influenced the incidence of osteoporotic fracture in various ways, but the exact changes have not yet been well elucidated. The purpose of this study was to investigate the impact of the COVID-19 pandemic on the incidence of osteoporotic fracture using a nationwide cohort. @*Methods@#The monthly incidence rates of vertebral; hip; and non-vertebral, non-hip fractures were collected from a nationwide database of the Korean National Health Insurance Review and Assessment from July 2016 to June 2021. Segmented regression models were used to assess the change in levels and trends in the monthly incidence of osteoporotic fractures. @*Results@#There was a step decrease in the incidence of vertebral fractures for both males (6.181 per 100,000, P=0.002) and females (19.299 per 100,000, P=0.006). However, there was a negative trend in the incidence of hip fracture among both males (-0.023 per 100,000 per month, P=0.023) and females (-0.032 per 100,000 per month, P=0.019). No impact of COVID-19-related social distancing was noted. @*Conclusions@#In conclusion, during the early days of the COVID-19 pandemic, vertebral fracture incidence considerably decreased with the implementation of social distancing measures.

RESUMEN

Background@#This study aimed to evaluate the relationship between clinical experience and death certificate (DC) errors by analyzing DCs written by experienced emergency physicians (EPs). @*Methods@#DCs issued by four experienced EPs over a 10-year period were retrospectively reviewed. DC errors were divided into major and minor errors based on whether they affected the cause of death (COD) determination. The errors were judged through first and second evaluations. Basic information regarding DCs and 10-year changes in DC errors were analyzed. @*Results@#A total of 505 DCs were analyzed, with an average of 34 to 70 for each study year.The number of CODs written in the DCs tended to decrease over time. The presentation of major DC errors did not show a tendency to change over time. However, the sum of the major and minor errors tended to increase over time. Secondary conditions as the underlying COD tended to increase, and the incompatible causal relationships between CODs tended to decrease over time in the detailed analysis of major errors. The increasing tendency for incorrect other significant conditions, incorrect type of accident, incorrect intention of the external cause, no record of the trauma mechanism, and record of the trauma mechanism without another COD were found in the detailed analysis of minor errors. @*Conclusion@#DC errors did not decrease as clinical experience increased. Education to reduce DC errors and a feedback process for written DCs are necessary, regardless of clinical experience.

RESUMEN

Background@#/Aim: Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT). @*Methods@#We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1. @*Results@#A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74). @*Conclusion@#The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

RESUMEN

We systematically reviewed the literature on the co-occurrence of squamous cell carcinoma (SCC) and Warthin’s tumor (WT), thought to be quite rare, to help reduce misdiagnosis and improve treatment planning. For this systematic review, we searched for articles in the Web of Science and PubMed databases, analyzed relevant studies for forward and backward citations, and identified only articles reporting on the “co-occurrence” of WT and SCC.Of the 237 studies identified, 12 comprising 18 patients met the inclusion criteria, to which we added one study from our institution. Most WTs were associated with SCC in the parotid gland or cervical lymph nodes. Most patients (89.5%) underwent selective or radical neck dissection due to identification of lesions separate from the primary SCC. Despite its frequent co-occurrence with other neoplasms, WT in the parotid or cervical lymph nodes tends to be misdiagnosed as a metastatic node when SCC is observed as the primary tumor. Factors to consider in diagnosis and neck management include identification of an association other than growth or development by lymphangiogenesis and whether the patient is a smoker, a strong risk factor.

RESUMEN

Nontuberculous mycobacteria (NTM) represent a broad spectrum of acid-fast bacilli, excluding the pathogens responsible for tuberculosis and leprosy. Over 200 species have been identified and classified as NTM, based on shared phenotypic characteristics. These bacteria are prevalent in diverse environments and are implicated in NTM pulmonary disease (NTM-PD), resulting from interactions between the host, the environment, and the microorganism.Current Concepts: Diagnosing NTM-PD necessitates a comprehensive approach. It is essential to identify the risk factors, including underlying lung conditions, compromised immune responses, and other host-specific factors. The clinical diagnosis considers pulmonary or systemic symptoms aligned with the disease and the exclusion of alternative pulmonary disorders. Radiological evaluations, such as chest X-rays and computed tomography scans reveal patterns indicative of the disease, including fibrocavitary and nodular bronchiectatic forms. Microbiological criteria are fundamental to the diagnostic process and require a minimum of two positive cultures from separate sputum samples or a single positive result from invasive techniques, such as bronchoscopy or biopsies.Discussion and Conclusion: As there are multiple phenotypes of NTM-PD, it is necessary to assess the likelihood of the disease in individuals with increased risk factors. A combination of the clinical, radiological, and microbiological criteria is essential for the accurate diagnosis of NTM-PD. Once diagnosed, a thorough assessment is necessary to guide appropriate management decisions.

RESUMEN

This article aims to summarize the available information and present treatment recommendations. The scope of this discussion is limited to physeal and metaphyseal fractures of the pediatric distal radius.Current Concepts: Pediatric distal radial fractures are common among children and adolescents. The mechanism of injury is usually a fall on an outstretched hand, and fractures typically occur during sports-related activities. Children with distal radial fractures initially present with pain, swelling, and distal forearm deformities. Plain radiographs are essential for evaluating the fracture type and degree of displacement. Complete wrist, forearm, and elbow views should also be assessed, especially for high-energy injuries, to identify ipsilateral fractures. Fractures typically involve the distal radial metaphysis or physis. Metaphyseal fractures are classified as torus, buckle, and bicortical fractures. Most displaced Salter-Harris types I and II and non-displaced metaphyseal fractures can be treated with closed reduction and casting. Operative treatment is recommended if irreducibility or soft-tissue neurovascular compromise is suspected. Operative options include closed reduction, percutaneous pinning, or open reduction, followed by pin or plate fixation. Malunion, nonunion, physeal arrest, ulnocarpal impaction, and nerve injury are possible complications of distal radial fractures in pediatric patients.Discussion and Conclusion: Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Clinicians should be aware of delayed complications and understand how to manage them to ensure successful long-term outcomes.

RESUMEN

Hyperammonemic encephalopathy commonly occur in patients with liver disease, but it can also occur due to other causes. A portosystemic shunt without liver cirrhosis is one of the causes of non-cirrhotic hyperammonemic encephalopathy. Herein, we present a case of a 78-year-old male patient with hyperammonemic encephalopathy resulting from portosystemic shunts without liver cirrhosis, which was successfully treated with endovascular shunt closure.