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ObjectiveTo analyze the risk factors associated with adverse events after carotid endarterectomy (CEA) in patients with unilateral severe carotid stenosis and contralateral occlusion.MethodsPatients were recruited for CEA between August 2014 and February 2020. CEA was performed under general anesthesia. The carotid clamp time (CCT; long CCT: >20 min) is defined as the period between clamp-on and clamp-off for the stenotic carotid artery. The perioperative factors and postoperative adverse events were recorded. All patients were followed up for 1 year after CEA.ResultsSixty subjects (65.8 ± 7.2 years; 54 males) were included. Patients with adverse events had significantly longer CCT than those without adverse events (60% vs. 40%, P = 0.013). Univariate logistic regression analysis showed that a history of diabetes was significantly associated with adverse events (OR, 0.190; 95% CI, 0.045–0.814; P = 0.025); long CCT was significantly associated with adverse events (OR, 8.500; 95% CI, 1.617–44.682; P = 0.011). After adjusting for confounding factors, including age, sex, BMI, diabetes, PSV, long CCT, non–use of shunt, and history of stroke or TIA, the associations between diabetes and adverse events (OR, 0.113; 95% CI, 0.013–0.959; P = 0.046) were statistically significant; the associations between long CCT and adverse events (OR, 1.301; 95% CI, 1.049–1.613; P = 0.017) were statistically significant.ConclusionsA longer carotid clamp time (>20 min) and a history of diabetes may increase the risk of adverse events in patients with unilateral severe carotid stenosis and contralateral occlusion after CEA. With good preoperative evaluation and intraoperative monitoring, the use of shunts may not be needed intraoperatively in patients with unilateral severe carotid stenosis and contralateral occlusion.

Kun Yang,1 Mengdong Shi,1 Cong Fu,2,* Ran Huo1,2,* 1Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China; 2Department of Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cong Fu; Ran Huo, Tel +86 15154101889 ; +86 15168889001, Fax +860531-68778153, Email cong3399@outlook.com; huoran@medmail.com.cnAbstract: Follicular occlusion triad (FOT) is a chronic inflammatory skin disease that comprises hidradenitis suppurativa, acne conglobata, and perifolliculitis capitis abscedens et suffodiens and can seriously affect a patient’s quality of life. Currently, there is no consensus on the treatment plan for FOT. There are also only a few reports on the treatment of severe FOT. In July 2020, a male patient who was diagnosed with severe FOT was treated in our hospital and received comprehensive surgical treatment for 2 months. This treatment strategy was effective and the patient had no recurrence during a follow-up period of > 1 year. By retrospectively analyzing the clinical data of the patient, recording the patient’s condition during postoperative recovery, and reviewing relevant literatures, the clinical manifestations, diagnosis, choice of treatment methods, and prognosis of FOT were evaluated.Keywords: chronic inflammatory skin disease, comprehensive treatment, surgical management

Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis. Methods Elderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed. Results Of the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36–10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35–33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals. Conclusions Carotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

Background Lipofibromatosis is a rare, benign, soft tissue tumor that usually presents in children. Low incidence and lack of specificity in clinical presentation make its diagnosis difficult. Case presentation This is a case report of a patient with a giant lipofibromatosis on the back that resembles an infantile hemangioma, which posed great difficulty in diagnosis due to atypical clinical manifestations. After the postoperative pathological and immunohistochemical examination and fluorescence in situ hybridization, the patient was finally diagnosed with lipofibromatosis. Conclusions The incidence of fibromatosis was low. This case presents an atypical clinical manifestation since the tumor growth was on the back, and this can easily cause misdiagnosis. This case suggests that the diagnosis of lipofibromatosis depends on the pathology and fluorescence in situ hybridization.

Paired comparison models are used for analyzing data that involves pairwise comparisons among a set of objects. When the outcomes of the pairwise comparisons have no ties, the paired comparison models can be generalized as a class of binary response models. Receiver operating characteristic (ROC) curves and their corresponding areas under the curves are commonly used as performance metrics to evaluate the discriminating ability of binary response models. Despite their individual wide range of usage and their close connection to binary response models, ROC analysis to our knowledge has never been extended to paired comparison models since the problem of using different objects as the reference in paired comparison models prevents traditional ROC approach from generating unambiguous and interpretable curves. We focus on addressing this problem by proposing two novel methods to construct ROC curves for paired comparison data which provide interpretable statistics and maintain desired asymptotic properties. The methods are then applied and analyzed on head-to-head professional sports competition data.