Objective: To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients. Design:Retrospective cross-sectional observational study. Setting Main outcome measures:The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis.Results: A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population New knowledge added by this study • Studies on paediatric arteriovenous malformation (AVM) are scarce and mostly based in Caucasian populations. This multicentre study involving Chinese paediatric patients found that small AVM nidus size and diffuse nidal morphology are independent risk factors for haemorrhage. Implications for clinical practice or policy • These two angiographic features associated with haemorrhagic presentation can help local clinicians to assess bleeding risk and determine the therapeutic approach (aggressive vs conservative) and treatment timeframe in paediatric patients with cerebral AVM.

Purpose.To compare the tibial tuberosity-trochlear groove (TTTG) distance in Chinese patients with or without recurrent patellar dislocation. Methods. The TTTG distance of 14 knees in 5 men and 9 women aged 16 to 38 years with recurrent patellar dislocation were compared with that of 73 control knees using magnetic resonance imaging. Results. The mean TTTG distance was significantly greater in patients with recurrent patellar dislocation than in controls (16.4 mm vs. 10.1 mm, p<0.001). Six (43%) knees with recurrent patellar dislocation had the TTTG distance greater than the cut-off threshold of 16.4 mm, compared to none in controls. Conclusion. The TTTG distance is related to height and is shorter in Chinese than Caucasian patients; the threshold for tibial tuberosity transfer should be lower in Chinese patients.

Malignant superior vena cava syndrome (SVCS) is no longer considered a medical emergency in most cases because it rarely leads to life-threatening complications. However, it results in disturbing symptoms that can significantly affect patients' quality of life. Treating this condition effectively while minimising treatment-related morbidity is of increasing importance as cancer patients are living longer from advances in oncological treatments. This clinical practice review discusses the implications of these advances on the decision to consider stenting as the initial treatment for SVCS. Stenting is increasingly popular as it provides quick symptomatic relief with low rates of complications. Systemic treatments have evolved in the past two decades with the development of immunotherapy and targeted therapies that have different response patterns compared to conventional chemotherapy. Furthermore, major changes have also been seen in radiotherapy techniques that allow treatments to better conform to targets while sparing normal tissues.These advances have changed practice patterns for stent placement in SVCS patients in both the localised and metastatic settings. Prospective studies using standardised patient-reported outcome tools are needed to determine the optimal treatment sequence for SVCS patients, as current recommendations are mainly based on retrospective single-arm studies. An individualized approach with multidisciplinary input is therefore important to optimize patient outcomes before more robust evidence is available.

Magnetic resonance imaging (MRI) is a commonly used imaging modality to detect early avascular necrosis (AVN). When MRI is inconclusive, bone scan is helpful in detecting AVN during early phase of the disease. As newer nuclear medicine equipment, such as single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography, are emerging in medical science, the role of these imaging modalities in AVN of femoral head is re-evaluated.

Acute massive pulmonary embolism is known to be associated with high mortality, and treatment options may be limited if systemic fibrinolysis is contraindicated. We report the exciting results of a novel mechanical-pharmacological hybrid approach in 3 patients with life-threatening massive pulmonary embolism, in whom systemic fibrinolysis was contraindicated.