6-month Postoperation Research Articles

Developing preclinical dog models for reconstructive severed spinal cord continuity via spinal cord fusion technique

BackgroundSpinal cord injury (SCI) is a severe impairment of the central nervous system, leading to motor, sensory, and autonomic dysfunction. The present study investigates the efficacy of the polyethylene glycol (PEG)-mediated spinal cord fusion (SCF) techniques, demonstrating efficacious in various animal models with complete spinal cord transection at the T10 level. This research focuses on a comparative analysis of three SCF treatment models in beagles: spinal cord transection (SCT), vascular pedicle hemisected spinal cord transplantation (vSCT), and vascularized allograft spinal cord transplantation (vASCT) surgical model. MethodsSeven female beagles were included in the SCT surgical model, while four female dogs were enrolled in the vSCT surgical model. Additionally, twelve female dogs underwent vASCT in a paired donor-recipient setup. Three surgical model were evaluated and compared through electrophysiology, imaging and behavioral recovery. ResultsThe results showed a progressive recovery in the SCT, vSCT and vASCT surgical models, with no statistically significant differences observed in cBBB scores at both 2-month and 6-month post-operation (both P>0.05). Neuroimaging analysis across the SCT, vSCT and vASCT surgical models revealed spinal cord graft survival and fiber regrowth across transection sites at 6 months postoperatively. Also, positive MEP waveforms were recorded in all three surgical models at 6-month post-surgery. ConclusionThe study underscores the clinical relevance of PEG-mediated SCF techniques in promoting nerve fusion, repair, and motor functional recovery in SCI. SCT, vSCT, and vASCT, tailored to specific clinical characteristics, demonstrated similar effective therapeutic outcomes.

Alteration of White Matter Connectivity for MR-Guided Focused Ultrasound in the Treatment of Essential Tremor.

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has been implemented as a therapeutic alternative for the treatment of drug-refractory essential tremor (ET). However, its impact on the brain structural network is still unclear. To investigate both global and local alterations of the white matter (WM) connectivity network in ET after MRgFUS thalamotomy. Retrospective. Twenty-seven ET patients (61 ± 11 years, 19 males) with MRgFUS thalamotomy and 28 healthy controls (HC) (61 ± 11 years, 20 males) were recruited for comparison. A 3 T/single shell diffusion tensor imaging by using spin-echo-based echo-planar imaging, three-dimensional T1 weighted imaging by using gradient-echo-based sequence. Patients were undergoing MRgFUS thalamotomy and their clinical data were collected from pre-operation to 6-month post-operation. Network topological metrics, including rich-club organization, small-world, and efficiency properties were calculated. Correlation between the topological metrics and tremor scores in ET groups was also calculated to assess the role of neural remodeling in the brain. Two-sample independent t-tests, chi-squared test, ANOVA, Bonferroni test, and Spearman's correlation. Statistical significance was set at P < 0.05. For ET patients, the strength of rich-club connection and clustering coefficient significantly increased vs. characteristic path length decreased at 6-month post-operation compared with pre-operation. The distribution pattern of rich-club regions was different in ET groups. Specifically, the order of the rich-club regions was changed according to the network degree value after MRgFUS thalamotomy. Moreover, the altered nodal efficiency in the right temporal pole of the superior temporal gyrus (R = 0.434-0.596) and right putamen (R = 0.413-0.436) was positively correlated with different tremor improvement. These findings might improve understanding of treatment-induced modulation from a network perspective and may work as an objective marker in the assessment of ET tremor control with MRgFUS thalamotomy. 3 TECHNICAL EFFICACY: Stage 4.

Alveolar Ridge Splitting with Simultaneous Implant Placement in Narrow Atrophic Ridges: A Case Series

&lt;p&gt;Objectives: Implant placement in atrophic ridges with severe horizontal bone deficiency without adequate bony housing around the defects remains a significant clinical challenge. The aim of this case series is to evaluate the effectiveness of alveolar ridge splitting (ARS) with simultaneous implant placement. Materials and Methods: Four patients with severe horizontal bone deficiency in atrophic ridges received ARS with simultaneous implant placement. The stability of the widened ridges was evaluated by superimposition of initial and postoperative CBCT images. The ridge thickness at baseline (RT0) and at least 6-month postoperation (RT1), as well as horizontal bone gain (HBG), were measured with the reference of implant platform. Results: All 7 implant sites healed uneventfully without complications. The mean RT0 was 3.84 &amp;plusmn; 0.56 mm at baseline; the mean RT1 was 7.61 &amp;plusmn; 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 &amp;plusmn; 0.80 mm. The results demonstrated significant HBG and sufficient bone thickness around implants after ARS with simultaneous implant placement in all cases. Conclusion: The ARS technique with simultaneous implant placement is an effective and predictable treatment modality to augment ridge width significantly for narrow atrophic ridges without adequate bony housing.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Radiological Evaluation of Marginal Bone Loss Around Sandblasted and Acid-etched (SLA) and Modified Surface (SLActive) Tissue-level Implants Surfaces: A Retrospective 5-year Follow-up Study

&lt;p&gt;Objectives: Implant placement in atrophic ridges with severe horizontal bone deficiency without adequate bony housing around the defects remains a significant clinical challenge. The aim of this case series is to evaluate the effectiveness of alveolar ridge splitting (ARS) with simultaneous implant placement. Materials and Methods: Four patients with severe horizontal bone deficiency in atrophic ridges received ARS with simultaneous implant placement. The stability of the widened ridges was evaluated by superimposition of initial and postoperative CBCT images. The ridge thickness at baseline (RT0) and at least 6-month postoperation (RT1), as well as horizontal bone gain (HBG), were measured with the reference of implant platform. Results: All 7 implant sites healed uneventfully without complications. The mean RT0 was 3.84 &amp;plusmn; 0.56 mm at baseline; the mean RT1 was 7.61 &amp;plusmn; 0.96 mm at least 6-month postoperatively, with the mean HBG of 3.77 &amp;plusmn; 0.80 mm. The results demonstrated significant HBG and sufficient bone thickness around implants after ARS with simultaneous implant placement in all cases. Conclusion: The ARS technique with simultaneous implant placement is an effective and predictable treatment modality to augment ridge width significantly for narrow atrophic ridges without adequate bony housing.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

An aggressive case of Warthin-like variant of papillary thyroid carcinoma (PTC)

Abstract Introduction/Objective Warthin-like variant of PTC is a rare subtype of PTC, characterized by papillary growth lined with oncocytic neoplastic cells and lymphocytic rich stroma in the stalks of the papillae. It is frequently associated with Hashimoto thyroiditis and has good prognosis due to lower risk of metastasis. An association with BRAF V600E mutation has been reported. Here we report an aggressive case of Warthin-like variant of PTC. Methods/Case Report A 33-year-old Hispanic female presented with a progressively expanding neck mass, difficulty swallowing, voice hoarseness, and neck pain. Ultrasound showed a 3.8 cm left thyroid nodule which on biopsy was positive for PTC. Laboratory tests were positive for anti-peroxidase and anti-thyroglobulin antibodies. A total thyroidectomy was performed. Grossly, the left thyroid lobe nodule was well-circumscribed, unencapsulated, and firm with solid homogenous gray-tan cut surface. Microscopically, the nodule consisted of large eosinophilic cells demonstrating characteristic PTC nuclear features, arranged in papillary structures with the cores packed with prominent lymphoplasmacytic infiltrate consistent with Warthin-like variant of PTC (figure). Separate sub-centimeter foci of PTC with similar features were identified in a background of chronic lymphocytic thyroiditis. Central and left neck dissection showed extensive lymph node metastasis which had features similar to the primary tumor but with less pronounced lymphoplasmacytic cores. The patient is currently 6-month post operation and is receiving iodine ablative therapy. Results (if a Case Study enter NA) NA Conclusion Molecular analysis of the tumor may aid in identifying molecular aberrations responsible for the aggressive nature in this case and potentially guide treatment.

Abstract P168: Predictors Of Htn Remission Post-bariatric Surgery: A Contemporary Analysis

Introduction: The effect of bariatric surgery on improvement and remission of hypertension (HTN) is well documented. However, the factors that influence HTN remission in this population are poorly understood and have not been investigated in over a decade. We aim to describe predictors of HTN remission post-bariatric surgery in a contemporary patient population. Methods: All patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass from January 2014 to December 2018 at an urban academic institution were included in the analysis. Blood pressure (BP) was recorded pre-operatively, 6-month post operation, and 12-month post operation. HTN was defined as BP ≥ 140/90 or patients on anti-hypertensive medications. Remission was defined as BP &lt; 140/90 off all blood pressure medications. Baseline characteristics of patients with and without HTN remission were described. Logistic regression analysis was performed to assess indicators of HTN remission. A p-value of 0.05 was used for all statistical analyses. Results: Among 844 patients who underwent bariatric surgery, 497 (58.9%) patients had HTN. Among HTN patients 167 (33.6%) had remission at 6 months and 126 (25.4%) had remission at 12 months. The major predictor of HTN remission on multivariate analysis was number of pre-operative medications at 6 months (OR 2.5, 95% CI 2.03 to 3.29) and 12 months (OR 2.6, 95% CI 1.99 to 3.56). Major predictors on univariate analysis at 12 months were CVA (OR 4.3, 95% CI 1.40 to 12.47) and HLD (OR 1.76, 95% CI 1.27 to 2.45). Conclusion: Number of pre-operative medications is a top predictor of HTN remission. HLD and history of stroke may be present in patients who are less likely to have HTN remission.

Early graft calcification without graft dysfunction after living donor liver transplantation: two case reports

Graft calcification after liver transplantation (LT) has seldom been reported, but almost of all previously reported cases have been attributed to graft dysfunction. We herein report two cases of graft calcification without liver dysfunction after living donor liver transplantation (LDLT). Two patients who underwent LDLT were found to have graft calcification in the early postoperative period (< 1 month). Calcification in the first case was found at the cut edge of the liver at post-operative day (POD) 10, showing a time-dependent increase in calcification severity. The second patient underwent hepatic artery re-anastomosis due to hepatic artery thrombosis on POD4 and received balloon-occluded retrograde transvenous obliteration of the splenic kidney shunt due to decreased portal vein blood flow on POD6. She was found to have diffuse hepatic calcification in the distant hepatic artery area at 1-month post-operation followed by gradual graft calcification at the resection margin at 6-month post-operation. Neither case showed post-operative graft dysfunction. Calcification of the liver graft after LDLT is likely rare, and graft calcification does not seem to affect the short-term liver function in LDLT cases. We recommend strictly controlling the warm/cold ischemia time and reducing the physical damage to the donor specimen as well as monitoring for early calcification by computed tomography.

Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages.

ObjectiveThis retrospective study aimed to compare vertebral endplate cyst formation (VECF), an early predictor for pseudoarthrosis, in different types of interbody cages. MethodsWe reviewed 84 cases treated with single-level posterior/transforaminal lumbar interbody fusion. We utilized a polyetheretherketone cage in 20 cases (group P), a titanium cage in 16 cases (group Ti), a titanium-coating polyetheretherketone cage in 13 cases (group TiP) and a porous tantalum cage in 35 cases (group Tn). VECF was evaluated comparing the computed tomography scans taken at day 0 and 6-month postoperation. We defined VECF (+) as enlargement of a pre-existing cyst or de novo formation of a cyst with the diameter over 2 mm. We calculated the adjusted odds ratio (OR) and 95% confidence intervals (CIs) as an indicator of association between different types of cages and VECF using a logistic regression model. ResultsVECF was observed in 13 (65%), 7 (44%), 9 (69%), and 8 (23%) cases in groups P, Ti, TiP and Tn, respectively. VECF correlated with the type of cage (p = 0.04). In comparison with group P, the proportion of VECF (+) cases was lower in group Tn (OR, 0.16; 95% CI, 0.04–0.60) but not different in group Ti (OR, 0.47; 95% CI, 0.10–2.20) and group TiP (OR, 1.06; 95% CI, 0.21–5.28). No patient underwent additional surgery for the fused spinal level during the follow-up periods (average, 37.9 months; range, 6–76 months). ConclusionVECF was the least in the porous Tn cage, suggesting its potential superiority for initial stability.

Efficacy of Autologous Blood Clot in Primary Pterygium Excision Compared with Suture Technique

Background: To assess the efficacy of pterygium excision and conjunctival autograft surgery among patients underwent autologous blood clot or using sutures (10-0 monofilament nylon). &#x0D; Materials and methods: A randomized controlled trial was done at Department of Ophthalmology, Chittagong Medical College Hospital, with a study period from February 2017 to November 2018 was conducted with 60 eyes from 60 patients having primary nasal pterygium. They were selected according to inclusion and exclusion criteria and randomized into two groups for conjunctival autograft. Group A (30) was treated with autologous blood clot and Group B (30) was treated with sutures (10-0 monofilament nylon). All surgeries were performed by a single surgeon at single center. Standard examinations were performed preoperatively and postoperatively, preoperative and postoperative outcomes were evaluated and compared statistically where follow up was done at 1st day,7th days, 1-month, 3-month, and 6-month post operation. The mainoutcome variables were postoperative discomfort, graft stability and complications. &#x0D; Results: This study included 60 patients (60 eyes) with a mean age of 46.77±7.04 (SD) (Range 33 to 58 years) in Group A (30) and 46.17±7.53 (SD) (Range 22 to 58 years) in Group B (30). In Group A, male was 22 (73.3%) and female was 8 (26.7%) where Group Bcontained male 20 (66.7%) and female 10 (33.3%). Follow-up at 1st and 7th post operation days showed marked discomfort in Group B (Mean rank 41.82 and 40.62) compared to Group A (Mean rank 19.18 and 20.38) respectively (p&lt;0.001). At 1st post operation day there were 3 (10%) graft retraction in Group Aonly. Within 6 months follow-up, all grafts were stable and there wasonly 1 (3.3%) granuloma in Group B. &#x0D; Conclusion: In primary pterygium excision, autologous blood clot showed excellent post- operative outcomes with much comfort, more stableas well as fewer complications. So, it appears to be an effective means to treat primary pterygium surgically.&#x0D; JCMCTA 2020 ; 31 (1) : 42-47

Opioids and Spinal Cord Stimulators: Pre- and Postoperative Opioid Use Patterns and Predictors of Prolonged Postoperative Opioid Use.

ObjectiveThe aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. MethodsA database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magnitudes of preoperative opioid use. ResultsA total of 2,374 patients who underwent SCS placement were identified. Of all patients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. ConclusionPatients with greater number of preoperative opioid prescriptions may not attain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.

Transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma

ObjectivesTo investigate the effective and safety of transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma by compared with CO2 laser surgery. Materials and MethodsFrom September 2015 to July 2018, 44 patients with early glottic carcinoma underwent transoral microsurgery were divided into 980-nm/1470-nm dual-wavelength fiber laser surgery (Dual-wavelength fiber laser group) and CO2 laser surgery (CO2 laser group). The operative time, number of other hemostatic devices used, postoperative blood loss, surgical complications and postoperative length of hospital stay The time of mucosal epithelialization and Voice Handicap Index-10(VHI-10) in pre-operation, 1-month postoperation and 6-month postoperation in both two groupswere retrospectively analyzed. ResultsAll the patients underwent successful operation and all the tumors received en-bloc resection with negative margins. The median operative time in Dual-wavelength laser group was faster than CO2 laser group (32.00 min vs 37.50 min, p = 0.014). There was no statistically significant difference between the two groups in the median postoperative hospital stay and the median time of mucosal epithelialization. No patient need feeding tubes place temporarily or permanently in both two groups. Tongue numbness, tear of the palatal arch, postoperative vocal cord adhesion, VHI-10 score in Pre-operation, 1-month postoperation and 6-month postoperation were similar in both two group. No recurrence was reported in both groups during follow-up. ConclusionCompared to the CO2 laser surgery, transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery is a safe and feasible procedure for early-stage glottic carcinoma. It can provide clearer surgical field without hemorrhage and make the operation simpler, smoother and faster.

Une technique arthroscopique pour la réparation des ruptures complètes de la coiffe des rotateurs par transposition de la longue portion du biceps

Arthroscopic rotator cuff (RC) repair is now considered as an effective treatment for patients with symptomatic rotator cuff tears. We reported a new method for repairing a full-thickness RC tear by using the double-row technique with transposition of the long head of biceps (LHB). The novelty of this technique is using the long head of the biceps as an augmentation. The indication of this technique consists of two aspects including LHB lesions and RC tears. Three patients were enrolled. An ideal reconstruction of the anatomic footprint of the tendon and stabilization of glenohumeral joint was achieved after the double-row technique with the transposition of the long head of biceps. At 6-month postoperation, the mean VAS score was 1.23±0.15 and the mean Constant score was 88.00±9.17. Transposition of the long head of biceps is a choice for full-thickness RC tear. Level of evidenceIV, case series.

An arthroscopic technique for full-thickness rotator cuff repair by transposition of the long head of biceps

Arthroscopic rotator cuff (RC) repair is now considered as an effective treatment for patients with symptomatic rotator cuff tears. We reported a new method for repairing a full-thickness RC tear by using the double-row technique with transposition of the long head of biceps (LHB). The novelty of this technique is using the long head of the biceps as an augmentation. The indication of this technique consists of two aspects including LHB lesions and RC tears. Three patients were enrolled. An ideal reconstruction of the anatomic footprint of the tendon and stabilization of glenohumeral joint was achieved after the double-row technique with the transposition of the long head of biceps. At 6-month postoperation, the mean VAS score was 1.23±0.15 and the mean Constant score was 88.00±9.17. Transposition of the long head of biceps is a choice for full-thickness RC tear. Level of evidenceIV, case series.

Evaluation of Thompson's quadricepsplasty results in patients with knee stiffness resulted from femoral fracture

Background:Posttraumatic and/or postsurgical knee stiffness is one of the orthopedic complications which is difficult to be treated and can affect individual's life negatively. The aim of this study is to investigate the results of quadricepsplasty in patients with knee stiffness resulted from femoral fracture.Materials and Methods:This is a cross-sectional study on all patients with femoral fracture which has caused knee flexion limitation referred to Kashani and Al-Zahra Hospitals in Isfahan from January 2010 to March 2013. The type and site of fracture, joint extension, and fracture fixation technique were recorded. Moreover, the range of motion (ROM) before surgery, under general anesthesia, and 3- and 6-month postoperation were measured.Results:Among the patients, 13 had a simple fracture (48%) and 14 had a segmental fracture (51.9%). Considering the fracture site, 11, 10, and 6 patients had femoral (40.74%), supracondylar (37.3%), and femoral supracondylar (22.2%) fractures, respectively. The fracture fixation was performed by the plate, external, and Wagner fixation techniques for 24 (88.9%), 2 (7.4%), and 1 (3.7%) patients, respectively. The mean ROM before operation, under general anesthesia, and 3- and 6-month postoperation were determined to be 33.15° ± 24.73°, 122.60° ± 10.22°, 99.63° ± 16.52°, and 100.74° ± 15.67°, respectively. The mean ROM value at various stages was not similar (P < 0.001). The mean changes in the ROM were 79.2° ± 24.6° and 62.1° ± 19.7° in the cases with simple and segmental fractures, respectively. The mean changes in the knee ROM were significantly higher in simple fractures in comparison with the segmental femoral fracture (P = 0.03).Conclusion:We found Thompson's quadricepsplasty may successfully increase the range of knee flexion in knee fracture and also regardless of quadriceps time.

Results of pterygium excision adjunct with conjunctival autograft transplantation for primary pterygium by ophthalmology trainees.

To evaluate the results of pterygium excision with conjunctival autograft transplantation for primary pterygium performed by trainee ophthalmologists. Design Prospective interventional case series. Setting A tertiary eye care center in northern Thailand. Participants Patients with primary pterygium recruited from July 2011 to August 2012. Intervention In all cases, the affected eye underwent pterygium excision followed by a superior conjunctival autograft carried out by trainee ophthalmologists. Main outcome measure The recurrence of pterygium and other post-operative complications. Results Sixty-two eyes from 54 patients were studied. There were 36 females (66.7%) and 18 males (33.3%). The mean age of the patients was 54.5 (±9.8) years with the mean corneal invasion measured at 3.3(±0.8) mm. Pterygium morphologies of Grade 1, Grade 2, and Grade 3 were 33.9, 48.4, and 17.7%, respectively, with the mean follow-up time of 17.3 (±7.9) months. Pterygium recurred in the cornea of six eyes (9.7%). All recurrences occurred within 6-month post-operation. Other post-operative complications included conjunctival recurrence (4.8%), graft retraction (3.2%), conjunctival cyst (3.2%), and increased intraocular pressure (1.6%). The recurrence of pterygium was not associated with the patient age (p=0.72), occupation (p=0.23), sun exposure time (p=0.18), pterygium duration (p=0.22), pterygium size (p=0.67), or pterygium morphology (p=0.85). Conclusion The recurrence rate and post-operative complications of pterygium excision with conjunctival autograft performed by trainee ophthalmologists were within acceptable limits. All recurrence occurred within 6months after surgery.

Breast Cancer Survivorship—Intersecting Gendered Discourses in a 5-Year Follow-Up Study

In this article the authors present a follow-up study of women's interview narratives about life 5 to 7 years after a breast cancer operation. The women had taken part in a study during the 6-month postoperation period. Art therapy contributed to well-being, including strengthening personal boundaries. In the new study, interview analysis informed by critical discursive psychology indicated three problematic discourses that the women still struggled with several years after the operation: the female survivor, the “good woman,” and individual responsibility. We concluded that many women with a history of breast cancer need support several years after their medical treatment is finished.

Retracted: Impact on quality of life of using an onlay mesh to prevent incisional hernia in midline laparotomy: a randomized clinical trial.

Recent studies have demonstrated the effectiveness of using prophylactic meshes to achieve abdominal wall closure, decreasing the risk of incisional hernia. However, the effect of prophylactic mesh placement on a patient's quality of life has not yet been evaluated. A controlled, prospective, randomized, and blind study was carried out. The patients in group A (mesh) were fitted with a polypropylene mesh to reinforce the standard abdominal wall closure. The patients in group B (nonmesh) were given a standard abdominal wall closure and were not fitted with the mesh. All patients were administered the 36-Item Short-Form generic health questionnaire during their preoperation visit and during their 1-month, 6-month, and 1-year follow-up appointments. The scores of the questionnaires have been compared with those recorded when the questionnaire was administered before surgery. The Kaplan-Meier survival curves show that the likelihood of incisional hernia at 12 months is 1.5% in mesh group compared with 35.9% in nonmesh group (p > 0.0001), which means that the differences are statistically significant. Patients with mesh placement had greater improvement in general health and bodily pain than patients in nonmesh group at 1-month and 6-month post operation. One year after operation, patients in the mesh group had statistically significant better quality of life than patients in the nonmesh group in the physical functioning, general health perceptions, vitality, social role functioning, mental health, physical component summary and mental component summary dimensions. Fitting a prophylactic supra-aponeurotic mesh prevents incisional hernia.

A Comparative Study of Antiviral Therapy After Resection of Hepatocellular Carcinoma in the Immune-Active Phase of Hepatitis B Virus Infection

The role of antiviral therapy for patients in the immune-active phase of hepatitis B virus (HBV) infection who underwent partial hepatectomy for hepatocellular carcinoma (HCC) is unknown. From January 2004 to June 2007, a nonrandomized comparative study for postoperative antiviral treatment was conducted on patients who underwent curative hepatectomy for advanced HCC. Patients in the treatment group (n = 43) received lamivudine with or without adefovir dipivoxil, while the control group (n = 36) received no antiviral treatment. The treatment group had a significantly higher HBeAg seroconversion rate (57.2% vs. 5.6%) and a higher HBV DNA suppression rate (87.2% vs. 2.8%) after 12 months of antiviral treatment. The treatment group also had a significantly greater increase in residual liver volume per unit surface area following hepatectomy (78.0 +/- 40.1 cm(3)/m(2) vs. 35.8 +/- 56.0 cm(3)/m(2)) at 6-month postoperation. After a median follow-up of 12 months, there was no significant difference in recurrence rate after surgery between the treatment group and the control group (76.7% and 91.7%). There was a significant difference in the overall survival rate but not in the disease-free survival rate. The 1- and 2-year overall survival rates were 41.9% and 7.0%, respectively, for the treatment group, and 33.3% and 0%, respectively, for the control group. The 1- and 2-year disease-free survival rates were 23.3% and 2.3%, respectively, for the treatment group, and 8.3% and 0%, respectively, for the control group. Although nucleoside analogs did not reduce short-term recurrence rate, they promoted postoperative viral clearance and increased residual liver volume, which significantly enhanced tolerance to subsequent therapy for disease recurrence.

Changes of collagen fiber during reattaching of the musseter muscle following different curved osteotomies of prominent mandibular angle: a study in goats

Objective To investigate the changes of the constitution and its ratio of collagen fiber in the process of masseter reattachment following different osteotomies of the prominent mandibular angle so as to offer guidance for the resection of mandibular angle. Methods Sixteen adult goats were randomized into four groups. In group A we performed unilateral curved osteotomy of the mandibular angle. In group B unilateral curved ostectomy was performed with partial masseter resection. In group C unilateral angle splitting ostectomy, while in group D unilateral dissection of the masseter muscle was conducted. The constitution and its ratio of collagen fiber in the interface were observed at 1-month, 2-month, 3-month, and 6-month after operation. Results On the changes of collagen fiber in the process of muscular reattachment, at 1-month post-operation, the constitution of collagen fiber (types Ⅰ and Ⅲ) in groups A and B were significantly different from that of control group (P 0.05). At 2-month, 3-month and 6-month post-operation, those of all experimental groups had no statistic difference from control group. And with time, the percentage of collagen fiber type Ⅰ increased and type Ⅲ decreased gradually. Conclusion The recovery sequences of masseter muscle reattachment in this study are firstly group C, secondly group A and finally group B. It suggests that the recoveries of mastication and other oral activities are different. Group B turns out to be with a slow muscle reattachment. Thus, we recommend treating different kinds of mandibular hypertrophy with different ostectomies. Key words: Prominent mandibular angle; Collagen fiber; Reattachment; Curved osteotomy