Selection Criteria Research Articles

Urge fecal incontinence: are intramural rectal injections of botulinum toxin a long-term treatment option?

Unsuccessful first-line conservative treatments for managing fecal incontinence (FI) lead to considering predominantly invasive options, posing challenges in terms of cost and patient acceptance of benefit/risk ratio. Recent data from a prospective randomized study have highlighted intramural rectal botulinum toxin (BoNT/A) injection as a promising minimally invasive alternative for urge FI, demonstrating efficacy at 3months but lacking long-term evidence. This study aimed to evaluate the sustained efficacy and injection frequency of intramural rectal BoNT/A injection in the treatment of urge FI. This retrospective monocentric study enrolled all patients who underwent intramural rectal BoNT/A injection for urge FI after failed conservative therapy or sacral neuromodulation (SNM). Injections were administered during sigmoidoscopy, delivering 200 U of BoNT/A at 10 circumferentially distributed sites. Treatment effectiveness was assessed using the Cleveland clinic incontinence score (CCS) and a visual analog scale (VAS) to measure the severity of discomfort related to episodes of fecal urgency, with reinjection performed upon symptom recurrence. In total, 41 patients (34 females) were included, with a median follow-up of 24.9 (range 3.2-70.3) months. Overall, 11 patients had previously failed sacral nerve stimulation. Significant reductions were observed in the CCS (median 11 versus 7, p = 0.001) and VAS symptoms (median 4, range 0-5 versus median 2, range 0-5, p = 0.001). In total, 22 patients (53%) experienced a reduction in the CCS by over 50%. The median interval between intramural rectal BoNT/A injections was 9.8months (range 5.3-47.9 months). This study provides the first evidence of the sustained efficacy of intramural rectal BoNT/A injection for urge FI. Further investigations are warranted to refine patient selection and reinjection criteria, evaluate socioeconomic impacts, and compare rectal BoNT/A injection with other therapeutic modalities.

Comparative outcomes of video-assisted thoracic surgery versus open thoracic surgery in pediatric pulmonary metastasectomy: a systematic review and meta-analysis.

This meta-analysis aimed to compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracotomy in pediatric patients undergoing pulmonary metastasectomy for various malignancies. We systematically searched PubMed, Embase, and Cochrane Library databases for studies comparing VATS and open thoracotomy in pediatric patients. The treatment effects for continuous outcomes were compared using mean differences (MDs), and binary endpoints were evaluated using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analyses were performed using R software, version 4.4.1. A total of 4 studies involving 1,541 patients were included. There were no significant differences in overall survival (OR 0.65; 95% CI 0.36-1.18; p = 0.16) or disease-free survival (DFS) (OR 1.65; 95% CI 0.88-3.10; p = 0.12) between groups. However, VATS was associated with a significantly reduced length of hospital stay (MD -2.06days; 95% CI -2.93 to -1.20; p < 0.01). This meta-analysis suggests that VATS significantly reduces hospitalization duration compared to open thoracotomy, with no significant difference in survival outcomes. Future prospective studies are needed to validate these findings and optimize patient selection criteria. International Prospective Register of Systematic Reviews; No: CRD42024581284; URL: https://www.crd.york.ac.uk/prospero/ .

Overdensity of Lyman-break galaxy candidates around hot-dust-obscured galaxies

Hot dust-obscured galaxies (hot DOGs) are a family of hyper-luminous, heavily obscured quasars. A number of studies based on the identification of companions at optical to far-infrared (FIR) wavelengths have shown that these objects reside in significantly overdense regions of the Universe. Here we present further characterisation of their environments by studying the surface density of Lyman break galaxy (LBG) candidates in the vicinity of three hot DOGs. For two of them, WISE J041010.60–091305.2 (W0410--0913) at $z=3.631$ and WISE J083153.25+014010.8 (W0831+0140) at $z=3.912$, we identify the candidate LBG companions using deep observations obtained with Baade/IMACS. For the third, WISE J224607.56--052634.9 (W2246--0526) at $z=4.601$, we reanalyse previously published data obtained with Gemini-S/GMOS-S. We optimise the LBG photometric selection criteria at the redshift of each target using the COSMOS2020 catalog. When comparing the density of LBG candidates found in the vicinity of these hot DOGs with that in the COSMOS2020 catalog, we find overdensities of $ 2.21$), and $ 1.96$) around W0410--0913, W0831+0140, and W2246--0526, respectively, without (with) contamination correction. Additionally, we find that the overdensities are centrally concentrated around each hot DOG. Our analysis also reveals that the overdensity of the fields surrounding W0410--0913 and W0831+0140 declines steeply beyond physical scales of sim 2 Mpc. If these overdensities evolve into clusters by $z=0$, the present results suggest that the hot DOG may correspond to the early formation stages of the brightest cluster galaxy. We were unable to determine whether or not this is also the case for W2246--0526 due to the smaller field of view (FOV) of the GMOS-S observations. Our results imply that hot DOGs may be excellent tracers of protoclusters.

A novel trace-based sampling method for conformance checking

It is crucial for organizations to ensure that their business processes are executed accurately and comply with internal policies and requirements. Process mining is a discipline of data science that exploits business process execution data to analyze and improve business processes. It provides a data-driven approach to understanding how processes actually work in practice. Conformance checking is one of the three most relevant process mining tasks. It consists of determining the degree of correspondence or deviation between the expected (or modeled) behavior of a process vs the real one observed and revealed from the historical events recorded in an event log during the execution of each instance of the process. Under a big data scenario, traditional conformance checking methods struggle to analyzing the instances or traces in large event logs, increasing the associated computational cost. In this article, we study and address the conformance-checking task supported by a traces selection approach that uses representative sample data of the event log and thus reduces the processing time and computational cost without losing confidence in the obtained conformance value. As main contributions, we present a novel conformance checking method that (i) takes into account the data dispersion that exists in the event log data using a statistic measure, (ii) determines the size of the representative sample of the event log for the conformance checking task, and (iii) establishes selection criteria of traces based on the dispersion level. The method was validated and evaluated using fitness, precision, generalization, and processing time metrics by experiments on three actual event logs in the health domain and two synthetic event logs. The experimental evaluation and results revealed the effectiveness of our method in coping with the problem of conformance between a process model and its corresponding large event log.

Assessing the need for a doctor of philosophy (Ph.D.) degree in Endodontics: perspective and implication for advancing dental education and research in Saudi Arabia

AimThis study aims to evaluate the necessity and feasibility of integrating a Doctor of Philosophy (Ph.D.) degree into Endodontic programs at the Faculty of Dentistry King Abdulaziz University, (KAUFD), Jeddah, Saudi Arabia, and to gather insights from key stakeholders regarding the value and necessity of a Ph.D. in enhancing the field of Endodontics.Materials and MethodsAn online questionnaire link was distributed among potential Ph.D. candidates and key decision-makers in Endodontics in Saudi Arabia through social media and emails to members of the Saudi Endodontic Society and the Saudi Endodontic Journal. The questionnaire assessed demographics, professional background, interest in Ph.D. programs, program preferences, perceived need for Ph.D. programs in various sectors, and university selection criteria. Data were analyzed using IBM SPSS Statistics (Version 23).Results141 responses were received. Most respondents were aged 31–40, with an almost equal gender distribution. In terms of current position, a significant number were Endodontic consultants (35.7%) and Endodontic residents/Master students (28.6%) (P = 0.006). Additionally, a considerable proportion of probable prospective students had less than 5 years of expertise (45.7%) (p = 0.013), and the highest degree held by many was a bachelor’s degree (35.7%) (P = 0.007). Key considerations for prospective students were program duration, Saudi Commission for Health Specialists (SCFHS) recognition, part-time options, and cost. The importance of acquiring research skills, such as learning new research technologies and gaining publication experience, was also highlighted.ConclusionThe findings strongly suggest a need for a Ph.D. program in Endodontics in Saudi Arabia. The results provide valuable insights for developing a program that aligns with potential candidates’ and key stakeholders’ needs and preferences, thereby advancing Endodontic research and education within the country.

Development of a Decision Support System for University Administration: Integrating Business Process Management and Multidimensional Data Analysis

The paper provides an overview of decision support systems to demonstrate their role in supporting decision-making in university administration. Enhancing university performance and modernizing university administration must be top priorities for university leaders and decision-makers since quality is the foundation that supports innovation. Good decision-making is the first step towards efficiency and quality in the academic setting. The article’s main topic is developing IT solutions to support decision-making business processes of student admission. By utilizing models of university business processes and applying business intelligence principles, with the support of multidimensional data analysis, it can be effectively introduced and integrated. The study attempts to provide selection criteria for selecting a development environment for creating a support system focused on university management based on data from the student information system database and the author’s personal experience. The contributions include creating OLAP analytical models and a data warehouse model to support university managerial decisions.

Lack of an association between spleen volume and risk of pneumococcal infection in cancer patients: a nested case-control study

BackgroundThe spleen is a key organ in preventing pneumococcal infection, especially in patients with immunocompromised condition such as those with cancer. Previous studies have shown that a small spleen volume in pneumococcal pneumonia patients is associated with severe disease course. However, it is unknown whether a small spleen increases risk of pneumococcal infection. We investigated the association between spleen volume and risk of pneumococcal infection.MethodsThis study was a retrospective cohort study using a nested case-control design and involved adult patients with malignancy who underwent chest and/or abdominal CT scans from January 1, 2008, to September 30, 2020, at a tertiary care center in Japan. Exclusion criteria comprised patients diagnosed with hepatic cirrhosis, leukemia, lymphoma, and/or post-splenectomy. From the cohort group that met all selection criteria (n = 22475), we identified all incident cases of pneumococcal infection (pneumococcal pneumonia and/or invasive pneumococcal diseases) and matched them with four controls by age, sex, and follow-up duration. Odds ratios (ORs) for the association between spleen volume and pneumococcal infection were estimated using conditional logistic regression models adjusted for body surface area, performance status, Charlson comorbidity index, and metastatic cancer.ResultsThe median spleen volume was 85.8 (interquartile range, 65.8–120.8) cm3. Over a median follow-up of 4.95 (interquartile range, 1.54–9.25) years, 60 patients were diagnosed with pneumococcal infection (20 with invasive pneumococcal disease and 40 with pneumonia without invasive pneumococcal disease) and matched with 240 controls. Spleen volume reduction (per 10 cm3) did not increase risk of pneumococcal infection in a crude analysis [OR 1.04 (95% CI 0.98–1.11)]. The outcome remained unchanged in the multivariable analysis (OR 1.01 [95% CI 0.95–1.08]).ConclusionsSmall spleen volume did not increase risk of pneumococcal infection in cancer patients.

Challenges of providing of special care services in hospitals during emergencies and disasters: a scoping review

BackgroundThe ability of hospitals to provide special care services for critically ill or injured patients during emergencies and disasters poses very significant challenges that necessitate the response in-place plans. the increasing frequency of such events, coupled with limited hospital resources and increasing patient volumes, underscores the urgency of addressing these issues. Specifically, this study aims to identify the challenges faced by hospitals in providing special services during disasters.MethodThis scoping review, conducted in 2024, based upon the framework developed by Arksey and O’Malley. An extensive search of Literature searching was performed using gray literature and databases including Google Scholar, PubMed, Web of Science, and Scopus. Applying the selection criteria, a total of 33 relevant studies were identified that discuss the challenges faced when providing special care services in hospitals during emergencies and disasters. Results are presented in accordance with the PRISMA checklist to ensure quality and transparency. Data was analyzed through a systematic coding process where common themes across the studies were identified.ResultsThis review identified 15 distinct challenges associated with providing special care services in hospitals during emergencies and disasters: limited resources, inadequate infrastructure, lack of pre-hospital care, financial constraints, failures in the emergency response system, triage, deficiencies in management structure, planning, and preparation, communication and coordination deficits, training and protocols development, employee welfare challenges, challenges of continuity of care, increased demand, different and complex needs of patients, ethical challenges, imbalance in distribution of service resources.ConclusionsResponse in a hospital to the needs of special care during a disaster has to be responded to with more effective preparedness through comprehensive disaster preparedness plans, better communication and coordination, and training of staff and allocation of resources. In particular, standardized triage protocols and ethical frameworks will provide the foundation for the optimization of resource use in emergency responses. Better communication among departments and also with other outside organizations will improve how resources are used to better achieve good patient outcomes within emergency responses.

Comparison of Primal Reflex Release Technique and Positional Release Therapy on Pain, Functional Ability and Ankle Range in patients with Plantar Fasciitis: An Experimental Study

Background: Plantar fasciitis (PF) is characterized by inflammation, fibrosis and structural deterioration of foot and there is pain over heel and plantar fascia. Plantar fasciitis pain is gradual in onset, sharp and diffusely located initially which later localizes to medial calcaneal tuberosity. Typically, pain is most severe in the morning which lessens with movement but intensifies with long-standing weight bearing. Plantar fasciitis has been experienced by 10% of the non-athletic population and most typically observed in weight-bearing activities. So, the aim was to study the effects of primal reflex release technique and positional release therapy on pain, functional ability and ankle range in patients with plantar fasciitis. Method: Total 36 patients were recruited for the study as per the selection criteria and were divided into two groups (18 in each group). Group A was treated with primal reflex release technique (PRRT) along with conventional therapy and Group B was treated with positional release therapy (PRT) along with conventional therapy for 7 consecutive days. Intergroup analysis by independent t-test showed statistically significant improvement in pain and functional ability (P value ≤ 0.001). Conclusion: Primal reflex release technique along with conventional therapy was found to be more predominant in improving pain and functional ability than positional release therapy along with conventional therapy. Also, Primal reflex release technique along with conventional therapy and positional release therapy along with conventional therapy were equally effective in improving ankle range of motion.

Scientific mapping of the use of lecithin in breast cancer therapy

Lecithin, a natural phospholipid, possesses health-beneficial properties, recognized for its potential in breast cancer treatment. In recent years, it has been utilized in systems to enhance chemotherapy effectiveness, increase tumor penetration, and reduce side effects, offering less invasive and economically viable treatments. The aim of this study was to identify publication trends and patterns, leading journals, prominent authors, frequent keywords, and the influence of collaboration among researchers and institutions in scientific production on the topic. Employing a scientometrics approach, the study involved rigorous criteria for material search and selection to ensure data quality. A total of 241 studies were identified, with 81 selected after detailed filtering. Results indicate a rise in publications post-2012, peaking in 2020. 411 authors were identified, with Le, Ngoc Thuy Trang standing out, alongside three high-impact factor journals dominating the field. Strong collaboration among researchers and institutions was observed. Results were interpreted and discussed within the broader context of scientometrics. The study faced limitations, such as exclusive use of Bibliometrix potentially restricting analysis scope, and reliance on different databases yielding incomplete information. This study suggests future research to explore other natural substances with therapeutic potential and develop new methodologies to optimize drug delivery.

Exploring Clinician Barriers and Enablers in Referring Patients to a Virtual Hospital for Acute Care

Background: Virtual hospitals offer a promising solution to alleviate pressures on traditional healthcare systems by providing acute care in patients' homes. Despite the implementation of a virtual hospital model in South Australia, referral rates remain below expectations. Aim: To explore clinician attitudes, beliefs, barriers, and enablers influencing referrals to a virtual hospital for acute care. Methods: A qualitative exploratory study was conducted using semi-structured interviews with nine clinicians who had experience referring patients to the virtual hospital. Data were analysed thematically using a grounded theory approach. Results: Four key themes emerged: (1) Complexity of the healthcare ecosystem leading to duplication and navigation challenges; (2) Ambiguity in patient selection criteria causing uncertainty in referrals; (3) Higher social complexity and non-medical care needs acting as barriers; (4) Interoperability issues and the need for effective change management. Conclusions: Addressing the identified barriers through refining referral pathways, clarifying eligibility criteria, enhancing support for patients with complex needs, and improving system interoperability could increase referral rates to the virtual hospital. Engaging clinicians in the co-design of virtual care models is essential for successful implementation.

Association of Protein Intake with Sarcopenia and Related Indicators Among Korean Older Adults: A Systematic Review and Meta-Analysis

Objectives: Due to variations in the standards for optimal protein intake and conflicting results across studies for Korean older adults, this study aimed to quantitatively integrate existing research on the association of protein intake with sarcopenia and related indicators in Koreans aged 65 and older through meta-analysis. Methods: A total of 23 studies were selected according to the study selection criteria (PICOS). Sixteen cross-sectional studies, 5 randomized controlled trials (RCTs), and 2 non-RCTs were included in the review, with 9 out of 23 studies included in the meta-analysis. We used fixed-effects models and performed subgroup and sensitivity analyses. Results: A meta-analysis found that the risk of sarcopenia was significantly higher in the &lt;0.8 g/kg/day protein intake group compared to the 0.8–1.2 g/kg/day and ≥1.2 g/kg/day groups, with odds ratios (ORs) of 1.25 (95% confidence interval (CI), 1.10 to 1.42; I2 = 55%) and 1.79 (95% CI, 1.53 to 2.10; I2 = 71%), respectively. For low hand grip strength (HGS), the risk was higher in the &lt;0.8 g/kg/day group compared to the 0.8–1.2 g/kg/day or ≥1.2 g/kg/day groups (OR 1.31; 95% CI, 1.03 to 1.65; I2 = 28%). No significant associations were found with other sarcopenia indicators, such as skeletal muscle mass, short physical performance battery score, balance test, gait speed, and timed up-and-go test. Conclusions: Lower protein intake is associated with a higher risk of sarcopenia and low HGS in Korean older adults. To establish protein intake recommendations for the prevention and management of sarcopenia in this population, further well-designed RCTs incorporating both protein supplementation and resistance training are necessary.

Effect of Levothyroxine on Lipid Profile in Hypothyroid Patients Attending in a Tertiary Care Hospital

Background: Hypothyroidism is a common endocrine disorder in our country and is associated with many biochemical abnormalities.Clinical data suggest that levothyroxine replacement therapy has beneficial effect on lipid profile. Objective: The present study intends to find out the effect of levothyroxine replacement therapy on lipid profile in hypothyroid patients. Methods: A prospective analytical study was done in Endocrinology Outpatient Department of Dhaka Medical college and Hospital, Dhaka from January 2022 to December 2022. A total of 30 newly diagnosed hypothyroid patients were included according to selection criteria. The patient’s demographic, past, present history and relevant data needed for the study were collected by face-to-face interview by using structured questionnaire. Baseline data of serum free thyroxine (FT4), thyroid stimulating hormone (TSH), fasting lipid profile, Blood pressure and clinical features of hypothyroidism were recorded in a data collection form during first visit and after 3 months follow up. All patients were treated with tablet levothyroxine and dose was adjusted 4-6 weekly till patients were biochemically euthyroid. Results: 30 hypothyroid patients were followed up for 3 months. There was significant improvement in hypothyroid symptoms after thyroxine replacement. The mean age of the patient was 35.40±11.52 years. Mean FT4 level was significantly increased from 8.06±3.78 to 16.40±3.95(p&lt;0.001). There was significant reduction in mean TSH from 32.55±37.31 to 2.52±2.71(p&lt;0.001). Mean Total cholesterol, TG, LDL-C level was significantly decreased from 193.27±41.69, 173.33±63.71, 119.58±40.11 to 177.80±38.17, 155.87±58.25, 103.07±26.25 (p=0.022, 0.044, 0.042) respectively, but HDL has decreased from 45.04±13.14mg/dl to 43.11±10.78 mg/dl (p=0.415) though not significantly. Conclusion: Thyroxine replacement therapy improves lipid profiles and enhances quality of life. Levothyroxine directly reduces TC, LDL-C, and TG levels but not HDL-C. J Rang Med Col. September 2024; Vol. 9, No. 2: 61-66

Allergen immunotherapy.

Allergen immunotherapy (AIT) is a potentially disease-modifying therapy that is effective for the treatment of allergic rhinitis/conjunctivitis, allergic asthma and stinging insect hypersensitivity. The decision to proceed with AIT should be made on a case-by-case basis, based on a comprehensive evaluation of the patient, allergy testing and a thorough discussion with the patient about treatment goals, risks vs. benefits, and long-term commitment to the treatment plan. For those with allergic rhinitis and/or asthma, it is also important to consider individual patient factors, such as the degree to which symptoms can be reduced by avoidance measures and pharmacological therapy, the amount and type of medication required to control symptoms, the adverse effects of pharmacological treatment, and patient preferences.Since AIT is associated with a risk of anaphylaxis, it should only be prescribed by physicians who are adequately trained in the treatment of allergic conditions. Furthermore, for subcutaneous therapy, injections must be given under medical supervision in clinics that are equipped to manage anaphylaxis. In this article, we review the indications and contraindications, patient selection criteria, and details regarding the administration, safety and efficacy of AIT for allergens other than foods. Immunotherapy for food allergy will be discussed in the Oral Immunotherapy article in this supplement.

A comparative study of dynamic versus static rehabilitation protocols after acute Achilles tendon rupture repair with channel assisted minimally invasive repair technique

To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique through a prospective comparative trial, aiming to provide a reference for clinically selecting a feasible treatment regimen. Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study, with 60 patients meeting the selection criteria. They were randomly divided into a dynamic rehabilitation group ( n=30) and a static rehabilitation group ( n=30) using a computer-generated random number method. There was no significant difference in baseline data such as gender, age, body mass index, smoking history, injured side, cause of injury, and disease duration between the two groups ( P>0.05). After Achilles tendon anastomosis by using CAMIR technique, the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks, while the static rehabilitation group maintained a non-weight-bearing status during this period. Complications in both groups were recorded. At 3 and 6 months after operation, the Achilles tendon total rupture score (ATRS) was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb, and the 12-Item Short Form Health Survey (SF-12 scale) was used to assess the patients' quality of life, including physical component summary (PCS) and mental component summary (MCS) scores. No sural nerve injury occurred during operation in both groups. All patients were followed up 12-18 months (mean, 14 months). The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group ( P<0.05). At 3 months after operation, the dynamic rehabilitation group had significantly lower PCS, MCS, and SF-12 total scores compared to the static rehabilitation group ( P<0.05). At 6 months, all quality of life scores in the two groups were similar ( P>0.05). Two cases (6.6%) in the dynamic rehabilitation group and 5 cases (16.7%) in the static rehabilitation group developed complications, with no significant difference in incidence of complications ( P>0.05). For acute Achilles tendon rupture, the dynamic rehabilitation protocol after Achilles tendon anastomosis by using CAMIR technique can improve early functional recovery and maintains comparable safety and effectiveness compared to static rehabilitation.

Comparative study of Achillon Achilles tendon suture guide combined with circuit suture via perineural channel and Krachow suture via posterolateral incision of Achilles tendon in treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture

To compare the effectiveness of Achillon Achilles tendon suture guide combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture. The clinical data of 38 patients with Kuwada type Ⅱ acute closed Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed. Krachow suture via posterolateral incision was used in 24 cases (traditional group), and Achillon Achilles tendon suture guide combined with circuit suture via perineural channel was used in 14 cases (minimally invasive group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, time from injury to operation, characteristics of Achilles tendon injury (broken end distance, stump length), and preoperative Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score between the two groups ( P>0.05). The operation time, incision length, hospital stay, and complications (re-tear, incision infection, sural nerve irritation, deep venous thrombosis) were recorded. ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation. All patients successfully completed the operation. The operation time, incision length, and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group ( P<0.05). Patients in both groups were followed up 8-16 months, with an average of 12.7 months. There was no sural nerve injury or re-tear of Achilles tendon in both groups. In the traditional group, 1 case had incision infection,1 case had suture rejection, and 1 case had intermuscular venous thrombosis; in the minimally invasive group, no incision healing complication, suture knot discomfort, or thrombosis occurred. There was no significant difference in the incidence of complications between the two groups ( P=0.283). The ATRS score and AOFAS ankle and hindfoot function score of the two groups were improved after operation, but there was no significant difference ( P>0.05). Except that there was no significant difference in AOFAS ankle and hindfoot function scores between the two groups at 6 months after operation ( P>0.05), the ATRS scores and AOFAS ankle and hindfoot function scores in the minimally invasive group were significantly better than those in the traditional group at other time points ( P<0.05). The treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture with Achillon Achilles tendon suture guide combined with circuit suture via the perineural channel has similar ankle function comparable to traditional operation, but the incision is smaller and the incidenc of incision infection is lower, which is beneficial for patients to recover early ankle function.

Prospective study of three-dimensional-printed in vitro guide plates assisted hip arthroscopy in treatment of Cam-type femoroacetabular impingement

A prospective study was conducted to investigate the feasibility and effectiveness of three-dimensional printed in vitro guide plates assisted hip arthroscopy in the treatment of Cam-type femoroacetabular impingement (FAI). The clinical data of 25 patients with Cam-type FAI who met the selection criteria between December 2016 and September 2022 were collected. There were 13 males and 12 females with an average age of 42 years (range, 19-66 years). The disease duration ranged from 3 to 120 months, with an average of 22.2 months. The preoperative range of internal rotation-external rotation was (28.70±4.50)°, α angle was (69.04±0.99)°, visual analogue scale (VAS) score was 6.5±0.2, and modified Harris hip score (HHS) was 50.5±0.7. All patients were treated with hip arthroscopy assisted by three-dimensional printed in vitro guide plate. The occurrence of complications was observed postoperatively, α angle of the affected hip joint was measured on Dunn X-ray film, and the glenoid labrum injury was observed by MRI. The percentage of overlap between the Cam plasty area and the preoperative simulated grinding area was calculated by three-dimensional CT+reconstruction. The effectiveness was evaluated by VAS score and modified HHS score. Postoperative dorsalis pedis numbness occurred in 1 case, and the symptoms disappeared after 1 month of conventional drug treatment such as neurotrophy. Two cases of perineal skin injury occurred, and healed after symptomatic treatment. There was no male erectile dysfunction, deep incision infection, pulmonary embolism, or other serious complications occurred. The percentage of overlap between the Cam plasty area and the preoperative simulated grinding area was 81.6%-95.3%, with an average of 89.8%. All 25 patients were followed up 6-12 months, with an average of 8 months. At last follow-up, the range of internal rotation-external rotation was (40.10±2.98)°, α angle was (43.72±0.84)°, VAS score was 1.8±0.2, and the modified HHS score was 72.1±1.3, which significantly improved when compared with preoperative ones ( P<0.05). The treatment of Cam-type FAI with three-dimensional printed in vitro guide plates assisted hip arthroscopy is safe and feasible, and can achieve good effectiveness.

Comparative study on effectiveness of injecting platelet-rich plasma with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury

To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone ( n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups ( P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection ( P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group ( P>0.05), the above scores showed significant differences between different time points ( P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased ( P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group ( P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups ( P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group ( P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group ( P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.

Restoring with flowables: An injection moulding technique – A report of two cases

This case report showcases the conservative management of aesthetic anterior restorations for patients seeking to enhance their smiles using the highly filled flowable composite resin injectable moulding technique. This efficient method resulted in optimal, aesthetically pleasing outcomes, leading to high patient and dentist satisfaction. Direct veneers made from injectable flowable resin composites provide a minimally invasive treatment option, given that the case selection criteria are appropriately followed. Furthermore, this approach can be viewed as a more cost-effective alternative. However, additional follow-ups are essential to thoroughly assess the clinical longevity of both the restorations and the materials utilised.

Arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique for recurrent anterior dislocation of shoulder joint

To explore effectiveness of arthroscopic Eden-Hybinette procedure with Triple-Pulley and four point anti-rotation fixation technique in the treatment of recurrent anterior dislocation of shoulder joint. A clinical data of 14 patients with recurrent anterior dislocation of shoulder joint and glenoid bone defect, who were met the selective criteria and admitted between February 2021 and February 2022, was retrospectively analyzed. All patients were treated with arthroscopic Eden-Hybinette procedure and the bone blocks were fixed by using Triple-Pulley and four point anti-rotation fixation technique. There were 9 males and 5 females with an average age of 31.2 years (range, 22-40 years). Shoulder dislocation occurred 4-10 times (mean, 6.8 times). The time from the initial dislocation to the admission was 1-6 years (mean, 3.3 years). The Instability Severity Index Score (ISIS) was 7.2±0.8, the Beighton score was 2.9±2.4, and the width ratio of glenoid bone defect was 26.64%±1.86%. Pre- and post-operative visual analogue scale (VAS) score, the University of Califonia-Los Angeles (UCLA) shoulder score, Constant score, and American Association of Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder pain and function. The position, healing, resorption, and remodeling (glenoid area) of the bone blocks were evaluated by CT of shoulder joint. All patients underwent surgery successfully without any serious complications. All patients were followed up 11.5-13.8 months (mean, 12.0 months). The VAS scores of shoulder joint after operation decreased compared to preoperative levels, while the UCLA score, Constant score, and ASES score all increased, with significant differences ( P<0.05). And with the prolongation of time, the above indicators further improved, and the differences between different time points were significant ( P<0.05). Imaging reexamination showed that the bone block completely filled the glenoid defect, with good position and no significant displacement. Over time, the bone block healed and partially absorbed and remodelled. The postoperative glenoid area increased significantly compared to preoperative area ( P<0.05). With the prolongation of time, the glenoid area significantly decreased, but the difference was not significant between different time points ( P>0.05). For the recurrent anterior dislocation of shoulder joint, Triple-Pulley and four point anti-rotation fixation technique in Eden-Hybinette procedure can effectively prevent bone rotation, make fixation more reliable, and easy to operate and achieve good effectiveness.