Duration Of Implantation Research Articles

Normalcy Among Individuals Living With Long-Term Mechanical Circulatory Support: A Reflexive Thematic Analysis.

To explore descriptions of normalcy among individuals who have lived with mechanical circulatory support for a long time. Reflexive thematic analysis was used for this qualitative research. A parent study, utilising constructivist grounded theory, was conducted to explore the experiences of advance care planning among mechanical circulatory support individuals. Participants spontaneously shared their experiences of normalcy, which was outside the scope of the primary study. Thus, a secondary analysis using reflexive thematic analysis was performed to explore experiences of normalcy among individuals living with mechanical circulatory support for long-term use. Twelve transcripts were purposively sampled and analysed. Three major themes were derived from the data: acquiescence, adapting to the device and restructuring family roles. Normalcy continued to evolve years after device implantation because individuals were not prepared to face ongoing psychosocial challenges. Clinicians and researchers must address the complex emotional and social needs related to changes in goal therapy and unanticipated transplant delays. This includes the development of support groups that are aligned with the various stages of the MCS trajectory. Clinicians need to engage patients in conversations about disruptions to their perceived 'normal' lifestyle and how they plan to adapt to complex changes. Future support groups can be organised according to individuals' duration of implantation and goal therapy to reduce social withdrawal. Additionally, clinicians should assess bridge to transplant individuals' attitudes before connecting them with transplanted volunteers. Finally, clinicians can support resilience by recognising and discussing the ongoing work required to adapt to the complex changes throughout the mechanical circulatory support trajectory. Perceptions of normalcy among mechanical circulatory support individuals are subject to ongoing change. Findings will inform clinicians of the social, emotional and familial challenges that require ongoing support and resources for long-term mechanical circulatory support individuals. Reporting adhered to the COREQ checklist. Participants contributed to this study by sharing their experiences of normalcy after living with mechanical circulatory support for 2 years or more.

Is MAGEC X better than earlier designs of magnetically controlled growing rod: an explant study.

Determine the performance of MAGEC X rods through retrieval analysis and comparison with clinical data. A multicentre explant database was searched to identify cases using MAGEC X device. Clinical and surgical data was gathered prospectively. Prior to rod disassembly, rods underwent testing with an external remote controller to measure the force output. Eleven cases from 6 centres were identified. Implantation occurred at mean age 6.9years with mean duration of implantation 42months. Dual rod constructs were used in all but one case, providing 21 MAGEC X rods for explant analysis. Tissue metallosis was identified at revision surgery in 8/11 cases (73%). Of the 21 rods, 13/21 (62%) produced no force while 8/21 (38%) produced the force stated by the manufacturer. Endcap separation was seen in 5/21 (24%) rods. Where full disassembly was possible, 13/14 (93%) rods had an intact locking pin. Average rod growth was 18mm (range 2-45mm), equivalent to 5.1mm per year. Wear debris was found within 20/21 (95%) MAGEC X rods. Despite the substantial design changes with MAGEC X tissue metallosis was seen in most cases; most explanted MAGEC X rods had lengthened only partially and produced no force output. While the previous issue of locking pin fracture appears to have been mitigated with MAGEC X, there are multiple other and new failure modes, such as endcap separation. Overall MAGEC X appears to give little improvement over earlier iterations of the rod.

Benefits of reducing duration of endoscopic duodenal-jejunal bypass liner implantation to nine months in treatment of diabesity

Aims: To assess the safety and efficacy of duodenal-jejunal bypass liner (DJBL) implantation for 9 months or 12 months in patients with obesity and sub-optomally controlled type 2 diabetes (T2DM). Methods: Over 4.25 years DJBLs were implanted in 90 adult patients with obesity and sub-optimally controlled T2DM at a single centre in England. The liners remained in situ for up to 12 months and outcomes were monitored in a registry. Results: Of the 90 patients (BMI 41.5±7.1kg/m2, HbA1c 79.3±20 mmol/mol), 53% were insulin-treated. During DJBL treatment, there was no difference between the mean±SD fall in HbA1c at 9 months (20.5±18.8mmol/mol) vs. 12 months (20.5±19.4mmol/mol) (p=0.95). The mean±SD weight loss at 9 months (13.8±7.7kg) was 1.6±3.6kg less than that at 12 months (15.4±8.4kg) (p<0.001). By 12 months, 15.6% of patients had had early DJBL removal due to serious adverse events (SAEs), from which they all recovered. Of these SAEs, 43% would have been avoided by DJBL removal at 9 months. Conclusion: DJBL is effective in people with intractable diabesity. To reduce the incidence of SAEs, our data support reducing the recommended/conventional implantation period for DJBL from 12 months to 9 months.

Transcatheter non-acute retrieval of the tine-based leadless ventricular pacemaker.

We report our single-centre experience of mid-term to long-term retrieval and reimplantation of a tine-based leadless pacemaker [Micra transcatheter pacing system (TPS)]. The TPS is a clinically effective alternative to transvenous single-chamber ventricular pacemakers. Whereas it is currently recommended to abandon the TPS at the end of device life, catheter-based retrieval may be favourable in specific scenarios. We report on nine consecutive patients with the implanted TPS who subsequently underwent transcatheter retrieval attempts. The retrieval system consists of the original TPS delivery catheter and an off-the-shelf single-loop 7 mm snare. The procedure was guided by fluoroscopy and intracardiac echocardiography. After an implantation duration of 3.1 ± 2.8 years (range 0.4-9.0), the overall retrieval success rate was 88.9% (8 of 9 patients). The mean procedure time was 89 ± 16 min, and the fluoroscopy time was 18.0 ± 6.6 min. No procedure-related adverse device events occurred. In the one unsuccessful retrieval, intracardiac echocardiography revealed that the TPS was partially embedded in the ventricular tissue surrounding the leadless pacemaker body in the right ventricle. After retrieval, three patients were reimplanted with a new TPS device. All implantations were successful without complications. A series of transvenous late retrievals of implanted TPS devices demonstrated safety and feasibility, followed by elective replacement with a new leadless pacing device or conventional transvenous pacing system. This provides a viable end-of-life management alternative to simple abandonment of this leadless pacemaker.

Factors influencing the speed of correction speed of distal tibial valgus deformity in children with percutaneous epiphyseodesis using transphyseal screw

IntroductionThe distal tibial valgus deformity in children mimics a hindfoot valgus and is observed in several conditions of both non-neurogenic and neurogenic origin. The deformity can only be detected with radiological examination and can be safely and effectively corrected in children with medial percutaneous epiphysiodesis using transphyseal screws (PETS). The aims of the study are: 1. to determine the correction rates of the distal tibial valgus deformity due to different pathologies, 2. to examine the correction rate in relation to the age at implantation, severity of the initial deformity and the duration of implantation, 3. and types of foot deformities associated with the deformity. Materials and methodsA retrospective study was done on children who underwent a PETS for a distal tibial valgus deformity. The lateral distal tibia angle 89° ± 3° on ankle mortice x-rays was taken as normal. An analysis of variance and covariance was done to investigate differences in parameters between aetiologies and relations between parameters respectively. ResultsFollowing exclusion of 191 limbs, 155 limbs in 104 children were included the study, 5 groups could be identified: Idiopathic, ICP (cerebral palsy), MMC (Meningomyelocele), Dysmelia, MHE (multiple hereditary exostosis). The mean age at implantation of all patients was 10.9 ± 1.4 years. The average correction of 0.45° ± 0.08°/month with no significant differences in the correction rates between groups. However, the correction rates were dependent on the age, the initial deformity and the duration of treatment. The incidence of a valgus foot deformity was 86.4 %. ConclusionThe correction rates of the distal tibial valgus deformity following PETS are variable and depend, on the age at implantation, duration of treatment and initial deformity. The spectrum of foot deformities associated with distal tibial valgus deformity, especially a high prevalence of valgus foot deformity warrants an ankle mortice x-ray. Level of EvidenceLevel III, retrospective study

FNIRS Changes in the Middle Temporal and Occipital Cortices After a Cochlear Implant.

The relationship between the middle temporal (MTG) and occipital cortices in post-lingually deaf (PLD) individuals is unclear. This study aimed to investigate changes in the MTG and occipital cortices excitability and their effects on the occipital cortex in individuals with PLD after receiving a cochlear implant (CI). Twenty-six individuals with severe-to-profound binaural sensorineural PLD were assessed clinically. Nine individuals had received a unilateral cochlear implant over 6 months, while 17 had not. Brodmann area 19 (BA19, extra-striate occipital cortex) and MTG (auditory-related area of cortex) were selected as regions of interest. The excitability of the ROI was observed and compared in the surgery and no-surgery groups by functional near-infrared spectroscopy (fNIRS) in the resting state, and correlations between connectivity of the MTG and occipital cortex, and as well as the duration of time that had elapsed following CI surgery, were investigated. fNIRS revealed enhanced global cortical connectivity in the BA19 and MTG on the operative side (p < 0.05) and the connectivity between BA19 and the MTG also increased (p < 0.05). The connectivity between the MTG and BA19 was positively correlated with the duration of cochlear implantation, as was the case for BA18. There was evidence for remodeling of the cerebral cortex: increased excitability was observed in the MTG and BA19, and their connectivity was enhanced, indicating a synergistic effect. Moreover, the MTG may further stimulate the visual cortex by strengthening their connectivity after CI. 3 Laryngoscope, 2024.

The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study.

The present study clinically analyzes implant survival of immediate implant placement cases using the drilling through roots (DTR) technique for anatomically-guided implant site preparation, as an aid to placing immediate dental implants in multi-radicular teeth. This clinical analysis utilized patients' electronic dental records who underwent immediate implant surgery using the DTR technique. All immediately placed implants were followed up regularly every year, after restoration. Implant survival was assessed with the Albrektsson et al. criteria. Inferential statistics was performed using SPSS v 21(IBM Corp., Armonk, NY) software. The Kaplan-Meier survival analysis was done to assess the implant survival probability. A total of 250 records of dental implants placed in 227 subjects using the DTR technique were considered. Results showed that the mean survival duration of implants was found 63.29 months and the median survival duration to be 55 months. A 100% success rate was seen in implant fixed bridge cases, and about 97.6% success was seen in single crown cases. No significant difference was seen in the survival rates during the follow-up period when compared according to the quadrants/site of implant placement. The findings concluded that tooth-guided rapid implant placement is a unique strategy for convenient and safe insertion, providing accurate three-dimensional positioning. The DTR method is a novel approach that facilitates accurate positioning and angulation of the implant bed preparation by stabilizing and guiding the osteotomy drills using the retained root. As a result, it enables optimal implant positioning at multirooted extraction sites. How to cite this article: Mahesh L, Miselli A, Bhasin MT, et al. The DTR Technique-Drilling through the Roots of Posterior Teeth for Anatomically Guided Immediate Implant Placement: A Cohort Study. J Contemp Dent Pract 2024;25(5):432-439.

Safety and efficiency of deep brain stimulation in the elderly patients with Parkinson's disease.

Deep brain stimulation (DBS) is not routinely performed in elderly patients (≥75 years old) to date because of concerns about complications and decreased benefit. This study aimed to evaluate the safety and efficacy of DBS in elderly patients with Parkinson's disease. A retrospective analysis was performed using data from 40 elderly patients from four centers who were treated with neurosurgical robot-assisted DBS between September 2016 and December 2021. These patients were followed up for a minimum period of 2 years, with a subgroup of nine patients followed up for 5-7 years. Patient demographic characteristics, surgical information, pre- and postoperative motor scores, non-motor scores, activities of daily living, and complications were retrospectively analyzed. The mean surgical procedure duration was 1.65 ± 0.24 h, with a mean electrode implantation duration of 1.10 ± 0.23 h and a mean pulse generator implantation duration of 0.55 ± 0.07 h. The mean pneumocephalus volume, electrode fusion error, and Tao's DBS surgery scale were 16.23 ± 12.81 cm3, 0.81 ± 0.23 mm, and 77.63 ± 8.08, respectively. One patient developed a skin infection, and the device was removed. The Unified Parkinson's disease rating scale, Unified Parkinson's disease rating scale of Part III, tremor, rigidity, bradykinesia, axial, and Barthel index for activities of daily living (ADL-Barthel) scores significantly improved at the 2-year follow-up (p < 0.05). The levodopa equivalent daily dose (LEDD) was significantly reduced at the 2-year follow-up (p < 0.05). However, the Montreal cognitive assessment, Hamilton depression scale, and Hamilton anxiety scale scores did not significantly change during the 2-year follow-up (p > 0.05). Additionally, in the subgroup with a 5-year follow-up, the motor symptoms, ADL-Barthel score, and cognitive function worsened over time compared to baseline. However, there was still an improvement in motor symptoms and ADL with DBS on-stimulation compared with the off-stimulation state. The LEDD increased 5 years after surgery compared to that at baseline. Eleven patients had passed away during follow-up, the mean survival time was 38.3 ± 17.3 months after surgery, and the mean age at the time of death was 81.2 (range 75-87) years. Robot-assisted DBS surgery for the elderly patients with Parkinson's disease is accurate and safe. Motor symptoms and ADL significantly improve and patients can benefit from long-term neuromodulation, which may decrease the risk of death.

Explantation with Lateral Pedicle Mastopexy.

While breast explantation combined with mastopexy is an increasingly common procedure, it does present certain technical difficulties. We present a technique of explantation mastopexy with the use of an extended lateral pedicle for auto-augmentation. A consecutive series of 40 cases was retrospectively reviewed, with patient reported outcome questionnaire and photography at 3 and 12 months. The mean age was 57 years (range 40 - 70 years), and mean duration of implantation was 20.4 years (range 7 - 42 years). 12 women had undergone previous mastopexy (30%). Minor wound complications requiring simple dressings were seen in 7 cases (17.5%). Major infected wound problems occurred in 1 case, who was a smoker and had other co-morbidities. All except 1 case reported being satisfied or very satisfied with the outcome, with a mean patient reported satisfaction score of 4.9/5. When the photographs were independently assessed by a cosmetic practitioner, all cases were rated as average, good or very good, with a mean score of 4.1/5. The procedure is associated with low risk of post-operative complications, good cosmetic outcomes, and a high degree of patient satisfaction. We feel this technique provides a logical, reproducible method for combined explantation and mastopexy.

Evaluation of tricuspid valve regurgitation following transvenous rotational mechanical lead extraction.

Transvenous lead extraction (TLE) is potentially complicated by significant tricuspid valve regurgitation increase (TRI). However, there are limited data on the effect of the bidirectional rotational mechanical sheaths on significant TRI. The aim of the present study was to investigate the rate of significant changes in tricuspid regurgitation (TR) severity following mechanical rotational TLE and their outcomes. In 158 patients (mean age 66 ± 16.9 years) undergoing mechanical rotational TLE, acute changes in TR severity were assessed by echocardiography evaluation. A significant acute TRI was defined as an increase of at least one grade with a post-extraction severity at least moderate. A total of 290 leads were extracted (mean implant duration, 93 ± 65 months). Significant TRI was noted in 5.7% of patients, and it was linked to tricuspid valve damage, TLE infection indication, and longer lead implant duration. Univariate predictors of significant TRI included implant duration of all leads [odds ratio (OR) 1.01; 95% confidence interval (CI) 1.003-1.018; P = 0.001] and right ventricular leads (OR 1.01; 95% CI 1.004-1.017; P = 0.002). Severe increase of TR following TLE was an independent predictor of mortality [hazard ratio (HR) 5.20; 95% CI 1.44-18.73; P = 0.012 ] along with severe systolic dysfunction (HR 2.37; 95% CI 1.01-5.20; P = 0.032), and systemic infection (HR 2.28; 95% CI 1.06-4.89; P = 0.035). Significant TRI was detected in 5.7% of patients following transvenous rotational mechanical lead extraction. The duration of lead implantation emerged as the sole predictor of significant TRI. Physicians engaged in TLE should exercise greater vigilance for this potential complication.

Resonance Frequency Analysis Identifies Implant- and Host-Related Factors Associated With Bone-Anchored Hearing Implant Stability.

Resonance frequency analysis (RFA) is a reliable, noninvasive method to assess the stability of bone-anchored hearing implants (BAHIs), although surgical-, implant-, and host-related factors can affect its outcome. BAHI plays an important role in restoring hearing function. However, implant- and host-related factors contribute to premature implant extrusion. To mitigate this, noninvasive methods to assess implant stability, along with a better understanding of factors contributing to BAHI failure, are needed. We evaluated the utility of RFA to quantify implant stability in sawbone (bone mimicking material), 29 human cadaveric samples, and a prospective cohort of 29 pediatric and 27 adult participants, and identified factors associated with implant stability. To validate the use of RFA in BAHI, we compared RFA-derived implant stability quotient (ISQ) estimates to peak loads obtained from mechanical push-out testing. ISQ and peak loads were significantly correlated (Spearman rho = 0.48, p = 0.0088), and ISQ reliably predicted peak load up to 1 kN. We then showed that in cadaveric samples, abutment length, internal table bone volume, and donor age were significantly associated with implant stability. We validated findings in our prospective patient cohort and showed that minimally invasive Ponto surgery (MIPS; versus linear incision), longer implantation durations (>16 wk), older age (>25 yr), and shorter abutment lengths (≤10 mm) were associated with better implant stability. Finally, we characterized the short-term reproducibility of ISQ measurements in sawbone and patient implants. Together, our findings support the use of ISQ as a measure of implant stability and emphasize important considerations that impact implant stability, including surgical method, implant duration, age, and abutment lengths.

The Power of Color Flow Doppler Ultrasonography Versus Blind Technique in Localization of Epidural Catheter: A Randomized Prospective Study.

The success of epidural analgesia hinges on the precise insertion of the needle within the epidural space; failure rates have been reported to reach 32%. We report a new method using color Doppler to help verify the accurate location of the epidural needle tip. This is a randomized prospective study. Sixty patients undergoing hysterectomy were enrolled, with 30 patients in each group. Color flow Doppler (CFD) ultrasonography was employed to guide epidural catheter placement. The ultrasound-guided epidural technique was used for patients where challenges in identifying traditional landmarks for epidural space localization were anticipated. The procedure commenced with a spinal epidural technique. After sterile preparation and draping of the area, a curvilinear ultrasound transducer, encased in a sterile sheath, was used to locate the interspinous space. The primary outcome measure focused on flow visualization at different insertion levels. Secondary outcome measures included the duration of catheter implantation, intervertebral level of insertion, and dermatome sensory levels. The study also assessed the quality of epidural analgesia and patients' assessment of analgesic quality using a Verbal Numerical Rating Scale. The study reported a successful and predominantly safe outcome, with high success rates in flow visualization and effective anesthesia coverage. Flow visualization at the insertion and surrounding levels demonstrated a 100% success rate at all observed points. The Visual Numeric Rating Scale (VNRS) results indicated a median pain score of 2 with an interquartile range (IQR) of 2 - 3, showcasing a generally low level of post-procedural pain among the subjects, reflecting good quality post-operative analgesia. Regarding dermatome sensory levels after 2 hours, the distribution across various levels, including T4, T6, T7, T8, T10, and T12, exhibited a favorable outcome. The highest proportion was observed at T10 (68.3%), suggesting effective anesthesia coverage in the targeted areas. The study demonstrated comparable efficiency between the CFD-guided and blind techniques in terms of procedural aspects. However, notable distinctions were observed in patients' reported pain levels, with the CFD group experiencing lower pain compared to the blind technique group. Additionally, the study highlighted the association between CFD and improved procedural accuracy and safety. This study advocates for the integration of CFD into routine clinical practice to enhance procedural outcomes and patient safety during hysterectomy surgeries.

Complicated calcified alloplastic implants in the nasal dorsum: A clinical analysis.

In rhinoplasty, calcification around silicone implants is frequently observed in the tip dorsum (TD) area. Additionally, based on a review of various literature, it is presumed that calcification in silicone implants occurs due to both inflammatory chemical reactions and physical friction against the tissue. The calcification of nasal silicone implants not only results in the functional loss of the implants, but also leads to material deformation. However, there is a lack of research on calcification of nasal silicone implants in the current literature. To elucidate various clinical characteristics of calcification around nasal silicone implants, using histological and radiological analysis. This study analyzed data from 16 patients of calcified nasal implants, who underwent revision rhinoplasty for various reasons after undergoing augmentation rhinoplasty with silicone implants. The collected data included information on implant duration, implant types, location of calcification, presence of inflammatory reactions, and computed tomography (CT) scans. The most common location of calcification, as visually analyzed, was in the TD area, accounting for 56%. Additionally, the analysis of CT scans revealed a trend of increasing Hounsfield Unit values for calcification with the duration of implantation, although this trend was not statistically significant (P = 0.139). Our study shows that reducing the frequency of calcification may be achievable by using softer silicone implants and by minimizing the damage to perioperative tissues.

In Vivo Durability of Polyurethane Insulated Implantable Cardioverter Defibrillator (ICD) Leads.

The 6935M Sprint Quattro Secure S and 6947M Sprint Quattro Secure are high voltage leads designed to administer a maximum of 40 joules of energy for terminating ventricular tachycardia or ventricular fibrillation. Both leads utilize silicone insulation and a polyurethane outer coating. The inner coil is shielded with polytetrafluoroethylene (PTFE) tubing, while other conductors are enveloped in ethylene tetrafluoroethylene (ETFE), contributing to the structural integrity and functionality of these leads. Polyurethane is a preferred material for the outer insulation of cardiac leads due to its flexibility and biocompatibility, while silicone rubber ensures chemical stability within the body, minimizing inflammatory or rejection responses. Thirteen implantable cardioverter defibrillator (ICD) leads were obtained from the Wright State University Anatomical Gift Program. The as-received devices exhibited varied in vivo implantation durations ranging from less than a month to 89 months, with an average in vivo duration of 41 ± 27 months. Tests were conducted using the Test Resources Q series system, ensuring compliance with ASTM Standard D 1708-02a and ASTM Standard D 412-06a. During testing, a load was applied to the intact lead, with careful inspection for surface defects before each test. Results of load to failure, percentage elongation, percentage elongation at 5 N, ultimate tensile strength, and modulus of elasticity were calculated. The findings revealed no significant differences in these parameters across all in vivo exposure durations. The residual properties of these ICD leads demonstrated remarkable stability and performance over a wide range of in vivo exposure durations, with no statistically significant degradation or performance changes observed.

Single-center experience with His bundle lead implantation: success rate, implantation method optimization, and lessons learned in 426 patients

Abstract Background Conduction system pacing (CSP) is increasingly used to avoid the development of pacing-induced cardiomyopathy in patients who require a high amount of ventricular pacing. His bundle pacing (HBP) is considered as ideal to achieve the narrowest paced QRS and optimal synchronization in patients with intrinsic narrow QRS or right bundle branch block but also as difficult at implantation. Purpose We analyzed our experience with HBP in terms of time and effort, pacing and sensing results, success rate, and lessons learned for optimization over a time period of 7 years. Methods All consecutive patients in whom HBP was attempted between 6/2016 and 11/2023 were included in this analysis. Implantations were performed using a pacing system analyzer (PSA) with high-resolution electrograms (EGMs). Data on implantation success [selective or non-selective HBP, left bundle branch area pacing (LBBAP)], sensing and pacing parameters, achievement of His bundle current of injury (coi), duration of implantation and fluoroscopy were collected prospectively. These results were compared for the 1st, 2nd, 3rd and 4th quartile of implantations and reasons for improvement or deterioration were analyzed. Results HBP was attempted in 426 patients (78±11 years, 38% female, 90% AV block, left ventricular ejection fraction 54±10 %, 81 single-, 286 dual-, 46 triple-chamber pacemakers, 2 dual- and 11 triple-chamber ICDs) and was successful in 404 patients (95%): 182 non-selective HBP, 206 selective HBP, and 16 LBBAP. R wave amplitude was 4.5±3.5 mV, pacing threshold 1.1 ± 0.6V/1.0 ms. In 16% of patients, a ventricular back-up lead was implanted. A His bundle coi was achieved in 61% of patients. The implantation duration was 92±43 min, fluoroscopy duration 10±8 min. Success rate increased from 89% in the 1st to 99% in the 4th quartile. Improved implantation success was associated with using a stiff 3D steerable sheath, implantation site at the distal His bundle, and an increased number of screw-in turns until a His bundle coi was visible. Conclusions Establishing an implantation routine with 1) a PSA and high-resolution EGMs, 2) use of a stiff 3D steerable sheath, 3) implantation at the distal His bundle with myocardial capture (non-selective HBP) as a back-up, and 4) an increased number of screw-in turns of the lead tip until a His bundle coi is achieved, HBP implantation can be facilitated and results optimized to a highly acceptable implantation effort and a success rate &amp;gt;95%.

Analysis of risk factors for difficult implant removal in children with slipped capital femoral epiphysis treated by cannulated screws.

Cannulated screws are widely used in the treatment of slipped capital femoral epiphysis, which can be removed after physeal closure on patient's request. This study aimed to analysis the potential risk factors for difficult removal in children with slipped capital femoral epiphysis treated by cannulated screws. This study enrolled 32 hips that had undergone removal of cannulated screws after treatment of slipped capital femoral epiphysis at our department. The primary outcomes were the difficult screw removal. The secondary outcomes were functional outcome assessed by using a modified Harris Hip Score and complications of fractures and surgical site infection. Related risk factors for difficult removal were recorded and analyzed by multivariable logistic regression. In total, 32 hips were evaluated, with a mean age of 14.9 ± 1.3 years old (range, 13-19 years). Six (18.8%) hips presented with difficult removal, including 4 cases of screws' slip and 2 breakages. The average implantation time in the difficult removal group (5.7 ± 1.0) was also significantly longer than that in the easily removed group (3.8 ± 0.9, p = 0.001). The mean surgical time in patients with difficult removal was 66.3 ± 11.6 min, which was also significantly longer than that (54.8 ± 8.3) in the other patients (p = 0.008). The duration of screw implantation was an independent risk factor for difficult removal. Prolonged screw duration was a predictor for difficult removal in children with slipped capital femoral epiphysis treated by cannulated screws. An early surgery after physeal closure might benefit those with a request for screw removal.

Comparative Assessment of Percutaneous Left-Atrial Appendage Occlusion (LAAO) Devices-A Single Center Cohort Study.

Percutaneous left-atrial appendage closure (LAAC) is an established method for preventing strokes in patients with atrial fibrillation, offering an alternative to oral anticoagulation. Various occluder devices have been developed to cater to individual anatomical needs and ensure a safe and effective procedure. In this retrospective, monocentric cohort study, we compare different LAAO devices with respect to clinical outcomes, LAA sealing properties, and device-related complications. We conducted a retrospective analysis of 270 patients who underwent percutaneous LAA closure in our center between 2009 and 2023. Patient data were extracted from medical records, including gender, age at implantation, indication, device type and size, laboratory values, LAA anatomy, periprocedural complications, ECG parameters, transthoracic and transesophageal echocardiography parameters (TTE and TEE), as well as medication at discharge. Moreover, fluoroscopy time and implantation duration, as well as post-implantation clinical events up to 1 year, were collected. Endpoints were bleeding events, recurrent stroke, thrombi on devices, and death. The implanted devices were the Watchman 2.5, Watchman FLX, Amplatzer Cardiac Plug (ACP), and Amulet. The procedural success rate was 95.7% (n = 265), with cactus anatomy posing the most challenges across all devices. The mean patient age was 75.5 ± 7.7 years, with 64.5% being male. The median CHA2DS2-VASc score was 4.8 ± 1.5 and the median HAS-BLED score was 3.8 ± 1.0. Indications for LAA closure included past bleeding events and elevated bleeding risk. Periprocedural complications were most commonly bleeding at the puncture site, particularly after ACP implantation (p = 0.014). Significant peridevice leaks (PDL) were observed in 21.4% of simple sealing mechanism devices versus 0% in double sealing mechanism devices (p = 0.004). Thrombi were detected on devices in six patients, with no subsequent ischemic stroke or thromboembolic event. Comparative analysis revealed no significant differences in the occurrence of stroke, transient ischemic attack (TIA), thromboembolic events, device-related thrombi, or mortality among different device types. A 62.3% relative risk reduction in thromboembolic events and 38.6% in major bleedings could be observed over 568.2 patient years. In summary, our study highlights the efficacy and safety of LAA closure using various occluder devices despite anatomical challenges. Our long-term follow-up findings support LAA closure as a promising option for stroke prevention in selected patient cohorts. Further research is needed to refine patient selection criteria and optimize outcomes in LAA closure procedures.

Language profile of children with cochlear implants: comparative study about the effect of age of cochlear implantation and the duration of rehabilitation

PurposeThe analysis of different language domains and exploration of variables that affect the outcomes of cochlear implantation would help to document the efficacy of cochlear implantation and intervention programs. The aim of this work was to examine the language profile of children with Cochlear Implants (CI) and to assess the effect of age at the time of cochlear implantation and the impact of duration of rehabilitation on the development of linguistic abilities for cochlear implanted children.MethodsThe study was conducted on 46 Arabic speaking children using unilateral CI who are receiving regular post-cochlear auditory and language rehabilitation in the phoniatrics unit, Kasr Alaini hospital. A Proficient Preschooler Language Evaluation (APPEL TOOL) was applied for the assessment of different language domains.ResultsChildren who received post implant rehabilitation for ≥ 2 years showed significant improvement in all subtests' scores of APPEL tool than children who received same rehabilitation for ≤ 1 year. There was no significant difference of language scores between children who have received CI before age of 3 years and those who have been implanted after age of 3 years.ConclusionThis study showed that the language profile of CI children was beneficially affected by the longer duration of therapy post implantation.

Evaluating Magnetic Seed Localization in Targeted Axillary Dissection for Node-Positive Early Breast Cancer Patients Receiving Neoadjuvant Systemic Therapy: A Comprehensive Review and Pooled Analysis.

Background/Objectives: De-escalation of axillary surgery is made possible by advancements in both neoadjuvant systemic therapy (NST) and in localisation technology for breast lesions. Magseed®, developed in 2013 by Dr. Michael Douk of Cambridge, United Kingdom, is a wire-free localisation technology that facilitates the localisation and retrieval of lymph nodes for staging. Targeted axillary dissection (TAD), which entails marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), has emerged as the preferred method to assess residual disease in post-NST node-positive patients. This systematic review and pooled analysis evaluate the performance of Magseed® in TAD. Methods: The search was carried out in PubMed and Google Scholar. An assessment of localisation, retrieval rates, concordance between MLNB and SLNB, and pathological complete response (pCR) in clinically node-positive patients post NST was undertaken. Results: Nine studies spanning 494 patients and 497 procedures were identified, with a 100% successful deployment rate, a 94.2% (468/497) [95% confidence interval (CI), 93.7-94.7] localisation rate, a 98.8% (491/497) retrieval rate, and a 68.8% (247/359) [95% CI 65.6-72.0] concordance rate. pCR was observed in 47.9% (220/459) ) [95% CI 43.3-52.6] of cases. Subgroup analysis of studies reporting the pathological status of MLNB and SLNB separately revealed an FNR of 4.2% for MLNB and 17.6% for SLNB (p = 0.0013). Mean duration of implantation was 37 days (range: 0-188). Conclusions: These findings highlight magnetic seed localisation's efficacy in TAD for NST-treated node-positive patients, aiding in accurate axillary pCR identification and safe de-escalation of axillary surgery in excellent responders.

Long-term Insights: Histopathological Assessment of Polyurethane Implant Capsules Over 24 Years.

Polyurethane (PU)-coated breast implants are known for their strong integration into breast tissue and the formation of capsules around them. However, capsular contracture can pose both aesthetic and clinical challenges. The objectives of this study were to analyze the biological and morphological characteristics of the capsular tissue surrounding PU-coated implants, irrespective of their contracture status, and to assess their potential suitability as a flap in revisional breast surgery for capsular contracture. A total of 23 tissue samples were harvested from the capsules surrounding PU-coated breast implants in 12 female patients during replacement or revisional surgery. We evaluated collagen abundance, cellular and vascular density, inflammation, collagen band types and alignment, synovial metaplasia, capsule thickness, and the expression of inflammatory biomarkers and myofibroblasts with immunohistochemical techniques. Scanning electron microscopy was employed to assess implant surface characteristics over time. We found a significant association of capsule contraction with longer implantation durations and greater implant surface roughness (P = .018 and P = .033, respectively). Synovial metaplasia was significantly more frequent in noncontracted capsules (P = .0049). Both capsule types consisted of paucicellular, type I collagen-rich compact fibrous tissue with low vascularization. There was a marked reduction in inflammatory cells within the foreign body granuloma. The expression of inflammatory biomarkers in the capsular tissue was negligible. Given the reduced levels of inflammatory and vascular components within the dense, fibrous capsular tissue, we consider them to be viable alternatives for capsular flaps in revisional surgery. This strategy has the potential to mimic the reconstruction achieved with acellular dermal matrix.