Dysplastic Group Research Articles

Dysplastic Hips Have Decreased Iliofemoral Ligament Thickness on Coronal Sequences in Magnetic Resonance Imaging: A Matched Cohort Analysis

To characterize hip capsule thickness on advanced imaging in patients with and without hip dysplasia and to also evaluate differences in capsular thickness between patients with borderline and patients with true dysplasia. Patients evaluated by the senior author for concerns of hip pathology from June 2020 to June 2021 were queried and images reviewed to determine dysplasia status by lateral center-edge angle (LCEA) ≤25°. A group of patients without dysplasia was identified and matched for age, sex, and body mass index. Hip capsular thickness was quantified using magnetic resonance imaging. A subanalysis was conducted to compare patients with true dysplasia (LCEA < 20°) with patients with borderline dysplasia (LCEAs between 20° and 25°). The analysis included independent samples t tests, χ2 tests, and multivariable regression. A total of eighty patients were included, with a mean age of 31.8 ± 11.7 years, a mean body mass index of 26.6 ± 6.5 points, and 70% (56) female patients. Patients with dysplasia had a mean LCEA of 19.8 ± 4.3°. Patients with dysplasia had decreased capsular thickness compared with patients without dysplasia (2.75 ± 0.96 mm vs 3.52 ± 1.22 mm, P= .003). Multivariable regression showed decreased capsular thickness associated with decreased LCEAs (β= 2.804, R= 0.432, P < .001) and dysplasia (β= -0.709, R2= 0.056, P= .004). Results of a subanalysis of the dysplastic group examining differences between accepted definitions of borderline dysplasia and true dysplasia showed no significant differences in capsular thickness between the 2 groups (P= .379). Patients with hip dysplasia were found to have thinner iliofemoral ligaments in the coronal plane on magnetic resonance imaging on magnetic resonance imaging. Further investigation is needed to evaluate any potential implications with hip instability, given the thinner hip capsule demonstrated in this study. Level III, retrospective comparative prognostic trial.

Breed-specific evaluation of serum biochemical markers in canine hip dysplasia observed in a Tornjak dog population.

Canine hip dysplasia (CHD) is a global disease and an improved diagnostic approach to this orthopedic condition is needed, with an emphasis on inexpensive and minimally invasive techniques. This research aimed to determine the differentiating potential of selected biochemical markers in serum between healthy dogs and dogs with hip dysplasia in a breed-specific study that involved the Tornjak dog population. 99 Tornjak dogs radiographically categorized (Federation Cynologique Internationale procedure and scoring scheme) between December 2019 and April 2021, as having no sign of hip dysplasia or near normal hip joints (nondysplastic group; n = 51) vs mild, moderate, or severe hip dysplasia (dysplastic group; 48). Serum concentrations and enzyme activity of the biochemical markers hyaluronic acid (HA), procollagen II C-terminal propeptide (PIICP), and metalloproteinase 9 (MMP9) were compared among adult dogs with or without radiographic hip dysplasia. Statistical tests used to examine the differentiating potential of biochemical markers in Tornjak dog groups were assessed using the Mann-Whitney U test, logistic regression, and receiving operating characteristics (ROC) analysis. Tornjak dogs with radiographic CHD had significantly lower serum concentrations of HA and higher concentrations of PIICP and MMP9 activity compared to dogs with radiographically normal hips (P < .05). Selected biochemical markers could distinguish dogs with radiographic CHD from those without CHD with high sensitivity and specificity. These data suggest that the diagnostic technique of measuring serum concentrations of HA, PIICP, and MMP9 activity has a selective ability to distinguish dogs with dysplastic from dogs with normal hips.

ACETABULAR SECTOR ANGLES IN ASYMPTOMATIC AND DYSPLASTIC HIPS: DEFINING THRESHOLDS FOR DYSPLASIA

Traditional radiographic criteria might underestimate or fail to detect subtle types of acetabular dysplasia. Acetabular sector angles (ASA) can measure the degree of anterior and posterior coverage of the femoral head on computed tomography (CT). This study aims to determine ASA values at different axial levels in a cohort of (1) asymptomatic, high-functioning hips without underlying hip pathology (controls); and (2) symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO). Thereby, we aimed to define CT-based thresholds for hip dysplasia and its subtypes.This is an IRB approved cross-sectional study of 51 high functioning, asymptomatic patients (102 hips) (Oxford Hip Score &gt;43), without signs of osteoarthritis (Tönnis grade≤1), who underwent a CT scan of the pelvis (mean age: 52.1±5.5 years; 52.9% females); and 66 patients (72 hips) with symptomatic hip dysplasia treated with peri-acetabular osteotomy (PAO) (mean age: 29.3±7.3 years; 85.9% females). Anterior and posterior acetabular sector angles (AASA &amp; PASA) were measured by two observers at three CT axial levels to determine equatorial, intermediate, and proximal ASA. Inter- and intra-observer reliability coefficient was high (between 0.882–0.992). Cut-off values for acetabular deficiency were determined based on Receiver Operating Characteristic (ROC) curve analysis, area under the curve (AUC) was calculated.The dysplastic group had significantly smaller ASAs compared to the Control Group, AUC was the highest at the proximal and intermediate PASA. Controls had a mean proximal PASA of 162°±17°, with a cut-off value for dysplasia of 137° (AUC: 0.908). At the intermediate level, the mean PASA of controls was 117°±11°, with a cut-off value of 107° (AUC 0.904). Cut-off for anterior dysplasia was 133° for proximal AASA (AUC 0.859) and 57° for equatorial AASA (AUC 0.868). Cut-off for posterior dysplasia was 102° for intermediate PASA (AUC 0.933).Measurement of ASA on CT is a reliable tool to identify dysplastic hips with high diagnostic accuracy. Posterior ASA less than 137° at the proximal level, and 107° at the intermediate level should alert clinicians of the presence of dysplasia.

Treatment of borderline hip dysplasia with triple pelvic osteotomy: preoperative values of acetabular index and lateral center edge angle can indicate overcorrection

IntroductionAfter pelvic osteotomy for the treatment of symptomatic hip dysplasia, the longevity of the hip joint can be compromised by acetabular overcorrection. This iatrogenic pincer-type deformity is considered to be one of the major risk factors for persistent pain and progressing osteoarthritis. There is evidence that acetabula in the borderline range, defined by a lateral center edge angle (LCEA) between 18° and 25°, are more delicate to be orientated physiologically. The aim of this study was to assess the quality of acetabular orientation by triple pelvic osteotomy (TPO), established by Tönnis and Kalchschmidt, especially with respect to acetabular overcorrection.Materials and methodsA retrospective examination on 368 consecutive hips treated with TPOs was conducted. On the preoperative pelvic radiograph and the radiographic control 5 days after surgery, LCEA, acetabular index (AI), and anterior (AWI) and posterior wall index (PWI) were measured. According to the above-mentioned definition, the hips were divided into a borderline (n = 196) and a dysplastic (n = 172) group. Acetabular overcorrection was defined as when LCEA exceeded 35°, AI was below 0° and AWI exceeded 0.60, postoperatively. The postoperative occurrence of a relevant femoroacetabular impingement was correlated to these thresholds. Statistics comprised a priori power analysis, correlation analyses and receiver operating characteristics (ROC).ResultsIn the borderline group, in 64 hips (32.7%), LCEA and AI indicated lateral overcorrection. In the dysplastic group, in 14 hips (8.1%), solely AI indicated overcorrection. In none of the hips, relevant anterior overcorrection was detected since AWI never exceeded 0.60. Chi-square test demonstrated a significant correlation between the occurrence of a postoperative femoroacetabular impingement and LCEA exceeding 35°, as well as AI below 0° (p < 0.001, resp.). Bravais–Pearson’s analysis showed a significant correlation between the pre- and postoperative values of all parameters in the borderline and the dysplasia group (p < 0.001). Thus, ROC analysis could be performed and provided preoperative cutoff values for LCEA (23°) and AI (12.5°), hinting at postoperative overcorrection.ConclusionThe comparison of radiographic parameters after TPO showed a considerably greater percentage of laterally overcorrected acetabula in the borderline hips than in the dysplastic hips. According to the wall indices, anterior overcorrection was not observed. ROC analysis anticipated unfavorable lateral overcorrection when preoperative LCEA was above 23° and AI below 12.5°. These findings should sensitize the surgeon to the delicate acetabular correction in borderline dysplastic hips.

Variation in Functional Pelvic Tilt in Female Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia

BackgroundAs the pelvis is a dynamic structure, the quantification of pelvic tilt (PT) should be done in different hip positions prior to total hip arthroplasty (THA). We sought to investigate functional PT in young female patients undergoing THA and explore the correlation of PT with the extent of acetabular dysplasia. Additionally, we aimed to define the PS-SI (pubic symphysis-sacroiliac joint) index as a PT quantifier on AP pelvis X-ray. MethodsPre-THA female patients under the age of 50 years (n = 678) were investigated. Functional PT in 3 positions (supine, standing, and sitting) were measured. Hip parameters including lateral center-edge angle (LCEA), Tönnis angle, head extrusion index (HEI), and femoro-epiphyseal acetabular roof (FEAR) index were correlated to PT values. The PS-SI/SI-SH (sacroiliac joint-sacral height) ratio was also correlated to PT. ResultsFrom the 678 patients, 80% were classified as having acetabular dysplasia. Among these patients, 50.6% were bilaterally dysplastic. The mean functional PT of the entire patient group was 7.4°, 4.1°, and −1.3° in the supine, standing and seated positions. The mean functional PT of the dysplastic group was 7.4°, 4.0°, and −1.2° in the supine, standing and seated positions. The PS-SI/SI-SH ratio was found to be correlated to PT. ConclusionMost of the pre-THA patients had acetabular dysplasia and exhibited anterior PT in the supine and standing positions, most pronounced in the standing position. PT values were comparable between the dysplastic and non-dysplastic group without change with worsening dysplasia. PS-SI/SI-SH ratio can be used to easily characterize PT.

MLH1, BRAF and p53 - searching for significant markers to predict evolution towards adenocarcinoma in colonic sessile serrated lesions.

Background and Aim: Colonic serrated lesions are premalignant lesions, using an alternative malignization pathway, including multiple genetic and epigenetic alterations, as: mismatch repair deficiency due to MutL homolog 1 (MLH1) promoter methylation, tumor protein p53 (TP53) mutations, activating mutations of v-Raf murine sarcoma viral oncogene homolog B (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS). Our study aims to evaluate MLH1, BRAF and p53 immunohistochemical (IHC) status in sessile serrated lesions (SSLs), with and without dysplasia. Materials and Methods: This is a retrospective case-control study including 20 SSLs with dysplasia and 20 SSLs without dysplasia (matching sex and age). IHC expression of MLH1, BRAF and p53 was evaluated as the percent of nuclear loss of MLH1, cytoplasmic positivity of BRAF and nuclear positivity of p53. Data concerning age, sex, localization of the lesion, dysplasia and IHC results were statistically processed using Microsoft Excel. Results: We had very polymorphous patterns of IHC expression for BRAF, MLH1 and p53, especially in the dysplastic group. Thus, two patients were BRAF+/MLH1-/p53+, three were BRAF+/MLH1-/p53-, one was BRAF+/MLH1+/p53- and six were BRAF+/MLH1+/p53+. Dysplastic lesions without BRAF mutation exhibited the following phenotype: one case BRAF-/MLH1-/p53+, four BRAF-/MLH1-/p53- and three BRAF-/MLH1+/p53+. In the control group (SSLs without dysplasia), there was a more homogenous distribution of cases: eight cases BRAF+/MLH1+/p53-, seven BRAF-/MLH1+/p53-, one BRAF-/MLH1-/p53+, two BRAF-/MLH1-/p53- and two BRAF-/MLH1+/p53+. Conclusions: There are more routes on the serrated pathway, with different mutations and time of acquisition of each genetic or epigenetic lesion with the same morphological result. These lesions should be stratified according to their risk to poor outcome and their need to further surveillance.

Discriminant models of the possibility of benign nevi occurrence and features in men depending on the characteristics of anthropo-somatotypological indicators

The multifactorial nature of the origin and development of nevi is the subject of debate so far. One way to understand this process and get an answer to this question is to use a constitutional method of research. The purpose of the study is to build and analyze discriminant models of benign nevi occurrence possibility in men depending on the characteristics of the structure and size of the body. For Ukrainian men aged 22 to 35 years with benign nevi (34 with melanocyte benign simple nevi; 27 with melanocyte benign dysplastic nevi; 14 with melanocyte benign congenital nevi; 17 with nonmelanocyte benign nevus) determined anthropometric indicators according to the scheme of Bunak V. V. (1941), components of the somatotype according to the Heath-Carter scheme (1990), as well as indicators of the component composition of body weight according to Matejko formulas (1921). The control group consisted of anthropometric and somatotypological indicators of 82 practically healthy men of the same age group selected from the data bank of the Research Center of National Pirogov Memorial Medical University, Vinnytsya. Discriminant analysis was performed in the licensed statistical package “Statistica 5.5”. With the help of discriminant analysis, reliable models of the possibility of benign nevi depending on the characteristics of anthropometric and somatotypological indicators are built. It was found that healthy and patients with benign nevi of men can reliably interpret the obtained classification indicators between healthy and sick, and between patients with melanocyte simple or dysplastic nevi and other groups of benign nevi (discriminant function covers 75.7 % of cases; Wilks' Lambda statistics=0.125; р&lt;0.001). Between groups of benign nevi, reliable interpretation of the obtained classification indicators is possible only between patients with melanocyte simple or dysplastic nevi and melanocyte congenital or non-melanocyte nevi (discriminant function covers 48.4 % of cases; Wilks' Lambda statistics=0.662; р&lt;0.001), however, the totality of all anthropological variables has little discrimination. The models of healthy and sick men include the skinfold thickness (42.8 %), girth sizes (28.6 %), shoulder width and endomorphic component of the somatotype (14.3 % each); and among men with benign nevi, only girth sizes of the body. The greatest contribution to discrimination in models of healthy and sick men is made by the circumference of the forearm at the top, the width of the shoulders and the skinfold thickness on the side; and among patients with benign nevi – chest girth on inspiration. The obtained results indicate a significant influence of environmental factors on the occurrence of benign nevi.

PD-L1 AND FOXP3 EXPRESSION IN ORAL DYSPLASTIC TISSUES AND ORAL SQUAMOUS CELL CARCINOMA

<h3>Background</h3> Oral squamous cell carcinoma (OSCC) is an aggressive, highly immunosuppressive cancer with a high mortality rate. Interactions between programmed cell death protein 1 (PD-1; on T cells) and programmed death ligand 1 (PD-L1; on tumor cells) within the tumor microenvironment facilitates T-lymphocyte exhaustion. Regulatory T cells (Treg) are a distinct lymphocyte population, expressing the transcription factor forkhead homeobox protein-3 (FoxP3), which downregulates immune responses in OSCC. PD-L1⁺ tumor cells and FoxP3⁺ Treg expression in OSCC has been associated with poor prognosis. This research investigates the expression of PD-L1⁺ cells and Tregs in control, dysplastic, and OSCC tissues. <h3>Objective</h3> To investigate and compare the expression of PD-L1⁺ tumor cells and FoxP3⁺ Tregs in nondysplastic tisssue, dysplastic tissue, and OSCC using immunohistochemistry. <h3>Methods</h3> Immunohistochemistry was performed on formalin-fixed, paraffin-embedded, archival tissues. Qualitative and quantitative analyses of positively stained cells were undertaken and the dysplastic (n = 20) and OSCC groups (n = 20) were compared against the non-dysplastic control group (n = 20), using image analysis <h3>Results</h3> A higher proportion score and immunoreactive score for PD-L1⁺ and FoxP3⁺ Tregs was found in OSCC and dysplastic groups when compared to the nondysplastic control group (<i>P</i> < .05). There was no significant difference between the OSCC and dysplastic tissues. <h3>Conclusions</h3> Significantly more PD-L1⁺ cells and Tregs were detected in dysplastic and OSCC tissues. An increase in PD-L1 and FoxP3 expression may serve as an indicator of progression from normal to a potentially malignant lesion.

Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips.

As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first ‘ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.

The Inverse Relationship Between Labral Size and Acetabular Coverage: Does It Protect the Cartilage in the Dysplastic Hip?

The aims of this study were to confirm the relationship between osseous coverage and labral size and toinvestigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size. Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements: lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants: anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with average labral size in the bottom quartile. A total of 1765 hips (1589 patients) were included in the study. The mean LCEA, Ax, and ACEA between the borderline dysplastic and nondysplastic groups were significantly different (P < .001). According to the Ax classification, there was significant evidence that borderline dysplastic hips had larger labra (P < .05). Among the dysplastic group, there was significantly more cartilage damage according to the Outerbridge classifications along both the acetabulum and femoral head in hips with labra in the upper quartile (P=.011 and .005, respectively). An inverse relationship may exist between acetabular depth and labral size. Additionally, specifically in borderline dysplastic hips, a relatively large labrum correlates with worse intra-articular damage compared to borderline dysplastic hips with a relatively small labrum. Larger labral size may indicate a higher degree of instability in patients with borderline dysplasia. Level III, case-control study.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group (P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group (P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group (P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

Intra-articular Injections of Cross-linked Hyaluronic Acid in Japanese Patients with Symptomatic Osteoarthritis of the Hip.

ABSTRACTObjectives:We investigated the efficacy and safety of Hylan G-F 20 for the treatment of hip osteoarthritis in Japanese patients.Methods:Twenty-nine patients with hip osteoarthritis (OA) received Hylan G-F 20 injection into the hip. The visual analog scale of pain during gait (VAS-G), VAS of pain at rest, hip joint function evaluated by the Japanese Orthopaedic Association (JOA) score, health-related quality of life (HRQoL), and adverse events were evaluated before, immediately after, and at 4, 8, and 12 weeks after injection. Patients were categorized according to the severity of OA (mild and severe OA groups) and dysplasia (dysplastic and non-dysplastic groups) and these groups were compared.Results:After the injection, VAS-G improved significantly for 12 weeks. VAS-G was lower (less pain) in the mild OA group than in the severe OA group at each time point. There were no differences in VAS-G between the dysplastic and non-dysplastic groups throughout the observation period. VAS-G improved significantly in the dysplastic group after the injection. The JOA score and HRQoL demonstrated the same tendency as VAS-G. Three patients experienced worsening of local pain immediately after the injection; however, the pain on the following day was less than that before the injection in all three hips.Conclusions:Hylan G-F 20 injection into the hip joint was effective in reducing hip pain and can be used as a non-operative treatment option for hip OA in the Japanese population.

Immunohistochemical Expression of HER2/neu, Ki-67 and MUC1 in Benign and Malignant Gall Bladder Lesions and its Association with Clinicopathological Parameters

Introduction: Gall Bladder Carcinoma (GBC) is a diagnostic and a therapeutic challenge. Although it is increasing, chronic cholecystitis remains the most worldwide gall bladder lesions, harbouring many epithelial changes that may end in carcinoma. Aim: To investigate the expression of HER2/neu (Human Epidermal Growth Factor Receptor 2), Ki-67 and MUC1 (Mucin 1) in malignant and non-malignant gall bladder lesions, and to evaluate its relation with clinicopathologic parameters of GBC. Materials and Methods: This retrospective study included 40 cases of GBC, eight cases of gall bladder dysplasia, 10 cases of gall bladder metaplastic changes and 25 cases of chronic cholecystitis as a control group. The blocks were collected from the Department of Pathology of Benha University Hospital, from January 2012 to December 2019. Immunohistochemical staining results of HER2/neu, Ki-67 and MUC1 were analysed and correlated by Statistical Package for the Social Sciences (SPSS) version 16 and Chi-square test or Fisher’s-exact tests. Results: Positive HER2/neu expression (+2, +3) was detected in 47.5% (19/40) of malignant cases and 12.5% (1/8) of dyspastic group, at the same time it was completely absent in the metaplastic and cholecystitis cases (p&lt;0.01). Similarly, Ki-67 Labeling Index (LI) (≥20%) expression was found in 55% (22/40) of malignant group, while it was completely absent in the other three studied groups. All cases of malignant group 100% (40/40), 50% (4/8) of dysplastic one, one case of metaplastic (1/10) showed cytoplasmic expression of MUC1, at the same time it was completely absent in control group (0/25) (p&lt;0.01). High MUC1 expression was found in 75% of both malignant (30/40) and dysplastic (6/8) studied cases and only one case (10%) of metaplastic group (p&lt;0.01). There was a significant correlation between MUC1 expression and studied parameters of GBC. Conclusion: HER2/neu, and Ki-67 are overexpressed in GBC cases compared with control and dysplastic group. The study also highlights that MUC1 would be a better marker of malignant transformation of gall bladder epithelium and its depolarised expression would be reliable for detection of invasive carcinoma, so a new therapeutic agent can target these cell surface adhesion molecule (MUC1). HER2/neu can be considered as a candidate for targeted therapy in GBC treatment strategy.

Deviation of the centre of rotation of the femoral head in dysplastic hip joints.

Hip instability may be based not only on some mismatch between the size of the femoral head and acetabulum but also on the deviation of the centre of rotation of the femoral head. The aim of this study was to compare the differences between the centre of rotation of the femoral head and that of the acetabulum in normal and dysplastic hips. Thirty dysplastic hips and 30 control hips without dysplastic hip were included in this study. Computed tomography data were imported into three-dimensional analysis software. The sphere radius of the acetabulum, the sphere radius of the femoral head, and the deviation of the centre of rotation of the femoral head from that of the acetabulum were analysed. The sphere radii of the acetabulum and femoral head were significantly larger in dysplastic hips. Distances between the centre of rotation of the acetabulum and that of the femoral head were significantly larger in dysplastic group than in control group. The centre of rotation of the femoral head was significantly deviated anterosuperiorly in dysplastic hips. We found significant negative correlations between centre-edge angle and the distance between the centre of rotation of the acetabulum and that of the femoral head in all subjects. In dysplastic hip joints, the centre of rotation of the femoral head was more deviated anterosuperiorly from that of the acetabulum than in normal hip joints even in static condition, which might be clinically associated with the micro-instability in dysplastic hips.

An assessment of how the anterior cerebral artery anatomy impacts ACoA aneurysm formation based on CFD analysis

Objective The aim of this study was to identify independent anatomic, morphologic and hemodynamic features of the ACoA (anterior communicating artery) complex that serve as risk factors for the occurrence of ACoA aneurysms. Methods Fifteen consecutive patients with 15 ACoA aneurysms were included. Computational fluid dynamics (CFD) simulations based on patient-specific models were carried out using 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA) images. A reverse reconstruction technique was used to generate a pre-aneurysm vessel anatomy. Geometric parameters and hemodynamic changes were compared and evaluated. Results The overall prevalence of symmetric, dysplastic, and absent A1 segments were 53.3%, 26.7%, and 20%. The mean wall shear stress (WSS) of the absent group (AG) was significantly higher than that of the symmetric group (SG) and dysplastic group (DG). The absolute mean A1 artery flow rate (410.2 ± 88 versus 439.4 ± 101 mL/min; p = .45) of the aneurysm side was similar between the SG and DG but significantly higher in the AG (528.1 ± 77 mL/min; p < .05). The A1-A2 angles of the aneurysm side showed no significant differences among the 3 groups (p = .32). However, the mean A1-A2 angle on the aneurysm side was smaller than the contralateral A1-A2 angle (101.9 ± 9.1˚ versus 120.3 ± 7.7˚; p <.05). A regression analysis demonstrated that high WSS was significantly associated with a large A1-A2 ratio (R 2=0.52; p <.05). Conclusions ACoA aneurysms are a high-WSS pathology. Severe flow impingement and the anatomic vasculature structures play a role in triggering the occurrence of ACoA aneurysms.

Early to midterm outcomes of anatomic shoulder arthroplasty performed on dysplastic glenoids.

Treatment of primary osteoarthritiswith glenoid dysplasia or Walch type C glenoids remains controversial. There is scant literature available on patient outcomes after anatomic shoulder arthroplasty in patients with Walch type C glenoids. The purpose of this study was to evaluate the outcomes of total shoulder arthroplasty (TSA) for Walch type C dysplastic glenoids with standard (nonaugmented) glenoid components compared with TSA for glenoids with concentric wear and minimal erosion (Walch type A1). We hypothesized that TSA performed for Walch type C dysplastic glenoids with standard glenoid components can reliably produce successful results at short- to midterm follow-up. We identified all patients who had primary anatomic TSA performed for osteoarthritis in a prospective shoulder arthroplasty registry collected from 2004 to the present time. Twenty-nine patients met inclusion criteria of a preoperative Walch type C dysplastic glenoid, treatment with TSA using standard (nonaugmented) glenoid components, and a minimum of 2-yearclinical follow-up. A matched cohort of 58 patients with a type A1 glenoid and minimum of 2-yearclinical follow-up for anatomic shoulder arthroplasty served as the control group. The American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), patient satisfaction, complications, and revisions were evaluated in both cohorts. The mean follow-up for this study was 4.5 years (standard deviation, 2.6 years; range, 2-10 years). Baseline measures were not significantly different between the Walch type C dysplastic group and the matched type A1 cohort (all P > .05). Both groups showed significant improvements in ASES, ASES pain, and SANE scores from baseline to the final follow-up (all P < .001). The Walch type C group had no significant differences in ASES score (P = .118), ASES pain (P = .730), or SANE score (P = .168) compared with the matched type A1 cohort. The complication rate of patients with a type C glenoid was 14% (4 of 29) with a 7% (2 of 29) revision rate. Similarly, the complication rate for the A1 matched cohort was 17% (10 of 58) with a 12% (7 of 58) revision rate. Both groups had high patient satisfaction without statistical differences (P = .549). In addition, there were no differences in the rate of radiographic lucencies or Lazarus scores (P = .222). Anatomic TSA reliably produced clinically significant improvements in pain and function and similar short- to midterm outcomes in patients with Walch type C dysplastic glenoids compared with patients with type A1 glenoids. Anatomic TSA with standard (nonaugmented) glenoid components should remain an option in patients with Walch type C dysplastic glenoids despite emerging treatment options including augmented glenoid components and reverse TSA.

Distraction index and Norberg angle to distinguish dysplastic and non-dysplastic hips based on FCI score.

Radiographic hip scoring according to the Fédération Cynologique Internationale (FCI) and PennHIP (Pennsylvania Hip Improvement Program) method was performed with the purpose to compare the PennHIP and FCI results as well as coxofemoral joint laxity by correlation of Norberg angle and distraction index measurements. A total of 167 dogs of various breeds presented for official screening examination in a veterinary teaching hospital in Germany were included. Using receiver operating characteristic analysis, the best Norberg angle and distraction index cut-off values to distinguish between dysplastic and non-dysplastic groups based on FCI grades and to distinguish between lax and tight hip joints according to the PennHIP proposal were calculated. More than one third (38.2 %) of dogs that passed the breeding criterions according to FCI (grades A and B) were in the half of the population with lax hip joints and should not be used for breeding according to the PennHIP proposal. A cut-off value for the distraction index of 0.44 with sensitivity of 82.7 % and specificity of 84.2 % was superior to the best cut-off value for the Norberg angle at 101.8° with sensitivity of 82.7 % and specificity of 71.9 % to discriminate between non-dysplastic joints (A, B) and dysplastic joints (C, D, E). Our results show a limited impact of laxity on the FCI grading. Breeding selection processes that are based on the FCI method could profit by an additional and complementary use of the distraction index.

Trochlear dysplasia influences patellotrochlear index when measuring patella alta

Objectives:Patella alta is a risk factor for patellar instability and its recurrence after treatment. The patellotrochlear index (PTI) is a measurement used to quantify patella alta, describing patellar engagement in the trochlea through an index of trochlear overlap with patellar articular surface based on sagittal imaging. Values less than 20% have been reported to indicate patella alta, yet this measurement has primarily been described in normal knees. Trochlear dysplasia is also a common risk factor in patellar instability and can affect the length of the trochlea. Therefore the purpose of this study was to compare PTI measurements in knees with and without trochlear dysplasia, and to describe its relationship with trochlear length.Methods:Knees with trochlear dysplasia (defined by trochlear depth<4mm) based on CT imaging were identified from a series of knees with symptomatic patellar instability and compared to age- and gender matched asymptomatic controls. Measurements of patellar height including PTI and Caton Deschamps Index (CDI) were performed, as well as additional measurements of trochlear dysplasia including lateral trochlear inclination [LTI] and sulcus angle [SA]. Trochlear length was quantified using a previously described method of trochlear center-edge angle (TCEA) measurement, an angle between the posterior femoral cortical line with its intersection with Blumensaat’s line to the most proximal margin of the trochlea, with a smaller angle indicating more proximal extension of the trochlea. TCEA was measured at the central, medial, and lateral trochlea. Measurements were compared between dysplastic and control groups using t-test. Linear and multivariate regression analyses were performed to assess the relationship between PTI and measurements of trochlear dysplasia.Results:21 knees with trochlear dysplasia (13 female and 8 male) were included in this study, and were compared with 21 age- and gender-matched controls. In the dysplastic group, trochlear depth (TD) was 0.7+/-2.4mm vs 6.8+/-2.5mm (p<0.001) in the control group, SA was 154.2+/-11.5 degrees vs 134.0+/-8.3 degrees (p<0.001), and LTI was 12.1+/-6.2 vs 23.7+/-4.4 degrees (p<0.001) . Despite CDI being greater in the symptomatic group (1.19+/-0.23 vs 1.06+/-0.19, p=0.053), PTI was greater (with more overlap) in the symptomatic group (34.92+/-15.23% vs 25.43+/-21.55%, p=0.076). In the symptomatic group, the trochlear groove extended more proximally at the central (TCEA 58.4 degrees vs 68.6 degrees, p<0.001) and medial aspects (68.9 degrees vs 77.9 degrees, p<0.001). In dysplastic knees, PTI demonstrated a weak negative correlation with TCEA (R=-0.40) and with LTI (R=-0.45).Conclusion:In this study, knees with trochlear dysplasia had a PTI of 35% vs 25% in the control group, indicating greater patellar engagement despite having greater measurements of patella alta based on CDI (1.19 vs 1.06). PTI correlated with increased proximal extension of the trochlea which may account for the greater patellofemoral overlap. As abnormal trochlear length can associated with supratrochlear spurs, greater values on PTI may not necessarily indicate functional patellofemoral engagement. Further studies are needed to identify the functional relationship between trochlear length and patella alta.

Association of Conjunctival Dysplasia (Squamous Intraepithelial Neoplasia) with Melanosis (Microscopic Non- Proliferative Melanin Pigmentation).

Purpose:To determine the association between conjunctival epithelial dysplasia (squamous intraepithelial neoplasia) and its melanosis (microscopic non-proliferative melanin pigmentation) in conjunctival biopsies.Methods:In this retrospective case series, histopathological slides from all conjunctival biopsies obtained in Khalil Hospital affiliated with Shiraz University of Medical Sciences for a period of 6 years (April 2009–July 2015) were reviewed. After considering the exclusion criteria (non-melanotic pigmentation, melanocytic proliferations, and squamous cell carcinoma), conjunctival biopsies were divided histopathologically into two groups of dysplastic and non-dysplastic. Then, the slides were reviewed by one ophthalmopathologists and one general pathologist. Melanin pigmentation was recorded in both groups as 0, 1+, 2+, and 3+. The data were analyzed, and the groups were compared.Results:Overall, 685 cases with a mean age of 47.78 (±17.74) years were included in this study. Dysplastic and non-dysplastic groups comprised 135 (19.7%) and 550 (80.3%) specimens, respectively. Seventy-six percent (76%) of the specimens in the dysplastic group versus 40% in the non-dysplastic group had melanosis (P = 0.001). However, the degree of dysplasia (1+, 2+, and 3+) was not statistically correlated with the degree of melanosis (1+, 2+, and 3+) (P = 0.393).Conclusion:Our results demonstrated that melanosis is a common finding in conjunctival epithelial dysplasia and might indicate an association with conjunctival epithelial dysplasia.

Intact Ligamentum Teres Predicts Superior Prognosis in Borderline Dysplastic Patients: A Matched Pair Controlled Study with Minimum Five-Year Outcomes Following Hip Arthroscopy

Objectives:(1) To report minimum five-year patient reported outcomes (PROs) in borderline dysplastic patients with ligamentum teres (LT) tears who underwent hip arthroscopy and (2) to compare these PROs to a pair-matched control group of borderline dysplastic hips without LT tears.Methods:Data was prospectively collected for patients who underwent hip arthroscopy during September 2008 and August 2013. Patients were included if had a preoperative diagnosis of borderline dysplasia [lateral center-edge angle (LCEA) of 18°- 25°] and had preoperative and minimum five-year postoperative modified Harris Hip Scores (mHHS), Non-Arthritic Hip Scores (NAHS), and Visual Analogue Scale for pain (VAS) scores. Exclusion criteria were Tönnis grade osteoarthritis >1, previous hip conditions, any prior ipsilateral hip surgery, or workers’ compensation status. Two borderline dysplastic groups were created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < 0.05.Results:24 LT tear patients (24 hips) were matched 24 patients (24 hips) without an LT tear. There was no significant difference in age, sex, BMI, or laterality between groups. Mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear group, respectively (P = 0.783). There were 17 (70.8%) and 16 (66.7%) females in the control and LT tear group, respectively and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear group, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures, except for LT treatment. Five-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey Mental Component (VR-12M) (P = 0.041) and Short Format 12 Mental Health (SF-12M) (P = 0.042). The control group exhibited less pain and higher satisfaction with surgery; however, this trend was not significant. Finally, the LT tear group was significantly less likely to achieve the patient acceptable symptomatic state (PASS) for mHHS (P = 0.022).Conclusion:Following hip arthroscopy, patients with borderline dysplasia and LT tears demonstrated favorable PROs at minimum five-year follow-up. Outcomes were similar to a pair-matched control group without LT tears, with the control group showing higher VR-12M and SF-12M scores. Furthermore, borderline dysplastic patients with LT tears were significantly less likely to achieve the PASS for mHHS.