Dysplastic Group Research Articles

Course of the sciatic nerve on magnetic resonance imaging in patients with osteoarthritis of the hip.

Sciatic nerve palsy is a serious complication after total hip arthroplasty (THA). This is the first study to report the relationship between the sciatic nerve and the acetabulum on magnetic resonance imaging (MRI) before THA. 235 patients underwent 261 elective, primary THAs via the mini-incision posterolateral approach. We measured the horizontal distance (mm) and vertical distance (mm) from the posterior edge of the acetabulum to the sciatic nerve by T1-weighted imaging on an axial section of the centre of the femoral head. We defined the Dysplastic Group as having a posterior acetabular sector angle (PASA) <90° and the Non-dysplastic Group as having a PASA ⩾ 90°. We compared anatomical distances and angles between the 2 groups. The horizontal and vertical distances were (mean ± SD) 8.0 ± 9.2 mm and 14 ± 5.0 mm from the posterior edge of the acetabulum to the lateral edge of the sciatic nerve, respectively. The acetabular anteversion (AA), anterior acetabular sector angle (AASA), and PASA were (mean ± SD) 19 ± 6.7°, 49 ± 8.4°, and 87 ± 8.6°, respectively. The horizontal and vertical distances were positively correlated (p < 0.0001). AA and PASA were positively correlated with the horizontal distances (p < 0.0001) as well as with the vertical distances (p = 0.0017 and p = 0.0438, respectively). The horizontal and vertical distances were significantly shorter in the Dysplastic Group than in the Non-dysplastic Group (p < 0.0001 and p = 0.021, respectively). In cases of posterior acetabular dysplasia we have to be mindful of the course of the sciatic nerve.

An Intact Ligamentum Teres Predicts a Superior Prognosis in Patients With Borderline Dysplasia: A Matched-Pair Controlled Study With Minimum 5-Year Outcomes After Hip Arthroscopic Surgery

Background: Hip arthroscopic surgery in patients with borderline dysplasia continues to be controversial. In addition, it has been suggested that ligamentum teres (LT) tears may lead to inferior short-term patient-reported outcomes (PROs) when compared with a match-controlled group. Purposes: (1) To report minimum 5-year PROs in patients with borderline dysplasia and LT tears who underwent hip arthroscopic surgery and (2) to compare these PROs to those of a matched-pair control group of patients with borderline dysplastic hips without LT tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery between September 2008 and August 2013. Patients were included if they had a preoperative diagnosis of borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and had preoperative and minimum 5-year postoperative modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain scores. Exclusion criteria were osteoarthritis of Tönnis grade >1, previous hip conditions, any previous ipsilateral hip surgery, or workers’ compensation status. There were 2 borderline dysplastic groups 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 < .05. Results: A total of 24 patients with an LT tear (24 hips) were matched to 24 patients without an LT tear (24 hips). There was no significant difference in age, sex, BMI, or laterality between groups. The mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear groups, respectively (P = .783). There were 17 (70.8%) and 16 (66.7%) female patients in the control and LT tear groups, respectively, and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear groups, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures. LT debridement was performed in 17 (70.8%) patients in the LT tear group compared with 0 (0.0%) in the control group. Also, 5-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey (VR-12) mental (P = .041) and Short Form–12 (SF-12) mental (P = .042) scores. Finally, hips with an intact LT were significantly more likely (P = .022) to achieve the patient acceptable symptomatic state (PASS) for the mHHS (100.0% and 75.0%, respectively). No significant differences were present between the groups for the minimal clinically important difference (MCID) of the mHHS (P = .140), MCID of the Hip Outcome Score–Sport-Specific Subscale (HOS-SSS) (P = .550), or PASS of the HOS-SSS (P = .390). Conclusion: After hip arthroscopic surgery, patients with borderline dysplasia and LT tears demonstrated favorable PROs at a minimum 5-year follow-up. Outcomes were similar to a matched-pair control group without LT tears, with the group with intact LTs showing higher VR-12 mental and SF-12 mental scores. Furthermore, patients with borderline dysplasia and intact LTs were significantly more likely to achieve the PASS for the mHHS.

384 High Accuracy and Effectiveness With Deep Neural Networks and Artificial Intelligence in Detection of Early Esophageal Neoplasia in Barrett's Esophagus

INTRODUCTION: The visual detection of early esophageal neoplasia (high grade dysplasia and T1 cancer) in BE with white light and virtual chromoendoscopy is still difficult. The aim of this study is to assess if a convolutional neural artificial intelligence network can aid in the recognition of early esophageal neoplasia in BE. METHODS: Over 800 images from 65 patients were retrospectively collected of histology-proven early esophageal neoplasia in BE containing high grade dysplasia or T1 cancer (Dysplasia Group). Within each image, the area of neoplasia was masked using image annotation software by two experts in BE imaging. Over 800 control images were collected of either histology-proven or confocal endomicroscopy-proven BE without high grade dysplasia (Non -Dysplastic Group). A training set with ∼1200 images split 50/50 Dysplasia/Non-Dysplasia was used to train the algorithm. We used a convolutional neural network (CNN) and hybrid algorithm design including Inception blocks to deepen the neural net and maximize efficiency and accuracy. The algorithm was pre-trained on ImageNet and then fine-tuned with the goal to provide the correct binary classification: “Dysplastic” (1) or “Non-dysplastic” (0). Adam optimizer performed stochastic optimization of a binary cross-entropy loss function to produce a probability value between 0 and 1. A set 458 images unique of the training set was used for algorithm validation. We additionally developed an object detection algorithm which drew localization boxes in real-time around regions classified as dysplasia. Testing was performed for near-focus images, non-near focus (far) images, white light and NBI images. RESULTS: The CNN analyzed 458 test images (225 dysplasia/233 non-dysplasia) and correctly detected early neoplasia in BE cases with sensitivity of 95.6% and specificity of 91.8%. The accuracy was 93.7% and the AUC was 0.94 (Figure 3). With regards to the object detection algorithm for all images in the validation set, the system was able to achieve a mean-average-precision (mAP) of 0.7533 at an intersection over union (IOU) of 0.3, Sensitivity 96.7% and Specificity 87.6% (Figure 1). CONCLUSION: Our AI model was able to detect early esophageal neoplasia in Barrett’s Esophagus images with 93.7% accuracy. In addition, the object detection algorithm was able to draw a localization box around the areas of dysplasia with high precision.

Technical variation of trans-articular sacroiliac joint (SIJ) fusion using three screws considering the effects of sacral dysplasia in patients with non-traumatic SIJ pain

BackgroundThis study evaluated the technical adequacy of trans-articular sacroiliac joint (SIJ) fusion using three screws for non-traumatic SIJ pain, considering different grades of sacral dysplasia.MethodsCadaveric CT data of unilateral sacropelvic complexes for 72 individuals (53.4 ± 8.4 years) were selected. A 3D model was reformatted into the plain lateral radiograph to mark the articular surface of the SIJ. Subjects were classified into dysplastic (DYS) and non-dysplastic sacrum (NDS) groups. Proximal (PS), middle (MS), and distal screws (DS) with 10-mm diameter were virtually introduced to the iliac bone and the SIJ on the lateral image with a 5-mm safety margin. On a corresponding axial image, each screw was advanced vertically to the sagittal plane with the same safety margin. The entry points for each screw to the endplate of S1 (S2) and to the corresponding anterior sacral margin on the lateral image were measured, along with the maximal screw lengths on the axial image. Whether each screw passed through the SIJ was determined. Different types of sacral dysplasia and screws were compared statistically.ResultsThirty-eight (26.4%) cases were DYS, and 106 (73.6%) were NDS. The entry points of all screws were significantly more distal in DYS than in NDS groups. The PS and MS screw lengths differed significantly between the 2 groups. Incidences of short sacral fixation (< 10 mm) were significantly higher for the DS in both NDS (38.7%) and DYS (39.5%) groups. Incidences of screw pass were lowest for the MS in both NDS (43.4%) and DYS (47.4%) groups.ConclusionsSacral dysplasia locates the SIJ more distally and therefore affects the entry point locations and screw lengths for all screws in trans-articular SIJ fusion, compared with a non-dysplastic sacrum. Moreover, three-screw fixation risks the development of unstable DS fixation and a high extra-articular fixation rate in MS.

Expression of interleukin-6 in ocular surface squamous neoplasia.

PurposeInterleukin-6 (IL-6) is an important cytokine in the cascade of inflammation and cancer progression. The aim of this study was to identify IL-6 expression in ocular surface squamous neoplasia (OSSN) in comparison with non-neoplastic conjunctival tissue.MethodsTwenty paraffin-embedded tissue sections of conjunctiva from patients with OSSN including conjunctival intraepithelial neoplasia (CIN) in all grades of severity and squamous cell carcinoma (SCC) were assessed by immunohistochemistry staining for IL-6. Twenty non-neoplastic conjunctival sections from age matched patients were selected as the control group. Tissues with more than one focus of inflammatory cell infiltration were excluded from the study. The mean area of positive staining was recorded and the intensity of staining was scored in both groups and compared by statistical methods.ResultsThe mean staining area in the dysplasia group was significantly more than non-neoplastic conjunctival tissue (63.5±25.96 and 30±15.98 percent respectively; P-value of <0.0001). Nuclear staining was observed in both groups and the difference was not statistically significant.ConclusionIL-6 expressed more in the dysplastic group in compare to non-neoplastic conjunctiva and can therefore be used to diagnose dysplastic state of the conjunctiva; however, in our study, intensity of staining does not correlate with the severity of dysplasia statistically; most probably because of a low sample size in each category. The role of nuclear staining is not clear. Our findings can be an introduction toward targeted treatment of ocular surface neoplasia by the aim of newer anti-IL agents. Further investigation is needed.

Tilt-adjusted Cup Anteversion in Patients with Severe Backward Pelvic Tilt is Associated with the Risk of Iliopsoas Impingement: A Three-dimensional Implantation Simulation.

Tilt-adjusted Cup Anteversion in Patients with Severe Backward Pelvic Tilt is Associated with the Risk of Iliopsoas Impingement: A Three-dimensional Implantation Simulation.

Iliopsoas tendonitis following total hip replacement in highly dysplastic hips: a retrospective study

BackgroundAs a recognized cause of groin pain following total hip arthroplasty, iliopsoas tendonitis probably results from different factors. Given the anatomic disadvantage, dysplastic hips theoretically make acetabular component relatively retroverted or oversized, screws implanted frequently, and iliopsoas tendonitis more likely. However, the prevalence and mechanism of iliopsoas tendonitis following total hip replacement in dysplastic hips are not fully understood.MethodsOne hundred and thirty-three total hip arthroplasties for Crowe type 2 to 4 dysplastic hips were compared with 126 total hip arthroplasties for hips without dysplasia in this study. Preoperative patient demographic data were well matched between the groups. Clinical and radiographic evaluations were performed.ResultsA significantly higher frequency of protruded screws (24.8% vs 0), anterior overhang of acetabular components (30.8% vs 4.0%), and increased leg lengthening (3.6 [2.0–6.8] vs 0.5 [0–1.8]) was found in the dysplastic group (all p values < 0.05). However, the femoral offset and inclination and anteversion of acetabular components between the groups did not differ significantly. No difference in the prevalence of iliopsoas tendonitis was found between the groups. A new cause of iliopsoas tendonitis following total hip arthroplasty was detected in the dysplastic group. The iliopsoas tendonitis was irritated by an instable artificial femoral head.ConclusionsThe dysplastic hips did not present a higher incidence of postoperative iliopsoas tendonitis in this study. Iliopsoas tendonitis could be somewhat prevented by smaller size of acetabular components and soft tissue release in dysplastic hips, but irritated by an instable artificial femoral head.

P53-positive expression in dysplastic surgical margins is a predictor of tumor recurrence in patients with early oral squamous cell carcinoma.

PurposeThis was a retrospective analysis of the impact of the expression of p53 in the dys-plastic surgical margins of early oral squamous cell carcinoma (OSCC) (pT1-2, N0).Patients and methodsSeventy-two patients with early oral squamous cell carcinoma (OSCC) were recruited. Margin characteristics were abstracted from the pathology report. Expression of p53 in dysplastic surgical margins was examined with the immunohistochemical method and was correlated with clinicopathological parameters and clinical outcomes.ResultsPatients with moderate/severe dysplasia had poor local relapse-free survival (RFS) compared to those with mild dysplasia. Thirty-two (44.4%) had at least one p53-positive margin, and there was a significant association between the expression of p53 and tumor recurrence (P<0.001). p53-positive expression was correlated with RFS in patients with dysplastic margins, and its expression in moderate/severe dysplastic groups had a worse RFS than mild dysplastic groups. We also found that the grade of the dysplasia margin was not correlated with RFS in p53-negative groups. Multivariable analysis validated p53 expression in dysplastic surgical margins as an independent risk factor for recurrence.ConclusionOur results validated that p53 expression was an independent risk factor for early OSCC with dysplastic surgical margins. Additional therapy and close follow-up are needed for these patients.

In vivo detection of oral precancer using a fluorescence-based, in-house-fabricated device: a Mahalanobis distance-based classification.

In vivo detection of oral precancer has been carried out by a fluorescence-based, in-house-developed handheld probe on three groups: oral squamous cell carcinoma (OSCC), dysplastic (precancer), and control (normal). Measurements have been performed on a total of 141 patients and volunteers of different age groups. Excitation wavelength of 405nm was used and fluorescence emission spectra were recorded in the scan range of 450.14 to 763.41nm at very low incident power (122μW) from different oral sites buccal mucosa (BM), lateral boarder of tongue (LBT), and dorsal surface of tongue (DST). Spectral profiles are found to vary among the three groups as well as among the different oral sites. Major and minor bands of flavin adenine dinucleotide (FAD) and porphyrins near 500, 634, 676, 689, and 703nm have been obtained. Porphyrin contribution is found to be more dominant than the FAD in OSCC and dysplastic groups as compared to the control group. A better classification has been observed using the entire spectral range rather than restricting to individual bands, by application of principal component analysis (PCA), Mahalanobis distance model, and receiver operating characteristic analysis (ROC). ROC on Mahalanobis distance differentiates OSCC to normal, dysplastic to normal, and OSCC to dysplastic with sensitivities from 71% to 98%, 92% to 94% and 81% to 93% and specificities 91% to 100%, 86% to 100% and 79% to 97% for oral sites BM, LBT and DST. LBT and DST appear to be more sensitive to dysplasia detection as compared to BM.

Hip Dysplasia Compromises the Outcome of Femoroacetabular Impingement Surgery

BackgroundThe optimal treatment for patients with symptomatic hip dysplasia presenting with labral tear is unknown. Although femoroacetabular osteoplasty (FAO) has excellent outcome for most femoroacetabular impingement patients, the presence of concomitant hip dysplasia has been implicated as an adverse prognostic factor. This study evaluated the outcome of FAO in a group of dysplastic hips and compared the outcome to a cohort of patients without dysplasia. MethodsSeventy-three patients (38 males, 35 females) with hip dysplasia who underwent FAO between 2007 and 2015 were identified. The minimum 2-year clinical, functional (modified Harris Hip Score and Short-Form 36 Health Survey), and radiological outcome was compared with 550 patients without dysplasia who underwent FAO by the same surgeon. The preoperative and postoperative alpha angle, Tonnis grade, joint space, and presence of chondral lesion were determined and compared. Conversion to total hip arthroplasty or revision FAO was considered as treatment failure. ResultsThe mean age in the dysplasia cohort was 30.7 ± 11.8 years compared to 34.5 ± 11.2 in the nondysplastic group. The mean follow-up was 4.3 years for dysplasia cohort and 4.1 for the nondysplastic group. The mean modified Harris Hip Score and Short-Form 36 Health Survey6 was significantly lower in the dysplastic group at 75.1 and 74.3 compared to 83.4 and 85.6 for the comparison group. There was a higher percentage of failure at 28.8% among dysplasia patients compared to 2.5% in the nondysplastic group. ConclusionAlthough labral repair and FAO may be an option for patients with hip dysplasia, the outcome in this population appears to be less optimal compared to femoroacetabular impingement patients with no evidence of dysplasia. Labral repair and osteoplasty should be limited to those with mild and borderline dysplasia.

Minor change in the sulcus angle during the first six years of life: a prospective study of the femoral trochlea development in dysplastic and normal knees.

PurposeThe aetiology of femoral trochlear dysplasia is unknown. The aim of this prospective cohort study was to describe trochlear development in a newborn population during the first six years of life.MethodsIn an earlier study, the femoral trochlea was examined by ultrasound in 174 newborns. A dysplastic trochlea was defined with a sulcus angle (SA) above 159°. Two groups were defined, one group of 15 knees with SA > 159° (dysplastic group), and one group of 101 knees with SA < 159° (non-dysplastic group). In the present follow-up study, the children were further examined at six, 18 and 72 months.ResultsThere was a statistically significant difference in the SA between the dysplastic and the non-dysplastic group at all follow-ups (p < 0.001). A small but statistically significant change in the SA between 0 to 72 months was detected for the dysplastic knees (p = 0.032) and for the controls (p < 0.001).ConclusionOnly minor changes in the anatomy of the femoral trochlea from newborn to age six years were found. A dysplastic trochlea at birth remains shallow and the anatomy does not change from normal to dysplastic during the same time span.Level of EvidenceII

Arthroscopic Treatment of Hip Pain in Adolescent Patients With Borderline Dysplasia of the Hip: Minimum 2-Year Follow-Up

To examine arthroscopic treatment of hip pain in patients with borderline hip dysplasia (lateral center edge angle [LCEA] between 20° and 25°). From 2008 to 2013, patients below 18years of age who underwent arthroscopic hip surgery with an LCEA between 20° and 25° were retrospectively matched 1:1 to a control group without dysplasia (LCEA ≥25°) based on age, gender, femoroplasty, labral treatment, and capsular plication. Indications for surgery included failure to improve with nonoperative treatments and anti-inflammatory medications after 3months. Patient-reported outcome data were collected using modified Harris hip score, hip outcome score-activities of daily living subscale, hip outcome score-sports-specific subscale, nonarthritic athletic hip score, and visual analog scale. From 2008 to 2013, 168 patients below the age of 18 underwent arthroscopic hip surgery. Twenty-one patients met inclusion criteria and were matched 1:1 to a control group. Follow-up was achieved for 17 patients in both groups (81%). Mean follow-up time, age, and LCEA were 2.19years, 15.5years, and 22.3° for the dysplastic group and 2.16years, 16.0years, and 31.2° for the control group, respectively. Preoperative patient-reported outcomes between groups were not statistically different. At the latest follow-up, both groups showed statistically significant improvement over baseline in modified Harris hip score, hip outcome score-activities of daily living subscale, hip outcome score-sports-specific subscale, nonarthritic athletic hip score, and visual analog scale (P < .001). Latest follow-up scores were not statistically different between groups. This study shows favorable 2-year outcomes in adolescent patients with borderline dysplasia undergoing labral treatment and capsular plication. Outcomes in the borderline dysplastic patients were as good as those of a control group. Although adolescents with borderline dysplasia have traditionally been a challenging group of patients to treat, these results suggest that an arthroscopic approach that addresses both labral pathology and instability may be beneficial. Level IV, therapeutic case series.

Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage?

Background: The literature contains conflicting reports regarding whether outcomes of hip arthroscopic surgery for patients with borderline dysplasia are inferior to outcomes in patients with normal acetabular coverage. Purpose: To assess differences in the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) in groups of patients with borderline dysplasia and normal coverage. Study Design: Cohort study; Level of evidence, 3. Methods: A registry of consecutive patients who had undergone primary hip arthroscopic surgery with capsular plication for FAI between January 2012 and January 2014 were divided based on the preoperative lateral center-edge angle (LCEA) into 2 distinct groups: (1) borderline dysplasia (LCEA 18°-25°) and (2) normal acetabular coverage (LCEA 25.1°-40°). There were 36 patients in the borderline dysplastic group and 312 patients in the normal coverage group. The primary outcome measure was the Hip Outcome Score–Activities of Daily Living (HOS-ADL) at a minimum of 2 years postoperatively. Secondary outcome measures included the HOS-Sports and modified Harris Hip Score (mHHS). Results: The mean preoperative LCEA differed significantly between groups (23.4° ± 1.5° for borderline dysplastic, 32.5° ± 3.8° for normal coverage; P < .001). The borderline dysplastic group had a higher percentage of female patients than the normal coverage group (27/36 [75%] vs 177/312 [57%], respectively; P = .048). There were no differences in other preoperative demographics and radiographic parameters. At a minimum 2 years after hip arthroscopic surgery (mean follow-up, 2.6 ± 0.6 years), both groups demonstrated significant improvements in all patient-reported outcome scores (P < .001 in all cases). There were no significant differences between the borderline dysplastic and normal coverage groups in final outcome scores, score improvements, or percentage of patients experiencing clinically significant improvements. One patient in the borderline dysplastic group (3%) underwent revision hip arthroscopic surgery, and none underwent total hip arthroplasty during the follow-up period. There were no differences between the borderline dysplastic and normal coverage groups with regard to subsequent surgery. Female patients in the borderline dysplastic group had greater improvements in the mean HOS-ADL (25.9 ± 16.3 vs 10.8 ± 18.5, respectively; P = .05) and mHHS (27.9 ± 12.9 vs 8.1 ± 19.0, respectively; P = .005) compared with male patients in the borderline dysplastic group, but male and female patients did not differ in outcomes for the normal coverage group. Conclusion: Patients who underwent hip arthroscopic surgery for FAI with capsular plication experienced significant clinical improvements with low rates of subsequent surgery, regardless of whether their acetabulum had borderline dysplasia or normal coverage.

Second Harmonic Generation (SHG) Anisotropy Imaging for Evaluation of Dysplasia in Barrettʼs Esophagus

Introduction: Barrett's without dysplasia (WD) and with dysplasia either low grade (LGD) or high grade (HGD) have different prognosis and management strategies. The standard mechanism for histologic diagnosis is tedious and can miss areas of interest. SHG laser is a coherent nonlinear process, where two lower energy photons are up-converted to twice the incident frequency (half the wavelength) of an excitation laser. SHG has the ability to directly visualize the collagen assembly in the extracellular matrix (ECM), which can be related to pathologic effect. Previous studies have demonstrated this effect on multiple tissues including differentiating between malignant and non-malignant colon polyp tissue. We postulate that SHG could be utilized in the evaluation of Barrett's tissue to differentiate between nondysplastic and dysplastic Barrett's tissue. Methods: A total of 9 de-identified H&E slides were obtained through IRB exempt protocol. This included 3 slides of Barrett's WD, 3 slides of LGD, and 3 slides of HGD. SHG laser was used to obtain 10 different images for WD and LGD, and 9 images for HGD at constant average power of excitation light (20 milliwatts) at 800 nm. Forward propagating SHG signal was collected. Images were taken with the analyzing polarizer in the parallel and orthogonal positions. Intensities of parallel (Ipar) and orthogonal (Iorth) components were measured from the collagen fibers aligned at 90 degrees relative to the polarization of excitation light. The anisotropy parameter was calculated: β= (Ipar - Iorth)/(Ipar + 2 Iorth). Results: The mean β for Barrett's tissue types, as well as Kruskall-Wallis mean rank (p=0.028) are seen in table 1. Barrett's WD had the highest β score, indicating the lowest proportion of non-aligned fibers. Post Hoc analysis using Mann-Whitney U (p=0.33) is shown in table 2. Conclusion: Samples of Barrett's WD had the highest β values, indicating the most aligned fibers. LGD and HGD showed lower β values compared to WD indicating more misaligned fiber. Statistical analysis shows significant difference between non-dysplastic and dysplastic groups in terms of anisotropy. This suggests that SHG can distinguish between non-dysplastic and dysplastic Barrett's tissue. More studies especially on live tissue need to be done to confirm these findings. SHG could be incorporated into the endoscope light source and utilized to supplement and enhance traditional pathology.Table 1: Mean β and Mean Rank for Anisotropy parameter β for Barrett's WD, low grade dysplasia, and high grade dysplasiaTable 2: Post Hoc analysis of Anisotropy parameter β between Barrett's WD and HGD

Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans.

BackgroundPercutaneous iliosacral screw fixation can provide stable fixation with a minimally invasive surgical technique for unstable posterior pelvic ring injuries. This surgical technique is not limited by cases of difficult fracture patterns, sacral dysplasia, and small sacral pedicles that can occur in Asians. The purpose of this study was to investigate the incidence of the sacral dysplasia in the Korean population and determine the optimal direction of iliosacral screws by analyzing pelvic three-dimensional computed tomography (3D-CT) scans.MethodsOne hundred adult patients who had pelvic 3D-CT scans were evaluated. The upper sacral morphology was classified into three groups, i.e., normal, transitional, and dysplastic groups; the cross-sectional area of the safe zone was measured in each group. S1 pedicle with a short width of more than 11 mm was defined as safe pedicle. The incidences of safe pedicles at different angles ranging from 0° to 15° were investigated in order to determine optimal angle for screw direction.ResultsThe incidence of normal, transitional, and dysplastic group was 46%, 32%, and 22%, respectively. There were significant increases of the cross-sectional area of the safe zones by increasing the angles from 0° to 15° in all groups. The incidence of safe pedicles increased similar to the changes in cross-sectional area. The overall incidence of safe pedicles was highest at the 10° tilt angle.ConclusionsThe incidence of sacral dysplasia in Koreans was 54%, which is higher than previous studies for Western populations. The cross-sectional area of the safe zone can be increased by anteromedial direction of the iliosacral screw. Considering the diversity of sacral morphology present in the Korean population, a tilt angle of 10° may be the safest angle.

Midterm Outcomes of Reverse (Anteverting) Periacetabular Osteotomy in Patients With Hip Impingement Secondary to Acetabular Retroversion

Background: There is a paucity of data on the results of reverse (anteverting) periacetabular osteotomy (RPAO) for treatment of femoroacetabular impingement (FAI) secondary to acetabular retroversion. Purpose: To evaluate the midterm outcomes of RPAO for FAI secondary to acetabular retroversion in those with and without hip dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review identified RPAOs performed on patients with acetabular retroversion in isolation or in the setting of dysplasia (lateral center-edge angle [LCEA] ≤19°). Acetabular retroversion with FAI was diagnosed clinically and radiographically, with a positive crossover and posterior wall signs on pelvic radiographs. Twenty-three patients (30 hips) met the inclusion criteria; 20 hips with isolated retroversion and 10 hips with retroversion and hip dysplasia. The average age at the time of the procedure was 26 years (range, 13-45 years). The average length of follow-up was 5 years (range, 2-19 years). Harris Hip Score (HHS) and radiographs were evaluated preoperatively and at last follow-up. Results: The mean preoperative LCEA was 31° (range, 22°-49°) in the isolated retroversion group and 9° (range, –4° to 17°) in the dysplastic group. Postoperatively, the LCEA in the dysplastic group increased to 35° (range, 15°-46°) (P = .0001). The crossover sign corrected in 55% (11/20) of the isolated retroversion group and 80% (8/10) of the dysplastic group. The acetabular index (mean ± SD) improved from 1.3 ± 0.3 to 1.7 ± 0.6 (P = .0001), indicating improved anteversion. At the latest follow-up, the average HHS in the isolated retroversion group increased from 58 preoperatively (range, 23-77) to 93 (range, 68-100) (P = .0001); the HHS in the dysplastic group improved from 49 (range, 20-74) to 92 (range, 77-100) (P < .0001). Complication rates were similar in both groups. Excluding hardware removal, additional surgeries were performed in 13% (4/30). Conclusion: RPAO performed for FAI in the young patient with isolated acetabular retroversion or retroversion in the setting of dysplasia successfully improved clinical and radiographic results at mid- to long-term follow-up.

Hip Arthroscopy in the Presence of Acetabular Dysplasia.

Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH.Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH.Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS.Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality.

Tu1538 Relationship Between Baseline Histology and Recurrence Histology After Successful Endoscopic Ablation for Barrett's Esophagus

Tu1538 Relationship Between Baseline Histology and Recurrence Histology After Successful Endoscopic Ablation for Barrett’s Esophagus Karthik Ragunathan*, Rajesh Krishnamoorthi, Sairaman Nagarajan, Prasad G. Iyer Dept of Internal Medicine, University of Illinois College of medicine, Peoria, IL, Peoria, IL; Mayo Clinic, Rochester, MN; Harvard university, Boston, MA Background: Several studies have reported risk of recurrence of Barrett’s esophagus (BE) after achieving complete remission of intestinal metaplasia (CRIM) through endotherapy. Recurrence risk after CRIM in non-dysplastic BE (NDBE) subjects undergoing ablation versus those with LGD, HGD or IMC (dysplastic BE, D-BE) is unclear. Additionally, the relationship between baseline histology and recurrence histology has not been studied. We aimed to study these relationships through a systematic review and meta-analysis. Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through July, 2014) to identify cohort studies reporting the recurrence of IM, dysplasia and/or esophageal adenocarcinoma (EAC) after CRIM following endotherapy for Barrett’s related neoplasia. We excluded studies which 1) with cohorts consisting of a combination of D-BE and NDBE patients, 2) did not report baseline and recurrence histology, and 3) did not report follow up duration after CRIM. Studies were categorised into Dysplastic group (low grade, high grade and/ or EAC) and Nondysplastic group based on baseline histology. Dysplastic recurrence (DR) was defined as recurrence of BE with dysplasia (LGD or HGD) or EAC after CRIM. Non Dysplastic recurrence (NDR)was defined as recurrence of BE without dysplasia after CRIM. Risk of dysplastic recurrence (RDR) was defined as difference between DR and NDR. Primary outcome was RDR in dysplastic and non-dysplastic groups. Results: A total of 12 studies were included with 7 studies in dysplastic group(118 recurrences in 676 patients with 1282.35 patient years of follow up) and 5 studies in nondysplastic group(39 recurrences in 360 patients with 2159.83 years of follow up).The pooled IR in the dysplastic and non-dysplastic group was 7.4 % per patient year (95% CI of 0.59-0.89) and was 0.7% per patient year(95% CI of 0.3-1.0) respectively. RDR in the dysplastic group and non dysplastic group was 0.04(95% CI -0.05 to 0.13) and -0.11(95%CI -0.14 to -0.07) respectively (Figure 1 and 2). Conclusion: Recurrence rates after endoscopic therapy in BE subjects with baseline dysplasia undergoing endoscopic therapy is about 10 times the rate in the NDBE patients. Given the higher rates of recurrence and possibility of dysplastic recurrence, D-BE patients should stay in long term surveillance after CRIM. Conversely, given the lower rates of recurrence and high likelihood of recurrence histology to be NDBE, surveillance intervals in NDBE patients could potentially be lengthened.

The Effect of Trochlear Dysplasia on Patellofemoral Biomechanics

Background: Trochlear dysplasia appears in different geometrical variations. The Dejour classification is widely used to grade the severity of trochlear dysplasia and to decide on treatment. Purpose: To investigate the effect of trochlear dysplasia on patellofemoral biomechanics and to determine if different types of trochlear dysplasia have different effects on patellofemoral biomechanics. Study Design: Controlled laboratory study. Methods: Trochlear dysplasia was simulated in 4 cadaveric knees by replacing the native cadaveric trochlea with different types of custom-made trochlear implants, manufactured with 3-dimensional printing. For each knee, 5 trochlear implants were designed: 1 implant simulated the native trochlea (control condition), and 4 implants simulated 4 types of trochlear dysplasia. The knees were subjected to 3 biomechanical tests: a squat simulation, an open chain extension simulation, and a patellar stability test. The patellofemoral kinematics, contact area, contact pressure, and stability were compared between the control condition (replica implants) and the trochlear dysplastic condition and among the subgroups of trochlear dysplasia. Results: The patellofemoral joint in the trochlear dysplastic group showed increased internal rotation, lateral tilt, and lateral translation; increased contact pressures; decreased contact areas; and decreased stability when compared with the control group. Within the trochlear dysplastic group, the implants graded as Dejour type D showed the largest deviations for the kinematical parameters, and the implants graded as Dejour types B and D showed the largest deviations for the patellofemoral contact areas and pressures. Conclusion: Patellofemoral kinematics, contact area, contact pressure, and stability are significantly affected by trochlear dysplasia. Of all types of trochlear dysplasia, the models characterized with a pronounced trochlear bump showed the largest deviations in patellofemoral biomechanics. Clinical Relevance: Investigating the relationship between the shape of the trochlea and patellofemoral biomechanics can provide insight into the short-term effects (maltracking, increased pressures, and instability) and long-term effects (osteoarthritis) of different types of trochlear dysplasia. Furthermore, this investigation provides an empirical explanation for better treatment outcomes of trochleoplasty for Dejour types B and D dysplasia.

Heat shock protein (HSP70) as a marker of epithelial dysplasia in oral dysplastic lesions: A clinicopathological study.

Objective:In the present study, expression of heat shock protein (HSP70) was evaluated and compared in oral dysplastic lesions, in particular leukoplakia (study group) and in normal mucosal tissues (control group). Additionally, correlation of HSP70 expression with clinical disease status was investigated.Subjects and Methods:A total of 60 fresh tissue specimens were obtained from the oral cavity, consisting of 30 dysplastic cases and 30 normal mucosal tissues. The presence of epithelial dysplasia and its histologic grading was evaluated. Immunohistochemistry was carried out with the monoclonal HSP70 antibodies and expression of cytoplasmic HSP70 within the epithelium was compared between dysplastic and normal mucosal samples using Student's t-test.Results:Expression of HSP70 was detected in 93% of the oral dysplastic tissues and 20% of the normal mucosal tissues. Statistical significant difference in the HSP70 expression was seen between oral dysplastic tissues and normal oral mucosal tissues (P < 0.000). The interexaminer reliability was 93.3%. Statistical significant difference was seen in the HSP70 expression between controls and different grades of dysplasia (mild, moderate and severe). There was no relationship of HSP70 expression with clinical parameters like age, sex, site of the lesion, history of adverse habits and duration of adverse habits.Conclusion:In the present study, HSP70 activity was significantly higher in oral dysplastic (leukoplakia) group than in the control group. Further, as the grade of dysplasia increased, the staining intensity and/or distribution increased, indicating that enhanced HSP70 expression occurs during oral carcinogenesis. Hence, it is concluded that increased HSP70 immunoexpression could be an objective marker for the presence of epithelial dysplasia.