Final Follow-up Visit Research Articles

Application of Solis fusion device in adjacent segment degeneration revision after anterior cervical discectomy bone grafting fusion

To observe the early clinical efficacy of the zero-remember cervical Solis fusion device in the treatment of adjacent segment degeneration(ASD) revision after anterior cervical discectomy and fusion(ACDF). A retrospective analysis was performed for 13 patients with adjacent spondylosis after anterior cervical discectomy bone graft fusion with Solis fusion device, including 5 males and 8 females, aging from 56 to 78 years old. The patients had intractable neck pain or superficial paresthesia of upper extremities before operation, and the effect of conservative treatment was not good. The operation time, intraoperative blood loss and postoperative complications were recorded. Before operation, 1 week postoperative and final follow-up, the visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores were used to assess clinical efficacy. X-ray and CT of the cervical spine were performed to measure and evaluate the height of the intervertebral space and intervertebral fusion. All patients were followed up from 18 to 36 months. All 13 patients successfully completed revision surgery with single gaps. The operation time was 63 to 93 min, the intraoperative blood loss was 15 to 83 ml. The pain VAS was reduced from 4 to 7 points before surgery to 1 to 3 points at 1 week and 1 to 2 points at the final follow-up. The height of the intervertebral space was increased from 5.2 to 7.2 mm before surgery to 6.4 to 8.0 mm at 1 week after surgery and 6.4 to 7.9 mm at the final follow-up. The JOA score was increased from 11 to 17 points before surgery to 13 to 17 points at 1 week after surgery and 16 to 17 points at the final follow-up visit. At the final follow-up, AP and lateral X-ray films of cervical spine showed homogeneous bone fusion of the Solis fusion. One patient developed transient left upper limb weakness after surgery, which recovered at follow-up, and all patients had no dysphagia, incision hematoma or infection, and displacement. The early clinical efficacy of Solis fusion device in the treatment of orthospondylosis after anterior cervical intervertebral fusion is satisfactory, and it has the advantages of less surgical trauma, adequate decompression, high osseointegration rate and fewer complications, which can provide a new option for minimally invasive treatment of orthospondylosis after cervical spine surgery.

Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial

Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings. In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial. We randomly assigned participants (1:1) to the intervention or control group using a random number draw. The intervention was a newly developed Problem Management for Moms (PM4M) programme: a ten-session treatment adapted from Problem Management Plus, which was offered by phone or in person. After randomisation, participants in the intervention group underwent pre-intervention screening, a post-intervention assessment, and a final follow-up assessment 9 months after treatment initiation (ie, final follow-up visit). The control group was assessed at the baseline of ZamCharts and at the final follow-up assessment, and these participants did not receive any intervention. The primary study outcomes were feasibility, acceptability, and participant mental distress measured using the SRQ-20. All primary and secondary outcomes were estimated in the intention-to-treat population, which included all participants who were randomised to the intervention group and attended the final follow-up assessment. Data on ethnicity were not collected. The trial is registered at ClinicalTrials.gov, NCT05627206, and has been completed. Women with lived experience of mental health symptoms were involved in this study. Between April 26, and July 14, 2021, 790 women were interviewed in the ZamCharts trial, of whom 265 had high mental distress and were randomly assigned to treatment groups in this trial (134 to the intervention group and 131 to the control group). Of the 134 women in the intervention group, 61 (46%) received the PM4M intervention and 73 (55%) were excluded; 103 in the intervention group and 106 in the control group were successfully interviewed at the final follow-up assessment. The mean age of participants was 27·6 years (SD 7·6) at ZamCharts baseline. PM4M sessions were conducted between Dec 16, 2022, and May 6, 2023. The 61 participants deemed eligible after pre-intervention screening who started the intervention completed a mean of 7·9 (SD 2·9) of ten sessions. 55 (77%) of these 61 participants were somewhat or very satisfied with the intervention. In adjusted intention-to-treat models, the intervention reduced mean SRQ-20 scores by 2·11 points (95% CI -3·50 to -0·63) at the final follow-up, and the adjusted odds ratio of having an SRQ-20 of more than 7 was 0·50 (95% CI 0·27 to 0·93). No serious adverse events were reported. The results presented here suggest that the PM4M mental health intervention is feasible and has high rates of acceptability. Further research is needed to assess the long-term efficacy of this intervention on women and their children, and its suitability for integration into routine care. The Eckenstein-Geigy Professorship.

Enhancing Detection of Glaucoma Progression: Utility of 24-2 Visual Field Central Points vs. 10-2 Visual Fields

PurposeTo test the hypothesis that a summary index derived from the central 12 points of the 24-2 visual field (MD12) could provide complementary information to that provided by the 24-2 visual field (VF) mean deviation (24-2 MD). DesignLongitudinal observational study Participants125 eyes (125 patients) with central damage or moderate to severe glaucoma from the Advanced Glaucoma Progression Study with four or more pairs of 10-2 and 24-2 SITA standard VFs. MethodsBaseline 10-2 and 24-2 VF dates were within six months, and the remaining pairs of VF tests were done in the same session. The MD12 index was calculated by averaging total deviation (TD) values from the central 12 points of 24-2 VF. Simple linear regression of MD against time was used to estimate 24-2 MD, 10-2 MD, and MD12 rates of change (RoC). Progression at the final follow-up visit was defined as a RoC <0 dB/year with p<0.05 for any summary index with confirmation. Main Outcome MeasuresProportion of progressing eyes based on 24-2 MD, 10-2 MD, and MD12 rates of change. ResultsThe average (SD) baseline 24-2 and 10-2 MD were –9.0 ± 6.2 and –8.5 ± 5.4 dB, respectively. The mean follow-up time was 5.7 (±1.6) years. The 3 summary indices were highly correlated at baseline: r (95% CI) =0.62 (0.52-0.74) between 10-2 MD and 24-2 MD, 0.84 (0.78-0.90) between MD12 and 24-2 MD, and 0.86 (0.80-0.92) between 10-2 MD and MD12. The corresponding correlations between RoC were weaker: r=0.41 (0.37-0.45), 0.80 (0.78-0.82), and 0.49 (0.45-0.53). Glaucoma progression was detected in 29 (23.2%), 22 (17.6%), and 23 eyes (18.4%) based on the 24-2, 10-2, and MD12 RoC, respectively; 7 eyes (9.6%) exhibited progression based on MD12 RoC and not with 24-2 MD; only 3 of these eyes progressed according to 10-2. ConclusionsMD12 rates of change and detection rates have a low level of agreement with those of 10-2 and hence do not replace the need for 10-2 VF MD to monitor central damage.

Percutaneous repair of achilles tendon ruptures: short-term results of 41 patients

Aims: Despite the current popularity of surgical treatment of Achilles tendon ruptures, there is no clear consensus about which technique should be applied. The aim of this study is to evaluate the short- to mid-term results of acute Achilles tendon ruptures treated with the percutaneous method and to discuss these results in light of the literature. Methods: In this study, 41 patients who were operated on percutaneously with the diagnosis of acute Achilles tendon rupture between 2016 and 2019, whose treatment was completed, and who had a follow-up period of at least 1 year were included. At the patients’ final follow-up visits, the range of motion of the ankle joint, time to return to work and sports, and complications were evaluated. For functional evaluations, the scoring system of the American Orthopaedic Foot &amp; Ankle Society (AOFAS) for the ankle joint was used. Results: The mean age of the patients was 29.3 (18-50) years and the mean follow-up duration was 23 (12-38) months. The mean dorsiflexion angle was 32.27° (20-45°) and the mean plantar flexion angle was 34.58° (20-45°). The time to return to work was 14.2 (8-21) weeks, while time to return to sports was 30.4 (17-49) weeks. The mean AOFAS score of the patients was 91.63 (74-100). The complications included infection in 2 (4.8%) patients, wound necrosis in 1 (2.4%) patient, re-rupture in 1 (2.4%) patient, and sural nerve neuropraxia in 1 (2.4%) patient. Conclusion: The findings of this study suggest that percutaneous repair is an effective method in the treatment of acute Achilles tendon ruptures, like other surgical methods that offer good functional results with low complication rates.

Safety and tolerability of tegoprubart in patients with amyotrophic lateral sclerosis: A Phase 2A clinical trial.

The interaction of CD40L and its receptor CD40 on activated T cells and B cells respectively control pro-inflammatory activation in the pathophysiology of autoimmunity and transplant rejection. Previous studies have implicated signaling pathways involving CD40L (interchangeably referred to as CD154), as well as adaptive and innate immune cell activation, in the induction of neuroinflammation in neurodegenerative diseases. This study aimed to assess the safety, tolerability, and impact on pro-inflammatory biomarker profiles of an anti CD40L antibody, tegoprubart, in individuals with amyotrophic lateral sclerosis (ALS). In this multicenter dose-escalating open-label Phase 2A study, 54 participants with a diagnosis of ALS received 6 infusions of tegoprubart administered intravenously every 2 weeks. The study was comprised of 4 dose cohorts: 1 mg/kg, 2 mg/kg, 4 mg/kg, and 8 mg/kg. The primary endpoint of the study was safety and tolerability. Exploratory endpoints assessed the pharmacokinetics of tegoprubart as well as anti-drug antibody (ADA) responses, changes in disease progression utilizing the Revised ALS Functional Rating Scale (ALSFRS-R), CD154 target engagement, changes in pro-inflammatory biomarkers, and neurofilament light chain (NFL). Seventy subjects were screened, and 54 subjects were enrolled in the study. Forty-nine of 54 subjects completed the study (90.7%) receiving all 6 infusions of tegoprubart and completing their final follow-up visit. The most common treatment emergent adverse events (TEAEs) overall (>10%) were fatigue (25.9%), falls (22.2%), headaches (20.4%), and muscle spasms (11.1%). Mean tegoprubart plasma concentrations increased proportionally with increasing dose with a half-life of approximately 24 days. ADA titers were low and circulating levels of tegoprubart were as predicted for all cohorts. Tegoprubart demonstrated dose dependent target engagement associated and a reduction in 18 pro-inflammatory biomarkers in circulation. Tegoprubart appeared to be safe and well tolerated in adults with ALS demonstrating dose-dependent reduction in pro-inflammatory chemokines and cytokines associated with ALS. These results warrant further clinical studies with sufficient power and duration to assess clinical outcomes as a potential treatment for adults with ALS. Clintrials.gov ID:NCT04322149.

Evaluating the Effectiveness of Ahmed Glaucoma Valve Implantation in Reducing Intraocular Pressure in Refractory Glaucoma in the Saudi Arabian Population at a Tertiary Care Centre

Objectives: To assess the efficacy of Ahmed glaucoma valve implantation (AGVI) in lowering intraocular pressure (IOP) in patients with refractory glaucoma. Methods: In this retrospective study, we analyzed the medical records of 60 patients who received AGVI for refractory glaucoma. Data collected included demographics, type of glaucoma, preoperative and postoperative IOP, number of glaucoma medications, and any surgical complications. Success was defined as achieving an IOP &lt;21 mmHg at the final follow-up visit. Results: At the final follow-up (mean duration of 11.6 months), AGVI achieved successful IOP control (IOP of &lt;21 mmHg) in 40 eyes (66.7%). The mean number of glaucoma medications decreased significantly from 2.95 preoperatively to 1.98 postoperatively (p &lt; 0.001). Neovascular glaucoma (NVG) had a lower success rate compared to other types of glaucoma. Prior glaucoma surgery was associated with a higher risk of failing to reach target IOP, although this trend was not statistically significant (p = 0.108). Conclusion: AGVI implantation effectively lowered IOP in patients with refractory glaucoma, especially in the short term. However, long-term success rates were lower, and NVG showed less favorable outcomes. AGVI is a valuable option for managing refractory glaucoma, but careful patient selection is essential. Further research is needed to evaluate long-term efficacy and refine treatment strategies.

Analysis of preoperative and postoperative depression and anxiety in patients with lumbar disc herniation with radiculopathy treated with percutaneous transforaminal endoscopic discectomy.

This study aims to examine the mental health of patients with lumbar disc herniation with radiculopathy (LDHR) and to evaluate the effects of percutaneous transforaminal endoscopic discectomy (PTED) on their mental well-being. This study included 114 LDHR patients who received PTED in the Spinal Orthopedics Department of Zhongshan Hospital of Traditional Chinese Medicine between May 2022 and May 2023. The study population was stratified into two groups according to the presence of preoperative anxiety and depression: Group A comprised patients with such symptoms, and Group B included the remainder. Patients were assessed using the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for Pain (VAS), and the Oswestry Disability Index (ODI) at preoperative and final follow-up visits. Evaluations were performed using the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale, and the Oswestry Disability Index (ODI) at the time of preoperation and during the last follow-up. Among the 114 LDHR patients who obtained complete follow-up, fifty-four had anxiety/depression symptoms before surgery, which accounted for a incidence of 47%. Both Group A and Group B patients showed significant improvement in all evaluation indicators after PTED, but the overall prognosis of Group A was worse than that of Group B. PTED can effectively improve patients' pain, functional activities and mental health, which has a positive impact on patients' quality of life, and there is a significant correlation between patients' preoperative mental health and prognosis.

Use of Continuous Oral Drospirenone for Menstrual Suppression in Adolescents

PurposeTo describe experiences of adolescents taking continuous drospirenone (DRSP-C) oral contraceptives, without placebo, for menstrual suppression, including breakthrough bleeding and other side-effects. MethodsThis was a retrospective chart review of adolescents prescribed DRSP-C for menstrual suppression. Demographics and indications for DRSP-C were collected on the visit where DRSP-C was prescribed. Data through the final follow-up visit during the study period included documented effects and side-effects of DRSP-C and continuation of therapy. Statistical analyses were primarily descriptive. ResultsPatients prescribed DRSP-C were included (n = 136). Dysmenorrhea was the most common indication for DRSP-C (58.8%, n = 80/136) followed by endometriosis (44.8%, n = 61/136). The median time on DRSP-C for the 116 patients who were able to initiate treatment was 12.3 months (interquartile range [IQR] 6.8, 17.4). Patients trialed, on average, 2 other forms of menstrual management before starting DRSP-C (IQR 1, 3). Pelvic pain or dysmenorrhea resolution or improvement was reported in 84.6% (44/52) of dysmenorrhea patients, and 77.8% (28/36) of pelvic pain patients. Almost half of patients reported breakthrough bleeding on DRSP-C (41.3%, n = 48/116); however, only 11 patients (42%, 11/26) discontinued DRSP-C because of it. Within the study period, 22.4% (n = 26/116) of patients discontinued DRSP-C, with a median treatment duration of 101 days (IQR 71, 157). Among patients who discontinued DRSP-C, the most common reason was breakthrough bleeding (42%, n = 11/26). DiscussionDRSP-C for menstrual suppression was well tolerated in adolescents, with most patients reporting resolution or improvement of their indication for taking DRSP-C. Findings demonstrate DRSP-C is a viable option for menstrual suppression in adolescents.

Outcomes After Switching to Faricimab for Refractive Macular Edema in Treatment-Experienced Eyes with Neovascular Age-Related Macular Degeneration.

To examine response to faricimab in neovascular age-related macular degeneration (nARMD) refractory to traditional anti-vascular endothelial growth factor (anti-VEGF) agents. Retrospective chart review was conducted on eyes with nARMD with persistent subretinal and/or intraretinal fluid despite previously receiving ≥15 injections with ≥2 different anti-VEGF agents. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters were collected at baseline, initial post-injection visit, and most recent visit with OCT following last faricimab. Nineteen eyes were included. Average logMAR BCVA was 0.47 ± 0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92μm at baseline, 279 ± 88μm at initial follow-up (p = 0.001), and 274 ± 100μm at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both initial and final follow-up visits. Faricimab mildly decreased CST and reduced fluid in some nARMD eyes refractory to traditional anti-VEGF agents but had minimal effect on BCVA.

Treatment of Kienböck's Disease Using Fourth and Fifth Extensor Compartmental Artery Vascularized Bone Grafts.

This study evaluated the radiological and clinical outcomes of bone grafts using fourth and fifth extensor compartmental arteries (4+5 ECAs) for the treatment of Kienböck's disease. In total, 21 patients (12 men and 9 women; mean age, 41 years; range, 19-59 years) were followed for a mean of 33 months. Radiological images were analyzed for the Lichtman stage, carpal height ratio, radioscaphoid angle, and Stahl's index. Clinical evaluation included range of motion, visual analog scale (VAS) score, grip strength, modified Mayo wrist score (MMWS), Lichtman outcome score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. At the time of surgery, 6, 14, and 1 patients had Lichtman stages II, IIIA, and IIIB, respectively. At the final follow-up visit, grip strength had improved from 65.4% to 79.7%, wrist extension had improved from 43° to 57°, and flexion had improved from 42° to 50°. There were no significant changes in the carpal height ratio, Stahl's index, or radioscaphoid angle. The mean VAS score was 1.7, and the mean DASH score was 6.9. The mean MMWS was 87.9, with excellent and good outcomes in 6 and 11 patients, respectively. Satisfactory Lichtman outcome scores were observed in 81%. Body mass index had a strong correlation and age had a weak correlation with MMWS (coefficient=-0.534, P=.013, and coefficient=-0.393, P=.078, respectively). The 4+5 ECA bone graft is effective for the treatment of Kienböck's disease in young patients with low body mass index. [Orthopedics. 202x;4x(x)xx-xx.].

Percutaneous functional spinal unit cementoplasty versus percutaneous kyphoplasty for severe osteoporotic vertebral compression fracture complicated with endplate-disc complex injury: A retrospective case-control study.

Severe osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury. This study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP. This was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI. A total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001). PFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies.

Ankle Fractures Treated With Locked Fibular Intramedullary Nailing: Description and Outcomes of a Minimally Invasive Open Technique.

To describe and report outcomes of a minimally invasive open fibular intramedullary (IM) nailing technique for fixation of ankle fractures. Case Series. Urban Level 1 trauma center. Adult patients with ankle fractures (OTA 44A-C) treated with locked fibular IM nailing through a minimally invasive open technique for fracture and syndesmotic reduction between 2021 and 2024. Quality of reduction, complications, and patient-reported outcomes. A total of 150 consecutive patients operated by a single surgeon were included. Mean age was 53.3 (17-97) years, and mean body mass index was 30.6 ± 7.4 kg/m 2 . Ninety-three (62%) patients were female, and 78 (52%) patients were White. Seventy-two (48%) patients were obese, 40 (27.7%) patients were current/former smokers, 39 (26%) patients had diabetes, and 23 (15.3%) patients had open fractures. Thirty-seven (24.7%) patients had isolated lateral malleolus fractures, 48 (32%) had bimalleolar fractures, and 65 (43.3%) had trimalleolar fractures. One hundred and twenty-three (82%) patients had 2 syndesmotic screws placed, 26 patients (17.3%) had 1 screw, and 1 patient (0.7%) had none. Quality of reduction was good for 98%, fair for 2%, and poor for none per McLennan criteria. One hundred thirteen patients (75.3%) were followed until clinical and radiographic union for a mean of 7.6 months (range 3-22) months. One hundred and ten patients (97.3%) went on to successful clinical and radiographic union after the index procedure. No patient had a superficial surgical-site infection, and 3 (2.6%) had deep surgical-site infections. Three patients had a loss of reduction, and 6 patients had implant failure (5 broken syndesmotic screws, and 1 medial malleolus screw). Nine (8%) patients had unplanned reoperations (3 for debridement, 2 for loss of reduction, and 4 for removal of symptomatic implants). Mean ankle range of motion at final follow-up visit was 12.9 degrees (0-40) of dorsiflexion, 39.6 degrees (10-70) of plantar flexion, 23.5 degrees (5-40) of inversion, and 18.2 degrees (5-50) of eversion. Mean PROs at final follow-up visit were Global Physical Health: 42.4 (23.5-67.6), Global Mental Health: 47.5 (21-67.6), Physical Function: 37.5 (14.7-57.8), Pain: 54.9 (22-72), and Mobility: 36.9 (16-65.3). Minimally invasive open fibular IM nailing allowed for excellent reduction and results in union with low rates of complications and good patient-reported outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Factors associated with patient satisfaction after arthroscopic rotator cuff repair: do they differ by age?

Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (<70 years), and the two age groups were further divided into satisfied and unsatisfied subgroups. Patient satisfaction was evaluated at the final follow-up visit using a binary question (yes or no). Clinical outcomes were assessed preoperatively and at the final follow-up. Satisfaction rates in the older and younger age groups were 75.41% and 79.47%, respectively. Mean changes in Constant and American Shoulder and Elbow Surgeons scores were significantly different between the satisfied and unsatisfied subgroups (P=0.031 and P=0.012, respectively) in the young patients. In the old patients, there was a significant difference in the mean change in depression subscale of the Hospital Anxiety and Depression Scale (P=0.031) and anxiety subscale of the Hospital Anxiety and Depression Scale (P=0.044) scores between the satisfied and unsatisfied subgroups. Factors affecting patient satisfaction after ARCR differed according to age. Psychological improvement was more important to elderly patients, whereas restoration of function was more important to younger patients. Pain relief was important for both age groups. Level of evidence: III.

Efficacy and safety of non-cross-linked hyaluronic acid compound in the treatment of keratosis pilaris: A split-body randomized clinical trial.

Keratosis pilaris (KP) is a prevalent benign dermatological condition characterized by small bumps at the hair follicles alongside surrounding redness, significantly impacting both aesthetics and mental well-being. This study investigated the potential benefits of a non-cross-linked hyaluronic acid (HA) compound for treating KP. A split-body, investigator-blinded, randomized, intraindividual comparative clinical trial was conducted. The non-cross-linked HA compound was injected into KP-affected regions on both upper arms. The treatment was delivered across four sessions scheduled at 4-week intervals. Blinded physicians and patients assessed differences in erythema, skin roughness, and overall scores between treated and control areas at the final follow-up visit. At the 12th and 24th weeks post-treatment, a four-point scale was utilized to assess subjects' perceived treatment efficacy. Additionally, dermoscopic images, histological alterations, and adverse events were monitored. Physician assessments revealed a significant reduction in roughness and overall scores for treated areas compared to controls. Patient self-assessments also reflected improvements in roughness, redness, and overall scores for treated sides at the final visit, with 35.71% of patients demonstrating sustained improvement in redness and 71.43% reporting persistent improvements in roughness at 24th weeks post-treatment. The dermatoscopic examinations revealed a notable enhancement in both the quantity of follicular plugs and the extent of erythema among the subjects in the treatment group. Histopathological outcomes also demonstrated improvement. This study suggests that the non-cross-linked HA compound effectively improves skin roughness and promotes hair shaft growth in KP treatment, demonstrating a favorable safety profile. These findings position it as a potentially viable alternative therapy in clinical practice.

Choroidal and retinal exudative changes following extensive endolaser pan retinal photocoagulation

BackgroundIn this report, we describe a case of proliferative diabetic retinopathy that developed into exudative changes confusing with central serous chorioretinopathy (CSCR) following extensive endolaser pan retinal photocoagulation.Case descriptionA 49-year-old male patient with diabetic retinopathy in both eyes presented with vitreous hemorrhage and 6/60 visual acuity in his left eye. Optical coherence tomography (OCT) scans at presentation revealed serous PEDs in both eyes. On day 10 after vitreoretinal surgery and complete peripheral endolaser PRP for the left eye, there was serous retinal detachment (SRD) and an increase in PED heights, mimicking CSCR. No additional treatment was considered. At the three-week post-operative visit, OCT scans revealed that the SRD had resolved and the PED heights had decreased without rupture. At the final follow-up visit, 12 weeks after surgery, the SRD had not recurred, and the PEDs had stabilized. Despite no additional ocular therapy for the right eye, the serous PED height had decreased. The choroidal thickness (CT) at the fovea at various points during the follow-up visits revealed a reduction in both eyes.ConclusionThis case demonstrated the course of SRD, PED, and CT following extensive PRP. These changes may be associated with intraocular VEGF changes. In the presence of SRD and serous PED, the PED morphology may help differentiate the condition from CSCR. Although caution should be exercised when performing PRP during surgery or as an outpatient procedure, the SRD usually resolves without problem.

Longitudinal analysis of cranial growth using comprehensive craniometric measurements after fronto-orbital advancement in coronal craniosynostosis.

The objective of this study was to investigate the longitudinal changes in cranial growth following fronto-orbital advancement (FOA) surgery in patients with unilateral and bilateral coronal craniosynostosis. This retrospective review analyzed head circumference (HC) and CT data during preoperative (T0), immediate postoperative (T1), and final follow-up (T2) visits in 40 patients (23 female, 17 male) who underwent FOA using either the open approach or distraction osteogenesis (DO) between 1987 and 2018. The mean follow-up period was 90.62 months. The z-scores of HC, CT-based intracranial volume, anteroposterior diameter (APD), biparietal diameter (BPD), and cranial height (CH) were calculated using sex- and age-specific standards. Logistic regression analysis was performed. While the z-scores of HC, intracranial volume, and BPD remained within the normal range, the z-scores of APD fluctuated between -2 and -1, and the z-scores of CH were > 2, indicating a substantial elevation compared with norms from T0 to T2. Age at surgery significantly influenced the z-scores of HC, BPD, and CH at T2 (all p < 0.05). Delayed surgical timing was correlated with increased BPD and CH z-scores from T1 to T2 (p = 0.007 and 0.019, respectively). The DO for FOA resulted in elevated HC z-scores at T2 and increased APD from T0 to T1, followed by a significant APD relapse from T1 to T2. These findings suggest that delayed surgical timing may support better cranial growth, as indicated by increased HC at long-term follow-up. However, delayed timing is also associated with worsening abnormally elevated CH. Despite the immediate APD expansion and long-term HC increase with DO, potential relapse warrants caution. While intentional overcorrection of APD is recommended, careful consideration of surgical timing and planning is essential.

Chiropractic rehabilitation in accelerated rehabilitation after total hip arthroplasty for Crowe type IV hip dysplasia.

To investigate the efficacy of chiropractic rehabilitation therapy in Crowe IV developmental dysplasia of the hip (DDH) patients after total hip arthroplasty. Seventy-two patients with Crowe IV type DDH hospitalized in the Department of Orthopedics I of Ya'an Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were selected for the study, and they were divided into 36 cases in the chiropractic rehabilitation therapy group (the treatment group) and 36 cases in the traditional rehabilitation therapy group (the control group) according to the method of randomized grouping. All patients were evaluated at preoperative, 1, 3, and 6 months postoperatively for follow-up, and the muscle strength of the affected limb, the patient's walking gait, the shortened length of the affected limb, the visual analog scale score (VAS score), the Oswestry Dysfunction Index Score (ODI score), the Harris Hip Score, and the degree of pelvic tilt were recorded to evaluate the results of the study. A total of 4 subjects withdrew from the study, 2 in the treatment group, and 2 in the control group. The muscle strength of the affected limb, walking gait, shortened length of the affected limb, VAS score, ODI score, Harris score, and pelvic tilt in the treatment and control groups improved significantly compared with the preoperative period. Comparisons between the 2 groups revealed that at the final follow-up visit, the limp gait of the patients in the treatment group was significantly reduced, the shortened length of the affected limb was significantly reduced, the VAS score was significantly reduced, and the ODI score was significantly reduced, in the treatment group relative to that of the control group, Harris Hip Score was significantly improved, and the degree of pelvic tilt was significantly reduced, but the improvement in muscle strength of the affected limb was not statistically significant. In future clinical practice, we recommend that chiropractic rehabilitation be used as a routine adjunctive treatment after TKA in patients with Crowe IV DDH to optimize outcomes and improve patients' quality of life.

Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery

To investigate the effect of Polyetheretherketone (PEEK) rod semi-rigid pedicle screw fixation system in lumbar spine non-fusion surgery. A total of 74 patients with tow-level lumbar degenerative diseases who underwent surgery from March 2017 to December 2019 were divided into PEEK rod group and titanium rod group. In the PEEK rod group, there were 34 patients, including 13 males and 21 females, aged from 51 to 79 years old with an average of (62.4±6.8) years old;There were 1 patient of L1-L3 segments, 7 patients of L2-L4 segments, 20 patients of L3-L5 segments and 6 patients of L4-S1 segments. In the titanium rod group, there were 40 patients, including 17 males and 23 females, aged from 52 to 81 years old with an average of (65.2±7.3) years old;There were 3 patient of L1-L3 segments, 11 patients of L2-L4 segments, 19 patients of L3-L5 segments and 7 patients of L4-S1 segments. The general conditions of operation, such as operation time, intraoperative blood loss, postoperative drainage was recorded. The visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI) were compared in preoperatively and postoperatively(3 months, 12 months and last follow-up) between two groups. The change of range of motion (ROM) was observed by flexion and extension x-ray of lumbar. All patients successfully completed the operation. The follow-up time ranged from 22 to 34 months with an average of(26.8±5.6) months. The operative time (142.2±44.7) min and intraoperative blood loss(166.5±67.4)ml in PEEK group were lower than those in titanium group [(160.7±57.3) min、(212.8±85.4) ml](P<0.05). There was no significant differences in postoperative drainage between the two groups (P>0.05). At the final follow-up visit, in PEEK group and titanium group VAS of low back pain[(0.8±0.4) points vs (1.0±0.5) points], VAS for leg pain [ (0.7±0.4) points vs (0.8±0.5) points] and ODI [(9.8±1.6)% vs (12.1±1.5)%] were compared with preoperative [ (5.8±1.1) points vs (6.0±1.1)points], [ (7.2±1.7) points vs (7.0±1.6) points], [(68.5±8.9)% vs(66.3±8.2)%] were significantly different(P<0.05). There was no significant difference in VAS scores between the two groups at each postoperative time point (P>0.05). At 3 months after surgery, there was no difference in ODI between the two groups (P>0.05). There were significant differences in ODI between PEEK group and titanium rod group at 12 months [(15.5±2.1)% vs (18.4±2.4)%] and at the last follow-up [(9.8±1.6)% vs (12.1±1.5)%] (P<0.05). The total range of motion (ROM) of lumbar decreased in both groups after surgery. At 12 months after surgery and the last follow-up, the PEEK group compared with the titanium rod group, the total range of motion of lumbar was statistically significant (P<0.05). The range of motion (ROM) of the fixed segments decreased in both groups after surgery. The ROM of the fixed segments in PEEK group decreased from (9.5±4.6)° to (4.1±1.9)° at the last follow-up (P<0.05), which in the titanium rod group was decreased from (9.8±4.3)°to (0.9±0.5)° at the last follow-up (P<0.05). The range of motion (ROM) of upper adjacent segment increased in both groups, there was statistical significance in the ROM of upper adjacent segment between the two groups at 12 months after surgery and the last follow-up, (P<0.05). There was no screw loosening and broken rods in both groups during the follow-up period. The PEEK rod semi-rigid pedicle screw internal fixation system used in lumbar non-fusion surgery can retain part of the mobility of the fixed segment, showing comparable short-term clinical efficacy to titanium rod fusion. PEEK rod semi-rigid pedicle screw internal fixation system is a feasible choice for the treatment of lumbar spine degenerative diseases, and its long-term efficacy needs further follow-up observation.

INVESTIGATION OF THE PATHOPHYSIOLOGY OF EPIRETINAL MEMBRANE FOVEOSCHISIS: Analysis of Longitudinal Changes in Visual Functions, Retinal Structures, and Retinal Traction Force.

To analyze the pathophysiology of epiretinal membrane foveoschisis (FS) by evaluating the longitudinal changes in visual function and several optical coherence tomography parameters. The medical records of 33 consecutive patients (35 eyes) with untreated epiretinal membrane foveoschisis were retrospectively reviewed. Best-corrected visual acuity, M-CHARTS score, and optical coherence tomography parameters including epiretinal membrane area, maximum depth of retinal folds, FS area, and FS circularity were evaluated. A wide range of FS area changes was observed at the final follow-up visit (59.68%-240.45% of the baseline FS area). In the FS enlargement group, best-corrected visual acuity and mean M-CHARTS scores significantly worsened and maximum depth of retinal folds significantly increased over time, whereas in the FS non-enlargement group, no significant change was observed in the best-corrected visual acuity, mean M-CHARTS scores, or maximum depth of retinal folds during the follow-up period. Multivariate logistic regression analyses revealed that maximum depth of retinal folds (odds ratio: 1.05, 95% confidence interval: 1.00-1.10, P = 0.048) and FS circularity (odds ratio: 0.91, 95% confidence interval: 0.83-1.00, P = 0.043) were significantly associated with FS enlargement. Epiretinal membrane foveoschisis encompasses diverse pathophysiologies. Since visual functions do not worsen in some cases, monitoring the changes in visual functions and retinal morphology over time is recommended to determine surgical indications.

Risk factors for poor neurological recovery after anterior cervical discectomy and fusion: imaging characteristics

BackgroundPoor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion.MethodsWe retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients’ neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the “good” and “poor” groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery.ResultsThe mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis.ConclusionISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients’ preoperative imaging characteristics can help in the development of surgical protocols and the management of patients’ surgical expectations.