Good Clinical Outcome Research Articles

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up.

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Case series; Level of evidence, 4. Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area

Introduction: The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of patients who underwent posterior correction and fusion for thoracic hyperkyphosis, with a focus on determining the optimal distal fusion level. Methods: From 2006 to 2012, 26 patients with a median age of 16.8 years (range 14–25), diagnosed with either idiopathic hyperkyphosis or Scheuermann’s kyphosis, underwent posterior fusion and Ponte osteotomies at two medical centers. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at the final follow-up and included assessments of fusion extension, Cobb angle, sagittal balance, and the presence of junctional kyphosis or discopathy. Results: The median follow-up period was 12.3 years (range 11–17). Good clinical outcomes were observed in 24 patients, with no cases of hardware failure. The distal fusion area included the first lordotic vertebra in 17 patients, the sagittal stable vertebra in four patients, and both in five patients. Cobb angle correction was maintained at 50% at the final follow-up (p > 0.05). Significant sagittal balance correction was achieved in 87% of patients immediately postoperatively and was maintained at the final follow-up (p > 0.05). Junctional kyphosis occurred in two patients whose fusion area included only the first lordotic vertebra. Conclusions: Including at least the first lordotic vertebra in the fusion area is crucial for preventing junctional kyphosis. Extending the fusion to the stable vertebra can reduce the incidence of distal junctional kyphosis, especially in symptomatic young adult patients, potentially avoiding the need for revision surgery.

A Rare Case of Osteoblastoma of the Sacrum

Osteoblastoma (OB) is a rare bone tumor. It is classified as benign and represents about 1% of all bone neoplasms. While it typically occurs in the axial skeleton, sacral involvement is extremely rare. Despite its non-malignant nature, OB can be locally aggressive and may lead to considerable morbidity if not addressed in a timely manner. This report discusses a unique case of sacral, focusing on the clinical, radiological, and surgical features.A 14-year-old male patient reported experiencing increasing pain in his left lower limb and lumbosacral region for two years. A magnetic resonance imaging (MRI) of the lumbosacral area identified a mass measuring 50x43 mm on the left side of the sacrum in T2-weighted images. Further evaluation with a positron emission tomography/computerized tomography (PET/CT) scan indicated a destructive bone lesion in the left sacrum, measuring 43x40 mm, with a soft tissue component and increased fluorodeoxyglucose (FDG) uptake (standardized uptake value maximum: 11). The patient underwent surgical excision by a neurosurgery team, and histopathological analysis confirmed the diagnosis of OB.Although OB is a benign tumor, its location can cause significant symptoms, particularly in rare areas like the sacrum. Diagnostic imaging modalities such as MRI and PET/CT are crucial for identifying the tumor and planning surgical intervention. The elevated FDG uptake observed on PET/CT indicated a metabolically active lesion, reinforcing the need for surgical treatment.Sacral OB is an exceptionally rare entity. This case underscores the need to include OB in the differential diagnosis of sacral lesions and illustrates the value of imaging in facilitating accurate diagnosis and management. Surgical resection remains the cornerstone of treatment, offering good clinical outcomes.

Evaluation of Internal and External Hexagon Connections in Immediately Loaded Full-Arch Rehabilitations: A Multicenter Randomized Split-Mouth Controlled Trial With a 6-Year Follow-Up.

Full-arch immediate loading rehabilitations are now a widely used rehabilitation method that guarantees predictable medium- and long-term results. Numerous factors can influence its success and stability in the medium and long term. Among these the implant-abutment connection seems to play an important role, however there is still little information on which is the most suitable in this type of treatment. The aim of the present multicenter split-mouth controlled trial is to evaluate whether external hexagonal connections (EHC) and internal hexagonal connections (IHC) can influence success, bone resorption and peri-implant parameters in immediate-load full-arch rehabilitations. Twenty patients were rehabilitated with immediately loaded fixed full-arch rehabilitations. All the implants presented the same macro- and micro-topography but different implant-abutment connection. IHC were used in one randomly selected side of the jaw and EHC was used in the other side. Outcome measures were implant survival rate, peri-implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, 36, and 72-month post-loading. Technical and biological complications were recorded. In 20 patients, 43 EHC and 40 IHC implants were placed. Between 32 and 72 months of follow-up two patients withdrew (died) and no implants were lost. The cumulative survival rate (CSR) was 97.44% for EHC implants and 97.22% for IHC implants. The MBL presented a resorption of 2 mm in the EHC group and 1.9 mm in the IHC group. No statistically significant differences were found between the two groups for any of the parameters at any time. No biological or technical complications were detected between the 36th and 72nd month of follow-up. After 72 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference in the clinical outcomes.

088. Transarterial Chemoembolization for Head and Neck Cancer: Case Series

Background: Head and neck cancers represent a diverse group of malignancies arising from the complex anatomy of the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, and salivary glands. While traditional treatments like surgery, radiation, and chemotherapy remain mainstays, transarterial chemoembolization (TACE) has emerged as a potential therapeutic option, particularly for advanced or recurrent cases. We present two cases of head and neck cancer that receive TACE. Case: First Case: A 46 years old woman, with big lump on her left cheek. The patient was diagnosed with Basal Cell Adenocarcinoma T3N0M0 at right submandibular region. He has history of Docetaxel and Carboplatin 6 cycles chemotherapy. Second Case: A 51 years old man, complain a lump on his right tongue. The patient was diagnosed with Squamous Cell Carcinoma Well Differentiated at left glossus region. But no history of chemotherapy. Conclusion: Two cases with head and neck cancer in our center has good clinical outcome after receiving chemotherapy through TACE procedure. TACE is offering a targeted approach to deliver chemotherapy and induce tumor necrosis. Although, TACE is commonly used for liver cancer, but it demonstrates promising potential in improving outcomes for head and neck cancer patients in the future.

Clinical and Radiologic Comparisons Between Oblique Lumbar Interbody Fusion Combined with Percutaneous Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for Adult Isthmic Spondylolisthesis: A 2-year Follow-Up Study

Adult isthmic spondylolisthesis(AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion(OLIF) is minimally invasive technique that use a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion(TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiological outcomes of these two surgical techniques for AIS. We analyzed the details of 62patients with AIS who were treated with either OLIF(n=26) or TLIF(n=36) between 2019 and 2022, with a minimum 2-year follow-up. The two surgical techniques were compared in terms of perioperative surgical, radiological, and clinical outcomes. The correlation between the severity of foraminal stenosis and clinical outcomes was evaluated. The OLIF group experienced significantly less blood loss, shorter operative times, and shorter hospital stay than the TLIF group. Radiological assessments showed no significant preoperative differences in disc height or slippage ratios, but postoperative slippage correction was significantly greater in the OLIF group than in the TLIF group(13.5±8.0 versus 5.0±8.9; p<0.001). The clinical outcome improvement ratios did not differ significantly between the two groups. The correlation between preoperative severity of foraminal stenosis and clinical outcomes in the OLIF group was not significant. OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.

Intramedullary nailing of tibial shaft fractures in the semi-extended position using suprapatellar approach: A case series in Hong Kong

Introduction The objective of this case series is to evaluate the clinical outcome of patients with tibial shaft fractures treated by suprapatellar nailing at a 2-year follow-up and to review available literature concerning this approach. Method and material This is a retrospective single-centre case series to evaluate patients' post-operative status at 2-year intervals. Fifteen (15) patients underwent intramedullary nailing with a supra-patella approach during the year 2019–2020 and consented to participate in this case series. Patients were regularly followed up in the outpatient clinic and evaluated in terms of range of movement, walking status and radiologically with RUST score and tibia alignment. Their functional outcome was assessed by a questionnaire including OKS, VAS, and Kujula scores. Results At post-op 2 years intervals, all patients had radiologically healed fractures as evidenced by RUST score and tibia alignment within five degrees in the coronal and sagittal plane, the functional outcome of the suprapatellar approach was satisfactory in the visual analogue scale and various knee scores. All patients achieved a full range of movement and could walk unaided. Discussion Technical tricks and tips for the suprapatellar approach are discussed. Literature review showed satisfactory outcomes for intramedullary nailing for tibial shaft fracture in different parts of the world. Compared with the infra-patellar approach, the suprapatellar approach is superior in fracture alignment but has no significant difference in terms of pain, disability and range of movement. Potential risk of suprapatellar approach is discussed including possible cartilage damage and intra-articular sepsis. Conclusion There is a good clinical outcome of the suprapatellar approach to tibial nail radiologically and functionally. Results are in line with the literature review, which also showed that compared with the infra-patellar approach, the suprapatellar approach is associated with better alignment and less knee pain but no significant difference in range of movement and disability.

Comparison of the Safety of Aspirin Monotherapy and Aspirin and P2Y12 Inhibitor Combination Therapy in Patients Post Coil Embolization During Admission: A Cross-Sectional Study Using a Nationwide Inpatient Database.

Some aspects regarding the use of antiplatelet agents after coil embolization for subarachnoid hemorrhage during admission remain unclear. This study used diagnostic procedure combination (DPC) data to investigate the safety and prognostic effects of aspirin monotherapy and aspirin and P2Y12 inhibitor combination therapy on bleeding events. This cross-sectional study used Japanese DPC data to assess patients who were hospitalized with subarachnoid hemorrhage and received aspirin monotherapy and aspirin and P2Y12 inhibitor combination therapy between April 2016 and March 2020 (n = 4421). The aspirin monotherapy (A group, n = 2848) and aspirin and P2Y12 inhibitor combination therapy (AP group, n = 1573) groups were compared. The primary and secondary endpoints were the incidence of bleeding events and proportion of patients with a modified Rankin Scale (mRS) score ≤ 2 at discharge, respectively. Data was analyzed using multivariable adjusted logistic regression (significance level, 5%). The adjusted odds ratio in AP group, with A group as the reference, for bleeding events and the proportion of patients with mRS score ≤ 2 at discharge were 0.97 (95% confidence interval [95% CI]: 0.75-1.26, p = 0.839) and 1.09 (95% CI: 0.92-1.29, p = 0.302), respectively. There are no differences in the incidence of bleeding events or good clinical outcomes (mRS score ≤ 2 at discharge) between aspirin monotherapy and aspirin and P2Y12 inhibitor combination therapy.

Structured and prompt treatment of early arthritis in clinical practice leverages window of opportunity and leads to excellent clinical outcomes: an innovativeretrospective cohort study.

With this work, we evaluated the impact of the Lisbon Early ARthritis cliNic (LEARN) on untreated inflammatory arthritis clinical and patient-reported outcomes. A retrospective cohort study enrolled patients in LEARN since its inception. Patients were followed for 12months and treated to achieve disease remission. Clinical, structural, and quality of life outcomes were assessed. The early arthritis module of the Portuguese Rheumatic Diseases Registry (Reuma.pt) is described. We assessed 292 patients between 2015 and 2022. Mean symptom duration and DAS-28-4V-ESR at baseline were 6.2 ± 3.5months and 5.6 ± 1.3, respectively. Rheumatoid arthritis (56.4%; 40.1% seropositive) and psoriatic arthritis (12.4%) were the most common diagnoses. Most patients were treated with methotrexate (75.3%) combined with low-dose oral prednisolone (88.1%). At 12months, a mean ΔDAS28-4V-ESR improvement of 2.3 ± 0.4 was registered, with 29.5% and 48.9% of patients achieving remission (DAS28-4V-ESR < 2.6) or low disease activity (DAS28-4V-ESR < 3.2), respectively. Among RA patients only, these figures were 20.6% and 46.6%, respectively. A clinically meaningful functional improvement was observed in 72.1% of the patients. Structural progression was limited, affecting only 16.1% of the patients. Fatigue, anxiety, depression, and quality of life also improved substantially, translated by improvements in FACIT, HADS, EQ5D, and SF-36 scores. A structured, dedicated approach to patients with early arthritis resulted in good clinical, structural, and functional outcomes. Furthermore, our findings suggest the window of opportunity for early intervention may have implications for mental health and global well-being. Key Points • Patient assessment is facilitated by reliable electronic clinical records, such as the early arthritis module of the Rheumatic Diseases Portuguese Register (Reuma.pt) which we describe here for the first time. • Inflammatory arthritis was confirmed in the majority of patients observed, but the time to first appointment was above the recommended. • Prompt start of conventional therapy allowed significant disease activity improvement and remission to be achieved in about one-third of the patients. • Key patient-reported outcomes elucidate disease impact and confirm the benefit of early treatment initiation, suggesting a window of opportunity also for mental health and global well-being.

Comparison of Glisson traction, soft or rigid cervical collars for the treatment of acute atlantoaxial rotatory subluxation in children: a retrospective study

To examine the clinical effect of different conservative therapies (Glisson traction, soft and rigid cervical collar) in the treatment of children with acute atlantoaxial rotatory subluxation. One hundred and forty-four children with acute atlantoaxial rotatory subluxation treated conservatively at our hospital from June 2017 to June 2022 were retrospectively analyzed. The children were divided into three groups consisting of patients treated with Glisson traction (n = 37), patients treated with soft cervical collar (n = 55), and patients treated with rigid cervical collar (n = 52). Clinical and functional results were compared among the three groups. Success outcomes were achieved at the end of treatment in the Glisson traction group (94.59%, 35/37), soft cervical collar group (83.64%, 46/55), and rigid cervical collar group (92.31%, 48/52). There was no significant difference between the success rates among the three groups (P > 0.05). At the last follow-up, the overall scores based on our scoring scale for the Glisson traction, soft cervical collar and rigid cervical collar groups were 95.95 ± 6.11 (range: 75–100), 94.64 ± 6.30 (range: 75–100) and 95.00 ± 6.02 (range: 70–100), respectively. There was no significant difference in the overall scores among the three groups (P > 0.05). All three conservative therapies for the treatment of acute atlantoaxial rotatory subluxation can attain a good clinical outcome. Treatment using a cervical collar should be given priority as it does not require the child to be hospitalized. Rigid cervical collar provides good immobilization and can possibly lead to better clinical outcomes compared to a soft cervical collar.

PHARMACOLOGICAL APPROACH AND TREATMENT OF PATENT DUCTUS ARTERIOSUS

The ductus arteriosus (CA) is an important vessel responsible for redirecting blood from the right ventricle to the descending aorta in the fetus. At birth, the AC undergoes physiological stimuli, causing the vessel to constrict. Some congenital heart diseases are caused by malformations in the structures of the heart resulting in cardiovascular hemodynamic dysfunction, among them the most common is patent ductus arteriosus (PDA), which is the difficulty in closing the ductus arteriosus in newborns. The aim of this article is to scan the medical literature to gain a detailed understanding of the pathophysiology of PDA in order to develop effective diagnostic strategies and appropriate therapeutic approaches. An integrative literature review was carried out, using databases as search engines and defining descriptors in order to filter the data. Thus, the review of these articles shows a relationship between patent ductus arteriosus and gestational age, especially at gestational ages of less than 28 weeks. The prevalence is due to the structural and functional immaturity of the ductus arteriosus, which remains open to supply the fetal circulation, thus requiring intervention and effective approaches, which should follow a step-by-step protocol, capable of evolving from pharmacological treatment to surgical procedure. The choice must be compatible with the patient's clinical conditions for a good clinical outcome.

Functional Outcomes After Decompressive Surgery in Patients with Malignant Space-Occupying Cerebellar Infarction

Background and Purpose: Decompressive surgery is a potentially life-saving treatment in patients with malignant space-occupying cerebellar infarction. However, there is only limited literature on functional outcomes and complications after surgery. Our aim was to establish markers which predict poor outcome. Methods: We retrospectively analyzed data of all patients who underwent surgery due to malignant swelling of a space-occupying cerebellar infarction in our hospital between 2005 and 2023. Statistical analyses were conducted on multiple parameters to identify predictors of poor functional outcome (mRS 4–6) 90 days after surgery. Complications during hospitalization were reviewed for each patient. Results: In total, 58 patients received decompressive surgery. The 90-day mortality rate was 27.6% (n = 16). A good functional outcome (mRS 0–3) 90 days after surgery was achieved in 24 patients (41.4%). Multivariable analysis revealed multiple factors associated with a poor outcome on day 90 (mRS 4–6): a higher premorbid mRS score (OR 2.715 [95% CI, 1.166–6.323]; p = 0.021), higher NIHSS score on admission (OR 1.088 [95% CI, 1.014, 1.168]; p = 0.019) and the presence of an additional brainstem infarction (OR 7.035, [95% CI, 1.255, 39.424], p = 0.027). Hyperactive delirium was associated with good clinical outcome (OR 0.020 [95%CI, 0.001–0.623]; p = 0.026). Aspiration pneumonia (n = 22, 37.9%), urinary tract infection (n = 15, 25.9%), and hyperactive delirium (n = 8, 13.8%) were the most common complications during hospitalization. Conclusions: Decompressive surgery is a safe, life-saving treatment for malignant space-occupying cerebellar infarction. Higher premorbid mRS, higher NIHSS score on admission and the presence of brainstem infarction are associated with a poor functional outcome.

Successful surgical repair of aortic root rupture during transcatheter aortic valve implantation: a case report

BackgroundAortic root rupture is a rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI). Herein, we report a case of aortic root rupture during TAVI that was successfully managed with partial aortic root repair and aortic valve replacement.Case presentationAn 83-year-old woman with severe bicuspid aortic stenosis underwent transfemoral TAVI using a 26 mm SAPIEN 3 Ultra RESILIA valve. Soon after valve implantation, transesophageal echocardiography detected pericardial effusion, which was accompanied by immediate hemodynamic instability. Subxiphoid pericardial drainage was performed, and extracorporeal membrane oxygenation was promptly initiated. Owing to the eruptive hemorrhage, we converted to open-heart surgery. Direct visualization enabled the detection of the aortic root rupture and the performance of partial aortic root repair using bovine pericardium and aortic valve replacement using a 19 mm INSPIRIS RESILIA valve. The patient was transferred to a different hospital 60 days after surgery without complications and is currently doing well as an outpatient.ConclusionsIn the present case, prompt treatment decisions and smooth cooperation among the institutional heart team led to the successful repair of aortic root rupture during TAVI and good clinical outcomes.

A prospective review of laparoscopic common bile duct exploration with nephroscope and primary closure without T tube

Background: Here we present a pioneering laparoscopic method for common bile duct (CBD) stone management, evaluating its practicality, safety, and effectiveness when employing a nephroscope and omitting the placement of a T tube. Methods: We have prospectively collected data from 100 patients who underwent exclusive CBD laparoscopic CBD exploration (LCBDE) along with/without laparoscopic cholecystectomy diagnosed to have Cholelithiasis with choledocholithiasis with a radiological CBD diameter of 10mm or more. Mortality, morbidity, hospital stay, and average duration of hospital stay were all assessed. Results: In this prospective series 100 patients underwent the procedure, of which we had no mortality, of the 100 patients, 4 patients (4%) had bile leak i.e., bile output of more than 100 ml n drain, and 2 patients (2%) needed endoscopic retrograde cholangiopancreatography (ERCP) and stenting. The other 2 patient’s leak settled by itself without any interventions. One patient (1%) was diagnosed to have sepsis post LCBDE which also required a prolonged stay of 7 days for antibiotics. Conclusions: LCBDE offers good clinical outcomes in dealing with CBD stones. Surgeons experienced in laparoscopy can perform this procedure securely and efficiently.

Arterial floating mural thrombi are a characteristic imaging pattern in SARS-CoV-2-related ischemic stroke.

Acute ischemic stroke (AIS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to explore neurovascular imaging patterns in patients with SARS-CoV-2-related AIS. We retrospectively analyzed clinical and radiological data of patients hospitalized with AIS and a positive PCR test for SARS-CoV-2 prior to AIS onset. The control group comprised of AIS patients from a pre-COVID-19 pandemic period matched for gender and age. Thirty-five SARS-CoV-2-related stroke patients, and 35 controls were included. Fifty-seven percent of SARS-CoV-2 patients had either mild or asymptomatic disease. A distinctive imaging pattern of floating arterial mural thrombus was detected in 5 patients of the SARS-CoV-2 group. In 4 patients thrombus was attached to a stenotic atherosclerotic plaque in the proximal internal carotid artery. In the 5th patient a cardiac CTA showed multiple floating thrombi in the descending aorta. In the control group, floating thrombus was only detected in one patient. Treatment with dual antiplatelet therapy was associated with thrombus dissolution and good clinical outcome. Patients with floating thrombi had a longer time from SARS-CoV-2 diagnosis to stroke onset (mean 7.4 versus 3.4 days). Floating arterial mural thrombi attached to atherosclerotic plaques are unique characteristic source of AIS in SARS-CoV-2 patients. They may lead to ischemic stroke in patients with mild or asymptomatic infection up to 1-2 weeks from SARS-CoV-2 diagnosis. Patients with embolic AIS and SARS-CoV-2 diagnosis should perform high resolution cranio-cervical vascular imaging to evaluate floating thrombi as a potential embolic source.

How to determine the course of preoperative chemotherapy for spinal tuberculosis: A single-center clinical study.

This study aims to explore the clinical efficacy and feasibility of preoperative 1-week chemotherapy for patients with spinal tuberculosis (STB) undergoing complete lesion removal. Clinical data of 76 patients with STB who underwent complete focal debridement in our hospital were collected from June 2020 to September 2023. The patients were divided into 38 cases of preoperative 1-week chemotherapy group (Group A) according to the length of preoperative chemotherapy, and 38 cases of preoperative 2 to 4-week chemotherapy group (Group B). Perioperative related, imaging, and laboratory examination indices as well as postoperative neurological function recovery, postoperative pain recovery, related complications, and clinical efficacy were analyzed to compare the clinical efficacy of the 2 groups. All patients successfully completed the treatment of stage I complete lesion removal combined with bone grafting fusion and internal fixation. The difference in erythrocyte setting rate and C-reactive protein at the same postoperative observation time between the 2 groups was not statistically significant (P > .05). The visual analogue scale scores of patients in the 2 groups decreased significantly with prolonged time, and the difference was statistically significant (P < .05). All patients achieved satisfactory clinical efficacy (P < .05). All patients achieved good clinical outcomes, the difference between the groups was not statistically significant (P > .05). The difference in incision healing rate at 3 months postoperatively and bone graft fusion rate at 6 months postoperatively was not statistically significant between the 2 groups (P > .05). The dissemination and recurrence of Mycobacterium tuberculosis were not statistically significantly different between the 2 groups after surgery (P > .05). In summary, with complete lesion clearance, 1 week of preoperative chemotherapy is feasible in patients with STB with varying degrees of neurological dysfunction.

Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis.

The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)]. In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.

Androgen production, uptake, and conversion (APUC) genes define prostate cancer patients with distinct clinical outcomes.

BACKGROUNDProstate cancer (PC) is driven by aberrant signaling of the androgen receptor (AR) or its ligands, and androgen deprivation therapies (ADTs) are a cornerstone of treatment. ADT responsiveness may be associated with germline changes in genes that regulate androgen production, uptake, and conversion (APUC).METHODSWe analyzed whole-exome sequencing (WES) and whole-transcriptome sequencing (WTS) data from prostate tissues (SU2C/PCF, TCGA, GETx). We also interrogated the Caris Precision Oncology Alliance (POA) DNA (592-gene/whole exome) and RNA (whole transcriptome) next-generation sequencing databases. Algorithm for Linking Activity Networks (ALAN) was used to quantify all pairwise gene-to-gene associations. Real-world overall survival was determined from insurance claims data using Kaplan-Meier estimates.RESULTSSix APUC genes (HSD3B1, HSD3B2, CYP3A43, CYP11A1, CYP11B1, CYP17A1) exhibited coalescent gene behavior in a cohort of metastatic tumors (n = 208). In the Caris POA dataset, the 6 APUC genes (APUC-6) exhibited robust clustering in primary prostate (n = 4,490) and metastatic (n = 2,593) biopsies. Surprisingly, tumors with elevated APUC-6 expression had statically lower expression of AR, AR-V7, and AR signaling scores, suggesting ligand-driven disease biology. APUC-6 genes instead associated with the expression of alternative steroid hormone receptors, ESR1/2 and PGR. We used RNA expression of AR or APUC-6 genes to define 2 subgroups of tumors with differential association with hallmark pathways and cell surface targets.CONCLUSIONSThe APUC-6-high/AR-low tumors represented a subgroup of patients with good clinical outcomes, in contrast with the AR-high or neuroendocrine PCs. Altogether, measuring the aggregate expression of APUC-6 genes in current genomic tests identifies PCs that are ligand (rather than AR) driven and require distinct therapeutic strategies.FUNDINGNCI/NIH 1R37CA288972-01, NCI Cancer Center Support P30 CA077598, DOD W81XWH-22-2-0025, R01 CA249279.

Hallux Extensus as a Rare Complication of Crural Fracture and Its Surgical Treatment

Hallux extensus is a persistent dorsiflexion of the first metatarsophalangeal joint. Apart from many other causes, it can also be caused by contracture of the extensor hallucis longus muscle, in our case resulting from surgical treatment of crural fracture. The authors present the case of a 17-year-old soccer player who sustained a fracture of both shin and calf bone during a soccer match and underwent surgical treatment with intramedullary nailing. While compartment syndrome wasn't observed, a postoperative complication in the form of progressive development of a dynamic type of hallux extensus was reported. The reason behind this complication was later found to be the interaction of the osteosynthesis material with the extensor hallucis longus muscle, which led to its scarring and shortening. A Z-lengthening of the musculus extensor hallucis longus tendon was indicated and performed with a good clinical outcome. During surgery, an anatomical variation in the course of the extensor hallucis longus was observed, which had to be taken into account to achieve a successful surgical outcome. Key words: cock-up big toe deformity, musculus extensor hallucis longus contracture, Z-lengthening tenotomy, crural fracture complication.

Combination of nusinersen and rehabilitation using hybrid assistive limb for type 3 spinal muscular atrophy

AbstractAn antisense oligonucleotide drug nusinersen can improve motor function of spinal muscular atrophy (SMA) patients. The Hybrid Assistive Limb (HAL) is a wearable robot assisting the wearers' movements in real time. Gait rehabilitation using HAL is useful for SMA. However, the efficacy of combined treatment has never been reported before. We have investigated the efficacy of combining both therapies. A 21‐year‐old man, genetically diagnosed with type 3 SMA, was treated by combining nusinersen and five sessions of gait rehabilitation using HAL over 2 years. Hammersmith Functional Motor Scale‐Expanded (HFMSE) score improved by 12 points after treatment. Electrophysiological parameters of the tibial nerves improved. Muscle volume also increased by 8% at 39 months. The combined therapy resulted in a good clinical outcome. This may be due to promotion of nerve regeneration and recovery of muscle volume by a synergy of nusinersen and motor learning correctly guided by HAL.