Neural Complications Research Articles

Effect of intranasal insulin on perioperative cognitive function in older adults: a randomized, placebo-controlled, double-blind clinical trial.

Postoperative cognitive impairment are common neural complications in older surgical patients and exacerbate the burden of medical care on families and society. A total of 140 older patients who were scheduled for elective orthopaedic surgery or pancreatic surgery with general anaesthesia were randomly assigned to Group S or Group I with a 1:1 allocation. Patients in Group S and Group I received intranasal administration of 400μL of normal saline or 40IU/400μL of insulin, respectively, once daily from 5minutes before anaesthesia induction until 3days postoperatively. Perioperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B) at 1day before and 3days after surgery and postoperative delirium (POD) incidence was assessed using the 3-minute Diagnostic Interview for CAM (3D-CAM) on postoperative days 1-3. Serum levels of interleukin-6 (IL-6), tumour necrosis factor α (TNF-α), S100-β and C-reactive protein (CRP) were measured on the first day after surgery. Insulin treatment significantly increased postoperative MMSE and MoCA-B scores in group I than in group S (P < 0.001, P = 0.001, respectively), decreased the incidence of POD within the 3-day postoperative period in Group I than in Group S (10.9% vs 26.6%, P = 0.024), and inhibited postoperative IL-6 and S100-β levels in Group I compared to Group S (P = 0.034, P = 0.044, respectively). Intranasal insulin administration is thus suggested as a potential therapy to improve postoperative cognition in older patients undergoing surgery. However, a more standardized multi-centre, large-sample study is needed to further validate these results.

Percutaneous Cannulation of the Axillary Artery: Does the Position of the Brachial Plexus Correlate With Bony Landmarks That Could Be Used to Reduce the Risk of Complications?

Introduction Endovascular surgery is an innovative way of carrying out procedures such as transcatheter aortic valve insertion where the femoral artery is commonly used as an access point. Conditions like peripheral arterial disease can make endovascular procedureschallenging when atherosclerotic plaques compromise the integrity of lower limb vessels. An alternativeaccess point for these patients isrequired. Access through the axillary artery has been proposed; however, the close proximity of the brachial plexus introduces a risk of neural complications. This study aims to find an anatomical or bony landmark(s) to help identify an area of safety on the axillary artery that can be used to gain access. Materials and methods Nine cadavers were used in the study and five parameters were measured using the acromion and coracoid processes as bony landmarks. The 1st parameter measured the distance between the acromion and the coracoid process. The 2nd parameter was the diameter of the axillary artery taken at a plane extending from the acromion to the coracoid process - now defined as the coracoacromial plane. The 3rd measurement was the distance between the coracoid process and the midpoint of the axillary artery diameter taken at the above plane; it is proposed this will form a safe point on the axillary artery. The 4th parameter measured was the distance between the safe point on the axillary artery and the median nerve. The 5th parameter was the distance between the safe point and the thoracoacromial trunk. Measurements were taken using digital callipers and were recorded for both sides of the cadaver except for one. Using the data from the measurements, an area of safety was calculated and statistical analysis was carried out using Student's t-test and Pearson's correlation to look for significant differences between the left and right sides. Results The mean distance from the safe point of the axillary artery to the median nerve was 23.25 mm on the left and 27.10 mm on the right. The p-value was 0.7, which indicated no significant differences between both sides. The mean distance between the safe point and the thoracoacromial trunk was 11.31 mm on the left and 13.21 mm on the right. The p-value was 0.24, indicating no significant differences between both sides. The mean area of safety was larger on the right side with an area of 184.37 mm and smaller on the left side with an area of 158.93 mm. The p-value was 0.62, which indicated no significant differences between both sides. There was no clear relationship between the distance from the acromion to the coracoid process compared to the distance between the acromion and a defined safe point on the axillary artery. This was confirmed using a Pearson's correlation test, which resulted in a p-value of 0.53 on the left and 0.93 on the right. These values were above the critical value, suggesting no correlation. Conclusion The acromion and the coracoid process are important bony landmarks that can be used to define the coracoacromial plane that traverses the axillary artery whereby avoiding the cords of the brachial plexus, the median nerve as well as the thoracoacromial trunk. Implementing this approach to define a safe vascular access point on the axillary artery could minimise complications like brachial plexus injuries. Further studies on a larger sample size using radiological methods may need to be carried out to help increase confidence in these preliminary cadaveric findings.

Comparison of Single or Double Titanium Mesh Cage for Anterior Reconstruction After Total En Bloc Spondylectomy for Thoracic and Lumbar Spinal Tumors.

To compare the clinical efficacy of anterior column reconstruction using single or double titanium mesh cage (TMC) after total en bloc spondylectomy (TES) of thoracic and lumbar spinal tumors. A retrospective cohort study was performed involving 39 patients with thoracic or lumbar spinal tumors. All patients underwent TES, followed by anterior reconstruction and screw-rod instrumentation via a posterior-only procedure. Twenty-two patients in group A were treated with a single TMC to reconstruct the anterior column, whereas 17 patients in group B were reconstructed with double TMCs. The overall follow-up is 20.5 ± 4.6 months. There is no significant difference between the 2 groups regarding age, sex, body mass index, tumor location, operative time, and intraoperative blood loss. The time for TMC placement was significantly shortened in the double TMCs group (5.2 ± 1.3 minutes vs. 15.6 ± 3.3 minutes, p = 0.004). Additionally, postoperative neural complications were significantly reduced with double TMCs (5/22 vs. 0/17, p = 0.046). The kyphotic Cobb angle and mean intervertebral height were significantly corrected in both groups (p ≤ 0.001), without obvious loss of correction at the last follow-up in either group. The bone fusion rates for single TMC and double TMCs were 77.3% and 76.5%, respectively. Using 2 smaller TMCs instead of a single large one eases the placement of TMC by shortening the time and avoiding nerve impingement. Anterior column reconstruction with double TMC is a clinically feasible, and safe alternative following TES for thoracic and lumbar tumors.

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Modification of Conventional Antrostomy, A Retrospective Review.

Introduction: Maxillary sinus pathology is commonly approached through endoscopic middle meatal antrostomy (MMA). However, MMA does not provide full exposure to certain aspects of the maxillary sinus, such as alveolar, zygomatic, and prelacrimal recesses. In these hidden maxillary sinus niches, a combination approach with MMA is required for better exposure and access. In this article, we present a modification of inferior maxillary antrostomy (IMA) to allow for a temporary intraoperative window with no significant postoperative consequences. Objectives: (1) To describe our modification of IMA. (2) To report the outcome of maxillary sinus disease, postoperative complications, and flap condition. Methods: This is a retrospective chart review study. It was performed on 20 patients where submucosal temporary inferior maxillary antrostomy (STIMA) was indicated in the period from January 1, 2020, and July 1, 2023. All patients were assessed for their demographics, diagnosis, indication for STIMA, maxillary disease outcome, presence of postoperative complications, and flap condition. Result: Total of 18 patients fulfilled our inclusion/exclusion criteria; of them, 13 were males while the remaining were females. Mean age of patients was 33 years; most common diagnosis was chronic sinusitis. Status of maxillary sinus mucosa was healthy in all except 4 patients having polypoidal mucosa while flap condition was intact in all patients except 2 patients with pinpoint defects. Postoperative complications assessment demonstrated no neural, orbital, lacrimal, or dental complications in all patients. Conclusion: This retrospective chart review showed promising technique to address challenging maxillary lesions in difficult-to-access locations where combined approaches are necessary.

Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2.

Our aim was to compare the costs and efficacy of ambroxol in combination with imiglucerase with the costs and efficacy of imiglucerase only in the treatment of Gaucher disease type 2 (GD2) in the socio-economic settings of the Republic of Serbia, an upper-middle-income European economy. The perspective of the Serbian Republic Health Insurance Fund was chosen for this study, and the time horizon was 6 years. The main outcomes of the study were quality-adjusted life years gained with ambroxol + imiglucerase and comparator, and direct costs of treatment. The study was conducted through the generation and simulation of the Markov chain model. The model results were obtained after Monte Carlo microsimulation of a sample with 1,000 virtual patients. Treatment with ambroxol in combination with imiglucerase was cost-effective when compared with imiglucerase only and was associated with positive values of net monetary benefit regardless of the onset of the disease. Such beneficial result for ambroxol and imiglucerase combination is primarily driven by the low cost of ambroxol and its considerable clinical effectiveness in slowing the progression of neural complications of GD2. If ambroxol and imiglucerase are used in combination for the treatment of GD2, it is more cost-effective than using imiglucerase alone.

Comparative Analysis of Uniportal and Biportal Endoscopic Transforaminal Lumbar Interbody Fusion in Early Learning Stage: Technical Considerations and Radiological Outcomes

Objective: This study compared the clinical and radiological outcomes of uniportal endoscopic and biportal endoscopic transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative disease during the early learning stage of the technique.Methods: We retrospectively analyzed patients who underwent uniportal endoscopic TLIF (n=15) and biportal endoscopic TLIF (n=19) between January and October 2021 during the first year of adoption of these techniques. Radiological parameters, including Bridewell fusion and subsidence grading, were evaluated by x-ray and computed tomography (CT) at 3-month, 6-month, and 1-year follow-up visits. Clinical outcomes were evaluated using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI).Results: Uniportal endoscopic TLIF showed significantly higher frequencies of intraoperative endplate injuries (uniportal [20%] vs. biportal [0%], p=0.01) and 1-year cage subsidence (uniportal [60%] vs. biportal [26.3%], p=0.04) than biportal endoscopic TLIF. The 1-year fusion rates did not differ significantly between the 2 surgical groups (uniportal [93.3%] vs. biportal [89.5%], p=0.37). Neural complications such as postoperative dysesthesia and dural tears occurred in uniportal endoscopic TLIF. There were no significant differences in the VAS for back and leg pain or ODI.Conclusion: Complete endplate preparation under endoscopic guidance improved interbody fusion, and this procedure may be feasible in the early learning stage, regardless of the type of endoscope. Both endoscopic TLIF techniques achieved good clinical outcomes and fusion rates. However, unskilled use of the cage guide device caused endplate breakage and neural injury during uniportal endoscopic cage insertion. Uniportal endoscopic TLIF may require more experience for appropriate cage insertion.

Effectiveness of Tactile and Kinaesthetic Stimulation on Hyperbilirubinemia: A Feasibility Study

Introduction: Neonatal hyperbilirubinemia is common among newborns, often necessitating hospitalisation and posing a risk of neural complications. Phototherapy, commonly used to treat hyperbilirubinemia, also has side effects, including eye and genital harm, dehydration, diarrhoea, and bronze baby syndrome. Therefore, there is a need to find alternatives or reduce treatment duration. Aim: To investigate the efficacy of tactile and kinaesthetic stimulation as adjunctive therapies with phototherapy for reducing bilirubin levels in preterm neonates with hyperbilirubinemia. Materials and Methods: A randomised controlled feasibility study, including 12 preterm neonates with hyperbilirubinemia, was conducted in the Neonatal Intensive Care Unit (NICU) of a Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Mullana, Ambala, India. The experimental group (n=6) received three sessions of tactile and kinaesthetic stimulation for 15 minutes per session alongside phototherapy, compared to a control group (n=6) receiving phototherapy alone for three days. Results: While no significant differences (p&gt;0.05) in demographics of neonates were observed, both groups experienced significant reductions (p&lt;0.001) in Total Serum Bilirubin (TSB) and Transcutaneous Bilirubin (TCB) levels, with change scores of 7.88±2.29 (TSB experimental), 7.84±2.85 (TSB control), 6.63±2.77 (TCB experimental), and 6.27±1.92 (TCB control). However, the change in mean levels of TSB and TCB was not significantly different when compared between the two groups (p&gt;0.05). Conclusion: There were significant reductions in TSB and TCB levels from Day 1 to Day 3 within each group. Both interventions were equally effective in reducing the bilirubin levels in the neonates.

Safety of the modified posteromedial approach in complex ankle fractures: Comparative analysis versus posterolateral access

IntroductionThe aim of the study was to evaluate the safety of the modified posteromedial approach (MfPM) in the surgical management of complex ankle fractures in terms of local complications. MethodsRetrospective multicenter review of a series of malleolar fractures surgically treated by posterior ankle approaches between 2016 and 2022. Two approaches were used. In the MfPM group patients were placed in a prone position and the incision was made 1 cm medially to the Achilles tendon. In the posterolateral access (PL) group patients were placed in a prone or lateral decubitus position and the incision was made between the lateral malleolus and the Achilles tendon. Complications evaluated were divided into wound complications, infections, neuritis, vascular alterations and others. Results81 ankle fractures with a posterior malleolar fragment treated by open reduction and internal fixation were identified. 20 cases were approached through the MfPM approach and 61 through the PL access. The mean follow up was 18.60 months (range 4–78 months). In the MfPM group the local complication rate was 10% (2/10 patients), both corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. In the PL group a complication rate of 8,19% (5/61 patients) was found, all of them corresponding to minor wound problems which required no surgical intervention. No infection or other neural or vascular complications were found. There were no significant differences between the two approaches regarding postoperative local complications (z score 0.249 - P: 0.803). ConclusionThe MfPM approach is safe and may become as readily used as the PL due to the low incidence of postoperative local complications, especially in fractures with a large fragment and posteromedial extension in which greater access to the posterior pilon can facilitate instrumentation for anatomic reduction and fixation.

Central myelin dysfunction bridges obesity and neurological diseases

The central nervous system (CNS) relies on myelin for proper functioning. Myelin remodeling is a risk factor for neurometabolic and endocrine malfunction, resulting in cognitive decline and heightened susceptibility to neurological diseases. The plasticity of myelin upon nutrient shifts may lead to dietary and hormonal interventions for preventing and treating neural complications.

Baker's cyst: etiopathogenesis, clinical picture, differential diagnosis of complications: A review

Bakers cyst (BC) is a common condition and can be caused by both inflammatory and non-inflammatory disorders. Small BCs are usually asymptomatic and accidentally revealed. Large BCs present with pain and discomfort in the posterior knee as well as certain limitations of mobility. Large BCs may rupture resulting the fluid efflux down into the calf, which in turn presents with acute pain and number of potential thrombotic and neural complications. On another note, BC rupture requires differentiation with some urgent conditions such as venosus or arterial thrombosis, soft tissue infections etc. In this article we present some aspects of the etiopathogenesis, clinical signs and course of the BC. We also discuss the problematic issues of assessment and diagnostic work-up in case of BC ruptures.

Innate immune responses in Behçet disease and relapsing polychondritis.

Behçet disease (BD) and relapsing polychondritis (RP) are chronic multisystem disorders characterized by recurrent flare-ups of tissue inflammation. Major clinical manifestations of BD are oral aphthae, genital aphthous ulcers, skin lesions, arthritis, and uveitis. Patients with BD may develop rare but serious neural, intestinal, and vascular complications, with high relapse rates. Meanwhile, RP is characterized by the inflammation of the cartilaginous tissues of the ears, nose, peripheral joints, and tracheobronchial tree. Additionally, it affects the proteoglycan-rich structures in the eyes, inner ear, heart, blood vessels, and kidneys. The mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome is a common characteristic of BD and RP. The immunopathology of these two diseases may be closely related. It is established that the genetic predisposition to BD is related to the human leukocyte antigen (HLA)-B51 gene. Skin histopathology demonstrates the overactivation of innate immunity, such as neutrophilic dermatitis/panniculitis, in patients with BD. Monocytes and neutrophils frequently infiltrate cartilaginous tissues of patients with RP. Somatic mutations in UBA1, which encodes a ubiquitylation-related enzyme, cause vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome (VEXAS) with severe systemic inflammation and activation of myeloid cells. VEXAS prompts auricular and/or nasal chondritis, with neutrophilic infiltration around the cartilage in 52-60% of patients. Thus, innate immune cells may play an important role in the initiation of inflammatory processes underlying both diseases. This review summarizes the recent advances in our understanding of the innate cell-mediated immunopathology of BD and RP, with a focus on the common and distinct features of these mechanisms.

105-OR: Omega-3 Polyunsaturated Fatty Acids in the Treatment of Diabetic Peripheral Neuropathy—Is the Source Important?

Introduction: We have shown that omega-3 polyunsaturated fatty acids (PUFA) derived from fish oil (FO) was an effective treatment for diabetes vascular and neural complications. However, is FO the best source of omega-3 PUFA for treating diabetic peripheral neuropathy (DPN)? Methods: To address this question we used a rat model of type 2 diabetes and a late intervention protocol. After 10 weeks of hyperglycemia, diabetic rats were treated for 12 weeks via diet with omega-3 PUFA derived from a variety of sources including menhaden (fish) oil (MO), krill oil (KO), oils derived from algae that produce primarily eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or combination of EPA and DHA, or commercial ethyl esters of EPA, DHA or combination of EPA and DHA. Primary endpoints were motor (MNCV) and sensory (SNCV) nerve conduction velocity, intraepidermal and cornea nerve fiber density, thermal and cornea sensitivity, and vascular reactivity of epineurial arterioles that provide circulation to the sciatic nerve. The omega-3 index, and serum fatty acid levels were also determined. Results: The dose of each omega-3 PUFA supplement was customized to create a healthy omega-3 index. Defined as the sum of EPA and DHA as a percentage of total fatty acids in red blood cells, range for healthy level 8 - 12%. Following 22 weeks of untreated diabetes neural and vascular endpoints were significantly impaired compared to control rats. Treatment with MO provided the greatest improvement for all neural endpoints followed by KO and algal oils or ethyl esters containing a combination of EPA and DHA. Algal oil or ethyl ester of EPA alone was the least effective. The greatest improvement in vascular reactivity of epineurial arterioles to acetylcholine was realized following treatment with MO with less benefit from the other omega-3 PUFA sources. Conclusion: These pre-clinical studies suggest that in a clinical trial for DPN the best outcome may be obtained by using FO as the source for omega-3 PUFA. Disclosure M.A.Yorek: Consultant; Novo Nordisk. Funding U.S. Department of Veterans Affairs (RX003826-01)

141-LB: Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (rt-CGM) vs. Intermittent-Scanning Continuous Glucose Monitoring (is-CGM) from a U.S. Payer Perspective in Patients with Type 2 Diabetes on Multiple Daily Injections of Insulin (PwT2D on MDI)

Diabetes management for PwT2D on MDI requires access to timely glucose readings to inform treatment decisions and avoid acute events like severe hypoglycemia (SHE) and Diabetic Ketoacidosis (DKA). CGM systems have different features that can impact glycemic outcomes and disease complications and costs. There is a gap in the literature on the cost-effectiveness of rt-CGM vs is-CGM systems. We conducted lifetime projections of disease outcomes and costs from a US payer perspective using the IQVIA Core Diabetes Model v9.5+. Cohort characteristics and clinical inputs were sourced from the DIAMOND T2D and REPLACE RCTs. Applying Bucher's adjusted indirect comparison method resulted in an HbA1c effect of -0.33 favoring rt-CGM, SHE incidence rates of 0.014 and 0 Per Person-Year (PPY) for is-CGM and rt-CGM, respectively, and DKA rates were estimated using Time-Above-Range (0.0313 and 0 PPY, respectively). The cost of both CGM systems is based on Medicare pricing and 80% reimbursement (HCPCS code A4239). A utility for fear of hypoglycemia (FoH) reduction was applied from the ALERTT1 RCT. The model associates rt-CGM use with reduced eye (-5.64%), renal (-7.42%), neural (-4.08%), and cardiovascular (-2.56%) complications compared to is-CGM. It projects rt-CGM users to have higher quality-adjusted life years (QALYs) by 0.454 with cost savings of -$1,355, and an incremental cost-effectiveness ratio of -$2,983/QALY. Rt-CGM remained cost-effective under the $50,000 willingness-to-pay threshold even when its cost was increased by 70% (+$1,713). Scenario analysis with 50% lower FoH utility, SHE, and DKA rates reduced QALYs gained to 0.264. Our analysis suggests that rt-CGM is cost-saving and cost-effective vs is-CGM in PwT2D on MDI in the US and can inform US payers of the economic value of different CGM systems. Disclosure H. Alshannaq: Employee; Dexcom, Inc., Other Relationship; Vertex Pharmaceuticals Incorporated. G. J. Norman: Employee; Dexcom, Inc. P. M. Lynch: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.

Amiodarone-induced blue man syndrome: a case report

BackgroundAmiodarone is one of the most commonly used and effective antiarrhythmic drugs to treat ventricular and supraventricular arrhythmias. Besides its advantages, this drug has side effects like liver, digestive, pulmonary, thyroid, neural, skin, optical, hematologic, psychiatric, and cardiac complications. Blue-gray cutaneous discoloration, also known as blue man syndrome, is an undesirable and unusual side-effect of chronic amiodarone therapy in less than 3% of patients.Case presentationThis report presents a 51-year-old Caucasian man treated for the past 3 years with amiodarone and implantable cardioverter defibrillators due to his ventricular arrhythmia and cardiomyopathy, without any follow-up visit to his doctor. He was referred to the medical center for blue-gray discoloration on his nose and cheeks, which had started to appear in the last 3 weeks.ConclusionConsidering the findings obtained in this report and the numerous side effects of amiodarone, the blue-man syndrome is a rare yet important finding of this drug which may influence the patient’s daily life. It is recommended that all patients under treatment with this drug be notified about its side effects and visit their doctors regularly. Regarding the high therapeutic value of this drug, the lack of any association between blue man syndrome and other complications, and the related aesthetic problems, the role of the caregiver becomes much more critical in the prescription of amiodarone.

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes.

Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes. A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in en bloc removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score. Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in en bloc decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed. The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries.

The analysis of the main contributing factors for the increasing trend of Diabetes Type 2, diabetes morbidity and mortality trends in England, 2017-2022.

Background and aim: Diabetes Type 2 is a non-communicable disease which is characterized by chronic hyperglycaemia and disruption of metabolism. A poor management of diabetes leads to serious cardiovascular and neural complications. The prevalence of Diabetes Type 2 is increasing globally; in the United Kingdom, the number of people living with a diabetes increased by more than 100,000 from 2018 to 20191. In 2019, 3,9 million people had diagnosis of diabetes, and predictions are that this number will increase to 5,3 million in 2025. The aim of this research is to examine the main contributing factors and their influence on the prevalence of Diabetes Type 2 among people aged 17+ in England based on the routine epidemiological data for 2017-2022 years. Additionally, this research will analyze trends for hospital admissions with the diagnosis of Diabetes Type 2 and diabetes mortality statistics. Methods: The Pearson’s and the Spearman’s correlation analyses are used to investigate possible associations, their strength, monotonicity and direction between the prevalence of diabetes, deprivation, low physical activity, obesity and density of fast food outlets. Stratified random sampling of 153 England counties &amp; unitary authorities (the division of 2017) are used for the statistical analysis. A comparative analysis is used to analyze trends for hospital admissions with the diagnosis Diabetes Type 2 and diabetes mortality statistics. Descriptive statistics and quantitative analysis of secondary routine numerical data collected by the National Health Service Digital, the National Health Survey and the Office for Health Improvement &amp; Disparities is used. Findings: The analysis revealed positive correlations between the prevalence of diabetes and indicators of deprivation, obesity, low physical activity. In general, diabetes, obesity and physically inactive adults are more prevalent in counties with higher deprivation score. The strong positive correlation was found between density of fast food outlets and deprivation; the analysis of mean values indicated a positive linear relationships between obesity, diabetes indicators and density of fast food outlets. The comparative analysis revealed an upward trend for both, hospital admissions with the diagnosis Diabetes Type 2 and diabetes mortality. Conclusion: In conclusion, analysis based on 80 counties &amp; unitary authorities of England indicated that the main contributing factors for the increasing trend of Diabetes Type 2 can be the increasing prevalence of overweight and obese adults, low physical activity and deprivation. Additionally, the analysis demonstrated that the availability and abundance of fast food outlets, especially in more deprived deciles of England are closely associated with obesity and indirectly with the prevalence of Diabetes Type 2. Additionally, an increasing trend in the prevalence of Diabetes Type 2 is accompanied by a similar growth of hospital admissions with the diagnosis of Diabetes Type 2 and diabetes mortality.

Role of high resolution ultrasonography in leprosy

Background: Ultrasonography is a safe and cost-effective modality to assess gross morphological changes in nerves non-invasively. Early diagnosis will allow the early institution of therapy and arrest the progression of the disease thus, helping in decreasing disabilitygrading. Aims and Objectives: The aim of the study was to assessing the role of high resolution ultrasonography (HRUS) in leprosy. The objectives of the study were to detect sonographic changes in nerves in leprosy patients, and to detect neural complications by sonography in leprosy patients. Materials and Methods: The study was conducted over 18 months from the year 2020–2021 at ‘Teerthanker Mahaveer Medical College and Research Centre, Moradabad. A total of 37 patients were included in our study. HRUS was performed on the bilateral ulnar nerve (UN), median nerve (MN), radial nerve (RN), lateral popliteal (LPN) nerve, and posterior tibial nerve (PTN) to see the following parameters: Nerve thickening, echogenicity, color flow, and abscess. Results: The UN was most frequently involved followed by the PTN, MN, LPN, and RN. Diagnostic performance of HRUS for echogenicity was good with sensitivity, positive predictive value, and accuracy and was observed as 91.17%, 100%, and 91.17%, respectively. Conclusion: HRUS has several benefits in leprosy scanning; it is a reliable and non-invasive method of assessing alternations in the nerve at sites that may be difficult to be biopsied for histology.

L4 Corpectomy: Surgical Approaches and Mitigating the Risk of Femoral Nerve Injuries

Because of the challenging anatomic location, corpectomies are performed less often at the fourth lumbar vertebral body than at other levels. Our objective was to review the literature of L4 corpectomy and anterior column reconstruction. A literature search in the Medline/PubMed database was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify all relevant cases and cases series describing corpectomies of the L4 vertebral body using "lumbar" AND "corpectomy" as search terms. We present an illustrative case to describe the technique. We identified 18 articles with 30 patients who met the search criteria. Including our case illustration, the most common approach used was the lateral retroperitoneal approach (n= 17, 54.8%), of which 8 (26.7%) were performed via a transpsoas approach. Seven (23%) patients underwent corpectomy through a posterior approach, 4 (12.9%) through an anterior retroperitoneal approach, and 3 (10%) through combined anterior and lateral retroperitoneal. The overall complications rate was 19.3% including 1 case each of femoral nerve injury and iatrogenic lumbar nerve root injury. Corpectomies of the L4 vertebral body are challenging. None of the various approaches described clearly demonstrates any superiority in mitigating the risk of neural complications. Decision making about which surgical approach to use should be based on patient-specific characteristics.

Application of 3D printing individualized guide plates in percutaneous needle biopsy of acetabular tumors.

Objective: The objective of the study was to investigate the effectiveness of applying the individualized guide plate which is based on digital image processing and 3D printing technology to percutaneous needle biopsy of periacetabular tumor. Methods: From July 2017 to August 2019, 11 patients (5 males and 6 females, aged 13–70 years, mean 42.3 years) with acetabular tumors diagnosed by needle biopsy in our hospital were enrolled in this retrospective study. Preoperative CT and MRI enhancement examination were performed routinely, and the DICOM data were collected and imported into Medraw Print software. According to the specific anatomical morphology of acetabula, this study adopted the reverse calculation and direct design to print the individualized puncture guide plate using 3D printing technology. The puncture point and sampling approaches were determined by the guide plate morphology and the “double guide-hole and slideable groove” design. First, we evaluated the fitness of the 3D guide plate to the local anatomical structure, its assisted-puncture accuracy was estimated by imaging examinations, and postoperative complications were recorded. The accuracy of the needle biopsy pathological result was estimated with reference to that of the tumor resection. Results: Our results showed that the 3D printing individualized guide plate matched the patients’ pelvic skin well, the puncture approach was consistent with the preoperative design, and no significant anatomical injuries including vascular and neural complications occurred after surgery. Nine patients’ (90%) biopsy results were consistent with their postoperative pathological results, and one patient gave up the tumor resection. Conclusion: Based on digital image processing and 3D printing technology, the individualized guide plate can be used to guide the needle biopsy of acetabular tumors which makes the operation simpler and more precise.

Navigational Transmaxillary Endoscopic Approach for Inferomedial Tumors.

Orbital tumors encompass a heterogeneous range of histopathology and usually variable in location. Traditionally, transconjunctival medial orbitotomy is used to access the medial orbital wall. However, it creates potential risk of soft tissue sequelae such as scarring, lid contracture, or entropion/ectropion. For the lesions close to the orbital apex, increased risk of optical nerve injury should be cautious during orbitotomy procedure. Transnasal endoscopic approach to the orbital walls has been applied since 1999. Although it provides good surgical visualization and prevents the soft tissue and neural complications, the narrow nasal corridor increases the surgical complexity. Extensive sphenoethmoidectomy is usually required to gaining access. Furthermore, the resultant medical orbital defect is difficult to repair. The maxillary sinus is the largest paranasal sinuses which is located beneath the orbital floor. It provides an ample working space for instrumentation. Meanwhile, repair of the orbital floor defect is feasible and with high degree of accuracy under navigation control. In this report, we propose a novel computer-assisted endoscopic protocol to excise the medial orbital tumors with immediate repair of the wall defect.