Nonsurgical Options Research Articles

Point-Counterpoint Debate: Surgery vs. Medical Treatment for the Management of Obesity.

Obesity is a chronic, relapsing condition with severe health risks and a huge economic burden. Effective interventions for severe obesity include bariatric or metabolic surgery and high-intensity medical management involving lifestyle changes and pharmacotherapy. This article summarizes the debate between Drs. Schauer and Rothberg at the June 2024 Endocrine Society meeting regarding the optimal approach to managing obesity, exploring mechanisms, outcomes, safety, quality-of-life, and cost-effectiveness. Metabolic surgery results in substantial and sustained weight loss, improvements in comorbidities like type 2 diabetes, reduced mortality, and is cost-effective. However, it carries risks associated with surgery and long-term complications, and its high upfront costs limit its scalability. Conversely, high-intensity medical management, which includes comprehensive lifestyle interventions and pharmacotherapy, leads to meaningful, though sometimes less substantial weight loss and health improvements. The latter approach prioritizes behavioral changes and is cost-effective but requires patient adherence and faces challenges with medication side effects and costs. Both interventions offer substantial health benefits; the choice between them should consider individual patient needs, health status, target weight loss, and personal preferences. Metabolic surgery may be more suitable for individuals with severe obesity or when comorbidities are inadequately controlled, whereas medical management may be more suited to patients with less severe obesity and those preferring non-surgical options. Future research should investigate the combined effects of surgery and medical management and enhance access to and affordability of these treatments. A multidisciplinary, personalized approach will likely yield the best outcomes in managing this complex health issue.

Exploring the Safety and Satisfaction of Patients Injected With Collagen Biostimulators-A Prospective Investigation Into Injectable Poly-l-Lactic Acid (PLLA).

Esthetic medicine has shifted significantly toward non-surgical procedures, with the collagen biostimulator poly-l-lactic acid (PLLA) becoming increasingly popular for facial rejuvenation. However, the safety and patient satisfaction associated with PLLA facial treatments remain largely unexplored. This study aimed to evaluate the safety profile of PLLA treatment and assess patient mid- and long-term satisfaction with the outcome. This prospective single-center study was conducted at Bravo Clinic in Rio de Janeiro from August 2023 to August 2024. The patients' mid and lower face was treated by injecting Rennova Elleva (a collagen biostimulator containing 210 mg of PLLA) into the zygomatic and pre-masseteric regions. All patients underwent monthly clinical evaluations for the first 150 days and kept diaries to self-record any adverse effects during the first 30 days. Patient satisfaction was measured using the Global Aesthetic Improvement Scale (GAIS) on days 90 and 150 post-injection. The study included 52 female patients [mean age: 49.87 ± 10.7 years; mean body mass index (BMI): 23.99 ± 3.5 kg/m2]. Patients reported mild to moderate injection site reactions, including redness, pain, hardening, swelling, lumps, bruises, and skin discoloration, with most symptoms resolving within a few days. Clinically, no major adverse events were noted, except for one small, painless nodulation that resolved without intervention. On post-injection Day 90, the average GAIS was rated at 2.32 ± 1.0. This rating remained stable at Day 150, with an average GAIS of 2.32 ± 0.8 (p = 0.862). Inverse correlations were identified between the duration of mild pain and GAIS (rs = -0.546, p = 0.035), as well as between the duration of mild bruises and GAIS (rs = -0.598, p = 0.019). The duration of moderate pain was significantly associated with age (rs = -0.894, p = 0.041). Rennova Elleva, a PLLA-based collagen biostimulator, is safe and well-tolerated with a low incidence of adverse effects. It provides long-lasting, satisfactory results for patients with mild to moderate facial sagging, rendering it an effective non-surgical option for enhancing facial esthetics.

Special Considerations in the Treatment of Idiopathic Intracranial Hypertension.

To review the management of Idiopathic Intracranial Hypertension (IIH) with co-existing conditions affecting therapy: obesity, sulfa allergy, nephrolithiasis, and pregnancy. The IIH-WT trial showed that bariatric surgery is currently the most effective method for obese patients with IIH to lose weight, leading to normalization of CSF pressure in many cases. Allergy to sulfonamide antibiotics does not preclude the use of acetazolamide; rather, penicillin allergy or multiple drug allergies are the strongest predictor of a hypersensitivity reaction. Carbonic anhydrase inhibitors should be avoided in individuals with a personal history of nephrolithiasis; the risk of renal stones increases with concomitant use of other medications with the potential for nephrolithiasis. Glucagon-like peptide-1 receptor antagonists (GLP-1RA) are promising non-surgical weight loss options although preliminary studies have not demonstrated considerable impact on papilledema, headache or vision. Women with IIH have high rates of pregnancy complications partly related to obesity. Recommendations for weight gain or loss during gestation are controversial. Recent studies show better outcomes in obese women who maintain or lose weight while pregnant including gestational diabetes, pre-eclampsia and emergency caesarian section. Progress continues in the search for the cause and best treatments for IIH. Larger multicenter trials of GLP-1RA are needed to determine their efficacy.

Unconventional Remedies for Squamous Cell Carcinoma: A Journey into Alternative Treatments.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and is typically found on sun-exposed skin. Risk factors include ultraviolet radiation exposure, older age, fairer complexion, smoking, and immunosuppression. SCC is a slow-growing tumor with the possibility of metastasis if not treated. The clinical presentation can range from a dry, scaly erythematous patch or plaque to a firm hyperkeratotic papule, plaque, or nodule, depending on the histological type via biopsy. The first-line therapies for SCC removal are standard excision and Mohs microscopic surgery; however, there are novel and alternative non-surgical options being considered for the treatment of SCC. This review summarizes the current guidelines for treating low-risk and high-risk SCC and discusses rare, experimental, and anecdotal non-surgical treatments for SCC in the literature.

“The Itsy-Bitsy Water Bead Went Down the Baby's Mouth. Will Drinking Gastrografin Help to Flush It Out?”

IntroductionForeign body ingestion is a common occurrence in the pediatric population. Superabsorbent polymers (i.e., water beads [WB]), such as Orbeez, are brightly colored spheres, can expand up to 100x their original size and are marketed as toys for kids. Ingested WB may lead to a bowel obstruction and typically require surgical removal. MethodsFully expanded WBs (N = 15) were placed into 1 of the 3 solutions: water (N = 5), gastrografin (N = 5), or 1:1 mixture of gg and water (N = 5), with serial diameter measurements obtained at 1, 4, 8, and 24 h. Additionally, fully expanded WBs were placed into succus containing post mortem porcine small bowel and mixed with gastrografin (N = 10) or nothing (N = 10), with diameters measured prior to placement and at 4 h. ResultsAt all time points, the mean WB diameter of the gastrografin arm was significantly smaller than the other two arms (P < 0.01). WBs submerged in gastrografin saw a 58% reduction in diameter at 4 h compared to 45% reduction in the 1:1 mixture and a 2% growth in water (P < 0.01). When placed into small bowel containing gastrografin, the mean WB diameter decreased by 47% at 4 h versus 37% in the control arm (P < 0.01). ConclusionsGastrografin significantly reduced the size of WB in both the in-vitro and ex-vivo post mortem animal study; and it may offer a nonsurgical option for the management of water bead ingestion. Studies assessing the clinical efficacy of a gastrografin nonoperative management strategy are needed.

Overview of Achilles Tendon Injury Treatments

Achilles tendon injuries, common among athletes and individuals engaged in high-impact activities, present significant challenges in both diagnosis and treatment. This article describes the Achilles tendon as a whole, the nature of related injuries, and how they are diagnosed and treated and how they are diagnosed, often magnetic resonance imaging (MRI) and ultrasound play crucial roles in differentiating the severity of these injuries. Treatment approaches range from non-surgical options, like functional bracing and physical therapy, to surgical interventions necessary for complete ruptures. Emerging biological therapies, it includes Platelet-Rich Plasma (PRP) and stem cell tech, show promise in enhancing recovery, though another research is needed to confirm their years effectiveness. Additionally, preventive measures and personalized rehabilitation programs are emphasized as essential strategies for reducing the incidence of Achilles tendon injuries and ensuring effective recovery. The paper concludes by discussing the future direction of treatment modalities, highlighting the potential of advanced technologies and therapies in improving patient outcomes.

Liveborn children with trisomy 18: A scoping review

Background There have been an increasing number of publications related to trisomy 18 associated with a shift in the philosophy of care. The objective of this review is to understand the scope of contemporary literature informing the care of children born alive with trisomy 18. Methods Included was peer-reviewed, primary literature in MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library from 2012 to 2023 reporting outcomes of children born alive with trisomy 18. Data extraction involved descriptive statistics of the types of studies, and an inductive thematic analysis of the questions addressed by the studies. Results Of 4628 records identified, 229 met inclusion criteria. Key themes were organized around the domains: What is trisomy 18? What are the chances of survival with trisomy 18? What can be done to improve the chances of survival with trisomy 18? How do children with trisomy 18 die? Do surgical interventions provide a benefit? Are there non-surgical options? What knowledge is informing medical management? How is life described for children with trisomy 18? What are children with trisomy 18 like as babies and as they get older? What is life like for families caring for children with trisomy 18? Conclusions A sizeable number of publications grouped trisomy 18 with other syndromes. Relatively few showed the longitudinal evolution of medical issues associated with trisomy 18, nor did they unfold the clinical heterogeneity of this population. This review shows the limited knowledge base guiding decision-making and care for children born alive with trisomy 18.

Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas

Painful neuromas are a complex clinical condition that results in notable disability and functional impairment after injury to a peripheral nerve. When regenerating axons lack a distal target, they form a stump neuroma. Up to 60% of neuromas are painful because of mechanical sensitivity and crosstalk between nerve fibers. Clinical evaluation includes a thorough history and physical examination followed by directed diagnostic imaging and procedures to assess pain generators and their effect on quality of life. Nonsurgical management options may include pharmacological interventions, desensitization strategies, injections, and therapies to reduce pain perception and improve function. Surgical interventions, such as nerve reconstruction by direct repair or grafting, redirection to alternative targets, and containment of regenerating axons by relocation into innervated tissues or in grafts, are considered when conservative measures fail. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. The plan should consider the underlying pathology, pain generators, and psychosocial factors contributing to the patient's pain.

NCOG-12. TREATMENT AND MORTALITY OF PRIMARY BRAIN TUMORS: A SINGLE CENTER OBSERVATIONAL STUDY OF GLIOBLASTOMAS AND ASTROCYTOMAS

Abstract Glioblastoma multiforme (GBM) is a WHO grade IV malignant tumor with a relatively poor prognosis (median survival of 15 months). Astrocytomas are WHO grade I-III tumors with a better prognosis than GBM; their median survival ranging from 2-10 years. We assessed the response to various mainstay treatment modalities in patients with GBM and astrocytoma, expecting to find that surgery and stereotactic radiation (SRS) treatment confer greater survival benefits than non-surgical and whole brain radiation (WBRT) options. We analyzed 108 patients at St. Luke’s University Health Network (SLUHN) who were previously diagnosed with a primary brain tumor consistent with GBM (90) or astrocytoma (18) prior to January 1, 2023. Mainstays of treatment were surgery with or without different radiation modalities (WBRT and SRS, and WBRT+SRS). Glioblastoma typically affected older patients (65.5), had mostly single lobe involvement (86.7%), and was predominantly located in the frontal (41.1%) and temporal lobes (37.7%). Astrocytoma was slightly younger (51.2), less often single lobe (72.2%), and mostly involved the frontal (44.4%), temporal (44.4%), and parietal lobes (33.3%). GBM found the greatest benefit from WBRT (without co-occurring SRS) with an increase of 16.4 months to 20.2 months (p=.789). Surgery, regardless of radiation status, appeared to provide the greatest benefit for patients with astrocytoma increasing average lifespan from 36.7 months to 53.6 months (p=.181). Patients with glioblastoma that underwent surgery also had increased survival of 18.2 months compared with nonsurgical patients at 12 months (p=0.097). While we were interested to see the impact these treatment modalities had on patient survival, our sample size was small and our results lacked statistical significance. Future studies with greater sample sizes would help determine whether statistical significance is correlated with meaningful clinical outcomes.

RADT-21. EFFICACY AND SAFETY OF DONUT-SHAPED CIRCUMFERENTIAL SPINE CYBERKNIFE STEREOTACTIC BODY RADIOTHERAPY FOR METASTATIC SPINE DISEASE

Abstract BACKGROUND Spinal metastases (SM) with epidural spinal cord compression (ESCC) are challenging to manage due to the risk of radiation-induced injury. Traditional approaches often avoid circumferential stereotactic body radiotherapy (SBRT) because of these risks. The efficacy and safety of donut-shaped circumferential SBRT, which envelops the spinal column while sparing the cord, remains underexplored. OBJECTIVE This study evaluates the safety and efficacy of donut-shaped circumferential spine CyberKnife SBRT in treating spinal metastases, focusing on preventing radiation-induced myelopathy and achieving local tumor control. METHOD We retrospectively analyzed patients treated with donut-shaped circumferential spine SBRT from 2014 to 2023. We evaluated demographics, grade of ESCC (Bilsky), prior treatments, symptoms, treatment parameters, and outcomes. Key measures included SBRT dosimetric data, radiation exposure to the spinal cord or cauda equina, adherence to dose-volume constraints, occurrence of post-SBRT myelopathy, other radiation-induced complications, and local tumor control. RESULTS Forty-eight lesions from 43 patients (median age: 65 years; range: 20-78) were analyzed. Only one patient underwent separation surgery for severe ESCC (Bilsky grade 3). The median clinical target volume (CTV) was 63.77 cc (range: 20.31-270.05), and the median margin dose was 24 Gy (range: 18-30). Over a median follow-up of 8 months (range: 1-91), local tumor control rates were 91.1% at 6 months, 87.1% at 1 year, 82.8% at 3 years, and 62.1% at 5 years. Median overall survival was 17 months. Of 20 lesions exceeding dose constraints, only one patient displayed clinical myelopathy symptoms, correlating with local tumor recurrence. There was no radiographic myelopathy or other radiation-induced complications during follow-up. CONCLUSION Donut-shaped circumferential spine CyberKnife SBRT provides effective and safe treatment for spinal metastases with or without epidural involvement. It achieves substantial local tumor control and has a minimal incidence of radiation-induced myelopathy, offering a viable non-surgical option for managing this complex condition.

Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment.

Severe respiratory distress of neonates with Robin sequence is traditionally managed by surgery. Stanford orthodontic airway plate treatment (SOAP) is a nonsurgical option. The study aimed to determine whether SOAP can improve polysomnography parameters of neonates with Robin sequence. Polysomnography of neonates with Robin sequence treated with SOAP at a single hospital were retrospectively analyzed. Patients without polysomnography at all 4 time points (pre, start of, mid, and posttreatment) were excluded. Data were analyzed using a linear mixed effects model. Sixteen patients were included. All patients had cleft palate. The median age (minimum, maximum) at the start of treatment was 1.1 months (0.3, 5.1) with the treatment duration of 4.5 months (3.5, 6.0). The mean obstructive apnea-hypopnea index (95% confidence interval) decreased from 39.3 events/h (32.9, 45.7) to 12.2 events/h (6.7, 17.7) (P < .001), obstructive apnea index decreased from 14.1 (11.2, 17.0) events/h to 1.0 (-1.5, 3.5) events/h (P < .001), and oxygen nadir increased from 79.9% (77.4, 82.5) to 88.2% (85.5, 90.8) (P < .001) between pre and start of treatment. Respiratory improvements were sustained during and after the treatment. All patients avoided mandibular distraction osteogenesis or tracheostomy following SOAP. As being a rare diagnosis, the number of participants was, as expected, low. However, the current study shows that SOAP can improve polysomnography parameters, demonstrating its potential utility before surgical interventions for neonates with Robin sequence and cleft palate experiencing severe respiratory distress. Choo H, Sidell DR, Kim J-W, Ahn H-W, Day HS, Sullivan SS. Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment. J Clin Sleep Med. 2024;20(11):1807-1817.

12395 Knowledge and Perspectives of Non-Surgical Management Options Among Patients With Uterine Fibroids: A Preliminary Analysis

12395 Knowledge and Perspectives of Non-Surgical Management Options Among Patients With Uterine Fibroids: A Preliminary Analysis

Teprotumumab's Impact on Proptosis in Long-duration Thyroid Eye Disease: A Systematic Review and Meta-analysis.

Background: Long-duration thyroid eye disease (TED) may present with persistent proptosis despite the absence of inflammatory symptoms, and treatment options have been limited to surgical intervention. Recently, teprotumumab, a monoclonal antibody, has garnered interest as a non-surgical option to reduce proptosis in such cases. This systematic review investigates the impact of teprotumumab on reducing proptosis in long-duration TED. Methods: A search was conducted across major online databases, and data were aggregated from observational studies, clinical trials and case series. Nine studies met the inclusion criteria. Cumulative and weighted effect measures were synthesized. The biases and limitations of each study were assessed. Results: Existing evidence shows teprotumumab to be highly efficacious in reducing proptosis in chronic TED; however, there are significant limitations in the quality of existing evidence. The cumulative meta-analysis reveals a mean proptosis reduction of 3.05 ± 0.54 mm across 182 orbits from nine studies, and the weighted meta-analysis shows a mean reduction of 2.69 ± 0.53 mm across 172 orbits from eight studies. Discussion: While existing clinical studies are open to bias and intrinsically limited, the meta-analysis dilutes the risk of bias by weighting more precise evidence, providing the highest quality evidence to date. Further research is essential to understand teprotumumab's long-term efficacy and comparative advantages over surgical options. These findings have significant implications for treating persistent proptosis in patients with long-duration TED, potentially offering a non-surgical alternative where options were previously limited.

Consumer survey to evaluate the effects of Mintop serum in the management of hair fall

Background: Hair fall, or alopecia, is a common concern influenced by various factors, necessitating diverse treatment. Methods: This single-group, non-comparative study enrolled 165 participants aged 18-55 years with hair fall complaints. Participants applied Mintop serum twice daily for 90 days. Assessments included hair pull tests, 1-minute comb tests, consumer questionnaires, and dermatologist evaluations at baseline, 1 month, and 3 months. Results: Of the 161 participants who completed the study, significant reductions in hair fall were observed after 1 month (p&lt;0.001) and 3 months (p&lt;0.001) of product use. Participants reported high satisfaction with the serum’s effectiveness in reducing hair fall (100% agreement) and stimulating new hair growth (99.4% after 1 month, 100% after 3 months). Objective measures such as the hair pull test and 1-minute comb test demonstrated substantial decreases in hair shedding across the study period. No adverse events were reported. Conclusions: Mintop Pro+ hair regrowth serum showed promising efficacy in reducing hair fall and improving hair density, strength, and overall hair health. The serum was well-tolerated without adverse effects, suggesting its potential as a safe and effective non-surgical option for managing hair loss.

Non-Surgical Approaches to the Management of the Intrathoracic Goiter-A Systematic Review.

Intrathoracic goiters (ITGs) are usually managed by surgical excision, However, over recent years, non-surgical strategies are emerging as an alternatives for treating this condition. A systematic review of research published since 2017 in the PubMed database was conducted and a total of 39 articles were retrieved, along with methodological issues and future directions in the research on ITGs. Several non-surgical treatments exist, including radio-iodine ablation (RIA) and mini-invasive approaches, such as transcervical microwave ablation (TcMA), transcervical radiofrequency ablation (TcRfA), or selective embolization of the thyroid arteries (SETA). Despite encouraging reports, their current use remains limited. Treatment of ITGs requires a multidisciplinary thyroid team, and when non-surgical options are chosen, patients need to be carefully selected, and their outcomes must be prudently considered and discussed with the patient.

Categorizing Extremely Positive Five-Star Online Reviews for Orthopedic Foot and Ankle Surgeons: A Retrospective Study.

Background Multiple studies have emphasized the increased use of physician rating websites by patients when searching for surgeons to perform elective procedures. This study aimed to analyze the comments associated with online five-star patient reviews for orthopedic foot and ankle surgeons. Methods A retrospective analysis of five-star online reviews and corresponding comments using Vitals.com in 2024 was completed. Surgeons were included if they could be found on Vitals.com, were within a 10-mile radius of one of the top 10 largest cities in the United States, and if they had at least one review with one corresponding comment. Comments were further stratified into the following categories: good outcomes, well-controlled pain, correct diagnosis, clear plan, bedside manner/patient experience, staff compliment, wait time, nice facility, and offering a nonsurgical option. Results In a sampling of 2,425 orthopedic foot and ankle surgeons, 148 physicians (6.1%) had at least one review with one comment. Ultimately, 1,833 five-star reviews comprising 3,215 comments were included in the final analysis. Comments stratified by category revealed the most common comments being related to good outcomes (n = 940; 29.2%) and bedside manner/patient experience (n = 921; 28.6%). From the comments related to bedside manner/patient experience (p < 0.001) and presence of a clear plan (p < 0.001), a significantly higher proportion of comments in the nonoperative group was found relative to the operative group. Conversely, from the comments related to well-controlled pain (p < 0.001), a significantly higher proportion of comments in the operative group was found relative to the nonoperative group. Conclusions The most common reasons behind five-star patient comments for orthopedic foot and ankle surgeons were related to good outcomes and bedside manner/patient experience. Comments from surgical patients were most likely to include mention of well-controlled pain, whereas comments from patients who underwent nonoperative care were more likely to center on bedside manner/patient experience and presence of a clear plan.

Evaluating the Efficacy of Platelet-Rich Plasma in Treating Primary Knee Osteoarthritis: A Prospective Interventional Study.

Knee osteoarthritis (OA) is a prevalent degenerative joint disorder causing pain, stiffness, and reduced function, significantly impacting the quality of life. Current treatments mainly provide symptomatic relief, with limited efficacy in halting disease progression. Platelet-rich plasma (PRP), a biological therapy rich in growth factors, has gained attention as a potential treatment for knee OA due to its regenerative properties. This study evaluates the efficacy of PRP in managing primary knee OA. This prospective interventional study included 100 patients diagnosed with primary knee OA, categorized using the Kellgren-Lawrence grading scale. Leukocyte-reduced PRP was prepared using the double-spin method and injected into the knee joint. The efficacy of PRP was assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) Index and Visual Analogue Scale (VAS) pain scores at six weeks, three months, and six months post-injection. Statistical analysis was performed using SPSS version 25.0, with significance set at p<0.05. Significant improvements in the WOMAC and VAS scores were observed at all-time points post-PRP injection. The WOMAC score decreased from a baseline of 81.06 to 63.52 at six months (p < 0.001), and the VAS score reduced from 7.53 to 3.09 (p < 0.001). PRP was more effective in patients with lower body mass index (BMI) and less severe OA (Grades 1 and 2). Adverse events were mild, with 18% reporting mild pain or swelling. PRP therapy significantly improves pain and function in patients with primary knee OA, particularly in early-stage disease. The treatment is generally safe, with minor adverse effects. PRP presents a promising non-surgical option, especially for those seeking to delay or avoid knee arthroplasty.

A Study of Fibroid Vascularization and Vascular Indices With Three-Dimensional Power Doppler and Superb Microvascular Imaging and the Correlation With Heavy Menstrual Bleeding.

Objective The objective of the study was to evaluate fibroid vascularization and vascular indices with three-dimensional (3D) power Doppler and superb microvascular imaging (SMI) and its correlation with heavy menstrual bleeding (HMB). Material and methods A total of 75 women with intramural uterine fibroid: 50 with HMB (Group A) and 25 without HMB (Group B)were recruited for the study. All participants were subjected to transabdominal and transvaginal color Doppler ultrasound. A 3D Power Doppler was used to measure Doppler Indices and flow rate in uterine arteries and the dominant vessel of fibroid. SMI was also used to determine vascularity in the dominant fibroid and to grade the vascularity. Results A significant association was observed between Doppler indices in the dominant feeding vessel of fibroid and HMB. Flow rates, namely peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly higher. Contrarily, resistance measured as Resistive Index (RI) and Pulsatility Index (PI) was lower in Group A than in Group B. The mean PSV of the dominant feeding vessel in group A was 26.42 ± 4.57and in group B was 14.56 ± 3.17, with p-value < 0.0001. For EDV, the median value (25th-75th percentile) in women with HMB was 6.76 (6.152-8.74) vs 3.99 (3.2-5.95)in womenwithout HMB (p < 0.0001). A significant association was observed between uterine artery Doppler indices (specifically, PSVand EDV) and HMB. However, no significant association was found between RI and PI of the uterine artery and HMB. In the study of the vascular pattern on SMI, the percentage of women exhibiting both central and peripheral vascularity in Group A and Group B were 72% and 4%, respectively (p< 0.0001). Women in Group A showed a significantly higher proportion of grade 2 and grade 3 vascularity (76% and 20%, respectively), whereas only 4% showed grade 1 vascularity. Conversely, in Group B, all the women showed grade 1 vascularity (p <0.001). Conclusion Doppler indices in the dominant feeding vessel of fibroid show a positive correlation with HMB. In the study of the vascular pattern on SMI, a significant proportion of women with HMB exhibited both peripheral and central vascularity and a higher grade. Most women with symptomatic fibroids are of childbearing age and fertility preservation is at times their prime concern. Fibroid vascularization assessed with 3D power Doppler ultrasound and the new advanced SMU tool may prove to be useful in the prediction of response to various non-surgical management options of uterine leiomyoma and thus aid in counseling and appropriate patient selection.

Surgical Management for Boutonniere Disease

Boutonniere disease is a hand injury causing extension lag or restriction in the proximal interphalangeal joint and hyperextension in the distal interphalangeal joint. This condition often arises from direct laceration or closure damage to the central tendon, rheumatoid arthritis, osteoarthritis, Dupuytren contracture, pulley injury, burns, and other conditions. Surgical management for Boutonniere deformity relies on the expertise of the attending physician and involves both non-surgical and surgical options. In acute cases, conservative therapy should be pursued, while in chronic cases, conservative management may be advised. Surgical intervention is used to transform excessive extension force of the distal interphalangeal joint into extension force of the proximal interphalangeal joint. This is necessary to heal an open rupture of the central tendon. Surgical techniques for chronic deformity are complex due to variables and hand surgeons' expertise. There is no definitive surgical therapy for persistent buttonhole deformity, but several approaches have been documented in case studies. These include terminal tenotomy, collateral band surgery, central tendon surgery, tendon transfer and grafting, stepwise extension mechanism readjustment surgery, and arthrodesis. Central tendon surgery addresses the central tendon, where injured tissue transforms into scar tissue, resulting in delayed extension of the proximal interphalangeal joint. Tendon transfer or grafting have been documented for rotator cuff mechanism rehabilitation, but no definitive guidance exists for these techniques. Curtis treatment introduced a sequential therapy approach for traumatic buttonhole deformity, which involves splinting, excising the transverse reticular ligament, resecting and lengthening the collateral ligament, and repositioning the core tendon. Arthrodesis may be applicable in cases of advanced arthritis, coronal plane deformity, functional impairment, or elderly patients. There are no definitive indications for surgical interventions for persistent buttonhole deformity, and outcomes may be variable or inferior. Understanding the deformity, its progression, and patient's functional constraints is crucial for effective treatment

A Non-Surgical Wearable Option for Bone Conduction Hearing Implants: A Comparative Study with Conventional Bone Conduction Hearing Aids Mounted on Eyeglasses.

This study aimed to compare the audiological benefits of a non-implantable wearable option for a bone conduction (BC) implant mounted on an arch (SoundArc) to those of traditional BC hearing aids (HAs) mounted on eyeglasses (BCHAs) in patients with moderate to severe conductive or mixed hearing loss. A preliminary cross-sectional observational prospective cohort study was conducted in the Tertiary Audiological Department, University Hospital. Fourteen adults with conductive or mixed hearing loss (PTA at 0.5-1-2-4 KHz = 67 ± 15 dB HL) who had been wearing conventional BCHAs mounted on eyeglasses for at least 3 years and had declined surgical implantation of a bone conduction hearing implant (BCHI) were included in the study. Unaided and aided pure-tone air conduction (AC) and bone conduction (BC) thresholds, as well as speech tests in quiet and noise, were recorded at baseline and in two different settings: with a BCHI mounted on SoundArc® and with their own BCHAs mounted on eyeglasses using two couplers. Participants completed questionnaires in both conditions, including the International Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults/Elderly (HHIA/E), the Speech, Spatial, and Qualities of Hearing Scale (SSQ), a 10-point visual analog scale (VAS), and the Fatigue Impact Scale (FIS). A significant functional gain was observed in both settings (p = 0.0001). Better speech perception in quiet and noise was observed with SoundArc compared to conventional BCHAs on eyeglasses (improvements in word repetition scores in noise: +19.3 at SNR +10 dB, p = 0.002; +12.1 at SNR 0 dB, p = 0.006; and +11.4 at SNR -10 dB, p = 0.002). No significant differences were found in IOI-HA, FIS, and HHIA/E scores. However, significantly better SSQ scores were reported for SoundArc in all domains (p = 0.0038). Although patients were accustomed to using BCHAs mounted on eyeglasses, the bone conduction wearable option of the BCHI (SoundArc) proved to be a viable alternative for adult patients with conductive or mixed hearing loss who are unable or unwilling to undergo BCHI surgery.