Posterior Extension Research Articles

A biomechanical investigation comparing a novel bone cement bridging screw system with conventional treatment methods for Kummell’s disease

Based on the characteristics of Kummell’s disease (KD) and related anatomical structures of the thoracolumbar spine, a novel bone cement screw system has been designed to effectively avoid the cement loosening and displacement. This experiment aimed to assess the biological effects of the novel bone cement screw system in KD on fresh cadaveric thoracolumbar spine specimens, thereby discussing its potential application value and providing a foundation for clinical implementation. This study employed a total of 50 fresh female adult cadaver specimens. Each specimen underwent extraction of the T12 to L2 segment followed by the creation of an artificial KD model at the L1 segment and subsequent establishment of five distinct types of bone cement repair models. Model A represents the percutaneous vertebroplasty (PVP) model, Model B combines PVP with unilateral percutaneous pediculoplasty (PPP), Model C combines PVP with bilateral PPP, Model D introduces the novel bone cement screw combined with unilateral PVP, and Model E combines the novel screw with bilateral PVP, each group consists of 10 specimens. Subsequently, the six-axis spine robot was employed to execute cement three-dimensional biomechanical strength tests in six directions, including anterior flexion and posterior extension, left and right lateral bending, as well as left and right rotation. The novel bone cement screw, whether used unilaterally or bilaterally in combination with the PVP model, exhibits significantly reduced bone cement mobility and superior biomechanical stability during anterior flexion, posterior extension, left lateral bending, and right lateral bending (P<0.05).No significant differences were observed among the five models under both left and right rotation (P > 0.05).When comparing the novel bone cement screw combined with PVP unilaterally and bilaterally, no statistically significant difference was observed in the stability of bone cement across all six directions of motion (P>0.05). To conclude, this novel bone cement bridging screw system exhibits superior biomechanical stability compared to commonly used treatments. Furthermore, both unilateral and bilateral implementations of the novel bone cement screw system yield without significant differences observed. These findings present a reliable and innovative approach for clinical management of KD.

Assessment of the trapezoidal miniplate with posterior extension for open management of condylar fractures: Can it be used instead of straight miniplates?

AbstractObjectiveThis study comparatively measures and evaluates the strength of five plating techniques for mandibular condylar fracture fixation when linear loading is applied.Materials and MethodsThe investigators designed and implemented a cross‐sectional in vitro study. The sample was composed of 60 polyurethane mandibles for the mechanical tests. For the photoelastic test, 10 photoelastic mandibles were used. The predictor variable is the plating technique, and it was categorized as groups G2P‐2.0: two 4‐hole 2.0 mm straight plates, G1TP‐2.0: 4‐hole 2.0 mm trapezoidal plate; G1TPPE‐2.0: 4‐hole 2.0 mm trapezoidal plate with posterior extension; G1TP‐1.5: 4‐hole 1.5 mm trapezoidal plate and G1TPPE‐1.5: 4‐hole 1.5 mm trapezoidal plate with posterior extension. The outcome variable is the strength of the plating techniques that was evaluated with the loading test: peak/ending load and peak/ending displacement measures collected. The photoelastic test was used to detect tension distribution throughout the structure helping to understand the material's behaviour. Values of the loading test were analysed using SAS (SAS Institute, Cary, NC, EUA). A p &lt;0.5 (p = 0.05) was considered significant and means were compared using the Tukey test.ResultsThe results indicated that the fixation with two plates presented a higher resistance in the anteroposterior direction and fixation with a trapezoidal plate with posterior extension is more resistant towards mediolateral. The photoelastic analysis showed that the strain lines were best distributed when trapezoidal plates were used.ConclusionAccording to the results, the posterior extension of the trapezoidal plates increased the strength of the fixation system, and the use of trapezoidal plates with or without posterior extension was favourable to a more balanced stress distribution. However, clinical studies must be done to confirm the biomechanical findings.

Using calcaneal plates in fixation of comminuted posterior wall acetabular fractures with cranial or posterior extension: a prospective case series and novel technique.

This study aims to evaluate the outcomes of using calcaneal plate in fixation of comminuted posterior wall (PW) acetabular fractures especially that have cranial (dome) or posterior extension (posterior column edge), and to evaluate its safety. To our knowledge, this is the first study that utilizes this off label implant technique in fixation of such fracture. Twenty-two patients enrolled in the study with a minimum follow up of one year. After reducing the PW fragments sequentially, calcaneal plate was applied, fixing its distal part at ischial tuberosity upper ends using 3 screws in a triangular fashion, while its proximal part and radial wings were firmly fixed along the acetabular rim together with the classic longitudinal anchorage. Any fixation failure or head subluxation was recorded. Radiological outcome showed 18 cases scored as excellent, 2 were good, and 2 were poor. The functional outcome revealed 2 patients were excellent, 6 were very good and 14 were good. There was no loss of reduction or fixation failures throughout the follow up period. Calcaneal plate may offer an alternative method of fixation of comminuted PW fractures with acceptable radiological and functional results. Our study result may encourage the comprehensibility and replicability of this practice, however randomized multicentered studies should be conducted to validate this assumption. This method provides valuable trick strategy, stable and soft-tissue-friendly fracture fixation where modern implantations may be unavailable or of high cost. Calcaneal plates show some fascinating features that allow using them outside their field being flexible with large footprint area for fracture buttressing beside numerous hole choices with diverse paths providing suitable fixation, articular stability and wide zone of coverage in PW comminuted fracture patterns with cranial or posterior extensions. The plate proximal triangular configuration together with distal triangular screw fixation gives a stiff rigid anchorage and buttressing similar to a metal mesh covering and fixing any fragment numbers up to dome level.

The Optimal Head Position Following Intratympanic Injection: A Research Based on HRCT Reconstruction.

Objective: This study aimed to investigate the optimal head position (OHP) following intratympanic injection, a critical intervention in treating inner ear disorders. Identifying OHP is essential to maximize drug retention in the middle ear, thereby significantly enhancing the therapeutic efficacy by mitigating the significant issue of injectate leakage through the eustachian tube (ET). Exploratory various positions of ET orifice and round window (RW) were investigated and associated with head movements. Methods: Twenty-two (10 males and 12 females) anonymized high-resolution computed tomography (HRCT) datasets of patients without structural ear disease were selected from January 2022 to December 2022 in the study. The subjects were categorized into two groups: children (≤18 years) and adult group (>18 years). The reconstruction of the ET orifice and RW from HRCT were analyzed using Mimics software and the distances from the center point of ET orifice or the center point of RW to the reference plane were defined as distance of ET orifice (DET) and distance of RW (DRW). Results: In the supine position, the OHP for intratympanic injection was 23°of pronation and 24° of posterior extension, and the maximum distance between the ET orifice and RW (DET-RW) was 9.29 ± 2.13 mm. As the head position extended posteriorly beyond 43°, DET was relatively high compared with DRW, resulting in the OHP a fully posteriorly extended 90° of the head being the optimal position with DET-RW of 2.13 ± 1.60 mm in the supine position, however, it is not realized in human beings. Moreover, the OHP had no obvious relevance corresponding to age following intratympanic injections. Conclusion: Our study suggested that OHP after intratympanic injections treatment consists of supine position, along with a slight pronation and posterior extension.

A New Genus of Prodidominae Cave Spider from a Paleoburrow and Ferruginous Caves in Brazil (Araneae: Prodidomidae)

A new monotypic genus of Prodidominae, Paleotoca gen. n., is proposed to include one cave species collected in a paleoburrow and ferruginous caves from Quadrilátero Ferrífero, Minas Gerais, Brazil: Paleotoca diminassp. n. (♂♀). The new genus is closely related to other Neotropical Prodidominae by sharing the classic claw tuft clasper. Paleotoca gen. n. is diagnosed by the absence of a dorsal abdominal scutum, a ventral parallel rows of strong spines on the tibia and metatarsus I–II, a lack of a conductor, a discrete median apophysis on the bulb and a bifid retrolateral tibial apophysis in the male palp, a posterior extension that is beak-shaped, and folds of a copulatory duct ventrally visible in the female epigyne. Like other Prodidominae species from caves, P. diminassp. n. is a troglobitic spider with morphological characteristics that indicate specialization to live in subterranean environments, including reduction in cuticular pigments, eye loss, heavy spination and trichobothria.

Comparative anatomy of siphons in tellinoidean clams (Bivalvia, Tellinoidea).

Siphons are tubular organs formed by fusion and posterior extension of the marginal mantle folds. They are supposed to have performed key roles in the evolution of bivalves by enabling these animals to occupy several ecological niches. However, anatomical details of these organs are scarce for one of the most diverse lineages of tropical bivalves, the superfamily Tellinoidea. We investigated the siphonal morphology of 15 species, sampling five tellinoidean families, by integrating scanning electron microscopy, confocal microscopy, and histology. The siphons revealed variations in length, pigmentation, tentacles, papillae, and number of nerve cords. Due to the presence of sensorial structures, such as papillae and tentacles, we reclassify the siphons of Tellinoidea from type A to A+. Additional anatomical patterns were identified at family and genus levels. For example, the incurrent siphon shorter than the excurrent and 24 tentacles are putative synapomorphies of Donacidae. We also highlight shared siphonal traits between Donacidae and Solecurtidae as well as between Semelidae and Tellinidae. In addition, our data support the idea of Psammobiidae as a paraphyletic lineage. Overall, we provide an extensive comparative data set on siphonal traits with significant relevance for bivalve taxonomy, functional anatomy, and evolutionary investigations.

The effect of core stability training combined with fascial release on patients with nonspecific low back pain.

Non-specific lower back pain (NLBP) is treated with a variety of therapies, including health education, exercise therapy, soft tissue release, psychological interventions, and shockwave therapy. However, some studies have shown that core stability training or fascial release therapy alone is not effective in the treatment of low back pain. The aim of this study was to investigate the effects of core stability training on patients' inflammatory cytokine levels and lumbar muscle temperature when combined with fascial release for the treatment of non-specific low back pain. In this study, a total of 60 patients with non-specific low back pain who were treated in Mindong Hospital of Ningde City between December 2021 and January 2023 were selected and randomly and equally divided into a control group (30 cases) and an experimental group (30 cases). The control group received core stability training, while the experimental group added fascial release surgery to this. We compared and assessed the pain visual analog score (VAS), Oswestry dysfunction index (ODI), lumbar spine mobility (including anterior flexion, posterior extension, left flexion, and right flexion), as well as levels of inflammatory factors IL-6, TNF-a, and muscle tissue temperature in the two groups. This study has been successfully implemented and covered 60 patients throughout the trials. Upon comparison, the two groups did not show statistically significant differences in baseline data such as age, gender and duration of disease (p> 0.05). After four weeks of treatment, the test group showed statistically significant (p< 0.05) differences in VAS scores, ODI scores, and IL-6 and TNF-a levels that were significantly lower than those of the control group. It is worth mentioning that the muscle tissue temperature of the patients in the test group, as well as their performance in lumbar anterior flexion, posterior extension, left flexion, and right flexion mobility, were significantly better than those of the control group, and these differences also showed statistical significance (p< 0.05). The combination of core stability training and fascial release demonstrates significant clinical results in the treatment of nonspecific lower back pain. Through medical thermography and serum inflammatory factor testing, we were able to assess the treatment effect more objectively, providing a strong basis for future clinical practice.

Tonsillar synovial sarcoma, unusual anatomical location: case report and literature review

BackgroundSynovial sarcoma is a rare soft tissue malignancy, occasionally found in the head and neck region. The diagnosis necessitates a multidisciplinary approach involving the clinical presentation, proper imaging studies and histological confirmation, with molecular testing for definitive identification. Treatment entails surgical resection with adjuvant therapies as needed.Case presentationA 33-year-old male patient presented with globus sensation concomitant with right-sided neck swelling. He was clinically found to have right tonsil enlargement with posterior extension. Therefore, he underwent right tonsillectomy with pharyngoplasty. Histopathological examination revealed a biphasic tumor consistent with synovial sarcoma, confirmed by immunohistochemistry and fluorescence in situ hybridization.ConclusionsTonsillar synovial sarcoma represents a diagnostic challenge, requiring a high index of suspicion and comprehensive evaluation. With only twenty previously published cases documented in the literature, awareness of this rare presentation is crucial for prompt diagnosis and appropriate management. Collaboration among multidisciplinary healthcare teams and ongoing research efforts are essential for optimizing diagnostic accuracy, treatment efficacy, and patient outcomes in this rare malignancy.

Effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.

The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head, maintaining shoulder joint stability. To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries. We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023. Patients were grouped using the envelope method. After treatment, the study group's treatment effective rate was 94.90% (46/49 patients), significantly higher than that in the control group (79.17%, 38/48 cases; P < 0.05). Before treatment, there was no difference in Constant Murley Score (CMS) scores, shoulder mobility, or 36-Item Short Form Health Survey (SF-36) scale scores (P > 0.05). Compared with those before treatment, the CMS scores (including pain, daily living ability, shoulder mobility, and muscle strength), all aspects of shoulder mobility (forward flexion, posterior extension, external rotation, internal rotation), and SF-36 scale scores (including physiological, psychological, emotional, physical, vitality, and health status) were higher in both groups after treatment and significantly higher in the study group (P < 0.05). There was no difference in the occurrence of complications between the two treatment groups (P > 0.05). Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries, helps accelerate the recovery of shoulder function, improves the quality of life, and is highly safe.

The effect of large channel-based foraminoplasty on lumbar biomechanics in percutaneous endoscopic discectomy: a finite element analysis

BackgroundThis study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine.MethodsA complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions—anterior flexion, posterior extension, left-right lateral bending, and left-right rotation—to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments.ResultsCompared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model.ConclusionForaminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption.

Morphological patterns and spatial probability maps of the inferior frontal sulcus in the human brain.

The inferior frontal sulcus (ifs) is a prominent sulcus on the lateral frontal cortex, separating the middle frontal gyrus from the inferior frontal gyrus. The morphology of the ifs can be difficult to distinguish from adjacent sulci, which are often misidentified as continuations of the ifs. The morphological variability of the ifs and its relationship to surrounding sulci were examined in 40 healthy human subjects (i.e., 80 hemispheres). The sulci were identified and labeled on the native cortical surface meshes of individual subjects, permitting proper intra-sulcal assessment. Two main morphological patterns of the ifs were identified across hemispheres: in Type I, the ifs was a single continuous sulcus, and in Type II, the ifs was discontinuous and appeared in two segments. The morphology of the ifs could be further subdivided into nine subtypes based on the presence of anterior and posterior sulcal extensions. The ifs was often observed to connect, either superficially or completely, with surrounding sulci, and seldom appeared as an independent sulcus. The spatial variability of the ifs and its various morphological configurations were quantified in the form of surface spatial probability maps which are made publicly available in the standard fsaverage space. These maps demonstrated that the ifs generally occupied a consistent position across hemispheres and across individuals. The normalized mean sulcal depths associated with the main morphological types were also computed. The present study provides the first detailed description of the ifs as a sulcal complex composed of segments and extensions that can be clearly differentiated from adjacent sulci. These descriptions, together with the spatial probability maps, are critical for the accurate identification of the ifs in anatomical and functional neuroimaging studies investigating the structural characteristics and functional organization of this region in the human brain.

Factors at the initial visit associated with poor visual outcomes in patients with acute retinal necrosis.

Acute retinal necrosis (ARN) is a vision-threatening disease caused by herpesvirus infection. This study aimed to investigate the visual prognostic factors that could be determined at the initial visit. This retrospective study included 34 patients with ARN. Logistic regression analysis was employed to evaluate the associations between poor final visual outcomes and various factors, including poor initial visual acuity, presence of retinal detachment at the initial visit, posterior extension of necrotizing retinitis, and circumferential extension of necrotizing retinitis. Posterior extension was evaluated with three zonings, from the periphery (zone 3), mid-periphery (zone 2), and macula (zone 1). Circumferential extension was evaluated according to the degree of necrotizing retinitis lesions using ultra-wide fundus imaging. The mean logarithm of the minimum angle of resolution was 0.63 ± 0.68 at the initial visit and 0.83 ± 0.65 at 12 months after the initial visit. Seven patients had a retinal detachment. The distribution of posterior extension at the initial visit was 5 in zone 1, 20 in zone 2, and 9 in zone 3. The average of necrotizing retinitis lesion angle was 249 ± 115°. The logistic regression analysis revealed that participants with wide angles of necrotizing retinitis were associated with final poor vision, with an odds ratio of 1.28 per 30° increase (95%CI: 1.00-1.65, p = 0.03). Assessment of the widespread circumferential extension of white necrotizing retinal lesions at the initial visit is a crucial risk factor for the visual prognosis in ARN.

Personalized and continuous care intervention affects rehabilitation, living quality, and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide. With progress in treatment methods and levels, the overall survival period has been prolonged, and the demand for quality care has increased. AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer. METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University (January 2021 to July 2023) were retrospectively selected as research participants. Among them, 134 received routine care intervention (routing group) and 66 received personalized and continuous care (intervention group). Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) scores, including limb shoulder joint activity, complication rate, and care satisfaction, were compared between both groups after care. RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care. The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care. The range of motion of shoulder anteflexion, posterior extension, abduction, internal rotation, and external rotation in the intervention group was higher than that in the routing group one month after care. The incidence of postoperative complications was 18.18% lower in the intervention group than in the routing group (34.33%; P &lt;0.05). Satisfaction with care was 90.91% higher in the intervention group than in the routing group (78.36%; P &lt;0.05). CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer, quicken rehabilitation of limb function, decrease the incidence of complications, and improve living quality and care satisfaction.

How reliable are femoropelvic kinematics during deep squats? The influence of subject-specific skeletal modelling on measurement variability

BackgroundBiplanar radiography displays promising results in the production of subject-specific (S.specific) biomechanical models. However, the focus has predominantly centred on methodological investigations in gait analysis. Exploring the influence of such models on the analysis of high range of motion tasks linked to hip pathologies is warranted. The aim of this study is to investigate the effect of S.Specific modelling techniques on the reliability of deep squats kinematics in comparison to generic modelling. Methods8 able-bodied male participants attended 5 motion capture sessions conducted by 3 observers and performed 5 deep squats in each. Prior to each session a biplanar scan was acquired with the reflective-markers attached. Inverse kinematics of pelvis and thigh segments were calculated based on S.specific and Generic model definition. Agreement between the two models femoropelvic orientation in standing was assessed with Bland-Altman plots and paired t- tests. Inter-trial, inter-session, inter-observer variability and observer/trial difference and ratio were calculated for squat kinematic data derived from the two modelling approaches. ResultsCompared to the Generic model, the S.Specific model produced a calibration trial that is significantly offset into more posterior pelvis tilt (–2.8±2.7), hip extension (–2.2±3.8), hip abduction (–1.2±3.6) and external rotation (–13.8±11.4). The S.specific model produced significantly different squat kinematics in the sagittal plane of the pelvis (entire squat cycle) and hip (between 40 % and 60 % of the squat cycle). Variability analysis indicated that the error magnitude between the two models was comparable (difference<2°). The S.specific model exhibited a lower variability in the observer/trial ratio in the sagittal pelvis and hip, the frontal hip, but showed a higher variability in the transverse hip. SignificanceS.specific modelling appears to introduce a calibration offset that primarily translates into an effect in the sagittal plane kinematics. However, the clinical added value of S.specific modelling in terms of reducing experimental sources of kinematic variability was limited.

Expanding the reach of the trans-middle cerebellar peduncle approach: pontine cavernous malformations, tissue transgression beyond the safe entry zone, and the invisible triangle.

In the authors' microsurgical experience, the trans-middle cerebellar peduncle (MCP) approach to the lateral and central pons has been the most common approach to brainstem cavernous malformations (BSCMs). This approach through a well-tolerated safe entry zone (SEZ) allows a wide vertical or posterior trajectory, reaching pontine lesions extending into the midbrain, medulla, and pontine tegmentum. Better understanding of the relationships among lesion location, surgical trajectory, and long-term clinical outcomes could determine areas of safe passage. A single-surgeon cohort study of all primary trans-MCP BSCM resections was conducted from July 1, 2017, to June 30, 2021. Preoperative and postoperative MR images were independently reviewed by 3 investigators blinded to the intervention, using a standardized rubric to define BSCM regions of interest (ROIs) involved with a lesion or microsurgical tract. Statistical testing, including the chi-square test with the Bonferroni correction, logistic regression, and structural equation modeling, was performed to analyze relationships between ROIs and clinical outcomes. Thirty-one patients underwent primary trans-MCP BSCM resection during the study period. The median age was 50 years (IQR 24-49 years); 19 (61%) patients were female, and 12 (39%) were male. Seven (23%) patients had familial cavernous malformation syndromes. The median follow-up was 9 months (range 6-37 months). At the last follow-up, composite neurological outcomes were favorable: 22 (71%) patients had 0 (n = 12, 39%) or 1 (n = 10, 32%) major persistent deficit, 5 patients (16%) had 2 deficits, 2 (7%) had 3 deficits, and 1 patient each (3%) had 4 or 6 deficits. Unfavorable composite outcomes were significantly associated with lesions (OR 7.14, p = 0.04) or surgical tracts (OR 12.18, p < 0.001) extending from the superior cerebellar peduncle (SCP) into the contralateral medial midbrain. The ipsilateral dorsal pons was the most frequently implicated ROI involving a surgical tract and the development of new postoperative deficits. This region involved the rhomboid pontine territory and transgression of the pontine tegmentum (OR 7.53, p < 0.001). Structural equation modeling supported medial midbrain and pontine tegmentum transgression as the primary drivers of morbidity. Trans-MCP resection is a safe and effective treatment for BSCMs, including lesions with marked superior or inferior ipsilateral extension. Two trajectories are associated with increased neurological risk: first, a superomedial trajectory to lesions extending into the midbrain that transgresses the SCP, its decussation, or both; and second, a posteromedial trajectory to lesions extending into the pontine tegmentum. The corticospinal tract, SCP, and pontine tegmentum form an invisible triangle within the pontine white matter tolerant of transgression. When the surgeon works within this triangle, most deep pontine BSCMs, including large lesions, those with contralateral or posterior extension, and others extending into the midbrain and medulla, can be resected safely with the trans-MCP approach.

Arthroscopic rotator cuff repair in active patients younger than 45 Years: a prospective analysis with a mean 5-year follow-up

PurposeTo report clinical and activity specific outcomes after arthroscopic RCR(ARCR) for full-thickness supraspinatus tears in active individuals younger than or equal to 45 years of age. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities. MethodsPatients were included in this study if they were (1)active individuals between 18 and 45 years of age at the time of surgery, (2)had a full-thickness rotator cuff tear(RCT) of the supraspinatus tendon with or without anterior or posterior extension and (3)underwent ARCR. Pre- and postoperative patient-reported outcomes scores including the American Shoulder and Elbow Surgeons(ASES) score, Disabilities of Arm, Shoulder and Hand(Quick-DASH), Single Assessment Numeric Evaluation(SANE), Short Form-12 Physical Component Summary(SF-12PCS) were prospectively collected and postoperative patient satisfaction(scale of 1-10) was recorded at a minimum of 2 years postoperatively. Attainment of the minimal clinically important difference(MCID) and patient acceptable symptom state(PASS) for the ASES was calculated. Athletic activity specific outcomes and return to activity(RTA) were investigated prospectively via a custom-made comprehensive questionnaire. ResultsBetween 11/2005 and 6/2020, of 1149 RCRs performed by the senior author, 54 patients (mean age 40.9 years,13 female; follow-up 69.7 ± 35.2 months in a range of 24.6 – 179.6 months) were included into the outcomes analysis. Of those, 4 patients(7.4%) had progressed to revision rotator cuff repair. At a follow-up of 5.8 years, outcome scores had significantly improved compared to preoperative baselines (ASES55.6±13.8to90.1+15.8;p<.001;QuickDASH38.9±18.4to 11.9±17.1;p<.001, SANE60.7±22.7to79.3±27.6;p=.001, SF-12PCS41.6±8.3to51.9±9.0;p<=.001). 93.6% of the patients reached the MCID and 72.6% reached the PASS. Median satisfaction was 9.5/10. 86% of the patients returned to sports, while 67% of the patients returned to a similar level compared to preoperatively. All sport specific metrics such as shoulder strength and endurance(p<.001), intensity(p<.001), and impairments from pain affecting speed(p=0.002), endurance(p=.002) and competition(p<.001) significantly improved postoperatively. ConclusionARCR of full-thickness RCT in active individuals aged 45 or younger results in a clinically relevant improvement of outcomes, function and quality of life at a minimum of 2 years and mean 5.8-year follow-up with a low rate of revision. While 86% of patients were able to RTA and sport specific outcome metrics significantly and substantially improved compared to preoperatively, a return to preinjury levels was not reliably achieved in all patients, with particular limitations observed in overhead active individuals. The data support the hypothesis that patients in this age group demonstrate significant improvements in clinical outcomes following ARCR along with significant improvements in athletic abilities.

How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group

PurposeIn clinical practice the assessment of the “vocal cord-arytenoid unit” (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. MethodsIn this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. ResultsTwenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. ConclusionsThe current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Effects of acupuncture at myofascial trigger points combined with sling exercise therapy on clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy

Objective This research aimed to ascertain the effects of acupuncture at myofascial trigger points (MTrPs) in combination with sling exercise therapy (SET) on the clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy (CRS). Methods Eighty patients with CSR were divided into Group A and Group B. Group A was treated with acupuncture at MTrPs, and Group B was treated with acupuncture at MTrPs combined with SET. The cervical spine function, pain level, cervical spine biomechanics and the occurrence of complications were compared between the two groups before and after treatment. Results After treatment, the Japanese Orthopaedic Association scores, Clinical Assessment Scale for Cervical Spondylosis scores, cervical forward flexion angle, posterior extension angle, left lateral flexion angle, right lateral flexion angle, left lateral rotation angle, and right lateral rotation angle of the Group B were raised, and the Neck Disability index, Visual Analogue Scale scores, and Neck Pain Questionnaire scores were reduced versus those of the Group A. The difference in complication rates between the two groups was not of statistical significance. Conclusion Acupuncture at MTrPs combined with SET promotes functional recovery of the cervical spine, reduces pain, and improves cervical spine biomechanics in patients with CRS.

Percutaneous elevation of proximal tibia depressed fractures using modified new instrument

Proximal tibia depression fracture often occur isolated or in conjunction with complex fracture presentations and elevation of such depression is required to retard arthritis in long term. Conventional open reduction by sub meniscal approach has many percutaneous alternatives from arthroscopy assisted reduction to balloon tibioplasty. Few authors even reported usage of PCL jig and percutaneous pins to elevate, while the primary author has previously described an instrument to elevate the depressed fragment percutaneously. With the shortcomings of the same instrument, authors have designed modifications in the same to address anterior and posterior extensions of depression without widening the metaphyseal window. In this article, we describe the size and concept of the modified design and its efficacy to address depression injuries.

A new feather mite species of the genus Mycterialges Gaud & Atyeo, 1981 (Acari, Xolalgidae) from the Oriental Stork, Ciconiaboyciana (Ciconiiformes, Ciconiidae) in Korea.

A new feather mite species, Mycterialgesboycianaesp. nov. (Xolalgidae), was identified from the Oriental Stork, Ciconiaboyciana Swinhoe, 1873, in Korea. Males of M.boycianaesp. nov. are distinguished from Mycterialgesmesomorphus Gaud & Atyeo, 1981, in having a single triangular prodorsal shield, sinuous margins of the opisthosoma located between setae e2 and h2 on the hysteronotal shield, an oval-shaped epiandrum without posterior extensions, a shorter tibia + tarsus IV than femoragenu IV, and an absent ambulacral disc of leg IV. Females differ in having a prodorsal shield with a posterior margin that is blunt-angular, and a concave posterior margin of the hysteronotal shield with posterior extensions. This study presents the first record of the feather mite genus Mycterialges in birds of the genus Ciconia (Ciconiidae). Additionally, we determined the phylogenetic relationship among Ingrassiinae using the mitochondrial cytochrome c oxidase subunit (COI).