Postoperative Assessment Research Articles

Imaging of the postoperative spine.

There has been a significant increase in the number of spinal surgical procedures performed over the last few decades, resulting in a proportionate increase in the number of postoperative imaging studies.An exhaustive literature search was performed along with consideration of various guidelines and expert opinions regarding postoperative spine imaging. Complications are divided into early (in the first few weeks) and delayed, depending on the time of onset. Some complications occurring in the early postoperative period are common for both the instrumented and non-instrumented spine. Delayed complications are specific to the type of surgery performed and have been described as such. This review discusses the normal postoperative appearance and the various early and delayed complications.An understanding of the normal postoperative appearance is pertinent to distinguish normal from abnormal. A plain radiograph is the primary imaging modality for immediate postoperative assessment and long-term follow-up after spinal instrumentation. MRI with or without contrast is the imaging modality of choice for the evaluation of the postoperative spine. CT is the best modality for the assessment of the instrumented spine and status of bony fusion. Imaging assessment of the postoperative spine is complex and requires knowledge of key factors for interpretation like indications for the initial surgical procedure, type and approach of the surgical procedure, instrumentation used, time elapsed since surgery, and clinical complaints. · For proper interpretation of the postoperative spine, it is very important to understand the indication and type of spinal procedure involved. · Baseline postoperative radiographs are important to detect any change in the position of metalwork and implant integration.. · Computed tomography is the modality of choice to evaluate bony fusion and metalwork-specific complications. · Postoperative fluid collection is the most common early complication and MRI is the imaging modality of choice for the identification of the same.. · Intravenous gadolinium is helpful to differentiate between scar/vascularized granulation tissue and recurrent or residual disc.. · Kaur S, Lalam R, Trivedi R. Imaging of the postoperative spine. Rofo 2025; DOI 10.1055/a-2507-8347.

Increased Retro-Odontoid Soft Tissue Ratio: A Risk Factor for Symptomatic Retro-Odontoid Pseudotumor Following Laminoplasty.

This study examines the risk of developing symptomatic retro-odontoid pseudotumor (ROP) following cervical laminoplasty. ROP can result in cervical myelopathy, leading to substantial morbidity. Identifying the risk factors for symptomatic ROP is essential to improving patient outcomes after laminoplasty. The study included 2 symptomatic ROP patients and 2 additional cases from the literature, compared with a cohort of 57 non-ROP patients who underwent Hirabayashi open-door laminoplasty. Radiological assessments were conducted to evaluate cervical spine alignment, including MRI and postoperative dynamic radiographs. A novel index, the retro-odontoid soft tissue ratio (RS ratio), was introduced to quantify the extent of retro-odontoid soft tissue compression. The study included 4 ROP patients (mean age: 68.5 years; all males) and 57 non-ROP patients (mean age: 65.7 years; 32 males, 25 females). The mean follow-up duration was 93.0 months (range: 48-156) for the ROP group and 32.5 months (range: 3-101) for the non-ROP group. The ROP group had significantly higher preoperative RS ratios (46.11 ± 4.80%) compared to the non-ROP group (30.29 ± 4.94%, p < 0.05). Post-operative cervical mobility assessment showed no significant difference in O-C2 contribution between the groups, with the ROP group at 59.82 ± 17.14% and the non-ROP group at 47.79 ± 14.17% (p = 0.13). The mean O-C7 range of motion (ROM) was lower in the ROP group (38.42 ± 16.23°) compared to the non-ROP group (49.69 ± 14.89°), but the difference was not statistically significant (p = 0.23). However, the change in O-C2 ROM was significantly different between the groups, with the ROP group showing an increase of +7.23 ± 4.70°, while the non-ROP group showed a decrease of -0.04 ± 9.90° (p < 0.05). This study highlights that a high preoperative RS ratio is a significant risk factor for symptomatic ROP, with a notable increase in O-C2 ROM observed in the ROP group following laminoplasty. These findings suggest that ROP is a progressive condition that may worsen after surgical intervention, particularly in patients with pre-existing retro-odontoid masses.

Efficacy of Electrofulguration for Women with recurrent urinary tract infection on quality of life and sexual function.

Introduction The primary objective of the study was to assess the impact of EF in women with rUTI on quality of life and sexual health. Methods This prospective observational clinical study included 152 patients women who underwent EF because of rUTI and were followed for a minimum of 18 months. The SF-12 questionnaire and the Female Sexual Function Index (FSFI) are used to evaluate quality of life and sexual dysfunction. The Patient Global Impression of Improvement (PGI-I) scale was assessed to evaluate subjective cure. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during cystoscopy Clinical success was defined as no urinary tract infections at the last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year. Chi-square test, Wilcoxon, and Student's paired t-test were used. Results Seventy patients (52.6%) were defined as cured at least a 1-year follow-up. The subjective cure rate was 71.4% (N = 95) according to PGI-I scores. Women had significantly higher average FSFI scores (P=0.001) in the one-year postoperative assessment. Overall, pathological mental health and physical health scores were significantly higher after the intervention (P=0.00). Thirty-one (23.3%) patients improved clinically with <3 infections per year, and 32 (24.1%) patients failed with >3 infections per year. A total of 97 (74.4%) patients had endoscopic resolution postoperative evaluation. Conclusion EF resulted in clinical cure and improvement in the large majority of the patients. A significant proportion of the patients demonstrated enhanced sexual function and quality of life.

Lisfranc Injury: a Comprehensive Analysis of LongTerm Outcomes - the Oswestry Experience.

Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment. We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria. We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results. In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury. Lisfranc injury, long-term, orthopaedic surgery, obesity.

A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study

BackgroundWe aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.MethodsThis retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.ResultsPredictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135—1.316), BMI (HR: 0.890, 95% CI: 0.796—0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610—12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751—0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer–Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.ConclusionsThe model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

A Workflow-Efficient Approach to Pre- and Post-Operative Assessment of Weightbearing Three-Dimensional Knee Kinematics.

Knee kinematics during daily activities reflect disease severity pre-operatively and are associated with clinical outcomes after total knee arthroplasty (TKA). It is widely believed that measured kinematics would be useful for preoperative planning and postoperative assessment. Despite decades-long interest in measuring three-dimensional (3D) knee kinematics, no methods are available for routine, practical clinical examinations. We report a clinically practical method utilizing machine-learning-enhanced software and upgraded C-arm fluoroscopy for the accurate and time-efficient measurement of pre-TKA and post-TKA 3D dynamic knee kinematics. Using a common C-arm with an upgraded detector and software, we performed an 8-second horizontal sweeping pulsed fluoroscopic scan of the weight-bearing knee joint. The patient's knee was then imaged using pulsed C-arm fluoroscopy while performing standing, kneeling, squatting, stair, chair, and gait motion activities. We used limited-arc cone-beam reconstruction methods to create 3D models of the femur and tibia/fibula bones with implants, which can then be used to perform model-image registration to quantify the 3D knee kinematics. The proposed protocol can be accomplished by an individual radiology technician in ten minutes and does not require additional equipment beyond a step and stool. The image analysis can be performed by a computer onboard the upgraded c-arm or in the cloud, before loading the examination results into the Picture Archiving and Communication System (PACS) and Electronic Medical Record (EMR) systems. Weight-bearing kinematics affect knee function pre-TKA and post-TKA. It has long been exclusively the domain of researchers to make such measurements. We present an approach that leverages common, but digitally upgraded, imaging hardware and software to implement an efficient examination protocol for accurately assessing 3D knee kinematics. With these capabilities, it will be possible to include dynamic 3D knee kinematics as a component of the routine clinical workup for patients who have diseased or replaced knees.

Endoscopic Endonasal Approach for Calcified Sellar/Parasellar Region Pathologies: Report of 11 Pituitary Adenoma Cases

Calcification in pituitary adenomas is a rare occurence and its differential diagnosis typically includes other sellar masses.Common calcifications in pituitary adenomas are classified into two morphological forms: capsular(eggshell-like)and multiple small nodular calcifications located within the adenoma.Also,there is a pituitary stone term.This study aims to present the results of calcified pituitary adenoma case series who underwent endoscopic endonasal approach(EEA)and the clinical,histopathological characteristics and surgical outcomes of these cases. This study conducted a retrospective cohort analysis of patients with calcified pituitary adenoma operated on by EEA between August 1997 and February 2024.The inclusion criteria were as follows:proven radiological calcification on pre-operative neuroimaging,intraoperative findings of calcification and definitive histopathological diagnosis of calcification.Among these patients,11 cases were included. The mean follow-up duration was 51.45±37.24 (6-118)months.Based on the pre-operative paranasal sinus computed tomography(CT)scans of patients,nine patients(81.8%)had intratumoral calcification,one(9.1%)had capsular(eggshell like)calcification and one(9.1%)had both intratumoral and capsular calcification.Moreover,stone-like calcifications were observed in four patients(36.4%),soft type calcifications in three(27.3%),hard-type calcifications in three(27.3%)and soft and hard-type calcifications in one(9%).Gross total resection(GTR)was achieved in nine patients(81.8%).Pathologic subtypes included non-functioning(n = 4),prolactin secreting(n = 3),growth hormone secreting adenoma(n = 2)and pituitary apoplexy(n = 2).Ten patients had psammomatous type calcifications and one had extensive ossification and osteoid metaplasia. Pre-operative radiological evaluation,intraoperative classification of calcification,and post-operative histopathological assessments are crucial in the treatment of calcified adenomas.Bases on these findings,the EEA,with its advantages,is an approach that can be effectively used in the management of these calcified adenomas.

Delta Neutrophil Index in Coronary Artery Bypass Surgery: An Innovation in Postoperative Mortality Assessment

Delta Neutrophil Index in Coronary Artery Bypass Surgery: An Innovation in Postoperative Mortality Assessment

Dynamics of the mitral valve annulus in hypertrophic obstructive cardiomyopathy patients undergoing septal myectomy: insights from 3D transesophageal echocardiography

Abstract Background Mitral annulus (MA) dynamics in HOCM patients and the impact of surgical myectomy on them is not fully understood. This study aimed to evaluate the MA dynamics and their changes after septal myectomy in HOCM patients. Methods This prospective, single-center study included 26 HOCM patients undergoing septal myectomy. Intraoperative Three-dimensional Trans-Esophageal Echocardiography (3DTEE) for the mitral valve (MV) was performed pre- and post-surgery followed by offline analysis of the acquired volumes to assess MA dimensions and dynamics before and immediately after myectomy using a dedicated post-processing software (4D MV analysis, QLAB version 15, Philips Healthcare). Results Pre-operatively, throughout four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in MA dimensions, Specifically, the anteroposterior (AP) diameter (3.753 ± 0.48, 3.756 ± 0.48, 3.866 ± 0.49, and 3.997 ± 0.49 cm, respectively; P=0.286), inter-trigonal diameter (2.88 ± 0.59, 2.89 ± 0.58, 2.89 ± 0.58, and 2.93 ± 0.60 cm, respectively; P=0.982), inter-commissural diameter (3.52 ± 0.38, 3.519 ± 0.36, 3.509 ± 0.35, and 3.526 ± 0.37 cm, respectively; P=0.999), 3D saddle-shaped annulus area (11.336 ± 2.26, 11.346 ± 2.27, 11.599 ± 2.3, and 12.031 ± 2.41 cm², respectively; P=0.714), annulus height (1.135 ± 0.24, 1.154 ± 0.25, 1.164 ± 0.24, and 1.148 ± 0.24 cm, respectively; P=0.981), aorto-mitral angle (105.64 ± 11.7, 104.62 ± 11, 103.8 ± 9.4, and 104.9 ± 10.40, respectively; P=0.949), and saddling (0.322 ± 0.06, 0.328 ± 0.06, 0.33 ± 0.06, and 0.326 ± 0.07, respectively; P=0.231). Post-operative comparisons revealed a notable _yet not statistically significant_ increase in the intercommissural and intertrigonal diameters in the mid systolic phase after myectomy that may be related to the relief of the obstruction. However, no statistically significant changes in MA dynamics throughout the four phases of the cardiac cycle regarding the AP diameter (P=0.939, 0.914, 0.965, and 0.505, respectively), inter-trigonal diameter (P=0.709, 0.701, 0.797, and 0.710, respectively), inter-commissural diameter (P=0.597, 0.990, 0.396, and 0.328, respectively), 3D saddle-shaped annulus area (P=0.854, 0.828, 0.880, and 0.619, respectively), annulus height (P=0.344, 0.318, 0.27, and 0.342, respectively), aorto-mitral angle (P=0.756, 0.702, 0.320, and 0.255, respectively), and saddling (P=0.1, 0.2, 0.062, and 0.067, respectively). Conclusion In HOCM patients, MA exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in MA dynamics. Therefore, further longitudinal studies are necessary to assess long-term changes in MA dynamics due to LV remodeling following septal myectomy procedures.

Contrast Sensitivity and Stereopsis Outcomes Following LASIK Presbyopia Correction Based on the Corneal Aberration Modulation or Corneal Multifocality Induction Methods: A Systematic Review

Background. Modern laser vision correction for presbyopia treatment involves non-linear aspheric corneal ablation with the controlled induction of spherical aberration modulation to extend the depth of focus or corneal multifocality induction methods with or without micro-monovision in the non-dominant eye to provide continuous clear vision across distances. Anisometropia and the new higher-order aberrations pattern may be potential risk factors for postoperative stereopsis and contrast sensitivity (CS) deterioration. Purpose. The objective of this systematic review was to assess articles published until 2023 in which CS and/or stereopsis were reported following LASIK presbyopia treatment. Methods. We searched the PubMed, Scopus and Web of Science databases in accordance with the PRISMA 2020 flow diagram. The inclusion criteria specified original papers evaluating the outcomes of laser presbyopia correction as well as the pre- and postoperative assessment of stereopsis and/or CS. The Quality Assessment Tool was applied to assess the risk of bias. Results. We identified 13 studies, including 856 presbyopes (1712 eyes), with preoperative refractive errors from −11.13 D to +5.75 D, with the follow-up range between 3 and 30 months. Either contrast sensitivity improvement or no change following Presbyond® Laser Blended Vision and PresbyMAX® Hybrid was found in the reviewed articles. Some authors reported a significant CS reduction after symmetrical PresbyLASIK, wavefront-guided LASIK and aspheric monovision LASIK. Several studies assessing the effect of Presbyond® LBV on stereopsis showed conflicting results, with the near stereopsis being reduced, unchanged or increased. A significant decrease in stereopsis was reported after aspheric monovision LASIK. (5) Conclusions. The Presbyond® Laser Blended Vision is a safe procedure in terms of the preservation of contrast sensitivity for presbyopia treatment. More studies are needed to elucidate the impact of aspheric corneal ablation methods or other methods inducing corneal multifocality with or without micro-monovision on stereopsis and contrast sensitivity.

The Clinical Value of the MAR+ Metal Artifact Reduction Algorithm for Postoperative Assessment of Lumbar Internal Fixation.

With the widespread use of lumbar pedicle screws for internal fixation, the morphology of the screws and the surrounding tissues should be evaluated. The metal artifact reduction (MAR) technique can reduce the artifacts caused by pedicle screws, improve the quality of computed tomography (CT) images after pedicle fixation, and provide more imaging information to the clinic. To explore whether the MAR+ method, a projection-based algorithm for correcting metal artifacts through multiple iterative operations, can reduce metal artifacts and have an impact on the structure of the surrounding metal. A total of 57 patients who underwent lumbar spine CT examination after lumbar internal fixation from January to December 2023 in our hospital were retrospectively enrolled. The CT images were reconstructed using MAR+ and non-MAR+ techniques and were subdivided into MAR+ and non-MAR+ groups. The CT number (in Hounsfield units) and the SD noise values of the spinal canal, vertebral body, psoas major muscle, and adjacent fat were measured in the 2 groups of CT images, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The subjective score was evaluated by two diagnostic radiologists using a double-blind method for image quality evaluation of the MAR+ group and the non-MAR+ group, and the image quality was classified on a 5-point scale. The rank-sum test was utilized to compare the subjective and objective scores of the 2 groups. The SD values of the spinal canal (Z=-4.12, P<0.01), vertebral body (Z=-3.81, P<0.01), and psoas major muscle (Z=-3.87, P<0.01) in the MAR+ group were significantly lower than those in the non-MAR+ group (P<0.05). However, the SD values of the adjacent fat (Z=-2.03, P=0.42) in the MAR+ group, although smaller than those in the non-MAR+ group, were not statistically significant. The CNR values of vertebral canal (Z=-2.67, P=0.008) and fat (Z=-2.60, P=0.009) were higher in the MAR+ group than in the non-MAR+ group, whereas the CNR values of the vertebral body (Z=-6.74, P<0.01) in the MAR+ group were smaller than those in the non-MAR+ group, and the difference of all of them was statistically significant (P<0.05). Furthermore, for both CT and SNR values, the MAR group's values were all less than those of the non-MAR group and were statistically significant (P<0.05). The subjective scores of the measurement points were all higher in the MAR+ group than in the non-MAR+ group. The MAR+ technique has a noise reduction effect on different tissues and artifacts are significantly reduced. Although the artifacts caused by metal screws were not completely eliminated, the MAR+ technique was able to reduce the interference of artifacts in the diagnosis of CT images, thus improving their diagnostic quality.

Case report: Non-linear evolution of oxytocin informs YBOCS changes post-DBS of the bed nucleus of the stria terminalis for treatment resistant OCD

IntroductionObsessive-compulsive disorder (OCD) is a challenging neuropsychiatric condition with a subset of patients remaining refractory to conventional treatments. Deep brain stimulation (DBS) of the bed nucleus of the stria terminalis (BNST) has shown promise for severe, treatment-resistant OCD. This case report examines the relationship between plasma oxytocin levels and OCD symptom severity following BNST-DBS.MethodsA 36-year-old patient with long-standing, treatment-resistant OCD underwent stereotactic implantation of DBS electrodes at the BNST. Postoperative assessments included OCD symptom severity using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and plasma oxytocin levels, measured at 12 time points over three years. Longitudinal and correlational analyses were performed using linear and polynomial regression models.ResultsNon-linear trends in oxytocin levels were identified, with polynomial regression revealing a significant quadratic term, suggesting a parabolic trend. Strong positive correlations were found between changes in oxytocin levels and YBOCS total, obsession, and compulsion scores.ConclusionThe findings suggest a significant non-linear evolution of oxytocin levels and a positive correlation with OCD symptom changes following BNST-DBS. Oxytocin levels could serve as a biomarker for DBS efficacy if this finding is replicated in larger studies.

Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment

Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment (FA) principle. Methods: This retrospective cohort study included 100 consecutive patients who underwent primary TKA for knee osteoarthritis through an image-based robotic system in a single center between October 2021 and February 2022. Whether modified KA or FA could achieve a balanced knee was evaluated by assessing the ligament balance in the medial and lateral compartments using a robotic system at extension and 90° flexion. Balance was defined as a difference of ≤2 mm between the compartments. Component positioning was adjusted within limits based on the functional positioning principles to achieve balance. Implant positioning and balance in extension and 90° flexion were compared between the modified KA plan (n = 100) and after FA adjustments (n = 100). Results: FA achieved significantly better balance in extension (FA, 99.0% vs. modified KA, 86.0%; p = 0.001) and flexion (98.0% vs. 43.0%; p &lt; 0.001) than the modified KA plan. The mean difference in gap balance in extension (FA, 0.1 mm vs. modified KA, 0.6 mm; p = 0.001) and flexion (0.1 mm vs. 2.3 mm; p &lt; 0.001) was also significant between the two techniques. The femoral component was positioned more externally rotated relative to the transepicondylar axis (FA, 2.5° vs. modified KA, 0.0°; p &lt; 0.001) to obtain balanced targets. There were significant improvements in the patient-reported outcome measures between preoperative and postoperative assessments two years after TKA (all p &lt; 0.05). Conclusions: FA consistently achieved superior balance in both extension and flexion following TKA compared with modified KA without altering the soft tissue envelope, leading to significant improvements in clinical outcomes at the two-year follow-up.

Multilocular thymic cysts- a diagnostic challenge on computed tomography

A recent case report provided a patient scenario, wherein, a 39-year-old male patient presented with occasional palpitations, headache, and fever. Evaluation of tumor markers did not show any abnormal results. Subsequently, a computed tomography (CT) scan was undertaken, and its findings were affirmative of thymic cancer. Finally, the postoperative histopathological assessment of the mass, after its resection, confirmed it as an anterior mediastinal multilocular thymic cyst (MTC), with concurrent acute upper respiratory tract infection and acute myocarditis. Accordingly, this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.

Patient-specific implants combined with 3D-printed drilling guides for corrective osteotomies of multiplanar tibial and femoral shaft malunions leads to more accurate corrections

PurposeThe aim of this study was to evaluate the feasibility of using patient-specific implants (PSI) for complex shaft corrective osteotomies in multiplanar deformities of long bones in the lower extremities. Additionally, it aimed to investigate the added value of these implants by quantifying surgical accuracy on postoperative CT, comparing their outcomes to two commonly used techniques: 3D virtual visualizations and 3D-printed surgical guides.MethodsSix tibial and femoral shaft corrective osteotomies were planned and performed on three Thiel embalmed human specimen. Depending on the specimen a different respective technique was used; 1) ‘3D Visualization’ using 3D virtual plan preoperatively and free-hand corrective osteotomy techniques with standard manually contoured plates; 2) ‘3D guided’ utilizing 3D surgical guides and manually contouring of conventional implant; and 3)‘3D PSI’ utilizing a 3D surgical guide with a patient-specific implant. Accuracy of the corrections was assessed through measurements for varus/valgus angulation, ante/recurvation, rotation and osteotomy plane error as quantified on postoperative CT-scans.ResultsTwelve corrective osteotomies were performed. For, the median difference between the surgical plan and postoperative CT assessment was 3.4°, 4.6°, and 2.2° for the ‘3D visualization’, ‘3D guided’, and ‘3D PSI’ methods respectively. Regarding ante/recurvation, the differences were 3.8°, 43.8°, and 1.2°, respectively. For rotation, the differences were 11.9°, 18.7°, and 3.5°, respectively. Discrepancies between planned and executed levels of osteotomy plane were 6.2 mm, 3.2 mm, and 1.4 mm, respectively.ConclusionPSIs with 3D-printed drilling guides for complex multiplanar corrective osteotomies of femoral and tibial shaft malunions is feasible and achieves accurate corrections. This technique enables precise determination of the osteotomy plane, guides correction in all three planes, and ensures satisfactory implant fitting; thus accurately translating the virtual surgical plan into clinical practice. The 3D PSI method is beneficial for complex cases with significant multiplanar deformities in bone anatomy, particularly with rotational malalignment.

Machine learning based quantitative pain assessment for the perioperative period

This study developed and evaluated a model for assessing pain during the surgical period using photoplethysmogram data from 242 patients. Pain levels were measured at 2 min intervals using a numerical rating scale or clinical criteria: preoperative, before and after intubation, before and after skin incision, and postoperative. Key features from the photoplethysmography waveform were extracted to build XGBoost-based models for intraoperative and postoperative pain assessment. The combined perioperative model was compared with a commercial surgical pain index, yielding area under the receiver operating characteristics curve scores of 0.819 and 0.927 for intraoperative and postoperative periods, respectively, compared to the commercial index’s scores of 0.829 and 0.577. These results highlight the models’ effectiveness in pain assessment throughout the surgical process, identifying waveform skewness and diastolic phase rate decrease as critical for intraoperative pain assessment and systolic phase area or baseline fluctuation as significant for postoperative pain assessment.Clinical trial registration: Registration name: Clinical Research Information Service (CRIS). Registration site: http://cris.nih.go.kr. Number: KCT0005840. Principal Investigator: Dr. Byung-Moon Choi. Date of registration: January 28, 2021

Postoperative accuracy quantification of corrective osteotomies: standardisation of Q3D-CT methodology

PurposeCurrently, no gold standard exists for 3D analysis of virtually planned surgery accuracy postoperatively. The aim of this study was to present a new, validated and standardised methodology for 3D postoperative assessment of surgical accuracy in patients undergoing 3D virtually planned and guided corrective osteotomies.MethodsAll patients who underwent 3D planned corrective osteotomy in 2021–2022 at our center with a postoperative CT were included. Postoperative surgical outcome was analysed with a postoperative CT and compared to the preoperative virtual surgical planning to determine achieved accuracy. Validation of the analysis was performed by evaluating the individual assessment of six experienced observers. A postoperative quantification was performed according to the proposed innovative methodology based on rotation axes of a virtual postoperative bone model aligned to the virtual preoperative bone model and virtual surgical planned bone model. To evaluate the intra-observer variability, one observer performed the assessment twice.ResultsQuantification of 13 patients according resulted in measurements with a median range (and its interquartile range) for 3D translation of: 2.43 mm (3.17), for the angle deviations: 3D rotation, 2D coronal, 2D sagittal and 2D axial were: 0.66° (1.66°), 0.74° (0.44°), 0.99° (1.27°), 2.37° (5.00°), respectively. The inter- and intraobserver reliability established with the Intraclass correlation coefficient was for all measurements excellent (> 0.76).ConclusionThe proposed 3D CT technique provides an significant more accurate and objective method for assessment of surgical outcome of a guided corrective osteotomy. The present proposed novel methodology showed excellent inter- and intra-observer reliability with clinically acceptable absolute surgical outcome measurements.

Development and validation of a novel artificial intelligence algorithm for precise prediction the postoperative prognosis of esophageal squamous cell carcinoma

BackgroundEsophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy, and current postoperative prognostic assessment methods remain unsatisfactory, underlining the urgent to develop a reliable approach for precision medicine. Given the similarities with gametogenesis, cancer/testis genes (CTGs) are acknowledged for regulation unrestrained multiplication and immune microenvironment during oncogenic processes. These processes are associated with advanced disease and poorer prognosis, indicating that CTGs could serve as ideal prognostic biomarkers in ESCC. The purpose of this study is to develop a novel clinically prognostic prediction system to facilitate the individualized postoperative care.MethodsWe conducted LASSO regression analysis of protein-coding CTGs and clinical characteristics from 119 pathologically confirmed ESCC patients to recognize powerful predictive variables. We employed nine supervised machine learning classifiers and integrated best predictive machine learning classifiers by weighted voting method to construct an ensemble model called PPMESCC. Additionally, functional assay was conducted to examine the potential effect of top-ranking CTG HENMT1 in ESCC.ResultsLASSO regression identified five CTGs and TNM stage as optimized prognostic features. Six machine learning classifiers were integrated to construct an ensemble model, PPMESCC, which exhibited outstanding performance in ESCC prediction. The AUC for PPMESCC was 0.9828 (95% confidence interval: 0.9608 to 0.9926), with an accuracy of 98.32% (95% CI: 96.64–99.16%) in the discovery cohort and 0.9057 (95% CI: 0.8897 to 0.9583) of AUC with an accuracy of 90% (95% CI: 89.08–93.28%) in validation cohort. In addition, the top-ranking CTG HENMT1 encodes 2’-O-methyltransferase of piRNAs that was confirmed positively correlated with the proliferation capacity of ESCC cells. Then we systematically screen piRNAs associated with esophageal carcinoma based on GWAS, eQTL-piRNA, and i2OM databases, and successfully discovered 8 piRNAs potentially regulated by HENMT1.ConclusionThe study highlights the clinical utility of PPMESCC algorithm in prognostic prediction that may facilitate to establish the personalized screening and management strategies for postoperative ESCC patients.

Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study.

An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life. We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614. DERR1-10.2196/59203.

A Lack of Joint Line Tenderness Is Consistent With a Healed Meniscus, But Positive Clinical Examination Findings and MRI Scans Are Inconsistent in Identifying Failure After Meniscal Repair: A Systematic Review and Subgroup Meta-analysis.

The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known. The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal. Systematic review and meta-analysis; Level of evidence, 4. This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing. No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ12 = 0.24; P = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76). This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.