Preoperative Parameters Research Articles

Preoperative Diffusion Tensor Imaging and Neurite Dispersion and Density Imaging in Isocitrate Dehydrogenase-Mutant Grade 2 and 3 Gliomas: Definition of Tumor-Related Epilepsy and Predictive Factors of Seizure Outcomes Based on a Single-Center Retrospective Case Series.

Understanding and managing seizure activity is crucial in neuro-oncology, especially for highly epileptogenic lesions like isocitrate dehydrogenase (IDH)-mutant gliomas. Advanced MRI techniques such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) have been used to describe microstructural changes associated with epilepsy. However, their role in tumor-related epilepsy (TRE) remains unclear. This study aims to investigate the role of DTI and NODDI tumor-derived metrics in defining TRE and predicting postoperative seizure outcomes in patients undergoing surgical resection for IDH-mutant grade 2 and 3 gliomas. This was a single-center retrospective study. Preoperative DTI parameters included fractional anisotropy and mean diffusivity. NODDI parameters included neurite density index (NDI), orientation dispersion index, and free-water fraction (FWF). These metrics were calculated within three volumes of interest (fluid-attenuated inversion recovery [FLAIR] tumor volume, FLAIR peripheral zone, and FLAIR central zone [Fcz]) and correlated with seizure presentation, type, and postoperative control, which was reported according to the Engel classification system. Fifty-seven patients were included in this study. Increased NODDI-derived FWF-Fcz (P = .031) and NDI-Fcz (P = .046) values correlated with preoperative generalized seizure presentation, although only the FWF-Fcz confirmed its statistical significance (P = .047) in the multivariate analysis. Lower mean diffusivity-FLAIR tumor volume correlated with poor postoperative seizure control both in the univariate (P = .015, P = .026) and multivariate analyses (P = .024, P = .036), while a trend toward significance was found between higher NDI-FLAIR peripheral zone and worse seizure control (P = .055). DTI and NODDI tumor-derived quantitative parameters may define TRE and predict postoperative seizure outcomes in patients with IDH-mutant gliomas. Notably, DTI metrics were found to be independent predictors of postoperative seizure outcomes, while preoperative NODDI parameters correlated with seizure presentation. Further research is warranted to validate our findings and to better understand the underlying mechanisms driving TRE.

A comparative study of Single-barrel and Double-barrel trabeculectomy: efficacy of intraoperative 5-fluorouracil in reducing intraocular pressure

ABSTRACT Background Trabeculectomy is a key surgical approach for managing glaucoma, particularly in patients with high intraocular pressure. This study compares the efficacy of Single-barrel and Double-barrel trabeculectomy techniques utilizing 5-fluorouracil (5-FU) to enhance intraocular pressure (IOP) control and surgical outcomes. Research design and methods A prospective cohort study of 78 patients (147 eyes) undergoing trabeculectomy with 5-FU was conducted. Patients were divided into Single-barrel and Double-barrel groups. Preoperative and postoperative parameters, including IOP, medication scores, and visual acuity, were assessed. Statistical analyses included propensity score matching, ANCOVA, and Kaplan-Meier survival analysis. Results Both techniques significantly reduced IOP postoperatively (p < 0.0001). The Double-barrel group demonstrated superior IOP control durability with longer time to failure (10.77 ± 1.67 months vs. 8.38 ± 1.72 months, p < 0.001), fewer total failures (11 vs. 15), and a trend toward reduced medication reliance (1.91 ± 0.80 vs. 2.11 ± 0.86, p = 0.137). Visual acuity improved in both groups, with a higher proportion of Double-barrel patients achieving 6/6 acuity. Conclusions The Double-barrel trabeculectomy technique demonstrated superior long-term IOP control and reduced reliance on glaucoma medications, highlighting its potential as a more effective surgical option in glaucoma management.

A Nomogram utilizing ECG P-wave parameters to predict recurrence risk following catheter ablation in paroxysmal atrial fibrillation

The objective of this study is to assess the predictive utility of perioperative P-wave parameters in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation, and to develop a predictive model using these parameters. A total of 213 patients with PAF undergoing catheter ablation were retrospectively analyzed. P-wave parameters were measured within 3 days preoperatively and on the day postoperatively to determine their predictive significance for postoperative PAF recurrence. Post-ablation, PAF did not recur in 168 patients, while 45 experienced recurrence. Significant differences were observed in preoperative P-wave parameters as Maximum P Wave Duration(Pmax), absolute value of P Wave Terminal Force of V1 (PtfV1) and P Wave Dispersion(Pd), postoperative P-wave parameters as P Wave Duration (PWDII, III, aVF), Pmax, P Wave Area(P-area), absolute value of PtfV1 and Pd, and changes in perioperative P-wave parameters (Delta-Pmax, Delta-PtfV1 absolute value, Delta-Pd, Delta-PWDII, III, aVF). Univariate logistic regression, receiver operating characteristic (ROC) curve analysis, and hazard ratio assessment identified predictive indicators for postoperative recurrence, including Pmax, PtfV1 absolute value, Pd, post-P area, post-PWDII, III, aVF and Delta-pwdII, III, aVF). A personalized nomogram model based on these P-wave parameters was developed. Calibration curve assessment demonstrated that the predictive performance of the nomogram for PAF recurrence following catheter ablation closely matched actual observed outcomes. ROC curve analysis indicated a sensitivity of 89.3% for the model, and decision curve analysis confirmed its significantly favorable predictive use and clinical benefits. P-wave parameters like PWDШ, PWDaVF, Pmax, Pd, and PtfV1 serve as predictors of PAF recurrence following catheter ablation. The nomogram model constructed using these P-wave parameters demonstrates robust predictive performance.

Outcomes of Calcaneal Lengthening Osteotomy in Ambulatory Patients with Cerebral Palsy and Planovalgus Foot Deformity.

To date, no studies have evaluated the longevity of calcaneal lengthening osteotomy (CLO) in patients with cerebral palsy (CP) and pes planovalgus. This study aimed to explore the changes in foot alignment following CLO in patients with CP, utilizing both radiographic evaluations and dynamic foot-pressure assessments. A retrospective study of 282 feet in 180 ambulatory patients was performed. The mean patient age at the surgical procedure was 8.9 ± 2.6 years. The mean follow-up period was 8.0 ± 4.3 years, and the mean age at the final follow-up 16.9 ± 4.4 years. Weight-bearing radiographs at 3 separate time points (before the surgical procedure, 6 months postoperatively, and at the final follow-up) were used. The feet were classified as corrected, undercorrected, or overcorrected on the basis of the radiographic parameters. At the final follow-up, we classified 98 feet (34.8%) as corrected, 58 (20.6%) as undercorrected, and 126 (44.7%) as overcorrected. Foot-pressure analysis demonstrated that the undercorrected feet had higher relative vertical impulses in the medial forefoot and medial midfoot than in the other groups, whereas the overcorrected feet had higher impulse in the lateral midfoot. There were no significant differences in preoperative radiographic parameters between the 3 groups, except for the calcaneal pitch angle. At 6 months after the surgical procedure, we classified 181 feet (64.2%) as corrected, 58 (20.6%) as undercorrected, and 43 (15.2%) as overcorrected. However, 53.6% of initially corrected feet changed to being undercorrected or overcorrected during further follow-up, 43.1% of the undercorrected feet became corrected or overcorrected, and 16.3% of the overcorrected feet became corrected. A younger age at the surgical procedure and lower naviculocuboid overlap at 6 months after the surgical procedure were the risk factors for overcorrection. Although CLO is an effective method for correcting planovalgus foot deformities and enhancing foot-pressure distribution, the extent of correction observed early after the surgical procedure was not necessarily sustained over the follow-up period in individuals with CP. Furthermore, our findings highlight a noticeable tendency toward the overcorrection of the deformity, as evidenced by increased pressure exerted on the lateral midfoot. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Presentation and Surgical Outcomes of Primary Hyperparathyroidism After Radioactive Iodine Therapy.

Radioactive iodine (RAI) is a common treatment for various thyroid diseases. Previous studies have suggested susceptibility of parathyroid glands to the mutagenic effect of RAI and the development of primary hyperparathyroidism (PHPT). We tested the possible link between prior RAI treatment, disease presentation, and treatment outcomes. A retrospective analysis of 704 individuals who underwent parathyroidectomy for PHPT at a tertiary care center between the years 2015 and 2023 was performed. Preoperative and postoperative parameters, including demographic characteristics, biochemical markers, imaging data, and surgical and pathology findings were collected and analyzed to compare differences in patients who had previous RAI treatment and those who did not (non-RAI). Univariate statistical analyses were performed. Twenty-nine patients had a history of RAI treatment. Indications for RAI treatment included hyperthyroidism (n=18), papillary thyroid cancer (n=6), subacute thyroiditis (n=1), follicular cancer (n=1), and toxic goiter (n=1). Average latency time between RAI exposure and development of PHPT was 18.4ys. On comparison of the two groups, there was no difference in age, sex, race/ethnicity, day of surgery body mass index, preoperative parathyroid hormone, calcium, glomerular filtration rate, creatinine, vitamin D, or phosphate levels. There was also no difference in preoperative diagnosis of osteoporosis or nephrolithiasis. Postoperatively, there was no difference in parathyroid hormone, calcium, or creatinine levels, or in rate of cure. There was significantly higher chance of unilateral exploration in the operating room (75.9% RAI, 54.1% non-RAI, P=0.02) and increased rate of single-gland disease in the RAI group, although the latter finding was not statistically significant (79.3% RAI, 65.2% non-RAI, P=0.12). There was no difference in adenoma size as noted on the pathology report (greatest dimension 1.7cm RAI, 1.7cm non-RAI, P=0.28). Subgroup analysis of the RAI group based on reason for RAI treatment (cancer versus hyperthyroidism) showed no statistically significant differences in the examined demographic or clinical data. There does not seem to be a relationship between prior RAI treatment and the clinical presentation of PHPT. Additionally, differences in RAI dose do not appear to be associated with a change in clinical presentation. Our study revalidates that age and latency are inversely related, which is a previously shown finding. Clinicians may be reassured that patients with prior RAI history may not have differences in clinical characteristics, disease presentation, or treatment outcomes.

Association of preoperative ultrasonographic parameters of the contralateral kidney with long-term serum creatinine in cats treated for unilateral ureteral obstruction

IntroductionPrediction of renal recovery after surgical management of feline unilateral ureteral obstruction (UO) is crucial to guide therapeutic decisions, but predictors of this outcome are still lacking. Despite the functional importance of the contralateral kidney, there is currently no precise description of its ultrasonographic (US) features. In addition, US parameters of both the renal collecting system and the renal parenchyma have been identified in human medicine as prognostic factors in the case of UO but have not been described in veterinary medicine. The aim of this study was to evaluate an association between preoperative structural US renal parameters and long-term International Renal Interest Society (IRIS) stage after successful renal decompression with subcutaneous ureteral bypass (SUB) device in cats with unilateral UO.MethodsThis retrospective study included 60 cats with unilateral UO and evaluated preoperative US parameters of both kidneys, including measurements of parenchymal and pelvic areas as well as a renal score. Cats were divided according to their serum creatinine at 3 months postoperatively into group A (IRIS stages I and II) and group B (IRIS stages III and IV).ResultsA higher US chronic kidney disease (US-CKD) score of the kidney contralateral to the UO was associated with long-term IRIS stages III and IV. It also appeared as a fair discriminator of long-term IRIS stage IV, with an area under the curve of 0.74. The optimal cutoff value for accurately identifying cats with long-term IRIS stage IV was a US-CKD score &amp;gt; 7, with a specificity of 98%, a sensitivity of 25%, and a positive likelihood ratio of 12.75. No preoperative US parameters regarding the obstructed kidney, including parenchymal and pelvic areas, were significantly associated with long-term creatinine.ConclusionUltrasonographic scoring of contralateral chronic kidney disease abnormalities is associated with IRIS stage following treatment of feline unilateral UO with a SUB device and serves as a specific indicator of cats presenting with long-term IRIS stage IV.

P0402 Preoperative body composition parameters are associated with postoperative complications and endoscopic postoperative recurrence in patients with Crohn’s disease

Abstract Background Alterations in body composition are common among patients with Crohn’s disease (CD) and may represent a modifiable risk factor for dismal postoperative outcomes. This study aimed to investigate the association of preoperative body composition with postoperative complications and endoscopic postoperative recurrence (ePOR) in CD patients following ileocolic (re-)resection (ICR). Methods CD patients (≥16 years) scheduled for ICR with a preoperative CT or MRI scan (&amp;lt;12 months prior to ICR) were identified from an ongoing prospective, multicenter cohort study. Cross-sectional area normalized for body height (i.e. index) and lipid content (i.e. radiation attenuation on CT or signal intensity on MRI) of sketelal muscle (SM), subcutaneous adipose (SAT), and visceral adipose tissue (VAT) were analyzed at L3 level. Cut-offs were based on sex-specific tertiles. The primary outcome was postoperative complications (Clavien-Dindo grade I-IV) within 30 days. Secondary outcomes were moderate-to-severe complications (Clavien-Dindo grade ≥II), infectious complications (intra- or extra-abdominal), and ePOR (modified Rutgeerts’ score ≥i2b) at six months postoperatively. Multivariable logistic regression was performed to assess the association of preoperative body composition with study outcomes. Results In total, 227 patients were included. Preoperative characteristiscs and postoperative outcomes are shown in Table 1. Median interval from preoperative imaging to ICR was 2.3 months (IQR 1.1–4.6). High lipid content of SM (i.e. myosteatosis) was associated with postoperative complications (aOR 2.51; 95%CI 1.21–5.22), moderate-to-severe complications (aOR 2.34; 95%CI 1.13–4.85), and infectious complications (aOR 2.20; 95%CI 1.01–4.80) (Figure 1). Low VAT-index was protective against postoperative complications (aOR 0.17; 95%CI 0.05–0.58). Low lipid content of VAT (aOR 3.98; 95%CI 1.15–13.78) and a high SAT-index (aOR 3.38; 95%CI 1.12–10.15) were associated with infectious complications. High SM-index was associated with ePOR (aOR 2.51; 95%CI 1.09–5.77). Preoperative body mass index (BMI) showed no association with study outcomes in uni- and multivariable analyses. Conclusion Preoperative myosteatosis on abdominal imaging is consistently associated with postoperative complications in patients with CD following ICR. Low VAT-index was identified as protective factor for postoperative complications, while low lipid content of VAT and a high SAT-index were associated with infectious complications. Surprisingly, high SM increased the risk of ePOR. Future research should identify strategies for preoperative improvement of body composition, rather than relying solely on BMI, and investigate if these improvements correlate with better postoperative outcomes.

Arthroscopic Microdrilling for Full-thickness Trochlear Cartilage Defects in Patients Undergoing High Tibial Osteotomy Confers Improved Cartilage Status at 1 year and Rate of Minimal Clinically Important Difference at Short-term Follow-up.

To compare the patient-reported outcome improvements and cartilage status of trochlear cartilage defects (TCDs) after additional arthroscopic microdrilling versus no treatment for TCDs during medial open-wedge high tibial osteotomy(MOWHTO) METHODS: Patients who underwent MOWHTO with either microdrilling (Group M) or no treatment (Group N) for near full-thickness TCDs (International Cartilage Repair Society[ICRS] grade≥3B) from March 2010 to September 2022 were retrospectively reviewed, with a minimum 2-year follow-up. 1:1 Propensity score matched-Group N was created. Comparative analyses were conducted using patient-reported outcomes(PROs) and minimal clinically important difference (MCID). Trochlear cartilage status was visually assessed via second-look arthroscopy 1 year postoperatively and categorized as deteriorated, maintained, or improved. Overall, 30 for group M and 84 patients for group N were included. The mean follow-up period of the matched groups was 32.8 and 32.0 months for groups M and N. The preoperative and postoperative radiographic parameters did not differ between the groups (Kellgren-Lawrence grade, pre- and postoperative alignment, medial proximal tibia angle). Both groups achieved significant clinical improvement in patients with medial compartment osteoarthritis and combined full-thickness TCD (p<0.001). PROs and improved PROs at final follow-up were not significantly different between groups, except for the Final Kujala anterior knee pain scale (70.4 [95% CI: 66.0-74.8] vs. 59.8 [95% CI: 53.0-67.6], p=0.018). MCID achievement rates in pain visual analogue scale (VAS), Knee injury and Osteoarthritis Outcome Scores (KOOS)-Pain, and KOOS-activity of daily living (ADL) were significantly higher in group M compared to group N (VAS, 93.3% vs. 63.3%, p=0.005; KOOS-Pain, 96.7% vs. 80.0%, p=0.044; KOOS-ADL, 86.7% vs. 63.3%, p=0.037). A significantly larger proportion of patients in group M demonstrated improvement in their TCD status compared to those in group N (93.1% vs. 44.8%, p<0.001). Arthroscopic microdrilling for near full-thickness TCD during MOWHTO improved trochlear cartilage status at 1 year but did not enhance final PROs at short-term follow-up, though it increased MCID achievement rates in some PROs (VAS, KOOS pain, KOOS ADL) compared to untreated patients. Level III, therapeutic retrospective cohort study.

Which Lenke type curve is most appropriate for vertebral body tethering in adolescent idiopathic scoliosis?

Clinical trials have studied the effects of curve magnitude and flexibility, age, and skeletal immaturity on the outcomes of VBT. No studies have assessed the effect of Lenke curve type on the outcomes of VBT. This study compares outcomes in patients who underwent VBT with Lenke type 1, 3, 5, and 6 curves. Single center retrospective review of patients undergoing mini-open thoracoscopic-assisted two row vertebral body tethering (2RVBT) for the correction of AIS with a minimum 2-year follow-up were included. Patients were grouped by Lenke type, which yielded 4 groups; types 1, 3, 5, or 6. Analysis included preoperative demographic parameters, as well as radiographic and clinical outcome measures. 156 2RVBT (Lenke 1, N = 61; Lenke 3, N = 35; Lenke 5, N = 37; Lenke 6, N = 23) patients met inclusion criteria. The mean preoperative apex Cobb angle in the Lenke type 1, 3, 5, and 6 groups were 50.2 ± 9.1, 50.5 ± 10.1, 45.0 ± 8.6, and 49.0 ± 10.8, respectively. This corrected to 21.2 ± 10.2, 19.2 ± 8.5, 13.6 ± 7.2, 18.5 ± 8.3 in Lenke type 1, 3, 5, and 6 groups, respectively, demonstrating that Lenke type 5 saw greatest correction following 2RVBT. With regards to revision recommendation following tether breakage, Lenke type 3 curves were most frequently indicated for fusion, whereas Lenke type 1 curves were most frequently not indicated for revision surgery. Lenke type 5 curves are the most amenable to correction via 2RVBT, as evident by their lower post-operative apex Cobb angles and lowest rate of recommendation for revision to posterior spinal fusion.

Influence of DOAC Levels and Thrombin Generation on Postoperative Bleeding [SONAR]: A Nested Case-Control Study.

A DOAC concentration threshold above which an impact on surgical hemostasis starts to occur is unknown. Thrombin generation assays (TGAs) provide a measure of the coagulation phenotype. This study aimed to determine whether preoperative TGA parameters are associated with postoperative bleeding, and whether this is partly due to residual DOAC levels. We conducted a nested case-control study using samples from apixaban/rivaroxaban-treated patients with atrial fibrillation from the PAUSE perioperative study. Cases were participants with postoperative major or clinically relevant non-major bleeding; controls were participants without bleeding. TGA parameters were measured using Calibrated Automated Thrombography (5 pM tissue factor). Generalized linear mixed models and causal mediation analyses were used to evaluate the relationship between DOAC levels, TGA parameters, and bleeding. Forty-eight cases were matched to 474 controls. Residual DOAC levels were higher in cases than controls (p = 0.03) and TGA parameters were correlated with residual DOAC levels (p < 0.05). A longer lag time (LT; OR = 1.319 per minute [95%CI 1.077-1.617]) and time-to-peak (TTP; OR = 1.154 per minute [95%CI 1.028-1.296]) were associated with an increased odds of bleeding; higher peak (OR = 0.994 per nM [95%CI 0.989-0.998]) and higher mean velocity rate index (mVRI; OR = 0.986 per nM/min [95%CI 0.976-0.996]) were associated with a lower odds of bleeding. The effect of apixaban/rivaroxaban levels on bleeding was mediated by altered TGA parameters (LT, TTP, peak, mVRI). TGA parameters are associated with postoperative bleeding and the impact of DOAC levels on bleeding is mediated by effects on thrombin generation.

Preliminary study assessing the long-term surgical outcomes of TBX6-associated congenital scoliosis (TACS) patients using the propensity score matching method: exploring the clinical implications of genetic discoveries in congenital scoliosis

BackgroundCompound inheritance of TBX6 accounts for approximately 10% of sporadic congenital scoliosis (CS) cases. Such cases are called TBX6-associated congenital scoliosis (TACS). TACS has been reported to have certain common clinical phenotypes. However, whether the surgical outcomes of TACS patients differ from those of other CS patients remains unclear.MethodsWe retrospectively searched for patients who were diagnosed with scoliosis. TACS was identified in genetic testing for CS. After propensity score matching, patients with TACS were matched with patients with NTACS according to sex, age, main curvature, classification, deformity location, surgical methods, fusion segment and number of fusions. We evaluated and compared the coronal and sagittal radiographic parameters before surgery, immediately after surgery, and at the final follow-up. Surgical information, including surgical method, fusion segment, blood loss and complications, was also compared and analyzed.ResultsTwenty-eight TACS patients were propensity score matched with 28 NTACS patients among 473 CS patients. The preoperative matching parameters mentioned in the Methods section were similar between the TACS group and the NTACS group. In the TACS group, the correction rate of the cranial compensatory curve (64.9 ± 18.6% vs. 51.2 ± 24.0%, P = 0.014) and the correction rate of the caudal compensatory curve (77.4 ± 12.5% vs. 65.4 ± 22.7%, P = 0.011) were significantly greater than those in the NTACS group, and the loss rate of correction of the cranial compensatory curve in the TACS group (0.6 ± 19.2% vs. 26.7 ± 50.8, P = 0.002) was significantly lower than that in the NTACS group. The total complication rate (7.2% vs. 14.3%) and incidence of adding-on (0 vs. 7.1%) were lower in the TACS group than in the NTACS group. There were no significant differences between the two groups in terms of blood loss, revision rate, other correction parameters, balance parameters or incidence of complications.ConclusionsTACS patients had better surgical outcomes than NTACS patients, which means that genetic diagnosis of the TBX6 gene mutation in CS before surgery can help predict better surgical outcomes. The specific genetic mechanism is not yet clear and may be related to the relatively normal development of paravertebral tissues in TACS patients. Further research is needed.Level of evidenceLeve: III.

Endoscopic Treatment of Chronic Plantar Fasciitis with Plantar Heel Spur Pain: A Combined Suprafascial and Infrafascial Approach.

To determine whether a combined endoscopic suprafascial and infrafascial approach with medial and lateral portals is a safe and effective technique for the endoscopic treatment of chronic plantar fasciitis with plantar heel spur pain. An interventional, prospective study was conducted. A total of 61 patients with plantar fasciitis with plantar heel spur pain underwent an endoscopic plantar fasciotomy with plantar heel spur resection, using a combined suprafascial and infrafascial approach between January 2018 and August 2022. Preoperative Foot and Ankle Ability Measure (FAAM), 36-Item Short Form Health Survey (SF-36), and visual analog scale (VAS) scores were measured. The measurements were repeated at 6 weeks, 3, 6, and 12 months postoperatively and at the final follow up. Preoperative and 1-year postoperative film parameters (Meary angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height) were compared.Complications were recorded at each encounter. The mean follow up time was 2.6 ± 1.1 years. At the 6-week postoperative visit, the mean change in FAAM-ADL, FAAM-Sport, SF-36 physical component summary, SF-36 mental component summary, and VAS were 26.0,19.0, 44.8, 61.2, and -5.8, respectively. These changes were statistically significant (P < .001). These findings were sustained and generally improved at all other follow-up points: 3, 6, and 12 months postoperatively and final follow-up. The average period until the recovery of activities of daily living and sport activities were 2.6 and 8.6 weeks, respectively. There were no significant differences between the pre- and 1-year postoperative radiographic values (P > .05). No cases resulted in medial arch collapse. Five cases (8%) had an injury to the first branch of lateral plantar nerve. Endoscopic plantar fascia release and plantar heel spur resection using a combined suprafascial and infrafascial approach resulted in the improvement of postoperative FAAM, SF-36, and VAS scores and involved a low incidence of postoperative complications.

Echocardiography evaluation of iatrogenic atrial septal defect after combined procedure of catheter ablation and left atrial appendage closure for atrial fibrillation

Using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to investigate the occurrence and related causes of iatrogenic atrial septal defect (iASD) after catheter ablation combined with left atrial appendage closure (LAAC) for atrial fibrillation (AF) and its impact on the right heart system. We retrospectively analyzed 330 patients that underwent combined procedure of catheter ablation for AF and LAAC at General Hospital of Northern Theater Command from January 2018 to March 2022. These patients were divided into iASD group and non-iASD group according to whether there was persistent iASD shown on TEE at 3 months after procedure. There were 96 (29.1%) patients with iASD and 234 patients without in the TEE follow up at 3 months post-operation. Patients with iASD had larger left atrial volumes (76.5 ± 35.2 ml vs. 61.1 ± 21.9 ml, p = 0.036) as well as higher occurrence of mitral regurgitation (MR) (32.3% vs. 12.8%, p = 0.018) and tricuspid regurgitation (TR) (27.1% vs. 7.3%, p = 0.002). Procedural features showed that patients with persistent iASD had longer procedure time (92.1 ± 36.3 vs. 69.1 ± 17.8 min, p = 0.003) and larger sheath sizes (4.1 ± 1.2 mm vs. 3.3 ± 1.2 mm, p = 0.022). The preoperative and postoperative right heart parameters of patients in the persistent iASD group were compared, and there were no significant differences on right atrial/ventricular diameter, right heart systolic/diastolic function and pulmonary artery pressure (P > 0.05). The occurrence of iASD 3 months after combined atrial fibrillation ablation and LAAC was 29.1%. The size of left atrium, the pressure of left atrium, the manipulation time within left atrium, the size of sheath, and the use of ICE during operation was related to the closure of iASD.

Change in spinopelvic mobility 3 months after THA using a direct anterior approach.

Spinopelvic kinematics, reflected by the change in spinopelvic tilt (ΔSPT) from a standing position to a flexed seated position, has been associated with the risk of prosthetic impingement and hip dislocation. Some studies have suggested changes in spinopelvic mobility after total hip arthroplasty (THA), but none have explored changes in mobility in the first three months following THA using a direct anterior approach. Our hypothesis was that changes in spinopelvic mobility occur in the first 3 months postoperatively, leading to increased hip mobility and increased spinopelvic kinematic abnormalities. This retrospective analysis of a consecutive series included 109 patients treated with primary anterior THA by a single senior surgeon. Lateral radiographs taken in standing and flexed seated positions before and three months after surgery were examined to analyze ΔSPT, pelvic femoral angle (PFA), lumbar lordosis (LL), and abnormal spinopelvic mobility (ΔSPT ≥20 °). Secondary objectives included examining the relationship between changes in lumbar flexion and hip flexion, and then analyzing preoperative spinopelvic parameters involved in postoperative pelvic mobility changes. Between the two periods of analysis, the ΔSPT increased on average by 9.53 ° (-34.4/50.3 °), the ΔPFA increased by 7.68 ° (-74/49 °), and lumbar flexion (ΔLL) decreased by 4.26 ° (-20.8/26 °). The rate of ΔSPT ≥20 ° was 22.9% before the operation and 47.7% after the operation (OR = 8.98; CI [2.82; 28.56]; p < 0.001). A strong positive correlation was found between changes in ΔSPT and ΔPFA (ρ = 0.76; r2 = 0.574; p < 0.001) and no correlation between changes in ΔSPT and ΔLL (ρ=-0.019; r2 = 0.005; p = 0.842). The multivariate analysis demonstrated independent predictors of change in ΔSPT were body mass index (BMI, β = -0.59, [-1.15; -0.03], p = 0.0386), ΔPFA (β = -0.46, [-0.59; -0.34], p < 0.001), and ΔLL (β = -0.36, [-0.53; -0.19], p < 0.001). No dislocation was observed. Spinopelvic mobility changes occur early on, within 3 months, after anterior THA. Patients with preoperative lumbar stiffness, associated with a stiff hip and lower BMI, should prompt surgeons to the risk of worsening spinopelvic kinematic abnormalities postoperatively. IV; retrospective study.

How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience.

The standardization of preoperative imaging in primary hyperparathyroidism is one of the current challenges of endocrine surgery. A correct localization of the hypersecretory gland by neck ultrasound and 99mTc-sestamibi (MIBI) scintigraphy are not sufficiently sensitive in some cases. In recent years, CT-4D, 18F-Fluorocholine PET/CT, and radio-guided parathyroidectomy have come into common use. The aim of this study is to evaluate the performance of 18F-Fluorocholine PET/CT after prior negative or discordant first-line imaging in patients with primary hyperparathyroidism undergoing parathyroid surgery. Monocentric observational study on patients affected by pHPT undergoing surgery from July 2009 to April 2024at the Division of General Surgery, Cattinara Teaching Hospital of Trieste. Preoperative, intra-operative, and follow-up data were collected. The imaging methods used were neck ultrasound, 99mTc-sestamibi (MIBI) scintigraphy, and 18F-Fluorocholine PET/CT (since 2018). 172 patients were included. As first radiologic examination, neck ultrasound (US) was performed in 140 cases and 99mTc-sestamibi (MIBI) scintigraphy in 162. Ultrasound and/or scintigraphy imaging were sufficient for the identification of the gland in 127 patients (73.8%), while in 45 patients (26.2%), the localization was defined with other techniques. Particularly, three patients with negative or discordant first-line imaging underwent neck 4D-CT scan who was useful for parathyroid localization all cases (100%). Only one patient received a neck magnetic resonance (MRI) and resulted positive for preoperative localization. Starting in 2018, 29 out of 45 patients underwent 18F-FCH PET/CT yielding a positive result in 29 patients (100%). In other 16 cases (before the introduction of PET/CT in our preoperative imaging study), the preoperative localization was inconclusive and bilateral neck exploration (BNE) was necessary. The sample was homogeneous in terms of age, anthropometric characteristics, and preoperative biochemical parameters. Male/female ratio was 1:5.1. In the intra-operative site, in the cases of exclusive PET/CT positivity, in 28 cases (96.5%), a diagnostic agreement was confirmed, and the gland was macroscopically smaller or normal in size. The combination of ultrasound and MIBI scintigraphy remains the preferred imaging approach for preoperative studies of pHPT. If secondary imaging is required, 18F -FCH PET/CT stands out as the most advantageous option due to its ability to provide anatomical and functional specificity. FCH PET/CT resulted an effective imaging modality with the highest sensitivity of the available imaging techniques for localizing the hyperfunctioning parathyroid gland. Therefore, this method can be recommended in patients showing negative or inconclusive results in the conventional diagnostic imaging.

Gait Analysis in Patients After Hemiepiphysiodesis Due to Valgus or Varus Knee Deformity.

Background: Developmental knee joint deformities are a common problem in pediatric orthopedics. Children with a valgus or varus deformity of the distal femur or the proximal tibia are commonly treated with hemiepiphysiodesis. Gait analysis in patients with lower limb deformities plays an important role in clinical practice. The purpose of our study was to assess gait parameters in patients who underwent hemiepiphysiodesis procedures of the distal femur or proximal tibia due to a knee deformity and to compare them with those in healthy controls. Methods: We prospectively evaluated 35 patients (14 females and 21 males) after hemiepiphysiodesis and compared the results with a healthy control group (26 participants). Gait was analyzed with a G-Sensor device (BTS Bioengineering Corp., Quincy, MA, USA). We assessed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, and step length. We assessed these gait parameters in a group of patients before and after treatment with hemiepiphysiodesis. We compared the patients' results before and after treatment to those of a healthy control group. The level of significance was set at p < 0.05. Results: The mean follow-up period was 13 months. There was no difference in the results of gait assessments in patients prior to and after treatment. The median step length was 47.09% in the treated limb after treatment and 54.01% in the intact limb (p = 0.018). There were no other differences in gait parameters in the treated limbs and the healthy, intact limbs in the patient group after treatment. There were no significant differences in the patients before and after treatment compared with those in the healthy control group in all gait parameters. Conclusions: Valgus or varus knee deformity correction with the use of hemiepiphysiodesis does not significantly improve preoperative gait parameters. The biomechanical outcomes of hemiepiphysiodesis in the treatment of valgus or varus knee deformity are good. We observed no differences in gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, gait velocity, cadence, or step length between the experimental and healthy control groups.

Role of Epidural Electrode Stimulation in Three Patients with Incomplete AIS D Spinal Cord Injury.

Background/Objectives: To determine whether epidural electrical stimulation (EES) improves sensory recovery and walking function in patients with chronic spinal cord injury (SCI) with a grade on the American Spinal Cord Injury Association impairment scale (AIS) of C or D at the cervical level. Methods: Three individuals with cervical-level chronic AIS D SCI were enrolled in the study. The mean injury duration and age were 4.8 ± 4.5 (range: 1.5-10) and 56.7 ± 9 years, respectively. The participants received personalized electrical stimulation for 36 weeks and were evaluated for their SCI characteristics, the result of an AIS assessment according to the lower extremity sensorimotor scale, their muscle activity, and preoperative walking ability parameters, initially as well as at weeks 8 and 36 of the EES intervention. Results: Participants receiving EES significantly increased the muscle activity in most lower limb muscles. Regarding the AIS assessment of the lower extremities, one participant fully regained a light touch sensation, while two fully recovered their pinprick sensation (AIS sensory scores increased from 14 to 28). One participant achieved a full motor score, whereas the others' scores increased by 19 and 7 points. Compared with preoperative gait parameters, two participants showed improvements in their walking speed and cadence. Walking symmetry, an important parameter for assessing walking function, improved by 68.7%, 88%, and 77% in the three participants, significantly improving the symmetry index (p = 0.003). Conclusions: Thus, EES may be an effective strategy for sensory impairment recovery, as well as muscular activity and strength improvement. These findings may facilitate stable walking in subjects with chronic incomplete SCI, but larger clinical trials are warranted. Clinical trial: NCT05433064.

The impact of lower thoracic versus upper lumbar upper instrumented vertebra in minimally invasive correction of adult spinal deformity.

The goal of this study was to compare the impact of using a lower thoracic (LT) versus upper lumbar (UL) level as the upper instrumented vertebra (UIV) on clinical and radiographic outcomes following minimally invasive surgery for adult spinal deformity. A multicenter retrospective study design was used. Inclusion criteria were age ≥ 18 years, and one of the following: coronal Cobb angle > 20°, sagittal vertical axis > 50 mm, pelvic tilt > 20°, pelvic incidence-lumbar lordosis mismatch > 10°. Patients were treated with circumferential or hybrid minimally invasive techniques at ≥ 3 spinal levels and had a 2-year minimum follow-up. They were then divided into 2 groups depending on whether the UIV was in the UL region, defined as a UIV location of L1-2, or the LT region, defined as T10-12. A total of 114 of 223 patients met the inclusion criteria (68 LT and 46 UL). The UL group was older (67.5 vs 62.3 years; p = 0.015). Preoperative spinopelvic parameters were similar, except for sacral slope, which was higher in the UL group (30.5° vs 26.5°; p < 0.001). The percentage of patients with fixation crossing the lumbosacral junction was also similar (70.6% vs 67.4%; p = 0.717). Postoperative lumbar lordosis (42.5° vs 35.5°; p = 0.01) and change in coronal Cobb angle (-23.2° vs -9.6°; p < 0.001) were greater in the LT group, but other changes in postoperative spinopelvic parameters and changes in health-related quality-of-life scores were similar between groups. Reoperation rates were lower in the UL group (17.4% vs 36.8%; p = 0.025), largely associated with fewer radiographic failures (UL = 10.9% vs LT = 26.5%; p = 0.042); however, overall complication rates were not significantly different (UL = 43.5% vs LT = 60.3%; p = 0.077). Selecting a UL vertebra for UIV in minimally invasive surgical correction of adult spinal deformity results in lower reoperation rates compared to extending fixation to the LT region. This choice also correlates with shorter operating room times and reduced estimated blood loss. Although extending fixation to the LT region is associated with slightly greater lumbar lordosis and a greater change in the coronal Cobb angle, clinical outcomes were similar between the LT and UL groups for UIV.

CT-Derived Quantitative Image Features Predict Neoadjuvant Treatment Response in Adenocarcinoma of the Gastroesophageal Junction with High Accuracy.

The purpose of this retrospective study was to evaluate the value of contrast-enhanced computed tomography (CE-CT) image features at baseline and after neoadjuvant chemotherapy in predicting histopathological response in patients with adenocarcinoma of the gastroesophageal junction (GEJ). A total of 105 patients with a diagnosis of adenocarcinoma of the GEJ were examined by CE-CT at baseline and preoperatively after neoadjuvant chemotherapy. All patients underwent surgical resection. Histopathological parameters and tumor regression grading according to Becker et al. were collected in 93 patients. Line profiles of the primary tumor area in baseline and preoperative CE-CT were generated using ImageJ. Maximum tumor density and tumor-to-wall density delta were calculated and correlated with the histopathological tumor response. In addition, tumor response was assessed according to standard RECIST measurements in all patients and by endoscopy in 72 patients. Baseline and change in baseline to preoperative CE-CT parameters showed no significant differences between responders (Becker grade 1a, 1b) and non-responders (Becker grade 2, 3). After neoadjuvant therapy, responders and non-responders showed significant differences in maximum density and tumor-to-wall density delta values. Line profile measurements showed excellent inter-rater agreement. In comparison, neither RECIST nor endoscopy showed significant differences between these groups. Posttreatment CE-CT can predict histopathological therapy response to neoadjuvant treatment in adenocarcinoma of GEJ patients with high accuracy and thus may improve patient management.

Predicting Success: The Crucial Role of Preoperative Data in Refractive Surgery Outcomes.

Refractive surgery, which includes techniques such as Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK) and Small Incision Lenticule Extraction (SMILE), has revolutionized ophthalmology by offering advanced solutions for vision correction. However, the choice of the technique to be used in the individual patient is highly dependent on a thorough preoperative evaluation. This retrospective study aims to investigate how preoperative parameters, including corneal thickness, topography, and refraction, affect long-term post-operative clinical outcomes. Through a systematic review of the literature published between 2000 and 2023, we identify the main predictors of success for each surgical technique. This study emphasizes the importance of personalized surgical strategies based on meticulous preoperative analysis.